Furaha Graduation and Resilience Model Sustainable, COmprehensive REsponses (SCORE) for vulnerable children and their families Furaha Graduation and Resilience Model 15 March 2017, Speke Resort Munyonyo

SCORE Briefer: USAID/PEPFAR Funding LEAD AGENCY AVSI Foundation – Care International FHI360 and TPO Uganda PARTNERS *12 Local Implementers (from 66) DURATION 7 Years (Apr 2011 – Apr 2018) TARGET 25,000 HHs, 125,000 people REACH *31,943 HHs *178,974 people COVERAGE 35 districts *21 districts (oct 16) BUDGET 38,322,700 USD (34,326,470 USAID and 3,996,230 Cost share)

Coverage 35 districts 23 districts COP 16: 21 districts Staff 177 Staff (14 TSC, 73 Regional level and 90 IP level)

Objective 1: Economic strengthening: SCORE Goal and Menu of Interventions Goal: To decrease the vulnerability of moderately and critically vulnerable children (VC) and their households. Objective 1: Economic strengthening: Village Savings and Loans Associations, Community skills training, Financial Literacy, Apprenticeship training, Market intelligence and linkages, Value Chain Development Objective 2: Food security and Nutrition: Farmer field school, junior farmer field schools, urban horticulture and kitchen gardens, Behavior change and communication; cooking demonstrations, radio spot messages, nutrition learning sessions, identification and referral of children with malnutrition Objective 3: Child protection and legal services child friendly school model, home visits, interactive learning sessions, Legal clinics, identification and referral of protection cases, birth registration Objective 4: Family strengthening & access to critical services Referrals to access critical services, parenting skills training, Life skills training, community dialogues, psychosocial support interventions, Early childhood development, mental health DREAMS: Reducing HIV incidence among AGYW 10-24 Combined SES (apprenticeship, VSLA, Financial literacy, Community skills), Reducing HIV risk and Social asset building (HCT, VMMC, life skills, parenting skills, stepping stones), mobilizing communities for change (GBV reduction, dialogues and health messaging)

SCORE Approach Multi-sectoral. Wide menu targeting members of the beneficiary households. Family-centered approach. Engaging individual household members in different activities within the family Commitment to “fit the project to the people”. Family- specific household development plans, featuring a mix of activities deemed most appropriate. Use of evidence and robust M&E System: Unique identifier for each HH member, CLA: Parenting skills Life skills, VSLA studies, Bank linkages, Measure Evaluation, Resilience Premised on capacity building and “Graduation model” Working with existing community resources, people, implementing partners

SCORE Approach – Tailored pathways

Beneficiary Flow Chart – Case management model Total ever enrolled 31,943 households 28,736 SCORE & 3,027 DREAMS Active: 8,161 with 5,134 SCORE and 3,027 DREAMS Household Development tool PEPFAR Funded initiatives VAT Health facilities VAT Police Retrogressed (26%) Resilient (74%) 10,164 (66%) out of 15,298 enrolled Vatted households “graduated” 2,196 out of 5,134 (43%) of active households in pre-graduation at VAT5 Multiple pathways tailored to individual HH needs and resources/capacities

SCORE Beneficiary Profile

SCORE Beneficiary Household Characteristics

HIV Status

90/90 Contribution

Activity Results Outcomes across result areas

Objective 1- Socio-economic strengthening

Objective 1- Socio-economic strengthening – Income changes

Socio-economic strengthening 1,615 VSLAs with 37,200 members have saved USD 3,889,055 and loaned USD 4,842,994. Av savings USD 108 2,264 youth enrolled into apprenticeship 1,348 (76%) gainfully employed or own businesses

13,375 trained in financial literacy 8,461 in community skills 11,580 in enterprise selection, planning and management (SPM) of IGAs

Objective 2- Food Security and Nutrition

Food security and Nutrition 15,124 members trained in improved agronomic skills through 504 farmer filed school groups 357 (71%) legally registered production and marketing groups. 60% (12,451) of enrolled household members (43% female) engaged in horticulture 27,946 people engaged in BCC (Nutrition dialogues/demos) 27.5% (2,973) households in FFS adopted environmentally friendly nutritional practices (use of energy-saving stoves) Established a network of certified resourceful community- based personnel (122 FFS Facilitators and 333 Nutrition Peer Educators)

7 to 9.5 months increment in the # of months households have adequate food in a year 51.6% to 13.5% (13.1% UW and 0.4% wasting/edema) reduction in the incidence of malnutrition 931 children identified with SAM and MAM referred and managed

