salvation army - evaluation of economic strengthening for ovc in uganda (april 2010 updated version)
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Evaluation of Economic Strengthening for OVC:
Using the WORTH Model in Uganda
SUMMARY OF FINDINGS
April 2010
Prepared by:
Brian Swarts MPA, Microfinance Technical Advisor, SAWSO
Paul Bukuluki PhD, External Consultant, Makerere University
Grace Mwangi MA, WORTH Consultant, PactJane Ruth Wanyama MBA, WORTH Program Coordinator
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ACKNOWLEDGEMENTSThis report was made possible through the support of many dedicated people. First, the leadership and staff of
The Salvation Army (TSA) Ugandaespecially the TSA OVC project manager (Sam), who ensured that all staff
and resources were organized to support the evaluation team, and the TSA Eastern regional field staff (Joseph,Jane, Medi, Agnes, Stephen, Michael, and Isaac), who committed seemingly endless workdays to the effort.
Secondly, the interview team. Our team conducted interviews with energy, patience and skill, despite the
constant challenges of mud and rain. Thirdly, Dr. Paul Bukuluki and Grace Mwangi. Their expertise was
invaluable in taking the evaluation from a promising idea to a 30-person team effort. Finally, a number of
colleagues in the U.S. gave substantial time and knowledge to crafting the final product: Dr. Rob Stephenson, Dr.
Jessica Greene, Jean Capps, Sara Davis (SAWSO) and Bram Bailey (SAWSO).
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TABLE OF CONTENTS
INTRODUCTION 6
The WORTH Model 6
Sustainable Community Support for Orphans and Vulnerable Children 7
Understanding the Role of WORTH in Improving OVC Welfare 7
EVALUATION METHODOLOGY 9
Household Survey of Caregivers and OVC 9
Qualitative Data from Final Evaluation of TSA OVC Project 10
Data Analysis 11
FINDINGS 12
General Findings on OVC Welfare and Empowerment 12
Nutrition 16
Education 17
Health & Hygiene 18
Shelter 20
Finances 21
Literacy & Numeracy 23
Outlook on Life 24
WORTH OVC Funds and Support for OVC in the Community 26
Comparing Survey Results to the Uganda Demographic and Health Survey (DHS) 28
LINKAGES TO AN OVC ECONOMIC STRENGTHENING FRAMEWORK 30
CONCLUSIONS 32
Areas of Success 32
Areas for Improvement 33
Recommendations for the Future 34
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LIST OF BOXES
Box 1: Non-Economic Benefits of Empowerment in WORTH Program 8
Box 2: General Evidence of WORTH Participation Benefiting OVC 13
Box 3: Empowering Changes in the Lives of WORTH Participants 14
Box 4: Benefits of Literacy and Numeracy Skills 23
Box 5: Changes in Capacity to Care for OVC Reported by Caregivers Themselves 25
LIST OF TABLES
Table 1: Survey Respondents 9
Table 2: Caregiver Participation in WORTH & Primary OVC Beneficiaries 12
Table 3: Number of Meals Eaten Yesterday by OVC 16
Table 4: Food Categories Eaten Yesterday by OVC 16
Table 5: Percentage Food Grown At Home 16
Table 6: What Caregivers Do to Help OVC School Performance 17
Table 7: Condition of OVC School Uniform 17
Table 8: Care OVC Received for Diarrhea 18
Table 9: Care OVC Received for Vomiting 18
Table 10: Care OVC Received for Fever 18
Table 11: OVC Have the Following Item at Home 19
Table 12: Condition of Shelter 20
Table 13: Repairs Made in the Last Year 20
Table 14: Biggest Source of Income 21
Table 15: Literacy & Numeracy Assessment Results 23
Table 16: Description of Life Five Years Ago 24Table 17: Describe Income Compared to Five Years Ago 24
Table 18: Description of Household Wealth in Comparison to Other Households 24
Table 19: How Do You Feel About your Life Right Now? 24
Table 20: OVC Support Fund Activity 26
Table 21: Nutrition Support 27
Table 22: Education Support 27
Table 23: Medical Support 27
Table 24: OVC School Attendance 28
Table 25: Believe HIV+ Children Should Attend School 29
Table 26: OVC Possessing Shoes and Blankets 29
Table 27: Program Strategies for Economic Strengthening and WORTH 31
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LIST OF FIGURES
Figure 1: Percentage of OVC Caregivers in WORTH 12
Figure 2: WORTH OVC: Meals Eaten Yesterday 16
Figure 3: Non-WORTH OVC: Meals Eaten Yesterday 16Figure 4: Tested for HIV 19
Figure 5: Caregiver Access to Savings & Loans 21
Figure 6: Caregiver Has Business 21
Figure 7: OVC Who Received Food Support 27
Figure 8: OVC Who Received Education Support 27
Figure 9: OVC Who Received Medical Support 27
Figure 10: OVC Receiving Material Support 28
Figure 11: Caregivers/Adults Tested for HIV 29
Figure 12: Caregiver/Adult Contraception Use 29
LIST OF ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
CAT Community Action Team
CBO Community-based Organization
DHS Demographic and Health Survey
EGAT Economic Growth and Trade
EW Empowerment Worker
HIV Human Immunodeficiency Virus
KAY Clubs Kids and Youth ClubsMFI Micro-finance Institution
NGO Non-governmental Organization
ORS Oral Rehydration Supplement
OVC Orphans and Vulnerable Children
PEPFAR Presidents Emergency Plan for AIDS Relief
SAWSO Salvation Army World Service Office
TSA The Salvation Army
USAID United States Agency for International Development
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Role of Empowerment
Promoting a womans empowerment is just as
critical, if not more critical, to improving her
capacity to care for OVC as is increasing her
income or assets.
INTRODUCTION
This Summary of Findings report presents evidence illustrating the role that WORTH, a womens
empowerment program centered on village banking, has played in The Salvation Armys Sustainable
Community Support for Orphans and Vulnerable Children project in Uganda (heretofore known as the TSA
OVC project). The aim of the project, funded by PEPFAR, was to improve the welfare of orphans and
vulnerable children (OVC) affected by HIV/AIDS.
The Salvation Army World Service Office(SAWSO), in collaboration with Pact, conducted an extensive evaluation
in March 2010 on the impact that WORTH has made in the lives of OVC involved in the TSA OVC project. The
evaluation team conducted 685 household surveys with caregivers of OVC and OVC between the ages of 12 to
19 years, collecting data on key areas of project impact: nutrition, education, health, shelter, finance and
psychosocial status (outlook). In addition to the household survey data, this report also incorporates data
collected from focus group interviews with project beneficiaries and staff during the final evaluation of the TSA
OVC project, conducted in February 2010. The original role of the WORTH program within this project was to
improve economic security for OVC, yet the evaluation reveals that the impact of WORTH went beyond
economic strengthening and has empowered OVC caregivers in other important ways as well.
