effective economic strengthening (es) for the ultra poor affected by hiv meaghan murphy, fhi 360...

Effective Economic Strengthening (ES) for the Ultra Poor Affected by HIV

Meaghan Murphy, FHI 360Mandy Swann, FHI 360

Gareth Evans, Save the ChildrenKirsten Weeks, DAI

SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

LEARNING OBJECTIVES• Learn about three proven tools & approaches for

improved understanding of the vulnerabilities of HIV affected ultra poor households (HH) for economic strengthening (ES)

• Put concepts, tools and approaches into action

• Practitioner-focused discussion around key issues, opportunities and challenges


WORKSHOP OVERVIEW

• Discuss vulnerabilities of HIV-affected populations, especially the ultra poor

• Brief presentation of practitioner-developed ES tools and approaches

• Small group activity

• Debrief and discussion


UNIQUE VULNERABILITIES OF HIV- AFFECTED POPULATIONS


Household Livelihoods and Food Security: Conceptual Framework


LOW

HO

USE

HO

LD L

IVEL

IHO

OD

& F

OO

D S

ECU

RITY

HIG

H

ProtectionAsset protection

Income and consumption stabilization

PromotionAsset, income and

consumption growth

HIG

HH

OU

SEH

OLD

VU

LNER

ABIL

ITY

LOW

ProvisionAsset recovery

Consumption support

HIG

HH

OU

SEH

OLD

VU

LN

ER

AB

ILIT

YLO

W

LO

WH

OU

SEH

OLD

LIV

ELIH

OO

D &

FO

OD

SEC

UR

ITY

HIG

H

Provision

Protection

Promotion

Higher risk threshold potential: Engaging in higher-risk, higher-return income generating activities

Minimal risk taking threshold: Engaging in low-risk, low-return income generating activities; diversifying income generating activities; building productive assets

Reversible: Selling/liquidating protective assets; seeking wage labor or migrating for work; borrowing; reducing spending and food consumption; drawing on social assetsLess reversible: Selling productive assets; borrowing at exorbitant rates; further reducing spending and food consumption

Income Growth

Income Stabilization

Risk Reduction

Loss Management

Destitute / Distress

Asset depletion: Depending on charity; breaking up household; migrating; going without food

Expand household income & consumption

Smooth household income & promote asset growth

Smooth household consumption & manage household cash flow

Build self-insurance methods & protect key assets

Recover, build assets & stabilize household consumption

Workforce development; credit and savings; business development services; micro, small and medium enterprise development; business enabling environment reform

Credit and savings; business development services; facilitate business/social networks; microenterprise development

Strengthen social networks; financial and market literacy; credit and savings

Income-based safety-nets; access to savings; credit; micro insurance; strengthen social safety nets; extend legal protection & reform laws

Transfers; social services

LIVELIHOOD

PHASE

COPING MECHANISMS / LIVELIHOODS STRATEGIES

LIVELIHOOD OBJECTIVES

POTENTIAL LIVELIHOOD INTERVENTIONS

PURPOSE OF ES/L/FS FRAMEWORK

• Assess HH characteristics in terms of vulnerability, livelihoods and food security

• Connect HH characteristics to coping mechanisms, strategies and livelihood phases

• Identify appropriate potential livelihood, ES and food security interventions to meet HH needs and interests


LIFT LIVELIHOODS AND FOOD SECURITY TECHNICAL ASSISTANCE PROJECT

Develop and strengthen referral mechanisms for linking PLHIV with ES/L/FS services through a facilitation model

Strengthen service provider capacity to deliver quality and appropriate ES/L/FS support to vulnerable, HIV-affected households

Expand the evidence base for ES/L/FS programming related to food security, nutrition and health


FRAMEWORK IN ACTION

• Provide a platform for common dialogue across donors, decision makers and stakeholders from different backgrounds (i.e., Health and Economic Development)

• Assist service providers and implementers to identify household vulnerability and assets, and understand household risk profiles

• Inform development of a diagnostic to match HIV client household needs with appropriate ES/L/FS activities


MATCH FAMILY TYPOLOGIES TO INTERVENTION STRATEGIES


Families prepared to grow PROMOTION Strategies to grow

income/expenses

Families struggling to make ends meet PROTECTION Strategies to match

income to expenses

Families in destitution PROVISION Strategies to meet basic needs

Household Livelihood Phase

Economic Strengthening Strategy

VULNERABILITY AND RESILIENCE INDICES USING HOUSEHOLD LEVEL DATA - WHY?

• Better understand the risks and challenges facing HIV-affected households in particular to foster better programming.

