salvation army - evaluation of economic strengthening for ovc in uganda (april 2010 updated version)

8/9/2019 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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v a l u a t i o n o f E c o n o m i c S t r e n g t h e n i n g f o r O V C : U s i n g t h e W O R T H M o d e l i n U g a n d a Page 2

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%


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%


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.


33/34


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

d b d h l l k h h h d

salvation army - evaluation of economic strengthening for ovc in uganda (april 2010 updated version)

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