The Cost of Case Management in Orphans and Vulnerable Children Programs Results from a Mixed-Methods, Six-Country Study

Stacie Gobin, Shaylen Foley - MEASURE Evaluation


Little is known about how much it costs to implement services for orphans and vulnerable children (OVC), such as case management. When cost estimate data are available, the ranges for unit expenditures are strikingly wide and it is difficult to compare across programs or intervention service areas. Case management—a cornerstone of OVC programming and the platform on which OVC services are delivered—is largely conducted by community-based case workers (CWs). Research shows that CWs contribute meaningfully to HIV service delivery, impacting the social determinants of health through the delivery of comprehensive suites of interventions. However, few cost analyses have attempted to disaggregate the costs of case management from other OVC program service areas.

To address this gap, the United States Agency for International Development (USAID)- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation worked with six OVC projects in six countries to gain insight on current approaches to OVC case management, map how costs can be linked to OVC case management activities, and determine the cost of OVC case management. To further inform and strengthen our understanding of the cost data, the study also qualitatively explored the context of the CWs’ experiences related to OVC case management. 

Similar to previous studies of the cost of OVC programs, we found wide variations in annual case management costs, the cost per beneficiary, the proportion of total expenditures, and the relative distribution of spending by cost element. The differences were due to the differences in case management modalities and the variation in how implementing mechanisms chose to invest in case management versus in other project service areas. The contextual information provided by the interviews helped bolster and support the cost estimates found in this study. Without the parallel approach of collecting both quantitative and qualitative data, the contextual information to triangulate with the quantitative data would have been lacking, and the validity of the results would have decreased.

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