Salvation Army - Evaluation of Economic Strengthening For OVC in Uganda (April 2010 UPDATED VERSION)

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, Pact
Jane Ruth Wanyama MBA, WORTH Program Coordinator
ACKNOWLEDGEMENTS
This report was made possible through the support of many dedicated people. First, the leadership and staff of
The Salvation Army (TSA) Uganda—especially 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).
E 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
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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 24
Table 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 16
Figure 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 Clubs
MFI Micro-finance Institution
NGO Non-governmental Organization
ORS Oral Rehydration Supplement
OVC Orphans and Vulnerable Children
PEPFAR President’s 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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INTRODUCTION
This “Summary of Findings” report presents evidence illustrating the role that WORTH, a women’s
empowerment program centered on village banking, has played in The Salvation Army’s “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 children’s rights to family health. As their
collective savings grows members take out loans to support income-generating activities, while others in the
group 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 Role of Empowerment
improving the welfare of OVC. In addition to Promoting a woman’s empowerment is just as
increasing savings and business income, the critical, if not more critical, to improving her
evaluations also found evidence of much
capacity to care for OVC as is increasing her
broader empowerment for the women
involved in the WORTH program, including income or assets.
improved literacy, self-confidence and capacity
to care for OVC. Most importantly, the findings reveal that promoting a woman’s 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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Sustainable Community Support for Orphans and Vulnerable Children
While this report focuses only on the outcomes of evaluations conducted in Uganda, SAWSO is currently
collaborating with both The Salvation Army Uganda and The Salvation Army Tanzania on its PEPFAR-funded
“Sustainable Community Support for Orphans and Vulnerable Children” (TSA OVC) project. In both countries
WORTH focuses on empowering the caregivers of OVC to provide better care for the OVC in their households. In
these two countries WORTH has empowered more than 22,093 women and provided support to more than
24,445 OVC.
In each of these countries WORTH works alongside Community Action Teams (CATs) to increase the capacity of
caregivers and local communities to care for OVC. As an initial entry-point into the communities, the CATs are
teams of local volunteers trained to: 1) facilitate conversations in communities about HIV/AIDS and OVC care; 2)
conduct in-home counseling to children and caregivers; and 3) organize weekly Kids and Youth (KAY) Clubs
where children have a safe place to play and learn about issues related to HIV/AIDS. In collaboration with the
work of CATs, the WORTH program then organizes women in the community into voluntary savings and loan
groups. While all women in the community are invited to join WORTH the CATs help recruit OVC caregivers to
participate in the program. Moreover, the training of WORTH group members goes beyond skills in literacy and
small business to cover issues directly related to better caring for the nutritional, educational, health and
psycho-social needs of the OVC in their households, and in the community at-large. The CATs and WORTH work
together to achieve the three basic objectives of the TSA OVC project:
1. Strengthen communities to construct community-based responses to meet the needs of OVC and others
affected by HIV/AIDS
2. Provide psycho-social support to OVC
3. Improve economic security of OVC
The central goal of the project is to build the capacity of communities and caregivers to meet the needs of OVC
so that the benefits of the program can be sustained without continuous outside support.
Understanding the Role of WORTH in Improving OVC Welfare

In comparison to traditional microfinance programs, WORTH specializes in serving “hard-to-reach” women and
children in rural areas often left out by other programs or services. Since the trained WORTH groups use their
own collective savings to make loans, they do not need outside support
Empowering Spaces to sustain them; making the program sustainable in the poorest areas
The WORTH group becomes an that need it the most.
“empowering space” where women
Equally important, WORTH goes beyond basic financial services to make
not only gather together to save, to
women’s empowerment a central part of its methodology. This
learn and to support each other.
empowerment process begins with literacy and numeracy training, and
then builds on this foundation to expand women’s knowledge and capabilities in other critical areas, such as
parenting skills, hygiene and nutrition, HIV/AIDS prevention and community leadership. The WORTH group
becomes an “empowering space” where women gather together to save, to learn and to support each other.
The strength of this methodology is that this “space” can be used to address any number of issues in the lives of
women. For this project the focus was on HIV/AIDS and women’s role as OVC caregivers, but other issues can
also be incorporated into the mobile workshop curriculums depending on the goals of a project.
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The biggest gap in the success of traditional microfinance
Holistic Empowerment
programs has been the inability to effectively reach the
poorest and most vulnerable. The evidence in this report Economic strengthening for the most
shows that programs simply focused on financial services vulnerable needs to be based on a
among the poorest or most vulnerable will likely have a foundation of broader empowerment in
limited and less sustainable impact. This is primarily order to create lasting change for those
because the poorest of the poor are not in a position to
most in need.
immediately 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.
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 income—such 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.
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.
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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 Table 1: Survey Respondents

