Household Economic Strengthening Leads to Improved Health Outcomes for Vulnerable Households -- Presenter: Michelle Ell - USAID/Higa Ubeho

Transcription

1 Household Economic Strengthening Leads to Improved Health Outcomes for Vulnerable Households -- Presenter: Michelle Ell - USAID/Higa Ubeho USAID Higa Ubeho is a programme of social Services for Vulnerable Populations that began in 2009 and covers 232 Districts. It has served 122,771 individuals, reached over 71,452 vulnerable households, built capacity for HES in 23 districts, and established 5,846 new community-based service points. 61,448 individuals have benefited from economic strengthening. The.of the review show a 36% decline in the number of 'Households In Destitution' and an overall progression to higher levels of resilience with an 18% increase in the number of households in the category of 'Households Struggling To Make Ends Meet', and a similar increase in the number of households in the category of 'Households Prepared to Grow'. The results above demonstrate reducing levels of vulnerability and increase resiliency in households. Along with these changes, researchers observed improved health outcomes, which are summarized below: 88% have health insurance 77% have long lasting insecticide treated nets 74% have covered latrines 78% of nutrition group members have good nutritional status (BMI ) 81% have timely health seeking behavior 91% adopt improved nutritional practices These findings not only demonstrate the impact of the program's resiliency model, they also signal the importance of investing in economic strengthening to achieve improved health outcomes. Participant question: Is the coverage in all 23 districts? What is the cost vs. Impact? Response: At the beginning of the program focused on OVC in all 23 districts in all sectors then 2 of the RPOs graduated and received direct support from USAID/ 3 new districts added since 2012, not in all sectors / Cost not known but varies from partner to partner Participant question: How do you deal with women empowerment, due to new income generated? Mostly men are making decision on use of these new resources Response: This is a challenge as 75% of beneficiaries are women. Gender mainstreaming component but not enough so since 4 months family days to complement MIGEPROF initiative/ open discussions between HH on decision making mechanisms/ positive parenting should be introduced still more to do Participant question: Are the outcomes shown are intended outcomes? What are particular interventions to get to these outcomes? Response: At the beginning of the project 70% budget for education school fees/ then devoted to Economic strengthening. So program transformed from a channel to deliver education support to a livelihoods program with broader impact. Saving groups, coops: emphasis is towards Economic Strengthening Question from Minister of Health: What are the criteria for identification of beneficiaries and what is the impact measurement? Response: Criteria used are Ubudehe categories. Most of beneficiaries are from Ubudehe 1, 2. Changes in assets/impact on HH were measured through scoring card. Results show 20% transitioned into Ubudehe 4 and 75% in Ubudehe 3. Program in discussion with GoR to make a decision to graduate those and put more resources in new beneficiaries form Ubudehe 1 and 2. 46

2 Household Economic Strengthening (HES) Contributes to Improved Health Outcomes Oral Abstract Presented at the 2014 Nutrition Summit Authors: Michelle Ell, Milton Funes, Global Communities

3 Coverage: 23 districts. Life of Program: October 2009 Present. Building Strategies for Self-reliance. Donor: USAID/President s Emergency Plan for AIDS Relief Consortium: ADEPR, ARCT-Ruhuka, CRS, EPR, DUHAMIC- ADRI, Global Communities, PAJER, SINAPISI, WE-ACTX FOR HOPE, WIF, YWCA. USAID HIGA UBEHO SOCIAL SERVICES FOR VULNERABLE POPULATIONS

4 By investing in household economic strengthening (HES) interventions, it is possible to achieve improved economic and health outcomes. DEVELOPMENT HYPOTHESIS H o u s e h o l d R e s i l i e n c y

5 Model for Building Household Resiliency Resilience Reduce vulnerability to economic, social, health, and environmental shocks. Linking people to networks of social, health, and education services. Safety Nets Households Communities Savings mobilization, asset building, entrepreneurship, and income generating activities. Economic Strengthening Market-based approaches Connecting people to sustainable income-generating opportunities and linking vulnerable households to local networks that provide critical safety nets.

