Economic Strengthening in the PEPFAR Program

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Overview of PEPFAR's strategic interests and experiences with economic strengthening for the Social Protection, Care & Support IATT and UNAIDS staff, March 4-5, 2014 in Geneva

Overview of PEPFAR's strategic interests and experiences with economic strengthening for the Social Protection, Care & Support IATT and UNAIDS staff, March 4-5, 2014 in Geneva

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  • 1. Economic Strengthening in the PEPFAR Program Jason Wolfe, Senior Technical Advisor March 4-5 2014 • SPCS WG • UNAIDS • Geneva
  • 2. Role of Economic Strengthening • Orphans & Vulnerable Children – Family strengthening • Care & Treatment – Socioeconomic determinants of ART adherence – Food security and nutrition • PMTCT – Socioeconomic determinants of ANC attendance and MNCH • Prevention – Structural drivers of HIV transmission – Socioeconomic determinants of sexual risk behavior
  • 3. Policy Guidance 1 The U.S. President’s  E m e r g ency  Pl an  fo r  AIDS  Re l ief GUIDANCE FOR THE PREVENTION OF SEXUALLY TRANSMITTED HIV INFECTIONS August 2011 ! 1! ! Prioritization of PEPFAR Care and Support Interventions Evidence summaries and resources to assist country teams in prioritizing Adult Care and Support Interventions ! PEPFAR!Adult!Care!and!Support!Technical!Working!Group! January!2014! !
  • 4. Hypotheses 1. Segmentation based on vulnerability improves efficiency (scale) and effectiveness (impact) 2. Most are “moderately vulnerable” 3. Savings groups are best entry point for most beneficiaries 4. Comprehensive programs build resilience 5. Tweaks and complementary interventions are necessary for many individual-level outcomes
  • 5. 1. Segmentation by Vulnerability for Better Programming Most Vulnerable Moderately Vulnerable Least Vulnerable Consumption Support Money Management Grow / Diversify Income
  • 6. 2. Most are Moderately Vulnerable • Tanzania | current OVC & HBC beneficiaries • Rwanda | current OVC beneficiaries • Uganda | current OVC beneficiaries 12% 66% 22% 16% 73% 11% 20% 51% 29%
  • 7. 3. Savings Groups as Entry Point • Ethnographic evidence that poor people use financial tools Rutherford 1999 • Collins, Morduch, Rutherford & Ruthven 2009 – Generating useful lump sums of cash – Weathering bad times – Funding day-to-day expenses • Experimental evidence that access to savings can increase investments in a range of domains – Agriculture & small business Duflo, Kremer & Robinson 2010 • Dupas & Robinson 2011a – Health Dupas & Robinson 2011b – Food security Gash & Odell 2013 • Non-experimental evidence suggests HIV-specific impacts Barber 2011 • Beck 2012 • IMARISHA 2013
  • 8. 3. Savings Groups as Entry Point contribute regular savings repay with interest make loans ( for working capital or consumption smoothing ) cycle continues 6-12 months share out savings + interest 15-25 trusted peers come together & make their rules How Savings Groups Work
  • 9. 4. Comprehensive Program Builds Resilience Most Vulnerable Moderately Vulnerable Least Vulnerable 2010 2012 2013 Distribution of Beneficiaries Rwanda | Higa Ubeho
  • 10. Most Mid Least MostMidLeast 2,676 2,211 12 3,447 1,165 1,029576 1 6 BaselineVulnerability Follow Up Vulnerability 5% got worse 51% got better 44% stayed the same Beneficiary Transition Uganda | SCORE 4. Comprehensive Program Builds Resilience
  • 11. 4. Comprehensive Program Builds Resilience • Implications for beneficiaries – Increased savings, assets, income – Increased food security – Improved mental outlook – Increased expenditures on education – Increased expenditures on health • Implications for donors and governments – Reduce reliance on direct subsidies (e.g., school fees, transport) – Free up resources to enroll/support more beneficiaries – But there will always be a need for subsidies and safety nets
  • 12. 5. Tweaks and Complementary Interventions • Money is a means to an end • How beneficiaries spend their money is what matters • Improved household welfare ≠ individual welfare – Role of gender – Role of age • Spending decisions are messy – Competing priorities – Time inconsistencies – Infrequent, lumpy expenses are hard to plan for • Supply-side factors
  • 13. 5. Tweaks and Complementary Interventions • Savings groups as a flexible model – Timing of share-outs – Multiple funds (e.g., emergency, education, health) – Collective purchases reduces costs and applies social pressure – Goal setting • Savings groups as a platform for integration – Community outreach for clinics/service providers (e.g., HTC) – Discussion groups (e.g, parenting, nutrition, GBV/IPV) – Peer support (e.g., positive living, mothers) – Collective action (e.g., ARV collection)
  • 14. Current and Planned Research • Zambia & Tanzania – Food security for OVC families • Malawi – PMTCT and pediatric care & treatment • Côte d’Ivoire – Risk reduction for sex workers • Mozambique – Education for OVC • South Africa – Adolescent transition (OVC & prevention)
  • 15. THANK YOU! Jason Wolfe Senior Technical Advisor, Economic Strengthening & Social Protection USAID Office of HIV/AIDS • jwolfe@usaid.gov • +1 (202) 712-1882