After all is processed (including the orphan investigation) and the documents have been checked for authenticity, it can take anywhere between 24 hours to two weeks to get the actual visa printing appointment.
Most recently, the U.S. Consulate has sent out "visa appointment" emails which causes some confusion because at those appointments no visas are issued. In the past, when a family would receive a "visa appointment" email, it was the appointment where the actual visa was printed and given. However, now the child attends the visa appointment and the orphanage is often told to wait for another email to pick up the visa and/or is told to come to another appointment to pick up the actual visa.
One family received an email stating that their visa had been approved, this was two weeks after their "visa appointment" and then it took another 1-1/2 weeks to actually receive the printed visa.