The WORTH Model
WORTH is an innovative microfinance and empowerment program through which women generate savings,
gain access to training and loans for small businesses, and teach themselves to read and write. Through WORTH
very poor women, in rural areas with few financial services, form savings and loan groups, or village banks, of
15-25 members. They meet on a weekly basis to deposit savings, to practice literacy and numeracy skills, and to
participate in mobile workshops on issues ranging from HIV/AIDS to childrens rights to family health. As their
collective savings grows members take out loans to support income-generating activities, while others in thegroup gain by earning interest on these loans. After one year of training groups are self-sustaining. The defining
features of the program are its sustainability and its ability to holistically empower women as wealth generators,
caregivers, decision-makers and agents of change in their homes and communities.
The findings of two recent evaluations of both the WORTH program and the overall TSA OVC project show that
WORTH has played a valuable role in economic
strengthening for OVC households, as well as
improving the welfare of OVC. In addition to
increasing savings and business income, the
evaluations also found evidence of muchbroader empowerment for the women
involved in the WORTH program, including
improved literacy, self-confidence and capacity
to care for OVC. Most importantly, the findings reveal that promoting a womans empowerment is just as
critical, if not more critical, to improving her capacity to care for OVC as is increasing her income or assets.
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Holistic Empowerment
Economic strengthening for the most
vulnerable needs to be based on a
foundation of broader empowerment in
order to create lasting change for those
most in need.
The biggest gap in the success of traditional microfinance
programs has been the inability to effectively reach the
poorest and most vulnerable. The evidence in this report
shows that programs simply focused on financial services
among the poorest or most vulnerable will likely have a
limited and less sustainable impact. This is primarily
because the poorest of the poor are not in a position toimmediately make large economic gains, even with access
to financial services, and some of the most important ways to improve their welfare go beyond money. Instead
they are improvements linked to attitudes, knowledge and skills.
The first step in economic strengthening for the most vulnerable is to build a foundation for future success by
empowering them to develop the assets and capabilities they need to lead more productive lives. A central part
of this foundation is access to basic services like savings and lending, yet these services must also be
complimented by improved capabilities in areas such as nutrition, health and hygiene, literacy, business, and
self-confidence. The benefits of improved capabilities in these areas are outlined in Box 1.
The findings summarized in this report highlight the importance of issues like these in using economic
strengthening initiatives to improve the welfare of OVC. The impact of the economic gains from WORTH on the
lives of OVC is largely shaped by the attitudes and capabilities of the OVC caregivers . These are all areas where
the WORTH program has actively worked to empower women as OVC caregivers, and they are areas in which
WORTH households are doing consistently better than other OVC households in the community. The outcomes
from the WORTH program in Uganda illustrate that empowering OVC caregivers with an integrated set of skills,
resources, and knowledge to strengthen their ability to care for OVC is a highly promising practice that should
be replicated.
Box 1: Non-Economic Benefits of Empowerment in WORTH Program
BETTER HEALTH: Improved knowledge and behavior for nutrition, health and hygiene
helps ensure that beneficiaries will remain healthy enough to be economically active, and
that they will use new income to effectively improve the health of their households.
BETTER EDUCATION: Literacy and business skills are essential ingredients to long-term
economic gains, since beneficiaries need both to effectively manage and identify the
most productive uses for their money.
BETTER SELF-IMAGE: Increased knowledge and self-confidence enables beneficiaries to
improve their lives in ways that reach beyond incomesuch as improvements in
relations with spouses, children or neighbors; improvements in attitudes on critical issues
like HIV/AIDS, family planning and education; or improvements in the way they see
themselves as agents of change in their own lives and communities.
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EVALUATION METHODOLOGY
Household Survey of Caregivers and OVC
The findings summarized in this report come primarily from 685 household surveys conducted in Uganda with
393 caregivers of OVC and 292 OVC between the ages of 12 to 19 years. The survey information was collected
through one-on-one interviews in the households of respondents over a seven-day period of field research.
Respondents: Participants in the WORTH program
represented 197 of the caregivers surveyed, while
196 of the caregivers surveyed were beneficiaries of
the TSA OVC project but not in the WORTH program.
For the OVC, 152 had caregivers participating in the
WORTH program and the other 140 OVC were linked
to the TSA OVC project but not the WORTH program.
All of the respondents were randomly selected from a list of all OVC project beneficiaries in the Eastern region of
project, covering the districts of Mbale, Manafwa and Sironko1
. This is the only region of Uganda where theWORTH program was implemented.
Survey Tool: The surveys were developed collaboratively with input from TSA staff working in the Eastern
region (including WORTH staff), project beneficiaries from the Eastern region, an external consultant (Dr. Paul
Bukuluki from Makerere University), WORTH consultants at Pact in Kenya, the SAWSO microfinance and
HIV/AIDS advisors, and several academic professionals working in public health. The survey questions were
largely based on the Uganda Demographic and Health Survey (2006), designed to cover issues related to the
nutritional, educational, health, psycho-social, and economic status of the OVC and their caregivers.
Evaluation Team: The interviews were conducted by a team of twenty interviewers, which included ten recentgraduates from the social science department at Makerere University (recommended by the external
consultant) and ten Empowerment Workers (EWs) from the WORTH program2. The EWs were chosen to
participate in the evaluation because of their familiarity with the program and their ability to communicate with
women and children from the local communities. In order to avoid bias, each EW only conducted interviews in
communities where she had no previous relationship or work history. All the interviewers went through four
days of training, conducted by Dr. Bukuluki, which included discussion of each survey question, practice of
proper interviewing technique and etiquette, instruction on how to accurately record responses and
observations, role-playing, and a day-long exercise conducting interviews in the field. The evaluation team also
included seven staff members from The Salvation Army Uganda, SAWSO and Pact who, along with Dr. Bukuluki,
served as observers for the interviewers and managed the logistics. Finally, at the end of each day the surveyswere collected and the data was checked and entered into an SPSS database by four trained entrants from
outside the program.
1WORTH is also active in Bududa district, but it was excluded from the evaluation due to recent fatal mud slides which
affected most families in the area, forcing many were into camps.
2The EWs are women hired from the local communities, by the WORTH program, to manage clusters of ten WORTH groups in an area
providing monitoring, mentoring and mobile workshops on issues like nutrition, hygiene and HIV/AIDS.
Table 1: Survey Respondents
Household Type Caregivers OVC Total
WORTH 197 152 349
Non-WORTH 196 140 336
Total 393 292 685
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Rationale: The goal of this survey methodology was to evaluate whether there are differences in the status of
respondents in the WORTH program (both caregivers who are members of the program and OVC who live with
caregivers in the program) compared to the status of respondents not in the WORTH program. The strategy in
identifying respondents for the survey was to isolate, as much as possible, the participation in WORTH as the key
variable in explaining potential differences between the respondent groups. All groups of respondents were
OVC households, all were registered beneficiaries of the larger TSA OVC project, and all were selected from the
same communities in the projects Eastern region, so the primary difference between the respondent groupswas participation in WORTH. Moreover, WORTH was a voluntary program open to all members of the
community and there is no evidence to indicate that women in involved in the program were any different from
the general population at the beginning of the program. In fact, background data in the survey affirms the basic
similarities between the two respondent groups. Finally, there are few organizations among the communities
sampled doing similar work on OVC psycho-social support or economic strengthening, which could possibly act
as confounding factors in WORTHs impact. Less than 10 percent of respondents claimed a connection to
another government, NGO or savings program in the area. While it is not possible to conclusively determine
that any differences between the WORTH and non-WORTH respondents are due to participation in the WORTH
program, it is highly plausible that consistent differences between the two groups are directly related to the
impact of the WORTH program.
