2. LIFT’S 1. Provide technical assistance and
strategic support to USG agencies
OBJECTIVES and their implementing partners
2. Build an evidence base
3. Improve access of NACS clients to
ES services through referrals
CURRENT FOCUS COUNTRIES:
Uganda, Tanzania, DRC, Malawi,
Namibia, Kenya and Nigeria.
PREVIOUS WORK IN: DRC, Namibia,
Nigeria, Swaziland and Ethiopia
3. OVERVIEW
• Five year associate award under
FIELD-Support LWA with PEFPAR
funding from USAID’s Global
Health Bureau, OHA
• $4.1M in core funding with
anticipated growth through
missions’ support
• Collaboration with other USG
food security, nutrition and
HIV/AIDS initiatives
• Managed by FHI 360 in
collaboration with core partners
Save the Children US and CARE
4. LIFT POTENTIAL • NACS linkages to economic
strengthening services
TECHNICAL • Implementing partner ES capacity
ASSISTANCE building and TA
INCLUDES: • Program assessments and country
level portfolio
reviews/recommendations for
programming
• PEPFAR Global and Country
Operational Plan technical guidance
5. ECONOMICS AT THE FAMILY LEVEL
Small
Food
Irregular Shelter
Healthcare
Unpredictable
Income generation
Income Expenses
often our priority always their priority
6. FAMILY TYPOLOGIES CORRESPOND TO INTERVENTION
STRATEGIES & EXPECTED OUTCOMES
PROMOTION strategies to
Families PREPARED to grow
grow income/expenses
Families STRUGGLING to PROTECTION strategies to
make ends meet match income to expenses
Families in PROVISION strategies to meet
DESTITUTION basic needs
7. LINKING NACS LIFT aims to integrate ES services
within NACS programs in order to:
WITH ECONOMIC
• Build the continuum of care for
STRENGTHENING people living with HIV and other
vulnerable households
• Prevent malnutrition
• Prevent relapse into therapeutic
feeding
• Increase social wellbeing and
reduce stigma
9. OBJECTIVES
The Care and Support TWG funded
research to examine and document
experiences in linking ES and
clinical HIV services
This included identifying promising
practices in referral systems, and
highlighting challenges and
recommendations to address them.
METHODOLOGY:
•Desktop literature review
•Field Research with Save the
Children programs
10. SAVE THE Food by Prescription (FBP), USG PEPFAR-funded
initiative (2009-2012) to improve the nutritional,
CHILDREN’S clinical and functional outcomes of malnourished
PLHIV by strengthening NACS services.
PROJECTS IN
ETHIOPIA Save the Children was contracted by USAID (2007-
2009) under the Home-based Care and Support
Program (HCSP) to engage volunteer outreach
workers to support family-focused HIV
prevention, care and treatment services.
TransACTION (2009-2014) aims at preventing new
HIV and STI infections among at risk populations
and strengthening linkages to care and support
services in 120 towns and commercial hotspots
along transportation corridors.
11. KEY CHALLENGES
IDENTIFIED
• Overburdened healthcare systems
• Limited resources on behalf of the CSOs
to provide ES services (waiting lists,
target groups, project cycles)
• Local NGOs and PLHIV groups have a
lack of expertise in ES programs
• Managing client expectations of ES –
dependency syndrome
• Limited engagement with local
government and community systems
• Traditional IGAs approaches appears to
have limited success
12. PROMISING DESIGNATED CASE MANAGERS
PRACTICES
AND COMMUNITY VOLUNTEERS
CAN MAKE A DIFFERENCE
• Provide essential psychosocial support to PLHIV
to continue to work or seek small enterprise
opportunities
• Volunteers relieve overburdened health
facilities of tracking clients
• Well positioned to follow-up with referrals but
not ideally placed to assess Client’s livelihood
needs/options
13. PROMISING ESTABLISH A COORDINATING
PRACTICES
COMMITTEE AT THE
COMMUNITY LEVEL
• In Ethiopia, coordinating committee is chaired by
HIV/AIDS Prevention and Control Office (HAPCO)
or the Bureau of Labor and Social Affairs (BOLSA)
• Brings together a range of stakeholders including
clincs, PLHIV support groups, private sector and ES
providers
• Referral forms are circulated through the
committee, to ensure an appropriate and complete
referral is made and data shared
14. • How do we integrate livelihoods and
CRITICAL economic strengthening into existing
QUESTIONS clinic referral systems?
• How do we effectively target
RAISED livelihoods assistance or clinical
services?
• How do we assess needs for
livelihoods support or economic
strengthening?
• How do we encourage private
sector engagement?
• How can we ensure two-way
referrals — from livelihoods and
economic strengthening to clinic-
based services and back?
16. OBJECTIVES
To build on the evidence from the
Ethiopia research and get stakeholder
input on the proposed referral model to:
• Identify opportunities to build linkages
from NACS programs to ES services in
Namibia
• Understand challenges to consider or
overcome
METHODOLOGY:
•Focus group discussions at national level
•Exploratory site visits at community
level
17. CONSTRAINTS & • Few formalized systems for
referrals and linkages between
CONSIDERATIONS clinical sites and community-
based services.
• Lack of awareness among clinical
staff about other existing services
in their communities.
• Formalized referral systems create
additional paperwork and work
for clinical and CBO staff.
• Decreasing donor support
18. PROGRAMMING • Demand for and recognition that
OPPORTUNITIES
referrals from NACS sites to ES programs
are essential to the continuum of care.
