Integrated Programming in HIV/AIDS contexts: Integrated Programming in HIV/AIDS contexts Multi-sectoral pilots based on livelihood support concept Jill Donahue Ntongi McFadyen


Context - Community Resilience and Dialogue (CRD): Context - Community Resilience and Dialogue (CRD) Pilot located in 3 types of conflict areas in Uganda: active (Acholiland); intermittent (Western Uganda and Karamoja) and post conflict (West Nile) Complexity required integrated response from multiple technical “angles” HIV/AIDS Peace Building Psychosocial Support Economic Development


Context - Positive Change: Children, Communities and Care (PC3): Context - Positive Change: Children, Communities and Care (PC3) Pilot implementation in a context of severe poverty exacerbated by famine, civil war and HIV/AIDS Complexity required integrated response from multiple technical “angles” HIV/AIDS prevention and awareness Home Based Care (HBC) Care and support for orphans and vulnerable children Livelihood support


Tiered approach: Tiered approach


CRD integration: Community feels hopeful about the future and their ability to control what happens to them Community networks take action to respond to and prevent conflict Households absorb economic shocks from HIV/AIDS and conflict Community reduces stigma to prevent HIV and mitigate impact of AIDS Reduce human impact CRD integration


PC3 Integration: Community coalitions mobilize to provide care and support for children orphaned & vulnerable. Community networks provide care and support to PLWHA Households are able to care for the children in their care Community is aware of how HIV is transmitted, stigma is reduced & risky behavior changed Improve OVC wellbeing PC3 Integration


Principles of effective livelihood support: Principles of effective livelihood support Match the livelihood support to the livelihood situation – “rule of the tool” Work towards sustainability of the service and of the impact Help people do what they already do, better. BUILD on, instead of replace Emphasis is on services in which clients are willing to invest, not what project staff feel they need. Support must be demand-driven (demand pull, not supply push) Build on existing market channels whenever possible


Issues: Issues Targeting: Pro-active or reactive? Serve households in need of rescuing (destitute) Serve households economically vulnerable (poor but not destitute) Capacity of partners to implement livelihood/MED support Local NGOs and community groups are responsible for implementation; but they are rarely specialists in livelihood/MED support Monitoring impact


Targeting: Pro-active or re-active? : Targeting: Pro-active or re-active? Community safety net Destitute TIME INCOME High Income Poor Poorer Poverty Line HH Safety Net


Answer? Both!: Household Livelihood Security Framework ……describes a contiguum of related activities that overlap. These are not neatly separated categories. Answer? Both!


Dual approach to livelihood support: Dual approach to livelihood support Generalized “package” offered within communities affected by HIV/AIDS, which attract poor, but stable clients; Self-selection Reaching large numbers of people with a standard MED service in a cost effective and sustainable manner (MFI, VSL, BDS) Service aims to strengthen (promote), but also maintain (protection) economic resources


Dual approach to livelihood support: Dual approach to livelihood support Targeted “package” aimed at clients who are very vulnerable because of AIDS related crises Selection is based on a process that catalyzes genuine community ownership Reaching fewer numbers, which allows for case by case “tailoring” of assistance Services aim to restore/maintain (protection) economic resources, but could include material assistance and community support (provision)


AIDS is a moving target…..: AIDS is a moving target….. Not vulnerable Somewhat vulnerable Vulnerable (but stable) Very vulnerable (in transition) Most vulnerable Community driven support (provision) Generalized livelihood package (promotion)—strengthens economic resources Targeted Livelihood package (protection)—restores economic resources


Livelihood Packages : Livelihood Packages Generalized Community Saving and Self-Help Groups (CSSG) Linkage to Microfinance Institutions Creating savings and credit associations Targeted Mobilizing community support / social services / material assistance Facilitating market access Business mgt / skills / vocational training Mentoring /apprenticeship Seed money /small grants


Capacity: Capacity Community groups effective in mobilizing grass roots support and identifying those truly in need BUT, MED was rarely the organization’s core business Danger of diverting the focus of the community organization simply to gain funding


Proposed solution?: Proposed solution? Identify specialist NGOs whose core business is MED to implement the generalized approach Community organizations to mobilize livelihood provision (targeted approach) for households that they identify as the most vulnerable


Monitoring Impact: Monitoring Impact Overarching Goal of livelihood support CRD: …to mitigate and reduce economic impact due to conflict (conflict and HIV/AIDS are mutually reinforcing) PC3: ... to enhance households’ economic capacity to ensure the well being of children


Monitoring and Evaluation: Monitoring and Evaluation To avoid exacerbating stigma, M&E for the generalized approach can use proxy indicators; i.e. caring for a chronically ill person in their household client who is chronically ill caring for additional children / dependents (orphans and vulnerable children) experienced a death or multiple deaths in the household Indicators are not used for selection purposes Statistics for these indicators are gathered: during the baseline and final impact survey, as well as recorded in the client registers and other monitoring instruments.


Slide19: Household economic resources improved Livelihood/MED interventions Output: - # and type of livelihood interventions implemented - # of children and households benefiting Outcome: - % change in types of assets in HH - % change in sources of income Are children better off? Impact: % change in daily meals Children sent to and stay in school