represented 197 of the caregivers surveyed, while Household Type Caregivers OVC Total
196 of the caregivers surveyed were beneficiaries of
WORTH 197 152 349
the TSA OVC project but not in the WORTH program.
For the OVC, 152 had caregivers participating in the Non-WORTH 196 140 336
WORTH program and the other 140 OVC were linked
Total 393 292 685
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 the
WORTH 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 recent
graduates 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 surveys
were collected and the data was checked and entered into an SPSS database by four trained entrants from
outside the program.
1
WORTH 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.
2
The 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.
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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 project’s Eastern region, so the primary difference between the respondent groups
was 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 WORTH’s 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 robust
qualitative 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 debrief
with 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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FINDINGS
The purpose of this report is to offer a summary of the key evaluation findings, with possible follow-up reports
coming later to offer more detail on specific areas of interest. The quantitative data from household surveys is
presented along with qualitative evidence collected during interviews and focus groups. The findings are
categorized to provide the most comprehensive picture of the areas of OVC welfare measured by the evaluation,
and to illustrate where WORTH is having an impact. In the primary area of WORTH, economic empowerment,
the differences between WORTH and non-WORTH households are large. This is a strong indication that WORTH
was successful in its economic strengthening objective. In some areas of OVC welfare the differences are not as
large, but WORTH households still score consistently higher across nearly every indicator in the evaluation. It
was expected that differences in these areas might be smaller since both WORTH and non-WORTH households
were receiving the same services from the TSA OVC project to support OVC welfare. The fact that WORTH OVC
still show a consistently higher well-being on nearly every indicator is compelling evidence that the
empowerment of WORTH caregivers played a unique and positive role in increasing OVC welfare.
I. General Findings on OVC Welfare and Empowerment

In evaluating the impact of the WORTH program in Uganda one of the first things to consider is the number of
beneficiaries reached by the program. Table 2 below illustrates both the number of women who have
participated in the WORTH program, as well as the number of OVC living in their households.
Table 2: Caregiver Participation in WORTH & Primary OVC Beneficiaries

Total Number Number of Women OVC Households
Cohort of Women (Households) with OVC No. of OVC as % of total
First Cohort 3,442 3,115 9,268 90 percent
Second
Cohort 4,163 3,644 9,077 88 percent
TOTAL 7,605 6,759 18,345 89 percent
Figure 1
By reaching 7,605 women, the program exceeded its goal of 7,500, not
including 43 “village banks” (involving 904 women) that have been initiated by
women outside the program with the help of existing WORTH members.
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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 caregiver’s 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, while
upcoming 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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One point that has come across clearly in both the quantitative and qualitative data is the empowerment
experienced by women in the WORTH program. While the most obvious aspect of the program is economic
empowerment, the women also emphasize the importance of other empowering changes in their lives.
Box 3: Empowering Changes in the Lives of WORTH Participants
 EMPOWERMENT THROUGH SUPPORT NETWORK: WORTH caregivers have a wider

social support network than non-WORTH caregivers. While all WORTH caregivers have
the support of their WORTH group, in addition to any other support groups, less than
percent of non-WORTH caregivers indicate participation in a support group or program.
Not only is this a network for material support for OVC but the women in WORTH also
clearly expressed that this is a place where they find emotional support and courage to
take risks for a better future. This was seen in both survey data and the testimony of
women in the program as a reason for their participation in WORTH.
 EMPOWERMENT THROUGH LITERACY: WORTH caregivers show clear gains in literacy

and, according to their own testimony, this has a positive impact on OVC as well as their
own lives (discussed in detail in later section).
 EMPOWERMENT THROUGH IMPROVED CARE-GIVING CAPACITY: Finally, WORTH