• Our indices usage has evolved from looking at measuring vulnerability (VI), that which puts households at risk, to complementing that with measuring resilience (RI), that what makes households stronger.

• We’ve developed localized indices three times (Cambodia [VI] and twice in Tanzania (ROADS [VI] and IMARISHA [VI, RI]).


HOW WAS THE INDEX DESIGNED?

• Data source: Household survey – Abbreviated Save the Children/UK’s Household Economic Assessment Tool (combined with other standard survey tools – DHS and household hunger scale)

• First two applications: Vulnerability index in Cambodia and East Africa based on predetermined set of indicators, weighted equally and chosen based on a literature review and in consultation with local partners


VULNERABILITY AND RESILIENCE INDICES (IMARISHA, TANZANIA)

• Partner consultation and qualitative research prioritized key factors that characterized vulnerable households (household hunger and inability to seek medical care due to finances as the two greatest challenges).

• VI variables identified based on bi- and multivariate risk-ratio analysis of variables with highest correlation of severe hunger and inability to seek care due to cost.

• Resiliency index introduced as those indicators most commonly found in households without hunger, access to care and access to education.

• Data analyzed in uni-, bi- and multivariate analysis with particular emphasis on odds and risk ratios. SEEP 2012 Annual Conference

Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

HOW WAS THE INDEX PART OF A SOLUTION?

• Indices have been used as practical tools to understand and guide programming, and not as a static indicator, but as a programming tool.

• Prioritize programming and intervention areas.

• Focus partner programming (e.g., greater investment in savings as a source of household stability rather than unfocused IGA activities)

• Iterative work in progress – we continue to gather data and are using the VI and RI as an evaluation tool for the final evaluation of IMARISHA to measure changes over time.


CHARACTERISTICS OF INDICESVulnerability Indicators• Household size• Number of earners within the

household • Household hunger scale• OVC within the household • Not receiving medical treatment

due to inability to pay• Lack of transport• Lack of savings

Resilience Indicators • Use of productive behaviors for

agriculture and business• Participation in savings• Engagement with the formal

financial sector • Perception of control About

economic future of the household (sense of greater control characterizes greater resiliency)

• Perception on household food situation (optimism characterizes greater resiliency)

• Perception on community economic situation (optimism characterizes greater resiliency) SEEP 2012 Annual Conference


WHY LINK CLIENTS WITH COMPLEMENTARY SUPPORT?

Linking ES activities to clinical and community support for ultra poor HIV-affected households aims to:

• Build a continuum of support for people living with HIV

• Increase physical and social well-being

• Improve economic potential

• Reduce exposure to additional risk SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions


NACS: A platform for integrating nutrition into the continuum of care

Nutrition care & support

Economic strengthening,

livelihoods & food security

Health system strengthening

HIV-free survival

OBJECTIVES:• Improve nutritional status• Improve infant survival• Reduce food insecurity• Strengthen health systems

GOAL: Improved health and quality of life

Nutrition Assessment Counseling and Support (NACS)

LIFT WORKING MODEL FOR LINKING ES SERVICES TO A CONTINUUM OF SUPPORT


INTEGRATION MODEL• Understand Household Vulnerability• Develop diagnostic tool to match client needs with appropriate

services

• Facilitate Referrals• Conduct organizational network analysis• Identify community intermediaries• Support improved clinic-community referral processes and follow

up• Build capacity

• Strengthen Quality of ES Services• Provide TA on ES standards of practice and application for

vulnerable populations• Support analysis and response with HIV lens SEEP 2012 Annual Conference


RECENT EXPERIENCES INFORMING APPROACH

• Ethiopia Research: Promising Practices for Linking Economic Strengthening & Clinical Services

• National assessments and stakeholder consultations in Namibia and South Africa

• Coordination and planning to operationalize model in DRC, Malawi, Namibia, Lesotho and Zambia


GROUP ACTIVITY


LEARN MORE

DAI http://dai.com

FHI 360 http://fhi360.org

Save the Children http://www.savethechildren.org

LIFT Project http://kdid.org/projects/field-support/lift

Practitioner groups of interest STEP UP & HAMED


http://dai.com/

http://fhi360.org/

http://www.savethechildren.org/

http://kdid.org/projects/field-support/lift

QUESTIONS? CONTACT US!

Meaghan Murphy, [email protected]

Mandy Swann, [email protected]

Gareth Evans, [email protected]

Kirsten Weeks, [email protected]

THANK YOU! SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

effective economic strengthening (es) for the ultra poor affected by hiv meaghan murphy, fhi 360...

Documents

household livelihoods

household migrating

enterprise solutions

household risk profiles

food security interventions

hiv client household

health seep

discussion seep