Qualitative Data from Final
Evaluation of TSA OVC Project
Additional qualitative evidence was also
used for this report from the final
evaluation of the entire TSA OVC project in
Uganda, which was conducted in February
2010, led by Jean Capps, an external
consultant from the United States. The goal
of the final evaluation was to assess
progress towards project goals and
objectives as specified in the signed
Cooperative Agreement with the U.S.
Government PEPFAR program. For the final
evaluation official documents, partner agreements, project reports and evaluations (where available), trip
reports, memos and meeting minutes were reviewed. Monitoring data results were triangulated as much as
possible through focus groups and key informant interviews. Available information and mapping exercises were
used to randomly select project districts and communities for field visits. Focus group discussions were
conducted with several groups of OVC, caregivers, CAT members, WORTH members, Kids and Youth Club
organizers, community counselors, community leaders, and TSA officers. Facilitated meetings were held with
evaluation team members to analyze field observations and develop consensus statements on the results from
each of the three regions where the evaluation was conducted. Since the WORTH program was only designed to
function in one of the three geographic regions where the OVC program is active, this report is only uses
qualitative evidence in the final evaluation from the Eastern region where WORTH has been implemented.
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Data Analysis
The quantitative data from surveys was gathered and entered into an SPSS database daily during the field
research period. This data was used to run frequencies on the response to every question for each of
respondent groups. An analysis of the differences in the responses to these questions is the primary basis for
the findings in this report.
In addition to THE SPSS analysis the results of these surveys have also been analyzed according to robustqualitative evidence about WORTH and other OVC project activities. Much of this evidence comes from focus
groups during in the final evaluation of the TSA
OVC project. Some qualitative evidence also
came from the observations of the household
survey interview team during their visits to the
households of respondents; including
observations of the shelter, respondent
behavior, attitudes or appearance of respondent,
etc. These observations, from the interview
team, were captured during a one-day debriefwith the team after all the interviews had been
conducted.
A final layer of analysis for this report has been
to compare new evaluation data with existing data on record for the WORTH program and the Eastern region of
Uganda. The WORTH program data used comes from monitoring reports collected on group activities, including
savings, lending, business, literacy tests and OVC Fund support since 2006. The regional data comes primarily
from the most recent Demographic and Health Survey(DHS), conducted in 2006. The DHS information serves as
a partial baseline comparison for the evaluation findings, since PEPFAR did not provide resources to conduct
baseline studies at the beginning of the grant cycle in 2005.
Note: A couple notes need to be made to properly understand the WORTH findings. First, the WORTH program
was implemented in two phases, represented by a 1st
and 2nd
cohort. A cohort represents the WORTH groups
who were initiated and trained at the same time. The 1st
Cohort of groups was initiated in 2005 and groups in
the 2nd
Cohort were formed in middle of 2008. Both now function independently and sustainably without
program support.
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Equally as important, nearly all participants in the WORTH program are caregivers for OVC (89%). This means
that the benefits of WORTH participation go directly to OVC households in the community. As members of
WORTH households, 18,345 OVC are primary beneficiaries of the program. This engagement of OVC caregivers
is at the foundation of how WORTH seeks to improve the welfare of OVC.
The evaluation discovered consistent evidence that a caregivers participation in WORTH has a positive impact
on the lives of OVC in her household. Box 2 below outlines the overall benefits of WORTH participation, whileupcoming sections provide greater details on how WORTH impacted key areas of OVC welfare such as nutrition
and education.
Box 2: General Evidence of WORTH Participation Benefiting OVC
MATERIAL SUPPORT: Survey data indicates that participation in WORTH has clear
material benefits for OVC households. Higher numbers of WORTH respondents indicated
receiving outside material support for food, education and health from the community in
the last three months than non-WORTH respondents. Fifty-four percent of WORTH OVC
were getting food support compared to 35 percent for non-WORTH. WORTH OVC also
received greater education support, 51 percent versus 36 percent, and health support
with 40 percent getting support versus just 24 percent for non-WORTH OVC. This is a
major finding since more than two-thirds of the support for WORTH OVC comes from
OVC Support Funds managed by WORTH groups in the community. This means that
WORTH is providing valuable support to OVC in WORTH households beyond what other
OVC in the community are getting.
OVC WELFARE: Overall the survey data indicates that OVC in WORTH households are
consistently better off in critical areas of welfare such as the number of meals eaten,
support for educational success, hygienic living conditions, and understanding of health
risks and behaviors. The specific differences in each of these areas are illustrated in
upcoming sections of the report.
POSITIVE OUTLOOK: Both OVC and caregivers in the WORTH program appear to have a
more positive outlook on themselves, their life situation and their future. This point is
illustrated through survey responses, as well as observations, made during interviews
and focus groups, about how respondents speak about themselves and their lives. This is
discussed in more detail under the Outlook section of the report.
HOUSEHOLD ASSETS: WORTH households were able increase income available for
emergencies and future needs, as well as improve valuable physical assets such as
shelter. Further details under the Shelter and Finance sections of the report.
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A strong and very proud woman, Alexanderena is eager to share her positive experiences and successes
with the WORTH program. With 60 years of life experience, she has a lot to reflect upon. Her eyes light up
when she talks, and it is obvious that this program has made a huge difference in her life.
At the beginning of the interview she proudly writes her long name on a piece of paper without hesitation
- quite a feat for a woman with little education and only four months of literacy training. When asked
about her favorite things in WORTH, Alexanderena says that she appreciates having regular meetings. Her
son died from HIV/AIDS, and his wife fled town, leaving Alexanderena with custody of all eight of their
children. As a grandmother caring for orphans, she values the support of other women of WORTH
during literacy and banking days. Meetings are something she looks forward to and remind her that she
isnt alone with her significant family and financial responsibilities. She runs a basic canteen in her village
to offset her household expenses and she frequently gets business advice from other women in her group.
Her time with other WORTH women also reminds her of her own strength, and her capability to change
her life. After joining WORTH, Alexanderena immediately realized the power of the program. She was
encouraged enough to contact her absentee daughter-in-law and convinced her to return to their village
and join WORTH too. The childrens mother and Alexanderena work together on their literacy skills and
encourage one another to keep saving. They have found a way between each other to provide for the
childrens basic needs, school fees, and school supplies. The school-aged children are now all able to go
back to school and the women feel confident that when the time comes, they will be able to help all eight
attend both primary and secondary school. The experience has also strengthened Alexanderenas
relationship with her husband, who boasts about how they are able to care for so many grandchildren,
keep savings in the bank, and even expand their canteen business with loans from the group.