caregivers exhibit a stronger capacity and desire to actively improve the welfare of OVC
living in their household. This is based on evidence from several survey responses, as
well as the observations of interviewers. The details of these findings are covered in the
sections below on nutrition, education and health.
The underlying message is that the impact of WORTH

extends beyond just economic strengthening and that
the broader empowerment of caregivers has just as
much to contribute to OVC welfare as increases in
income or household assets. In fact, the impact of
WORTH’s holistic approach to targeting and
empowering the most vulnerable is its most promising
contribution to improving the practice of OVC
programming.
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SPOTLIGHT ON WOMEN
OF WORTH:
Alexanderena’s Story
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
isn’t 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 children’s 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
children’s 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 Alexanderena’s
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.
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II. Nutrition
Nutrition 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.
Table 3: Number of Meals Eaten Yesterday by OVC Figure 2

Household Type Three Two One
WORTH 42% 45% 13%
Non WORTH 24% 57% 18%
2. DIET: Overall WORTH OVC had a more nutritious diet, and

were more likely to eat fruit and proteins in particular.
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%
Figure 3
3. FOOD SECURITY: Finally, WORTH households were more likely to grow their own food. This was
something 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.
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%
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 material
support 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.
Page 16
III. Education
One of the central goals of TSA’s 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 Role Models for Education
project, so it is not surprising that there are few A commitment to quality was the most
differences between the two groups. In fact, the distinguishing factor between WORTH and
attendance rate was 99 percent for OVC in both non-WORTH in education, re-emphasizing
groups. This means that the school attendance of the the empowering aspect of WORTH in
OVC in the TSA program was better than the 90 helping women become better role models
percent attendance statistic for all OVC in the region and caregivers for their children.
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 OVC’s 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
Table 6: What Caregivers Do to Help OVC School Performance
messages from
WORTH Household Extra time for Help with Pay fees for extra Provide all necessary
caregivers was Type homework homework study at school school materials
that their own WORTH 45% 55% 14% 53%
increased Non WORTH 37% 44% 7% 48%
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 Table 7: Condition of OVC School Uniform
WORTH and non-WORTH in the number of caregivers
who said the OVC’s uniform was good. At the same Household No
time 20 percent more non-WORTH caregivers reported Type Good Fair Poor uniform
not having any uniform at all for the OVC. WORTH 31% 35% 15% 19%
Non
With regards to education, it was the consensus of the WORTH 17% 33% 12% 39%
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.
Page 17
IV. Health & Hygiene
As 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 of
OVC 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 how
to 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

Home Visit to clinic or
Household Type Nothing remedy hospital Yes No
WORTH 10% 40% 62% 63% 37%
Non WORTH 9% 26% 70% 47% 53%
Table 9: Care OVC Received for Vomiting Received Medicine

WORTH 15% 32% 72% 63% 37%
Non WORTH 28% 31% 56% 45% 55%
Table 10: Care OVC Received for Fever Received Medicine

WORTH 7% 37% 62% 79% 21%
Non WORTH 11% 40% 52% 68% 32%
Page 18
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 the
following items. Moreover, they are more likely to be observed in “good” condition:
 Toothbrush Table 11: OVC Have the Following Item at Home

 Shoes WORTH Non WORTH
 Soap Toothbrush 53% 43%
 Bed Shoes 32% 24%
 Plate drying rack – this is something specially Soap 79% 74%
promoted within the WORTH program, and Bed 25% 12%
was less common in non-WORTH households Drying Rack 83% 67%
(some false reporting was observed in non- Latrine 93% 88%
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 to

freely 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.
Figure 4
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.
Page 19
V. Shelter
Shelter 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 Table 12: Condition of Shelter
difference in the types of materials used in shelters, Household Type Good Fair Poor
it became clear that WORTH households were more WORTH 40% 56% 4%
likely to report “good” as the condition of their Floor
Non WORTH 28% 52% 20%
shelter and much less likely to be reported as “poor”
as the condition than non-Worth (the conditions of WORTH 42% 51% 7%
Wall
these households was affirmed by interview Non WORTH 28% 55% 16%
observations). WORTH 50% 44% 6%
Roof
Non WORTH 39% 40% 20%
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 made
“repairs” in the last year on their shelters.
Table 13: Repairs Made in the Last Year
Household Type Yes No
WORTH 52% 48%
Non WORTH 29% 71%
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.
Page 20
VI. Finances
As 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
Figure 5
2. Business Activity: While 86 percent of WORTH

women had business initiatives it was less than
34 percent of non-WORTH caregivers in
businesses.
Figure 6
Table 14: Biggest Source of Income 3. Emphasis on Business:

