The AIDS epidemic has created a crisis for children, severely threatening the health and development of children whose parents are ill, have died and whose communities have lost a large percentage of their adults. Even when extended family can serve as guardians, their need to work in the context of widespread poverty decreases the amount of time they are able to spend with children. Other children live in child-headed households or with seniors unable to provide adequate care. Relative to the size of the need there are few interventions that provide support to orphans in sub-Saharan Africa. We report on two different models of community-based care that have emerged to fill this caregiving gap, and highlight the relative advantages of each. These programmes, one centralized and the other decentralized, are an effective means of caring for orphans and could be scaled up in other communities to meet the magnitude of the crisis.