SPOTLIGHT ON WOMENOF WORTH:
Alexanderenas Story
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II. NutritionNutrition and food security are critical areas of OVC welfare, particularly in rural areas with high poverty, so one
of the objectives of the evaluation survey was to determine the amount and type of food consumed by OVC.
Additionally, the survey gathered information about whether food was
bought, grown or donated.
Nutrition Differences Between WORTH and non-WORTH respondents:
1. NUMBER OF MEALS: WORTH OVC were nearly twice as likely to
have three plus meals per day, while non-WORTH OVC were
slightly more likely to have only one meal per day. The majority
of OVC in both groups had at least two meals per day.
2. DIET: Overall WORTH OVC had a more nutritious diet, and
were more likely to eat fruit and proteins in particular.
3. FOOD SECURITY: Finally, WORTH households were more likely to grow their own food. This wassomething specifically promoted by the WORTH program as a way to increase food security and to help
women free up more income for other expenditures, such as health and education.
When this evidence is analyzed in light of the observations of the interviewers it
makes a strong case that the material and educational support of the WORTH
program played a key role in the OVC nutritional outcomes. First it is the materialsupport provided by WORTH to the most vulnerable households, as well as the
increased income from entrepreneurship, that helped increase the number of
meals for WORTH households overall. Second, education about the value of a
nutritional diet and the benefits of growing food at home likely influenced the diet
of WORTH households. This increased awareness of nutrition also came across in
the thoroughness and confidence with which WORTH participants responded to
survey questions.
Table 3: Number of Meals Eaten Yesterday by OVC
Household Type Three Two One
WORTH 42% 45% 13%
Non WORTH 24% 57% 18%
Table 4: Food Categories Eaten Yesterday by OVC
Household Type Fruit Vegetables Protein Carbohydrates
WORTH 48% 84% 59% 98%
Non WORTH 36% 81% 48% 94%
Table 5: Percentage Food Grown At Home (Food Security)
Household Type Fruit Vegetables Protein Carbohydrates
WORTH 66% 45% 61% 62%
Non WORTH 57% 39% 44% 53%
Figure 2
Figure 3
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Role Models for Education
A commitment to quality was the most
distinguishing factor between WORTH andnon-WORTH in education, re-emphasizing
the empowering aspect of WORTH in
helping women become better role models
and caregivers for their children.
III. EducationOne of the central goals ofTSAs OVC project is to promote the importance of education and encourage children
to do well in school. Both the WORTH and non-
WORTH OVC participated in this aspect of the OVC
project, so it is not surprising that there are few
differences between the two groups. In fact, theattendance rate was 99 percent for OVC in both
groups. This means that the school attendance of the
OVC in the TSA program was better than the 90
percent attendance statistic for all OVC in the region
recorded by DHS. Yet the WORTH caregivers did
exhibit a unique area of strength on the issue of education for OVC. They seem to give a higher quality of
educational support to their OVC.
Higher quality of educational support by WORTH caregivers is exhibited in the following ways:
1. Material Support for Education: They strive to provide more than the minimum educational support for
OVC. While WORTH OVC are only slightly less likely to be lacking school supplies than non-WORTH the
interview team observed that WORTH caregivers seemed to be giving a higher quality of support to their
OVC. For example, rather than simply buy one workbook, they would purchase a workbook for each
subject. They also expressed more enthusiasm and commitment for the OVCs success in school.
2. Academic Enrichment: They are approximately 10 percent more likely to provide academic enrichment
to OVC, including paying tutoring fees, helping with homework and buying additional school supplies.
One of the clear
messages from
WORTHcaregivers was
that their own
increased
literacy had
improved their ability to help their children in school. Their commitment to learning provided a strong
example for the OVC and their new skills gave them the confidence and ability to help with homework.
3. Uniforms: Overall, there was a 14 percent gap between
WORTH and non-WORTH in the number of caregivers
who said the OVCs uniform was good. At the same
time 20 percent more non-WORTH caregivers reportednot having any uniform at all for the OVC.
With regards to education, it was the consensus of the
evaluation team that a commitment to quality was the most
distinguishing factor between WORTH and non-WORTH in education, re-emphasizing the empowering aspect of
WORTH in helping women become better role-models and caregivers for their children.
Table 6: What Caregivers Do to Help OVC School Performance
HouseholdType
Extra time forhomework
Help withhomework
Pay fees for extrastudy at school
Provide all necessaryschool materials
WORTH 45% 55% 14% 53%
Non WORTH 37% 44% 7% 48%
Table 7: Condition of OVC School Uniform
Household
Type Good Fair Poor
No
uniform
WORTH 31% 35% 15% 19%
Non
WORTH 17% 33% 12% 39%
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IV. Health & HygieneAs part of an OVC project designed to reduce the devastating impact of HIV/AIDS on children and their families,
assessing health and hygiene played a central part in the household surveys. The surveys assessed the health
and hygiene status of OVC and their households in areas of illness, medical treatment, HIV/AIDS awareness,
family planning, health attitudes and hygiene practices. The central findings in health and hygiene are:
1. Higher Quality of Health Care: WORTH caregivers appear to be more attentive to the health status ofOVC and more active in seeking better quality of care when children are sick. The evidence to support
this conclusion includes:
WORTH caregivers were more likely to know if an OVC was actually sick than a non-WORTH
caregiver. This was based on qualitative evidence where the interviews revealed that an OVC was
sick, yet the non-WORTH caregiver did not know.
Similarly, interviewers noted that the WORTH caregivers were better able to diagnose the illness
for OVC and determine the best treatment. Even though with most illnesses, such as fever or
vomiting, the WORTH caregivers were more likely to seek medical treatment, they actually less likely
to seek clinical treatment for diarrhea. The hypothesis is that WORTH caregivers had learned howto effectively treat diarrhea without going to the clinic by using ORS. This was a skill taught to them
as part of a WORTH mobile workshop on OVC health, and helps explain why they were less likely to
seek treatment on this issue alone.
Table 8: Care OVC Received for Diarrhea Received Medicine
Household Type Nothing
Home
remedy
Visit to clinic or
hospital Yes No
WORTH 10% 40% 62% 63% 37%
Non WORTH 9% 26% 70% 47% 53%
Table 9: Care OVC Received for Vomiting Received MedicineHousehold Type Nothing
Home
remedy
Visit to clinic or
hospital Yes No
WORTH 15% 32% 72% 63% 37%
Non WORTH 28% 31% 56% 45% 55%
Table 10: Care OVC Received for Fever Received MedicineHousehold Type Nothing
Home
remedy
Visit to clinic or
hospital Yes No
WORTH 7% 37% 62% 79% 21%
Non WORTH 11% 40% 52% 68% 32%
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2. More Clean Water: WORTH households use 15 to 19 percent higher levels of treated water than non-
WORTH. This, again, is largely because of the strong emphasis the WORTH program places on proper
hygiene.
