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Understanding Change Understanding Change Creating a Monitoring and Evaluation System for Family Health International’s Community Savings and Loans Groups in Ethiopia Columbia University’s School of International & Public Affairs Authors:1 | Page Sandhya Chari, Monica Gadkari, Jessica Hemphill, Leia Reisner, Beth Zikronah Rosen ACKNOWLEDGEMENTS Many individuals contributed to the completion of this project. We would like to thank all FHI Ethiopia staff, especially Francesca Stuer, Medhanit Wube, and Ephrem Fike. In addition, thanks goes out to the rest of FHI staff and affiliates who greatly facilitated our research and work, and extended extraordinary warmth and hospitality during both field visits. We are also incredibly grateful to all of the Community Savings and Loans Group members who took the time to meet and share their experiences us. Other individuals who provided much‐appreciated assistance include Nurul Alam, Professor Cristian Pop‐Eleches, Howard Friedman and Gautam Bastian. We would also like to thank Professor Helen Epstein, our faculty advisor, who has provided support and guidance throughout this process. Thank you to Melissa Giblock and Eugenia McGill for making all of this possible by managing the workshop process. 2 | Page EXECUTIVE SUMMARY Family Health International (FHI) Ethiopia has pioneered a holistic series of interventions to improve the quality of life for Persons Living with HIV/AIDS. Creation of and support for Community Savings and Loans Groups are key components of this initiative and aim to foster a savings culture, provide access to financial services, and boost incomes through investment in and expansion of income‐generating activities. While there is anecdotal evidence to suggest that this program is helping poor, HIV‐positive individuals to attain a greater degree of socio‐economic wellbeing and self‐sufficiency, there is not yet quantitative evidence of this success. Such information would be critical in refining and improving the program, and garnering funding necessary for expansion. Using a combination of primary research in Ethiopia and secondary desk research, a team from Columbia University’s School of International and Public Affairs developed a comprehensive monitoring and evaluation system necessary for FHI to collect quantitative and qualitative data on the program’s outputs, outcomes, and impacts. Specifically, the project focused on finding key indicators to measure economic growth and change in people’s lives. Ultimately, the team delivered monitoring and assessment survey tools for collecting data, along with detailed guides on how to implement the tools and to manage the information gathered. Continued donor support for development programs increasingly depends upon hard evidence that they are effectively and positively impacting the lives of vulnerable members. However, such programs are notoriously difficult to evaluate. It is anticipated that this monitoring and evaluation system will be useful not only for FHI, but could also serve as a model for other poverty alleviation programs that are underway across the developing world. In addition, this monitoring and evaluation system could be useful for putting these findings on a stronger statistical and empirical footing, and helping to guide the design of truly effective poverty alleviation programs in the future. 3 | Page CONTENTS ACKNOWLEDGEMENTS ................................................................................................................................. 2 EXECUTIVE SUMMARY .................................................................................................................................. 3 GLOSSARY OF TERMS .................................................................................................................................... 5 BACKGROUND ............................................................................................................................................... 6 METHODOLOGY .......................................................................................................................................... 17 PROJECT RESULTS ....................................................................................................................................... 25 FINDINGS ..................................................................................................................................................... 27 RECOMMENDATIONS ................................................................................................................................. 41 IMPLICATIONS AND CONCLUSIONS ............................................................................................................ 42 REFERENCES ................................................................................................................................................ 43 APPENDIX 1: Monitoring Tool ..................................................................................................................... 45 APPENDIX 2: Assessment Tool Part I........................................................................................................... 54 APPENDIX 3: Assessment Tool Part II ......................................................................................................... 68 APPENDIX 4: Implementation Guide .......................................................................................................... 73 APPENDIX 5: Point in Time Assessment .................................................................................................... 151 4 | Page GLOSSARY OF TERMS AIDS: Acquired Immune Deficiency Syndrome ART: Anti‐retroviral Treatment CSO: Civil Society Organizations CSLG: Community Savings and Loans Group FGD: Focus Group Discussion FHI: Family Health International GDP: Gross Domestic Product HCBC: Home‐ and Community‐Based Care HES: Household Economic Strengthening HIV: Human immunodeficiency virus IDI: In‐Depth Interview IGA: Income Generating Activity IP: Implementing Partner M&E: Monitoring and Evaluation NGO: Non‐Government Organization PLHA: People Living with HIV/AIDS SIPA: School of International and Public Affairs 5 | Page BACKGROUND FHI’s Community Savings and Loans Group (CSLG) program is operating in a country currently facing serious human development and economic challenges. Understanding these issues, including the situation facing Persons Living with HIV/AIDS (PLHAs), was considered particularly relevant for the project. ETHIOPIAN CONTEXT to Ethiopian democracy, in January of 2009, HUMAN DEVELOPMENT Parliament passed legislation curtailing activities of Civil Society Organizations (CSOs) Ethiopia, situated in the Horn of Africa, and banning, outright, organizations which struggles with significant poverty. Its population receive at least 10% of their funding from of approximately 79.8 million people1 is packed external sources from participating in any into 1.1 million square kilometers, making it one human rights or advocacy activity.5 While the of the most densely populated countries in SIPA team did not witness or directly deal with Africa.2 Its most recent Human Development any implications of this, the team does Index, which includes proxies of health, understand that it could have an impact on FHI education, and wealth, was 0.414, placing programs and work in the future. For now, FHI Ethiopia 171st out of 182 countries. Life mainly provides services, but the law interprets expectancy at birth was 54.7 years, the adult “advocacy” quite broadly. literacy rate was 35.9%, gross school enrollment rate was 49.0%, and gross domestic product (GDP) per capita, measured using purchasing THE ECONOMY 3 power parity, was US $779. Ethiopia’s Human Despite its continued status as one of the Poverty Index, which measures severe health poorest countries in the world, Ethiopia has had th deprivation, was 130 out of 135 countries, one of the fastest growing non‐oil economies in indicating extremely poor health statuses of its recent years with a GDP growth rate of 10.2% in residents. According to United Nations data, 2008/2009.6 However, this growth has been 50.9% of Ethiopians are not expected to live tempered by bouts of extreme inflation which 4 past age 40. in July of 2008 reached a record‐high of 64%, and subsequently fell to ‐3.7% by July of 2009.7 Since 1991, Ethiopia has been governed by The The extreme volatility of inflation is due to Ethiopian People’s Revolutionary Democratic linkage to grain prices and coffee prices, which Front (EPRDF), in the form of a multi‐party are naturally dependent on annual harvests and democracy. The country is now preparing for thus seasonal rains.8 Due to its heavy reliance another election. Demonstrating the limitations on agriculture, the country is extremely 6 | Page affected by seasonal changes such as droughts, Currently, the Joint United Nations Programme which have been increasing in severity since the on HIV/AIDS estimates that roughly one million 1970s.9 Ethiopians are living with HIV, about a tenth of whom are children.14 Currently, the overall Grain prices are extremely important, as bread adult prevalence rate is 2.4%, and rates are and injera (both grain based) are staples of the higher in urban versus rural areas (7.7% versus Ethiopian diet. Ethiopia’s economy is highly 0.9%) and among females (2.9%) rather than dependent on agriculture, “which accounts for males (1.9%).15 HIV prevalence is also higher half of GDP, 60% of exports, and 80% of total among refugees, displaced
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