1. PROJECT OVERVIEW

2. LIFTS 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

3. OVERVIEW Five year associate award under FIELD-Support LWA with PEFPAR funding from USAIDs 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 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

5. ECONOMICS AT THE FAMILY LEVEL often our priority IncomeExpenses Small Irregular Unpredictable Food Shelter Healthcare Income generation always their priority

6. 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

7. 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

8. LIFT RESEARCH IN ETHIOPIA

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 CHILDRENS 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 (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. 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 Clients livelihood needs/options DESIGNATED CASE MANAGERS AND COMMUNITY VOLUNTEERS CAN MAKE A DIFFERENCE PROMISING PRACTICES

13. 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 ESTABLISH A COORDINATING COMMITTEE AT THE COMMUNITY LEVEL PROMISING PRACTICES

14. 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 clinic- based services and back?

15. LIFT RESEARCH IN NAMIBIA

16. 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 OBJECTIVES

17. CONSTRAINTS & CONSIDERATIONS Few formalized systems for referrals and linkages between 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. 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 PROGRAMMING OPPORTUNITIES Existing cadre of CB volunteers providing HBC, OVC support and other services

19. 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 PROGRAMMING OPPORTUNITIES

20. KEY COMPONENTS OF NACS ES REFERRAL SYSTEMS

21. COMMUNITY OWNERSHIP KEY COMPONENTS OF EFFECTIVE ES REFERRAL SYSTEMS 1 MAP & EVALUATE AVAILABLE SERVICES 2 ENGAGE A LEAD ORGANIZATION 3 IDENTIFY REFERRAL POINTS OF CONTACT 4 ESTABLISH A REFERRAL COORDINATING COMMITTEE 5 ASSESS INDIVIDUAL PATIENT NEEDS & CAPACITY 6

22. LIFT MODEL FOR LINKING NACS WITH ES SERVICES

23. 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

24. 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