3. Greater Use of Hygiene Items: WORTH OVC and households are consistently more likely to possess thefollowing items. Moreover, they are more likely to be observed in good condition:
Toothbrush Shoes
Soap
Bed
Plate drying rack this is something specially
promoted within the WORTH program, and
was less common in non-WORTH households
(some false reporting was observed in non-
WORTH households by interviewers)
Latrine interviewers observed that WORTH households were more likely to have latrines in
good condition (many non-WORTH respondents claimed latrines that were not built yet)
4. Better HIV Awareness: WORTH caregivers exhibit better HIV knowledge overall. Their responses to HIV
awareness questions are, on average, 8.4% better than non-WORTH caregivers. WORTH OVC also
exhibited better HIV awareness than non-WORTH OVC but the differences were small. In addition to
general knowledge the following highlight to important points of difference between the groups:
WORTH caregivers are 12 percent more
likely to have been tested than non-WORTH.
WORTH OVC are twice as likely to have been
tested for HIV.
WORTH caregivers are much more willing tofreely discuss sensitive health issues, such as
HIV and family planning. The openness of
WORTH caregivers to sensitive issues means
they are more likely to speak with OVC
openly about these issues.
5. Family Planning: WORTH caregivers are more likely to be using some form of contraception (see Figure
12). This is likely due to the promotion of family planning in the WORTH curriculum.
The results follow the pattern of previous areas of OVC welfare. The most meaningful differences appear to
emerge out of the synergy between the social, economic and educational empowerment aspects of the program.
Economic strengthening is likely behind the ability of WORTH caregivers to provide the items OVC need for good
hygiene, but understanding the support for OVC goes beyond money; it is the training and encouragement that
WORTH caregivers receive on health and HIV/AIDS issues that empowers them to provide better care for OVC.
Table 11: OVC Have the Following Item at HomeWORTH Non WORTH
Toothbrush 53% 43%
Shoes 32% 24%
Soap 79% 74%
Bed 25% 12%
Drying Rack 83% 67%
Latrine 93% 88%
Figure 4
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V. ShelterShelter is another area where the evaluation anticipated possible differences between the WORTH and non-
WORTH respondents. However, due to the pervasive poverty and the high cost of many housing materials in the
village areas the differences between respondents were limited. The following illustrate the most notable
differences in shelter:
1. Better Condition of Shelter: While there was little
difference in the types of materials used in shelters,
it became clear that WORTH households were more
likely to report good as the condition of their
shelter and much less likely to be reported as poor
as the condition than non-Worth (the conditions of
these households was affirmed by interview
observations).
2. Better Organization & Hygiene: The interviewers observed during home visits that WORTH women kept
their homes much more organized and had better hygiene practices, such as cleaning dishes thoroughly,utilizing rubbish bins and keeping latrines well-maintained. This outcome is probably related to the fact
that WORTH emphasizes order and hygiene in their education programs. They even do regular home
visitations to check-up on members and fine them if the house is dirty or disorganized.
3. More Recent Repairs: Finally, the WORTH households were 23 percent more likely to have maderepairs in the last year on their shelters.
The evidence again is that while greater financial resources were likely factor in how much was invested in the
upkeep and repair of shelters, it was the social network and the hygiene education provided by the WORTH that
really helped differentiate them from the non-
WORTH.
Table 12: Condition of Shelter
Household Type Good Fair Poor
FloorWORTH 40% 56% 4%
Non WORTH 28% 52% 20%
WallWORTH 42% 51% 7%
Non WORTH 28% 55% 16%
RoofWORTH 50% 44% 6%
Non WORTH 39% 40% 20%
Table 13: Repairs Made in the Last Year
Household Type Yes No
WORTH 52% 48%
Non WORTH 29% 71%
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VI. FinancesAs anticipated, this was the area with the greatest differences between WORTH and non-WORTH. Regarding
finances, the goal of the evaluation in this area was to understand two things: 1) Is WORTH providing a unique
service that women would otherwise been unable to have without it? and 2) How do any increases in financial
activity or empowerment impact OVC? Below are the most notable findings:
1. Savings & Loans Activity: While 100 percent of
WORTH members had access to savings and
loan services, only 21 percent of non-WORTH
had access to loans, and less than 30 percent
had any savings
2. Business Activity: While 86 percent of WORTH
women had business initiatives it was less than
34 percent of non-WORTH caregivers in
businesses.
3. Emphasis on Business:WORTH households
report business as their
biggest source of
income versus casual
labor for non-WORTH.
Table 14: Biggest Source of Income
Household
Type
Casual
labor
Business
earnings
Borrowings
from friends
and family
Borrowings
from a savings
group or bank Salary
WORTH 16% 57% 1% 2% 0%
Non
WORTH 41% 21% 1% 0% 3%
Figure 5
Figure 6
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4. Productive Investments: WORTH members report making more productive use of their money (such as
investing profits into building and diversifying their businesses).
5. Financial Literacy: Finally, one of themost interesting findings was that
WORTH members are more aware of
their financial activities and the assets oftheir household. When asking survey
questions about expenses and income
the interviewers observed that WORTH
caregivers were able provide answers
with specificity and confidence, while
the non-WORTH were more likely to
make wild guesses. The most direct
conclusion is that the womens literacy
and numeracy skills, as well as their
need to monitor their savings and profits
on a weekly basis, gives them a much
stronger knowledge of their finances.
WORTH Works: Moving up the Economic Ladder
These results reveal that WORTH plays a critical role in giving poor
women access to financial services they would have otherwise not been
able to receive. Moreover, it illustrates that the literacy and numeracy
aspects of the program are producing a measurable impact on womens
lives. During focus group discussions in the final evaluation WORTH
women listed the ability to take loans for business (and receive businesstraining) as one of the primary motivators to join the program. This was
particularly true for women who had already initiated very small
enterprises and were eager to get money to take their business to the
next level of scale and profitability. It should be noted that WORTH
loans are different from typical MFI loans, which are usually much
larger. WORTH is designed to reach women in areas where traditional
MFIs cannot function well; yet by enabling women to begin learning the
practices of saving and lending, WORTH can help move women further
up the ladder of economic development and pave the way for
successfully accessing other financial services down the road, such as
larger loans and commercial savings accounts.
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VII. Literacy & NumeracyWORTH members show significantly higher levels of literacy in the household survey, with 67 percent of WORTH
women able to read compared to 45 percent of non-WORTH women. The womens self-report of reading ability
was verified by a short reading test during the interviews. The WORTH program also closely monitors womens
progress in literacy, and the tables below show the results of the WORTH womens literacy tests at the
beginning and the end of their training in the program.
