Transcript Slide 1

PROJECT
OVERVIEW
LIFT’S
OBJECTIVES
1. Provide technical assistance and
strategic support to USG agencies
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
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
LIFT POTENTIAL
TECHNICAL
ASSISTANCE
INCLUDES:
• NACS linkages to economic
strengthening services
• Implementing partner ES capacity
building and TA
• Program assessments and country
level portfolio
reviews/recommendations for
programming
• PEPFAR Global and Country
Operational Plan technical guidance
ECONOMICS AT THE FAMILY LEVEL
Small
Irregular
Food
Shelter
Healthcare
Unpredictable
Income generation
Income
often our priority
Expenses
always their priority
FAMILY TYPOLOGIES CORRESPOND TO INTERVENTION
STRATEGIES & EXPECTED OUTCOMES
Families PREPARED to grow
Families STRUGGLING to
make ends meet
Families in
DESTITUTION
PROMOTION strategies to
grow income/expenses
PROTECTION strategies to
match income to expenses
PROVISION strategies to meet
basic needs
LINKING NACS
WITH ECONOMIC
STRENGTHENING
LIFT aims to integrate ES services
within NACS programs in order to:
• Build the continuum of care for
people living with HIV and other
vulnerable households
• Prevent malnutrition
• Prevent relapse into therapeutic
feeding
• Increase social wellbeing and
reduce stigma
LIFT RESEARCH IN
ETHIOPIA
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
SAVE THE
CHILDREN’S
PROJECTS IN
ETHIOPIA
Food by Prescription (FBP), USG PEPFAR-funded
initiative (2009-2012) to improve the nutritional,
clinical and functional outcomes of malnourished
PLHIV by strengthening NACS services.
Save the Children was contracted by USAID (20072009) 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.
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
PROMISING
PRACTICES
DESIGNATED CASE MANAGERS
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
PROMISING
PRACTICES
ESTABLISH A COORDINATING
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
CRITICAL
QUESTIONS
RAISED
• How do we integrate livelihoods and
economic strengthening into existing
clinic referral systems?
• How do we effectively target
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 clinicbased services and back?
LIFT RESEARCH IN
NAMIBIA
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
CONSTRAINTS &
CONSIDERATIONS
• Few formalized systems for
referrals and linkages between
clinical sites and communitybased 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
PROGRAMMING
OPPORTUNITIES
• Demand for and recognition that
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
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
KEY COMPONENTS
OF NACS ES
REFERRAL SYSTEMS
KEY COMPONENTS OF EFFECTIVE ES REFERRAL SYSTEMS
1
COMMUNITY
OWNERSHIP
4
IDENTIFY REFERRAL
POINTS OF CONTACT
2
MAP & EVALUATE
AVAILABLE
SERVICES
5
ESTABLISH A REFERRAL
COORDINATING
COMMITTEE
3
ASSESS INDIVIDUAL
PATIENT NEEDS &
CAPACITY
6
ENGAGE A LEAD
ORGANIZATION
LIFT MODEL FOR LINKING NACS
WITH ES SERVICES
ADDITIONAL
SUPPORT
FOR LINKING
NACS WITH
ES SERVICES
• Technical assistance to improve the
quality of existing ES/L/FS services
• Identification of gaps in available
services
• Incentivizing ES providers to reach
target communities
• Strong involvement of the private
sector for sustainable employment
opportunities
FUTURE LIFT RESEARCH
Pilot and document
effective strategies for
linking NACS with ES
services
Build the evidence base
for health and nutrition
outcomes of ES
interventions