Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity May 30, 2013 Washington, DC Building Savings and Protecting Assets Ntongi McFadyen, Save the Children STRIVE Mozambique

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity STRIVE Mozambique context Chronic food insecurity and child malnutrition Nampula Province: – 63% of children under 5 chronically malnourished – Smallholder, subsistence-oriented farming – Hunger season from December to March

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Program activities STRIVE activities implemented in : – Village Savings and Loan (VSL) groups – Rotating labor scheme, Ajuda Mutua (AM) 10,000+ participants in VSL groups - potential to impact more than 25,000 children Overlay with SANA, a USAID Title II food security program addressing nutrition, agriculture, and disaster risk reduction.

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Impact evaluation To assess program effect on: – HH food security, HH and child food diversity, and child anthropometric measures – Intermediary outcomes: income, assets and social capital Household cohort survey: – August 2009 and August 2012 – 9.1% attrition rate – 1543 program beneficiaries and residents of the comparison group area

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Nampula Province

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Qualitative follow-up study To explore factors leading to the change in outcomes Subsample of households from impact evaluation with measured improvements in income and social capital In-depth interviews conducted in Nov-Dec 2012 – 43 VSL participants in Mossuril district – 42 VSL&AM participants in Angoche district

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity VSLAMVSL+AM Household Income per capita+++ Assets*+++ Mos. of adequate food**+++ Food diversity (FCS) +Not sig. Child Food diversity (FCS)+Not sig. StuntingNot sig.-- WastingNot sig. UnderweightNot sig. Results overview *aluminum panels, toilets (+) = better than control (-) = worse than control

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Difference in Difference design Effect of participation = Difference for VSL group – Difference for comparison group What would have happened in absence of treatment

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Results Income and Assets VSL vs. Control Baseline (2009) †DD =.85*** (log. scale); Ratio of difference is 2.3 † Propensity score weighted difference in difference, controlling for natural shocks Endline (2012) 1,000 Mzn = $38 Total per capita Income Total Durable Assets VSL Comparison Group VSL Comparison Group †DD = 1.124***

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Results Food Security and Dietary Diversity VSL vs Control Baseline (2009) †DD =.416*** † Propensity score weighted difference in difference, controlling for natural shocks Endline (2012) Mo. Adequate Food Dietary Diversity (FCS) VSL Comparison Group VSL Comparison Group †DD =.889***

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Key drivers of impact Income – Men have a central decision-making role in allocating savings and loans, although women participation is more dominant in VSL – Use of loans to invest in agriculture and business; large changes in income driven by investment in high value crops – Exposed to business training but sense of limited non-farm opportunities; no apparent income gains from livestock Assets – Households acquiring a range of durable assets (improved toilets, aluminum and zinc panels, bicycles, clocks, radios, etc) – Given a lump sum, are durable assets an easy and low risk purchase? Or are they a preference?

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Key drivers of impact Food security – Share-out almost always timed to align with the hunger season – Women referred to making food and daily needs purchases – Men referred to making agriculture and durable good investments – Members associated dietary diversity with desire for variety in tastes, rather than nutritional quality Child anthropometrics (stunting, wasting, underweight) – Some VSL members exposed to nutrition messages through SANA; acknowledgement of different food needs among children and equity in intra-household distribution of food – In hierarchy of needs, potential investment in children’s nutrition appears to be crowded out by other priority needs

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Questions

Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food Insecurity Implications going forward VSL - overlayed with SANA - was not enough to improve health and nutrition outcomes for children, in this context: –Would the explicit integration of health and nutrition within VSL yield nutritional outcomes for children? Is the problem not a priority or is the solution not well understood? –Would increased engagement of resource gatekeepers (men, grandmothers) change allocations to prioritize nutritional needs? VSL contributed to income, asset, and risk mitigation gains: –Would children’s nutritional needs eventually compete for finite resources as households work their way through priority expenditures? Can VSL achieve this, and under what timeframe? –What additional avenues can accelerate outcomes, e.g., readily available nutritional foods at a lower cost? In other contexts, how has VSL shown to have built and protected assets?