Table 15: Literacy & Numeracy Assessment Results
First Cohort
Scores3 0-5 6-10 11-15 16-20 Total No. of Women
Pre test results (%) 21.7 18.6 18.9 40.8 100.0
Post test results (%) 4.2 7.7 16.4 71.7 100.0
Second Cohort
Scores 0-5 6-10 11-15 16-20 Total No. of Women
Pre test results (%) 22.2 10.8 25.7 41.2 100.0
Post test results (%) 5.0 8.1 21.2 65.7 100.0
WORTHs focus on literacy development is unique among savings and loan programs. Testimonies from
participants make it clear that the benefits of literacy are some of the most personally significant and life-
changing for participantsespecially for older women or widows who are caring for OVC. The women express
great pride in their ability to learn a new skill and it emboldens them to take on other new activities that benefit
themselves and their households.
Similar to engaging in business activity, literacy plays an integral role in giving women the confidence and skills
to: 1) improve their own lives, 2) to better provide for their households, and 3) to take a more active role in the
community. This is because literacy and numeracy enables women to become continuous learners, and
unleashes them to engage in activities that they felt unable or unashamed to participate in previously.
3Score scale is 0-5 being the poorest score, and 16-20 being the best score.
Box 4: Benefits of Literacy and Numeracy Skills
Financial Management: Greater appreciation for the importance of accounting inbusiness activity promoting more profitable use of resources.
Education Support: Ability to help OVC with homework and model value for learning.
Self-Esteem: Improved self-esteem, which has led them into being agents of change in
the community mentoring other women, taking on leadership positions, etc.
Self-Education and Improvement: Ability to better participate in trainings on business,
agriculture, womens rights and issues related to improving care for OVC (including those
outside of WORTH, sponsored by other NGOs or government agencies).
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VIII. Outlook on LifeThe evaluation wanted to capture information about the outlook and emotional welfare of the respondents.
While attempting to measure outlook on life and well-being can seem abstract, the survey produced some
promising patterns about the affects of WORTH:
1. Improved Life Outlook:
Worth caregivers aremore likely to report
that they improved
their life in the last 5
years: 55 percent of
WORTH respondents are happier today, while only 23 percent of non-WORTH said the same.
2. Increased Income: WORTHcaregivers are more likely to
report that they increased their
income in the last 5 years: 55
percent of WORTH caregivers
reported an increase in their
income while the percentage for
non-WORTH is 19 percent.
3. Increased Financial Status: WORTH caregivers are more likely to see themselves as wealthy in
comparison with other homes, and much less likely to see themselves as poorer than others in the
community.
Table 18: Description of Household Wealth in Comparison to Other Households
Household
Type
Much wealthierthan other
households
Somewhatwealthier than
other households
About the sameas other
households
Somewhat lesswealthy than other
households
Much lesswealthy than
other households
Don
know
WORTH 15% 33% 12% 23% 16% 1
Non
WORTH 2% 18% 15% 21% 41% 4
4. Higher Level of Happiness: Overall,
WORTH OVC themselves report higher
levels ofhappiness and lower levels of
unhappiness than non-Worth OVC.
One of the running patterns in responses throughout nearly every section of the evaluation survey is the impact
that WORTH seems to have on the behavior and attitudes of the caregivers involved. This is most clearly shown
here, as the caregivers in WORTH exhibit a more positive assessment of their own happiness and wealth.
Table 16: Description of Life Five Years Ago
Household Type It was better 5 years ago Its better now Its about the same
WORTH 27% 55% 18%
Non WORTH 40% 23% 38%
Table 17: Describe Income Compared to Five Years Ago
Household Type
It was higher 5
years ago
It is higher
now
It is about the
same
WORTH 27% 55% 18%
Non WORTH 44% 19% 37%
Table 19: How Do You Feel About your Life Right Now?
Household
Type
Very
happy
Somewhat
happy Not too happy
WORTH 54% 31% 15Non WORTH 41% 32% 27
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Confidence in Capacity to Care for OVC
Even more important for the OVC project, there is evidence that an improved outlook is leading to
improvements in the way that OVC are cared for at home. WORTH participants testimony in focus groups
during the final evaluation expressed a strong sense of empowerment and transformation, as seen in Box 5
below.
Nearly all of these issues are reflected in the findings
presented in previous sections of this report. During the focus
groups women nearly always discussed improvements in the
lives of their familiesespecially childrenwhen asked aboutthe impact of WORTH. Even personal achievements such as
literacy or business income were usually talked about in terms
of how these gains have affected others, such as women who
are expressing how their literacy is setting an example for
children or how their new income is being used to help ensure
proper food and education to children in their household.
Box 5: Changes in Capacity to Care for OVC Reported by Caregivers Themselvs
Food: Increased ability to provide nutritious food
Education: Increased ability to provide school fees and materials
Health: Increased ability to support medical care when needed
Shelter: Improvements in shelter and bedding especially critical items like latrines,
roofs, and blankets
Behavior: Greater awareness of how to reduce risky behavior for OVC
Relationships: Improvements in the relationship between the caregiver and OVC
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IX. WORTH OVC Funds and Support for OVC in the CommunityOutside of supporting the OVC in their own households, numerous groups have made impressive contributions
to OVC welfare through the establishment of OVC Support Funds. The table below illustrates what WORTH
groups have donated to provide support to OVC in the community, as well as what kind of support they
provided. Support was generally given to the most vulnerable households in the community with no other
means of support. The 2nd Cohort participation was higher because the program placed greater emphasis onthe importance of OVC Support Funds after the mid-term evaluation for the TSA OVC project in 2007.
Table 20: OVC Support Fund Activity
Types of Support
Group
Participation
Rate
Total
Raised
(UGX)4
Total OVC
Supported Food Medicine Clothes
School
Support Other
1st
Cohort 52% 3,105,600 1469 13% 11% 12% 62% 2%2nd
Cohort 66% 3,592,250 3000 16% 1% 5% 77% 1%
OVERALL 59% 6,697,850 4469 14.5% 6% 8.5% 69.5 1.5%
Through the focus groups in the final evaluation of the TSA OVC project it was evident that the benefit of the
OVC Support Fund went beyond just the value of the material support that was given to OVC in the community.
The women of WORTH were clearly proud of what they were doing through the OVC Support Funds, and the
actual process of collecting and distributing support seemed to give the women a greater sense of commitment
to the welfare of OVC in their community.
It not only led the women to identify and interact with OVC in need, it also pushed the WORTH groups to
develop partnerships with other key stakeholders in the community, include the Community Action Teams
(CATs).
The quantitative evaluation survey revealed a strong level of collaboration between the WORTH OVC Support
Funds and the efforts of the CATs to provide material support to OVC. In every area of material supportfood,
education and medicalthe WORTH program provided the primary means of emergency support for OVC
connected to the WORTH program, while the CATs provided support to those not connected to the WORTH
program (Tables 21-23). It was clear that there was communication between the two programs to help ensurethat they could support as many OVC as possible with limited resources.
4Exchange rate: 1 UGX = $0.00049 USD; $1 USD = 2,039 UGX
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OVC RECEIVING OUTSIDE MATERIAL SUPPORT IN THE PREVIOUS 3 MONTHS
Table 21: Nutrition Support
Table 22: Education Support
Table 23: Medical Support
Who Provided Food Support?