Food security and Nutrition: Ex. Innovations

Value Chain Development

Objective 3- Protection and legal services

Operational school management committees Increased enrollments Re-enrollment of pregnant girls Suggestion boxes Positive discipline 651 Child friendly schools – over 6,532 pupils engaged and 300 teachers trained and active

Protection and legal services 34,912 children supported to access birth certificates - children with birth cards increased from 29% to 81% 29,708 people engaged in interactive learning sessions on protection Home visits: 29,000 (99%) of all households visited at home Legal referrals: 21,700 legal referrals through formal and informal structures. Created a network of community resources; 272 Community legal volunteers

Objective 4: Family Strengthening and Access to essential Services

Community dialogues: 33,535 people attended Life skills: 7,608 adolescents and youth trained in life skills Parenting skills: 6,500 caregivers trained in parenting skills Psychosocial Support: 10,840 people supported with individualized psychosocial activities

Referral: 11,924 people referred for critical services Family Strengthening and Access to essential Services Referral: 11,924 people referred for critical services  

Early Childhood Development 61 Community Play groups 1,800 children participating weekly

DREAMS Combined SES VSLA: 50 groups, 998 AGYW members, savings 19,463,900 UGX, loans 9,506,000 UGX Apprenticeship skills: 514 Community skills: 1223 Social Asset building Life skills 3,427 Parenting 713 Stepping stones – 110 HIV risk reduction messaging (2,593 AGYW)  

Changes in select variables over four years: Measure Evaluation Change in outcomes over time, N=17,953

Multi-sectoral Interventions Benefits Correlate Across Result Areas Improvements in one aspect of the life of the families (say, food security) are shown to be linked to improvement in another aspect, possibly in an entirely different technical area, say schooling. A strong argument in favor of multisectoral interventions, such as the SCORE Project.

Schooling and Food Security

Absenteeism and Food Security

Documentation and Learning Evaluations Documentaries Pictures Manuals

Furaha Graduation and Resilience Model Beginning, process and results and Lessons “Happiness model”

Beginning, process and results and Lessons

Furaha Graduation and Resilience model: step wise – case management approach Vulnerability Pre-graduation Graduation Resilience

Key concepts Vulnerability: State of being unable to withstand shock, risk and stress. When a household is assessed using the model’s vulnerability assessment tool [VAT] and it scores above 40, then it is vulnerable Pre-graduation: When a household’s vulnerability score drops below enrollment threshold (40) for the first time after at least one cycle of external assistance [1 year]. The HH receives only a thin layer of external assistance and will be monitored for 1 more year before graduation Graduation refers to that moment when project beneficiaries who return a vulnerability score below enrollment threshold for two consecutive measurements (annual measurements) are exited from direct project support. Resilience is when a graduated household remains below enrollment threshold (maintains a graduation status) a year after the time of graduation/exit from direct support Retrogression: When a pre-graduation or graduated HH returns a vulnerability score above enrolment threshold [40] after a year of monitoring.

Principles of Furaha Graduation model Designed and implemented within the USAID funded SCORE project in 2011 Targeting vulnerable households (characteristics like HIV affected, orphan hood, disability, chronic illness, poverty) Capacity building (no handouts), multi-sectoral and unique family tailored pathways Determined vulnerability and graduation thresholds (VAT – with “RED Flags”) Responsible graduation – allowing for pre-graduation stage for 1 year and follow up after graduation (3 year cycle) Resilience: when a graduated household remains below enrollment threshold a year after the time of graduation. 76-86% resilience levels recorded SCORE program cost is $281/HH/year

Findings on Graduation and Resilience

Transition in vulnerability

Results of the AVSI Foundation graduation and resilience model Enrolled 28,736 households 10,164 households graduated (66% of all active enrolled 15,289) 5,134 (17%) households still in care with 2,195 (43%) in pre-graduation 74% (3 of 4 households) of graduated households are resilient two years post exit

Resilience findings on sample of graduated households followed up Resilience findings on sample of graduated households followed up *2 years post graduation {August 2016)

Deeper Analysis on Graduation: Regression analysis table Analysis of overall improvement in vulnerability; where N = 17,482, LR Chi2 = 491.06, p < 0.01 Analysis of improvement in vulnerability from critical; where N = 17,482, LR Chi2 = 775.49, p < 0.01

Effect of interventions on graduation Participation in all SCORE Project objectives will lead to a reduction in vulnerability with child protection (OR 1.09), economic strengthening (OR 1.O7) and family strengthening (1.06) responsible for the greatest association Even if child protection (OR 1.09) is associated with improvement in vulnerability, it was not significantly associated with stability after graduation (P>0.05) Family strengthening (OR 1.O6, P<0.05) can enable a family transition from critical to moderate, slight vulnerability and eventual graduation Participation in family strengthening activities were found to enable maintenance of post graduation/ resilience status (OR 1.06, P<0.05)

Graduation- Regression analysis – Disability and HIV status Disability: odds of improved vulnerability and subsequent resilience were about 30% lower among households with a disability when compared to those without (OR = 0.71). Disability compounds households’ vulnerability.