• Many strong NGOs and CBOs, or HIV
support groups are well positioned to
lead referral coordination
• Existing cadre of CB
volunteers providing HBC,
OVC support and other
services
19. PROGRAMMING
OPPORTUNITIES • Peace Corps volunteers could be
engaged in start-up
• The Ministry of Health and Social
Services (MOHSS) is currently
training 3,500 health extension
workers, including basic social work
skills.
• MOHSS is already in the process of
formalizing a bi-directional referral
system for HIV-related services
21. KEY COMPONENTS OF EFFECTIVE ES REFERRAL SYSTEMS
1 COMMUNITY
OWNERSHIP
4 IDENTIFY REFERRAL
POINTS OF CONTACT
2 MAP & EVALUATE
AVAILABLE
5 ESTABLISH A REFERRAL
COORDINATING
SERVICES COMMITTEE
3 ASSESS INDIVIDUAL
PATIENT NEEDS & 6 ENGAGE A LEAD
ORGANIZATION
CAPACITY
23. • Technical assistance to improve the
quality of existing ES/L/FS services
ADDITIONAL
• Identification of gaps in available
SUPPORT services
FOR LINKING • Incentivizing ES providers to reach
NACS WITH target communities
ES SERVICES • Strong involvement of the private
sector for sustainable employment
opportunities
24. FUTURE LIFT RESEARCH
Pilot and document Build the evidence base
effective strategies for for health and nutrition
linking NACS with ES outcomes of ES
services interventions
Editor's Notes
Provide technical assistance and strategic support to USG agencies and their implementing partners to improve the quality of ES programs and activities that support PEPFAR investments.Build an evidence base demonstrating health and nutrition outcomes of ES interventions.Improve access of NACS clients to ES services through referrals and other health systems strengthening activities.
Collaboration….(FANTA-3, Feed the Future, AIDSTAR-II, MEASURE Evaluation)
NACS linkages to economic strengthening servicesPEPFAR Global and Country Operational Plan technical guidanceProgram assessments and country level portfolio reviews/recommendations for programmingFood security and livelihood assessmentsRapid market analysesEnabling environment and policy developmentImplementingpartner capacity building and technical trainingProgram monitoring and evaluation support
Training LIFT provides is based on Household Economic strengthening models.
LIFT’s conceptual framework looks at the vulnerabilities of households and matches them with appropriate strategies based on household risk profiles and priorities.A lot of NACS clients will be families in destitution, however ES programming in this area should be short-term and should aim to build assets to decrease household vulnerability. Many NACS clients may benefit from protection strategies that help prevent malnutrition.Know your families and their vulnerabilitiesBuild on natural household behaviors and assetsAppropriate for people affected by HIV, including Care Givers and OVCMarket-orientatedWhen in doubt, strengthen money management – especially through savings
Desktop Literature ReviewFindings revealed little published literature or data available on the impact of livelihoods and ES interventions offered through HIV referral networks Key documents identified from FHI and CRS focused on framework for general referral networksField research with Save the Children programs in EthiopiaConducted interviews and focus group discussions with project staff, clinical staff, partners and program participants and government counterparts across three programs that integrate ES referral systems
Embedded in health facility or with PLHIV groups, supported by Ministry of Health
The committee relieves the clinics of having to identify and coordinate referral network participants Brings together a range of stakeholders including, PLHIV organizations, private sector and ES providers --- to manage the referralsPromising practices from Ethiopia highlighted the need to move coordination and management to the community level away from overburdened health facilities.
Critical questions raised in Ethiopia2 Site visits included:A review of ES services that could be linked to NACS sitesKey informant interviews with clinic and CBO staff
NACS is already time consuming for clinical workers, adding to their burden.There may not be effective ES programs available to which patients could be linked.is resulting in scaling back of many community based programs (rather than expansion to take on additional NACS clients).
1) NACS ES linkageswould address important structural needs, and increase the sustainability and impact of current investments in clinical care. Almost all NACS patients could benefit from this support.2) Such entities are currently providing some form of informal referral function, and PEPFAR funded organizations can play a critical role in strengthening the capacity of these agencies. 3) Volunteercould support the referral system by tracking and following up on referrals in their catchment areas.
PCV: based at clinical sites or CBOs to get systems up and running and pass them on, provide cascade training, etc. Working with local leadership in communitiesHEW: Not enough social workers to handle the current case load.This group could be an important cadre to providecoordination and follow up in the referral system. BDR: If the ES referrals are institutionalized in the forms and training now in the pilot stage, it will avoid the need to re-print/re-train……………Unfortunately, current pilot system lacks a focus on non-clinical services and the feedback mechanism is not well developed;LIFT has provided technical input to strengthen the links to non-clinical services in this system………….limited over lap with NACS
Pulling it all together, what have we learned?Formalized referral networks and systems within NACS programs are just beginning to emergeAdditional research is needed to develop and test adaptable and scalable models. Next phase is to pilot referral systems and document learnings – in April starting in NamibiaSeveral key components identified based on LIT REVIEW, examined existing programs in Ethiopia and formative research in Namibia
In addition to supporting the development of referral pathways, effective NACS ES linkages require….and/or make them more appropriate for vulnerable populationsand support for advocacy to local NGOs, donors and government 4) Note mixed enthusiasm for private sector involvement in provision of supplemental feeding
LIFT is developing a research agenda to systematically build the evidence base around health and ES/L/FS. Working with MEASURE Evaluation.Mandate to document learnings and share with the broader community