6 ubudehe ubudehe ubudehe Ubudehe r e s i l i e n c e Safety Nets Education Subsidies Psychosocial Support Life Skills Strengthening Promoting Health Insurance Economic Strengthening Integrated Savings & Lending Groups Farmer Field Schools Nutrition Groups Vocational Training

7 122,771 individuals served. Reached over 71,452 vulnerable households. Built capacity for HES in 23 districts. Established 5,846 new community-based service points. 61,448 individuals benefit from economic strengthening. PROGRAM REACH

8 Routine Monitoring Performance Monitoring Plan OUTCOMES & IMPACT

9 External Assessment Type: Longitudinal Cohort Study Period: 2012, 2013, 2014 Sample size: 500 households Districts: Karongi, Muhanga, Kicukiro, Gasabo, Gakenke and Nyagatare OUTCOMES & IMPACT

10 Household Resilience Index (HRI) Household Assets & Income Household Expenses Household Health Outcomes Ubudehe 1 & 2 Ubudehe 3 Ubudehe 4 Families in Destitution Families Struggling to Make Ends Meet Families Prepared to Grow USAID OVC Task Force

11 Changes in Household Resiliency 80% 73% 70% 72% 60% 50% 55% 40% 30% 43% 2010 Ubudehe % 21% 20% 10% 7% 7% 0% 2% Households in destitution Households struggling to make ends meet Households prepared to grow

12 Researchers: American University, Washington D.C. Type: Program Assessment Period: November 2012-January 2013 Sample size: 98 households Districts: Kamonyi, Gicumbi, Rulindo OUTCOMES & IMPACT

13 Before I joined Higa Ubeho, I had many challenges related to the nutritional status of my family. I was often hospitalized...but right now I don t have problems regarding sickness... My CD4 count increased. And, I do my best to measure the weight of my children each month. Felicitee, Rulindo District Improved health

14 Before Higa Ubeho, I never used to prepare food [for my children] in the morning. I woke up and I went to the field to cultivate. But with Higa Ubeho I know how to prepare food and mix food products and make good food for my children. Marie Therese, RulindoDistrict Improved nutrition awareness

15 ...when I was coming from the farm, I would go back and then eat and then sleep without bathing. So since I learned those lessons, I bathe before I sleep...i used to get some diseases...now I do not... I learned a lot of things; how to eat complete meals, how to cultivate, how to do savings. Margarite, Gicumbi District Improved hygiene

16 Responsible: Rwandan Partner Organizations Routine Monitoring Performance Monitoring Plan Type: Program-level Monitoring Period: Life of Program Sample size: 340 people (31 groups) Districts: Kamonyi, Nyagatare, Rulindo OUTCOMES & IMPACT

17 90% 80% 80% 70% 66% Percentage of families with mutuelle coverage 60% 53% 50% 40% December 2012 (baseline) June 2013 Jan-14 HEALTH INSURANCE

18 90% 85% 84% 80% 75% 78% 70% 65% 60% 62% Percentage of sampled households with handwashing facilities. 55% 50% 45% 40% Dec-12 (baseline) Apr-13 Jan-14 HAND-WASHING FACILITIES

19 Axis Title 100% 97% 95% 94% 90% Percentage of sampled households with latrines 85% 84% 80% 75% Dec-12 (baseline) Apr-13 Jan-14 HOUSEHOLD LATRINES

20 80% of households have health insurance. Hand-washing facilities are used in 84% of households. 97% of households have covered latrines. Long-lasting treated nets are used 92% of households. 93% of households use dish drying racks. Investing in Household Economic Strengthening Contributes to Improved Health Outcomes

21 For more information, please contact : Michelle Ell, Program Coordinator, USAID/Higa Ubeho. mell@rw.globalcommunities.org