factors that contribute to and the consequences of orphanhood

Factors/Causes (all factors identified in bottom half of your problem tree)	Impact of Factor on MDGs	Measure to Prevent or Mitigate Negative Impacts
CAUSES OF ORPHANHOOD:
Father dies	Will result in increased household poverty and thus have a negative impact on achieving Goal 1 – reducing number of people who live on $1 a day.	AIDS prevention and improved health care services at the community level.
Maternal death in childbirth	Negative impact on achieving Goal 5 – Reducing maternal mortality.	Improved prenatal care and trained assistance at birth, thus lowering risk of maternal death.
Limited access to tertiary health care services	Negative impact on Goals 4 and 5 – reduced child and maternal mortality	Improved primary, secondary and tertiary health care services.
Limited health care budget	Negative impact on Goals 4, 5, and 6 – Reducing child and maternal mortality and Halting spread of AIDS malaria and other diseases.	Reallocating funds from military spending; increasing transparency of budgeting process; improved management of public resources; decentralize tax collection function; focus health care spending on public health and primary care investments, which are lower cost.
Not enough trained doctors in rural areas	Negative impact on Goals 4, 5, and 6 – Reducing child and maternal mortality and Halting spread of AIDS malaria and other diseases.	Require all graduating doctors to spend 1 – 2 years in underserved areas immediately after completing their studies as a pre-requisite to receiving medical license.
Unsanitary conditions at delivery	Negative impact on Goal 5 – Reducing maternal mortality.	Increase availability of primary care delivery services in rural areas; train traditional birth attendants.
Poorly trained traditional birth attendants (TBAs)	Negative impact on Goal 5 – Reducing maternal mortality.	Train traditional birth attendants.
Contaminated transfusions and needles	Negative impact on Goals 4, 5, and 6.	Revise primary care training curriculum so it includes module on minimizing transmission through transfusions and infected needles; MOH budget should include sufficient disposable syringes and needles.
CONSEQUENCES OF ORPHANHOOD:
Loss of affection and nurturing	May have an indirect impact on achieving Goals 1 and 2.	Develop effective foster parents program with adequate subsidies. Take all measures described above.
Depression	Most likely to impact achievement of Goal 2 – universal primary education and could, in turn, impact achievement of Goal 1, decline in people who live on less than $1 per day.	Ditto
Inadequate hygiene	Could impact on achieving Goal 4 – reducing child mortality.	Ditto
Loss of guidance and discipline	Could impact on achieving Goal 2 – universal primary education and, in turn Goal 1 decrease # people who live on $1 per day and possible Goal 6 – reverse spread of infectious diseases.	Ditto
Risk of prostitution and other risky behaviors	Could have direct impact on achieving Goal 6 and, in turn, Goal 4 and indirectly Goal 2 and, in turn, Goal 1.	Ditto and Invest heavily in HIV prevention program that targets most at risk populations; ensure that orphans have access to school through conditional cash transfers or other form of subsidy to lower the chance that s/he will engage in such activities.
Loss of regular primary health care	Direct impact on achieving Goal 6 and, in turn, Goal 4.	Need to greatly expand the availability of primary health care services and finance fee waivers or health care vouchers for orphans and other OVC.
Increased economic distress	Direct impact on achieving Goal 1 and 2.	Focus on preventive health care strategies; ensure that orphans and foster families receive targeted subsidies to minimize negative economic impact on household and orphan.
Child labor	Direct impact on achieving Goal 2 and, in turn, Goal 1. Indirectly related to achieving Goal 6 and, in turn, Goal 4.	Ensure that foster families receive conditional cash transfers or other forms of supplements to make sure that children are enrolled in school rather than forced to work.
School drop out	Direct impact on achieving Goal 2 and, in turn, Goal 1.	Finance conditional transfers for orphaned children to keep them in school.