December 1st is World AIDS Day. To highlight some of the work the AMA Innovation Lab is funding in the fight against HIV/AIDS, we conducted an Q&A with the Dean Yang, Professor in the Department of Economics and the Ford School of Public Policy at the University of Michigan to learn more about an AMA Innovation Lab-funded evaluation he is conducting of a new intervention program supported by President’s Emergency Plan for AIDS Relief (PEPFAR).
“Força à Comunidade e Crianças” (FCC), Strength to Community and Children (in English) is a new program in Mozambique sponsored by the President’s Emergency Plan for AIDS Relief (PEPFAR). Can you tell us a little about the goals of this new project with respect to HIV/AIDS?
PEPFAR funding is supporting a newly established program in Mozambique, which aims to reduce the socio-economic impact of HIV/AIDS on Orphans and Vulnerable Children (OVC) and their caregivers. FCC is a five-year program (begun in late 2015) and is being implemented in Mozambique by World Education Inc./Bantwana (WEI/B) (as lead organization) and a set of partner organizations.
There are multiple components involved in this project, a bundled set of interrelated interventions, which aim to improve access to health care and education for OVCs and caregivers. One of the main elements of the program involves strengthening links between the community referral networks and the public health clinics conducting HIV testing and treatment. The evaluation I am leading will more broadly examine the impact of a bundle of health and education interventions broadly on the outcomes of OVCs and their households. Our objective is the estimate the impact of a multifaceted “health and education access” program for OVC households. Follow-up survey work can help identify which pieces of the program appear to have positive impacts, and future work in subsequent studies can take these findings as inputs into design of programs that directly randomize and test the impacts of subcomponents of the bundle.
Another major aspect of the FCC program involves improving the socio-economic status of OVC households. This piece of the intervention will involve implementing village savings and loan (VSL) programs. VSL programs involve organizing and training individuals to arrange themselves into simple savings and credit groups, with the aim of improving access to savings and credit in populations that are poorly served by formal institutions. The buffer these savings provide may be especially important for households close to the edge of subsistence, or with serious chronic health conditions such as HIV.
[In a recent study conducted in Mozambique in Manica province (one of the FCC provinces) by PI Dean Yang, facilitation of formal savings for rural households was found to raise consumption levels and improve household ability to cope with agricultural shocks. For more information on this project, click here. A recent randomized controlled trial on the impact of VSL programs in Mali found that the program led to improved food security, consumption smoothing, and buffer stock savings. For more information on this project, click here.]
This evaluation of the FCC program has the opportunity to reveal whether the risk-coping benefits from informal group-savings programs can bring benefits to OVCs and their households. OVC households, due to the presence of individuals who may be HIV positive, have chronic health conditions that make access to financial mechanisms potentially useful for coping with the particular health shocks associated with HIV/AIDS. This will be the first study (to our knowledge) of the impact of a widely-implemented financial access intervention on the outcomes of OVCs and their households.
In Mozambique in 2012, 1.6 million people out of a population of 25.2 million were living with HIV, out of which 200,000 were children (aged 14 or below). The country has an estimated 120,000 new HIV infections annually, and one-sixth of these are children.
Who brought you in to conduct an evaluation of the program?
The Feed the Future Innovation Lab for Assets and Market Access was approached by the USAID Mozambique Mission to identify a research group willing to conduct an impact evaluation of this PEPFAR project. UC Davis Professor and Director of the AMA Innovation Lab, Michael Carter, reached out to me with this opportunity to take on the evaluation.
And what will you be evaluating? Any specific aspects?
The main question to answer is whether the FCC program will produce a positive impact on the outcomes of orphans and vulnerable children. I am also interested in whether the program effects health care utilization (health center visits, HIV testing, diagnosis, and treatment). As an economist, I would like to find evidence of whether the economic strengthening interventions such as the village savings and loans programs actually affect household ability to cope with health and other (e.g., agricultural, weather) types of shocks.
What are the possible impacts of this FCC program and what are the implications of further programming targeting at communities struggling with HIV/AIDS?
It is much too early to have any good sense of what the impacts of this program will be but possible positive effects may be seen on community use of health care opportunities (health center visits, HIV testing, diagnosis, and treatment), and more broadly on household economic welfare and stability.
Thank you, Professor Dean Yang, for your time answering our questions today, and for your work on this important and timely topic.