Graduation- Regression analysis table – Disability and HIV status No significant variations in improved vulnerability (OR 0.88) (p>0.05) and subsequent resilience was noted if the household was HIV affected or not. (OR 0.93) (p>0.05). This finding suggests that transition out of vulnerability or resilience after graduation is not affected by HIV positive status.

Who Benefits? Change in Vulnerability scores by HIV status

Characteristics of households who graduate – 10,164 (66%) VS those who do NOT graduate- 462 (3%) Prevalence of some demographic characteristics may affect transitions in vulnerability: Orphan hood, child headed, elderly headed households, disability, chronic illness

MEASURE Evaluation Results: Graduated HH had better outcomes, % Yes Food failure – orange (less among the grad HHs compared to grey) School for graduated yellow compared to blue for continuing HHs Findings from logistic regression with a random sample of 1000 children: -Better outcomes for graduated HHs vs continued HHs for: - food failure (p<0.0001) - school enrollment (p=0.0048)

Qualitative findings on a sample of graduated households followed up Qualitative findings on a sample of graduated households followed up *2 years post graduation {August 2016) Do graduated households experience shocks? Which type of shocks? How do they deal with the shocks? Do shocks result into retrogression? What interventions can better the management of shocks? Do graduated HHs still participate in SCORE interventions post graduation? Others include: Banana Bacteria wilt, Falling of the house, Imprisonment, Miscarriage, Mudslide, Robbery

Did graduated households experience shocks? Others include: Banana Bacteria wilt, Falling of the house, Imprisonment, Miscarriage, Mudslide, Robbery

Type of shocks experienced Others include: Banana Bacteria wilt, Falling of the house, Imprisonment, Miscarriage, Mudslide, Robbery

How do households deal with these shocks? OTHERS? Got health care, got out of prison, Evt: Organic pesticides, mulching, terraces, better agronomic practices, seed bulking,

Does experiencing a shock relate with retrogression? YES

Post graduation: Are SCORE interventions sustainable Post graduation: Are SCORE interventions sustainable? Who is participating in what? ATLEAST 16 activities with VSLA, FFS, Parenting,

Does continued participation provide immunity from retrogression Does continued participation provide immunity from retrogression? NOT REALLY. Work well with HHs when you have them… NO

Conclusions Even the most vulnerable households can graduate out of vulnerability once their capacities and confidence is built to enable them on their own meet their needs. SCORE project without consumption smoothing has demonstrated that capacity building and confidence building within a robust case management approach can motivate and enable households transition out of vulnerability and remain resilient Activity participants MUST be provided with a set of climate and other shock management approaches to enable them adapt and transform in front of these shocks post graduation The time to implement is NOW – during the project period. Even if interventions are sustainable – what matters most is the activity time (how you worked with beneficiaries to prepare them for the period after the activity ends) Multi-sectoral programs targeted to an entire household are critical as they respond to multiple needs and include several members thereby multiplying the effects and achieving ownership

Case Story: Akwero Santa A-KIR-0297-02 Before USAID/SCORE: Monthly household income of 60,000 UGX (17.6 USD), poor health, poor rented shelter, one meal a day, children missing school due to lack of scholastic materials, seasonal and dangerous source of income; stone quarrying/ bead making After USAID/SCORE: Monthly household income 500,000 UGX (I47 USD), on ART care and treatment and living positively, family eats three meals a day, children attend school regularly, (Santa’s son Ochaya completed a certificate course in mechanics and is now employed). Diverse sources of income; bakery, tailoring, beads with value addition, and the family now lives in their completed permanent house Vulnerability Assessment (VAT) SCORES VAT 1: 65, VAT 2:54, VAT 3:44, VAT 4:34 (Pre-graduation), VAT 5:36 (Graduated!) VAT 1: 65, VAT 2:54, VAT 3:44, VAT 4:34 (Pre-graduation), VAT 5:36 (Graduated!)

  “SCORE has encouraged me to work hard. I can now generate income by engaging in different IGAs. I am no longer someone who sits and waits for organizations or programs to come and give me handouts. I try to work hard for myself.” (Namayingo, current beneficiary)

Rita Larok Chief of Party AVSI Foundation Uganda Tel: 0312-501614 Email: secretariat.score@avsi.org website: www.score.or.ug