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
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
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
UNIQUE VULNERABILITIES OF HIVAFFECTED POPULATIONS
SEEP 2012 Annual Conference
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
HOUSEHOLD VULNERABILITY
Promotion
Asset, income and
consumption growth
Protection
Asset protection
Income and consumption
stabilization
Provision
LOW
HIGH
Asset recovery
Consumption support
HOUSEHOLD LIVELIHOOD & FOOD SECURITY
LOW
HIGH
Household Livelihoods and Food Security: Conceptual Framework
SEEP 2012 Annual Conference
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
HOUSEHOLD VULNERABILITY
Promotion
Expand household Workforce development; credit
income &
and savings; business development
consumption
services; micro, small and medium
enterprise development; business
enabling environment reform
Income
Stabilization
Minimal risk taking threshold:
Engaging in low-risk, low-return
income generating activities;
diversifying income generating
activities; building productive
assets
Smooth household Credit and savings; business
income & promote development services; facilitate
asset growth
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
Loss
Management
Protection
Less reversible: Selling
productive assets; borrowing at
exorbitant rates; further
reducing spending and food
consumption
Strengthen social networks;
financial and market literacy;
credit and savings
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
Recover, build
assets & stabilize
household
consumption
Transfers; social services
HIGH
Higher risk threshold potential:
Engaging in higher-risk, higherreturn income generating
activities
HOUSEHOLD LIVELIHOOD & FOOD SECURITY
LOW
Income
Growth
Destitute /
Distress
LIVELIHOOD
PHASE
Asset depletion: Depending on
charity; breaking up household;
migrating; going without food
COPING MECHANISMS /
LIVELIHOODS STRATEGIES
LIVELIHOOD
OBJECTIVES
POTENTIAL LIVELIHOOD
INTERVENTIONS
LOW
HIGH
Provision
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
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
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
MATCH FAMILY TYPOLOGIES TO
INTERVENTION STRATEGIES
Families prepared to
grow
Families struggling to
make ends meet
Families in destitution
Household Livelihood
Phase
PROMOTION
Strategies to grow
income/expenses
PROTECTION
Strategies to match
income to expenses
PROVISION
Strategies to meet
basic needs
Economic Strengthening
Strategy
SEEP 2012 Annual Conference
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
VULNERABILITY AND RESILIENCE INDICES
USING HOUSEHOLD LEVEL DATA - WHY?
• Better understand the risks and challenges facing HIVaffected 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
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
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.
SEEP 2012 Annual Conference
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
CHARACTERISTICS OF INDICES
Vulnerability Indicators
Resilience 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
• 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
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
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
Nutrition Assessment Counseling and Support (NACS)
GOAL: Improved health and quality of life
•
•
•
•
Nutrition care
& support
OBJECTIVES:
Improve nutritional status
Improve infant survival
Reduce food insecurity
Strengthen health systems
HIV-free survival
Economic
strengthening,
livelihoods & food
security
Health system
strengthening
NACS: A platform for integrating nutrition into the continuum of care
SEEP 2012 Annual Conference
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
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
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
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
GROUP ACTIVITY
SEEP 2012 Annual Conference
Building Inclusive Markets: Impact Through Financial and Enterprise Solutions
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
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