WORTH Non-WORTH
WORTH Group 72% 36%CAT 42% 74%
Family 9% 17%
Neighbors 9% 10%
Government 5% 3%
NGO/CBO 1% 4%
Church / Mosque 4% 3%
Other 0% 3%
Who Provided Education Support?
WORTH Non-WORTH
WORTH Group 81% 34%
CAT 40% 76%
Family 8% 13%
Neighbors 2% 3%
Government 3% 1%
NGO/CBO 1% 0%
Church / Mosque 5% 6%
Other 4% 6%
Who Provided Medical Support?
WORTH Non-WORTH
WORTH Group 44% 22%
CAT 27% 48%
Family 8% 11%
Neighbors 0% 11%
Government 37% 33%
NGO/CBO 5% 2%
Church / Mosque 5% 2%
Other 17% 9%
Figure 7
Figure 8
Figure 9
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X. Comparing Survey Results to the Uganda Demographic and Health Survey (DHS)5
Due to the constraints of the PEPFAR grant guidelines no funding was available to collect baseline data for the
TSA OVC project. However, it is possible to use the Uganda Demographic and Health Survey (DHS) data as way
to compare the findings of the current evaluation with similar statistics for the general population in the Eastern
region of Uganda (the region where the WORTH evaluation was conducted). While this comparison is limited it
does reveal several important areas where the data on households in the TSA OVC project (both WORTH and
non-WORTH) differ substantially from household data in the DHS.
1. TSA OVC Project Mobilized Higher Levels of Material Support for OVC
Overall, OVC households participating in the TSA OVC project received much higher levels of material
support from outside their households. This includes support in the areas of food, education and
medical. According to the DHS less
than 5 percent of OVC households in
the Eastern region received support in
any of these areas, while 48 percent of
WORTH households and 32 percent of
non-WORTH households in the TSA
OVC project received material support
in these areas. This provides strong
evidence that the TSA OVC project was
successful in its first objective:
Strengthen communities to construct
community-based responses to meet
the needs of OVC. It also illustrates
that WORTH was the most successful
in mobilizing support for OVC in its
program.
2. School Attendance
While there is virtually no difference between WORTH and non-WORTH households in terms of OVC
school attendance the overall attendance of both these groups (99 percent) is higher than the DHS
average of 90 percent for OVC in the Eastern region. Since the
TSA OVC project places a strong emphasis on attendance and
performance is school, this is notable evidence of the projects
impact on OVC.
5Uganda Demographic and Health Survey 2006. Uganda Bureau of Statistics and Macro International Inc., August 2007.
Table 24: OVC School Attendance
Household Type Attending
TSA OVC Project 99%
DHS OVC Average 90%
Figure 10
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3. HIV/AIDS and Family Planning: This area produced a couple of notable differences.
Caregivers in the TSA OVC project were more
likely to be tested for HIV than the DHS average.
Caregivers in the TSA OVC projectwere more likely to support HIV
positive children in school.
Caregivers in the TSA OVC project were 2 to
3 times more likely to use contraception.
4. OVC Hygiene Items (Shoes and Blankets): A higher
percentage of OVC in the TSA OVC project were more
likely to have shoes and blankets than the average OVC in
the Easter region (there could be other items in this
category but the data was not available).
Table 25: Believe HIV+ Children Should Attend SchoolHousehold Type Yes
Worth 94%
Non Worth 94%
DHS Average 83%
Table 26: OVC Possessing Shoes and Blankets
Household Type Shoes Blankets
WORTH 32% 54%
Non WORTH 24% 59%
DHS OVC Average 19% 32%
Figure 11
Figure 12
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Economic Opportunity for the
Most Vulnerable
The strength of WORTH is its ability to
meet the needs of women at every
stage of economic development, with
a special emphasis on providing
opportunities for the poorest and mos
vulnerable.
LINKAGES TO AN OVC ECONOMIC STRENGTHENING FRAMEWORK
One of the most interesting aspects to arise out of the evaluation of WORTH was the identification of linkages
between the program activities and an emerging framework for OVC economic strengthening outlined in a
report by Jason Wolfe in the Microenterprise Development office of USAID/EGAT6. Over the last several years,
it has become increasingly clear to those working with OVC programs that while economic strengthening needs
to be a central component of all OVC intervention efforts, it is not yet clear which approaches to economic
strengthening are most effective in improving the well-being of OVC.
Therefore, one of the first steps taken by USAID, and others, has been to
draft a framework describing how different types of economic
interventions might impact OVC households at various levels of economic
development. The idea is that economic interventions need to be
appropriate to the economic status of the OVC population served and,
recognizing that this status may vary between households or change over
the lifespan of a program, there is a need for a multi-faceted approach that
can support beneficiaries at different stages of economic development.
Table 27 on the next page illustrates the stages of economic
strengthening for OVC households, outlined within the USAID
framework, along with different types of interventions that can be
used to support households at each stage. The authors of this
report use the stages of economic strengthening to help illustrate
what the WORTH program is doing to strengthen OVC households
at different stages of economic development. WORTH is clearly
strongest in the following strategy areas: 1) Asset transfers via OVC
Support Funds, 2) Savings, 3) Financial literacy, 4) Strong social
networks, 5) Microenterprise, and 6) Credit access. The strength of
WORTH is its ability to meet the needs of women at every stage of
economic development, with a special emphasis on empowering the poorest and most vulnerable.
While there are other economic strengthening programs targeting highly poor or vulnerable women WORTH is
unique in its emphasis on holistic womens empowerment. This means going beyond financial services and tools
to let women develop as human beings: literacy, parenting skills, community activism, self-worth, etc.
Escaping extreme poverty is about more than finances, it also means having the capabilities to made positive
choices for you and your household. This is the opportunity that WORTH offers to women.
At the same time, in going forward WORTH should continue to work on strengthening and expanding this multi-
faceted approach to economic strengthening by looking at innovative ways to provide asset boosts to the
poorest beneficiaries and links to bigger economic opportunities (such as larger loans or vocational training) for
wealthier beneficiaries.
6Jason Wolfe HOUSEHOLD ECONOMIC STRENGTHENING IN TANZANIA: Framework for PEPFAR II Programming, June 2009,
USAID/EGAT.