Borrowings Borrowings WORTH households
Household Casual Business from friends from a savings report business as their
Type labor earnings and family group or bank Salary biggest source of
income versus casual
WORTH 16% 57% 1% 2% 0%
labor for non-WORTH.
Non
WORTH 41% 21% 1% 0% 3%
Page 21
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 the

most interesting findings was that
WORTH members are more aware of
their financial activities and the assets of
their 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 women’s 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 women’s
lives. During focus group discussions in the final evaluation WORTH
women listed the ability to take loans for business (and receive business
training) 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.
Page 22
VII. Literacy & Numeracy
WORTH 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 women’s self-report of reading ability
was verified by a short reading test during the interviews. The WORTH program also closely monitors women’s
progress in literacy, and the tables below show the results of the WORTH women’s 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
WORTH’s 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 participants—especially 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.
Box 4: Benefits of Literacy and Numeracy Skills
 Financial Management: Greater appreciation for the importance of accounting in

business 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, women’s rights and issues related to improving care for OVC (including those
outside of WORTH, sponsored by other NGOs or government agencies).
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.
3
Score scale is 0-5 being the poorest score, and 16-20 being the best score.
Page 23
VIII. Outlook on Life
The 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: Table 16: Description of Life Five Years Ago
Worth caregivers are
Household Type It was better 5 years ago Its better now Its about the same
more likely to report
that they improved WORTH 27% 55% 18%
their life in the last 5 Non WORTH 40% 23% 38%
years: 55 percent of
WORTH respondents are happier today, while only 23 percent of non-WORTH said the same.
2. Increased Income: WORTH

Table 17: Describe Income Compared to Five Years Ago
caregivers are more likely to
report that they increased their It was higher 5 It is higher It is about the
income in the last 5 years: 55 Household Type years ago now same
percent of WORTH caregivers WORTH 27% 55% 18%
reported an increase in their Non WORTH 44% 19% 37%
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

Much wealthier Somewhat About the same Somewhat less Much less
Household than other wealthier than as other wealthy than other wealthy than Dont
Type households other households households households other households know
WORTH 15% 33% 12% 23% 16% 1%
Non
WORTH 2% 18% 15% 21% 41% 4%
4. Higher Level of Happiness: Overall, Table 19: How Do You Feel About your Life Right Now?
WORTH OVC themselves report higher Household Very Somewhat
levels of “happiness” and lower levels of Type happy happy Not too happy
“unhappiness” than non-Worth OVC. WORTH 54% 31% 15%
Non WORTH 41% 32% 27%
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.
Page 24
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.
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
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 families—especially children—when asked about
the 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.
Page 25
IX. WORTH OVC Funds and Support for OVC in the Community
Outside 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 on
the 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 Total
Participation Raised Total OVC School
Rate (UGX)4 Supported Food Medicine Clothes 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 support—food,
education and medical—the 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 ensure
that they could support as many OVC as possible with limited resources.
4
Exchange rate: 1 UGX = $0.00049 USD; $1 USD = 2,039 UGX
Page 26
OVC RECEIVING OUTSIDE MATERIAL SUPPORT IN THE PREVIOUS 3 MONTHS
Table 21: Nutrition 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%
Figure 7
Table 22: Education Support

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%
Figure 8
Table 23: Medical Support

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 9
Page 27
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. Figure 10
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 Table 24: OVC School Attendance
TSA OVC project places a strong emphasis on attendance and Household Type Attending
performance is school, this is notable evidence of the project’s TSA OVC Project 99%
impact on OVC. DHS OVC Average 90%
5
“Uganda Demographic and Health Survey 2006.” Uganda Bureau of Statistics and Macro International Inc., August 2007.
Page 28
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.
Figure 11
 Caregivers in the TSA OVC project Table 25: Believe HIV+ Children Should Attend School
were more likely to support HIV Household Type Yes
positive children in school. Worth 94%
Non Worth 94%
DHS Average 83%
 Caregivers in the TSA OVC project were 2 to

