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

1. Effective Economic Strengthening (ES) for the Ultra Poor Affected by HIV Meaghan Murphy, FHI 360 Mandy Swann, FHI 360 Gareth Evans, Save the Children Kirsten Weeks, DAI SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

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

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

4. Unique Vulnerabilities of HIV- Affected populations SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

5. Household Livelihoods and Food Security: ConceptualFramework Promotion Asset, income and consumption growth HIGH Protection Asset protection Income and consumption stabilization LOW HOUSEHOLD LIVELIHOOD & FOOD SECURITY HOUSEHOLD VULNERABILITY Provision Asset recovery Consumption support LOW HIGH SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

6. Income Growth Higher risk threshold potential: Engaging in higher-risk, higher-return income generating activities Expand household income & consumption Workforce development; credit and savings; business development services; micro, small and medium enterprise development; business enabling environment reform HIGH LOW Promotion Income Stabilization Minimal risk taking threshold: Engaging in low-risk, low-return income generating activities; diversifying income generating activities; building productive assets Smooth household income & promote asset growth Credit and savings; business development services; facilitate business/social networks; microenterprise development Risk Reduction Reversible:Selling/liquidating protective assets; seeking wage labor or migrating for work; borrowing; reducing spending and food consumption; drawing on social assets Smooth household consumption & manage household cash flow Strengthen social networks; financial and market literacy; credit and savings Protection HOUSEHOLD LIVELIHOOD & FOOD SECURITY HOUSEHOLD VULNERABILITY Build self-insurance methods & protect key assets Income-based safety-nets; access to savings; credit; micro insurance; strengthen social safety nets; extend legal protection & reform laws Loss Management Less reversible: Selling productive assets; borrowing at exorbitant rates; further reducing spending and food consumption Provision Destitute / Distress Asset depletion: Depending on charity; breaking up household; migrating; going without food Recover, build assets & stabilize household consumption Transfers; social services LOW HIGH LIVELIHOOD PHASE COPING MECHANISMS / LIVELIHOODS STRATEGIES POTENTIAL LIVELIHOOD INTERVENTIONS LIVELIHOOD OBJECTIVES

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

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

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

10. Match Family typologies to intervention strategies SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

11. 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]). SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

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

13. 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

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

15. Characteristics of Indices Vulnerability Indicators 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) • 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 SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

16. 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

17. Nutrition Assessment Counseling and Support (NACS) GOAL: Improved health and quality of life • OBJECTIVES: • Improve nutritional status • Improve infant survival • Reduce food insecurity • Strengthen health systems Economic strengthening, livelihoods & food security Nutrition care & support Health system strengthening HIV-free survival NACS: A platform for integrating nutrition into the continuum of care SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

18. Lift Working model for linking ES Services to a Continuum of support SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

19. 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 Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

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

21. Group Activity SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions

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

23. Questions? Contact us! Meaghan Murphy, mmurphy@fhi360.org Mandy Swann, mswann@fhi360.org Gareth Evans, gevans@savechildren.org Kirsten Weeks, kirsten_weeks@dai.com Thank you! SEEP 2012 Annual Conference Building Inclusive Markets: Impact Through Financial and Enterprise Solutions