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Table 27: Program Strategies for Economic Strengthening and WORTH
Stage Strategy7 WORTH Activity or Outcome
Recover assets and
stabilize household
consumption
Asset transfers, primarily
in the form of cash, with
or without conditions
OVC Support Funds help provide transfers of
resources to the most vulnerable OVC households
in the community
Build self-insurance
mechanisms and
protect key-assets
Income-based safety nets,
with or without conditions
Savings mechanisms,
individual or group
Microinsurance
Strengthening social
networks
Development of savings
Social network of WORTH provides access to
emergency financial and material support (groups
set aside money to support members in crisis)
Increased incomes strengthen asset base
Investment in important physical assetssuch as
better shelter
Smooth household
consumption and
manage household
cashflow
Credit mechanisms,
individual or group
Financial literacy Strengthening social
networks
Access to loans
Development of financial literacy to improve
management of resources for household andbusiness
Tight social network where members learn from
and support each other both materially and
emotionally
Smooth household
income and
promote asset
growth
Income-generating
activities (low risk/return),
individual or group
Financial and market
literacy
Strengthening marketnetworks
Strengthening social
networks
Loans to strengthen or develop microenterprises
to increase income
Business training to improve understanding of
management, markets and efficiency
A network that provides opportunities for group
business collaboration, peer mentoring andmarketing
Expand household
income and
consumption
Self-employment through
microenterprise (higher
risk/return)
Employment through
workforce development
Microenterprise training and development
Members greatly increase business activity and
income using skills and assets from the program
7Ibid, p.10
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Empowering Caregivers
Empowering OVC caregivers with
an integrated set of skills,
resources, and knowledge to
strengthen their ability to care for
OVC is a central success of WORTH
in Uganda. It is a highly
promising practice with potential
to be successfully replicated in
other OVC programs.
CONCLUSIONS
Areas of Success
High Participation of OVC Caregivers: A key success of the program was the high participation of OVC
caregivers. This allowed for a direct link between the program and many OVC. The local CommunityAction Teams (CATs) and The Salvation Army (TSA) staff worked together to actively encourage
caregivers to join WORTH from the beginning of the program.
Economic Strengthening for OVC Caregivers: The program clearly led to the economic strengthening of
participants when this is added to the fact that this was the first time most participants were able to
engage in these activities this is a significant step forward.
Quality of Hygiene, Health Care and HIV Awareness:
WORTH caregivers are highly proactive and knowledgeable
on proper hygiene and health care. They maintained more
hygienic householdsfrom latrines to clean waterand
they were more attentive to OVC health needs. In terms of
HIV/AIDS, WORTH households exhibited better awareness of
HIV/AIDS and were more likely to be tested.
Promoting Importance of OVC Welfare: The women
repeatedly framed the benefits and impact of WORTH in
terms of how it was improving welfare for OVC in their
households. The program increased participants knowledge and commitment for the proper care of
OVC. The OVC Support Funds have encouraged them to invest more of their time and resources toward
ensuring a better future for the most vulnerable in their community.
Increased Literacy for OVC Caregivers: The literacy component of the program, along with other
educational initiatives, has opened up new doors for many participants. Through the education
provided by WORTH, members not only have skills that they can use to try or learn new things, but they
also seem to have a strengthened desire to engage in these activities.
Active Family Planning: WORTH caregivers are three times as likely to use contraception as the general
population (according to the DHS), likely due to strong focus on family planning in program training.
Holistic Womens Empowerment: The impact of the program went beyond just economic
strengtheningit was evident that members felt a clear sense of empowerment. Many are more active
in the community and confident in their ability to care for their familiesincluding OVC. Caregiver
empowerment is evident in improved knowledge of OVC nutrition and food security, increased
emphasis on education support, awareness of OVC health and hygiene issues, and an increasingly
positive outlook on themselves and their future.
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Multi-level Approach to Economic Strengthening: Overall, the WORTH approach covers many of the
critical areas for OVC Economic Strengthening set out by USAID. This includes asset provision, covered
through material support given to OVC through WORTH, asset protection, provided by skills and
opportunities to increase savings and a social network that provides protection during emergencies, and
asset growth, promoted through the increase in business income that grows of the womens access to
training, loans and networks of support for group enterprise.
Areas for Improvement
Geographic Coverage: The WORTH program was never designed to cover the entire geographic area of
the OVC program, and was implemented only in the Eastern region surrounding Mbale. The evaluation
found that all of the areas would likely have benefited from the inclusion of WORTH, and many other
communities who had heard about the program from TSA staff were requesting support to start the
program. Some communities had even tried to start savings and loan programs (or variations of this) on
their own.
Linking OVC and WORTH Activities from the Start: While the program seemed to do a good job of
linking WORTH activities with OVC beneficiaries it could have done a better job with this earlier on in the
program. The integration of OVC support into WORTH was increased significantly after the mid-term
evaluation in 2007, which revealed that OVC support was not as effectively mainstreamed into WORTH
activities as it could have been.
OVC Support Fund Participation: While the participation of OVC caregivers in WORTH was high (giving a
direct link to OVC) the percentage of groups with formal OVC Funds could be improved. The percentage
did rise between the 1st and 2nd Cohorts because the there was a greater emphasis placed on this after
the mid-term evaluation (and since the 2nd Cohort is still in development the number of participating
groups is likely still growing), yet overall it would be good to see higher participation levels in the future.
Extra Support For Those With Fewest Assets: A few communities (in the Sironko district) covered by
the WORTH program were significantly poorer than others, and this made it more difficult for these
women to build savings and start businesses with the same level of success as other areas.
Focus on HIV/AIDS Prevention and Treatment: While care and support for OVC by CAT and WORTH
groups was quite successful, the evaluation outcomes on HIV Knowledge and testing were slightly below
expectations. The WORTH mobile workshops and CAT community conversations (in partnership withWORTH) could have done more in this area.
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Recommendations for the Future
OVC-Centered Focus: Future programs should continue to strongly emphasize support for OVC as an
objective of the WORTH program from the beginning. This can be encouraged in four key ways: 1)
Introduce WORTH to the community as part of a larger initiative to improve the well-being of OVC and
their caregivers, 2) Encourage early links between WORTH and the CATs, 3) Try mobilize 100 percent of
WORTH groups to initiate OVC Support Funds, and 4) Find ways to actively empower women as OVC
caregivers.
Holistic Approach to Empowerment of Caregivers: The program should continue to integrate economic
strengthening with broader empowerment initiatives, including literacy, financial management and
training in basic skills critical to caring for OVC: nutrition, HIV/AIDS, hygiene and educational support.
Strategic Use of Mobile Workshops: The empowering space of WORTH is an important development
tool, and future projects should continue to consider how the mobile workshops and social network of
WORTH can be strategically used to achieve the goals of a project. For instance, this is an area where
WORTH could do more in the future to give women the skills to be more effective advocates for
HIV/AIDS prevention and treatment at home and in the community.
Expand Program Geographic Reach: The program should try to find a way to expand WORTH coverage
to all OVC service areas. It was designed as a pilot and the data indicates that WORTH has a positive
impact on OVC households and that there is a high demand for the program in other areas.
Improve Asset Provision to the Poorest: The program should identify areas where women are
significantly poorer, and develop ways to provide greater support for asset provision. For example,
the program might provide livestock, seeds or other materials to help women establish a group business
to boost the development of their savings
and the opportunity to engage in business.
(However, this should only be done after
the groups are well-established on their
own initiative to avoid the moral hazard of
women participating with the expectation
of a hand-out).
Expand Opportunities for Income and
Asset Growth: Based on an assessment ofthe communities where WORTH is
implemented, the program should consider
ways to link program participants to
additional opportunities for asset
protection and growth such as insurance, vocational education and larger loans from traditional MFIs.
One of the goals of WORTH should be to help women move up the economic ladder and, therefore, it
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