3 times more likely to use contraception.
Figure 12
4. OVC Hygiene Items (Shoes and Blankets): A higher

Table 26: OVC Possessing Shoes and Blankets
percentage of OVC in the TSA OVC project were more
Household Type Shoes Blankets
WORTH 32% 54% likely to have shoes and blankets than the average OVC in
Non WORTH 24% 59% the Easter region (there could be other items in this
DHS OVC Average 19% 32% category but the data was not available).
Page 29
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 Economic Opportunity for the
framework, along with different types of interventions that can be Most Vulnerable
used to support households at each stage. The authors of this The strength of WORTH is its ability to
report use the stages of economic strengthening to help illustrate meet the needs of women at every
what the WORTH program is doing to strengthen OVC households
stage of economic development, with
at different stages of economic development. WORTH is clearly
a special emphasis on providing
strongest in the following strategy areas: 1) Asset transfers via OVC
Support Funds, 2) Savings, 3) Financial literacy, 4) Strong social opportunities for the poorest and most
networks, 5) Microenterprise, and 6) Credit access. The strength of vulnerable.
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 women’s 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.
6
Jason Wolfe “HOUSEHOLD ECONOMIC STRENGTHENING IN TANZANIA: Framework for PEPFAR II Programming,” June 2009,
USAID/EGAT.
Page 30
Table 27: Program Strategies for Economic Strengthening and WORTH
Stage Strategy7 WORTH Activity or Outcome

Recover assets and  Asset transfers, primarily  OVC Support Funds help provide transfers of
stabilize household in the form of cash, with resources to the most vulnerable OVC households
consumption or without conditions in the community
Build self-insurance  Income-based safety nets,  Development of savings
mechanisms and with or without conditions  Social network of WORTH provides access to
protect key-assets  Savings mechanisms, emergency financial and material support (groups
individual or group set aside money to support members in crisis)
 Microinsurance  Increased incomes strengthen asset base
 Strengthening social  Investment in important physical assets—such as
networks better shelter
Smooth household  Credit mechanisms,  Access to loans
consumption and individual or group  Development of financial literacy to improve
manage household  Financial literacy management of resources for household and
cashflow
 Strengthening social business
networks  Tight social network where members learn from
and support each other both materially and
emotionally
Smooth household  Income-generating  Loans to strengthen or develop microenterprises
income and activities (low risk/return), to increase income
promote asset individual or group  Business training to improve understanding of
growth
 Financial and market management, markets and efficiency
literacy  A network that provides opportunities for group
 Strengthening market business collaboration, peer mentoring and
networks marketing
 Strengthening social
networks
Expand household  Self-employment through  Microenterprise training and development
income and microenterprise (higher  Members greatly increase business activity and
consumption risk/return) income using skills and assets from the program
 Employment through
workforce development
7
Ibid, p.10
Page 31
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 Community
Action 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.
Empowering Caregivers
 Quality of Hygiene, Health Care and HIV Awareness: Empowering OVC caregivers with
WORTH caregivers are highly proactive and knowledgeable an integrated set of skills,
on proper hygiene and health care. They maintained more resources, and knowledge to
hygienic households—from latrines to clean water—and strengthen their ability to care for
they were more attentive to OVC health needs. In terms of
OVC is a central success of WORTH
HIV/AIDS, WORTH households exhibited better awareness of
HIV/AIDS and were more likely to be tested. in Uganda. It is a highly
promising practice with potential
 Promoting Importance of OVC Welfare: The women to be successfully replicated in
repeatedly framed the benefits and impact of WORTH in other OVC programs.
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 Women’s Empowerment: The impact of the program went beyond just economic
strengthening—it 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 families—including 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.
Page 32
 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 women’s 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 with
WORTH) could have done more in this area.
Page 33
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 of
the 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
needs to be prepared to help link them to opportunities when they are ready to move up.
Page 34

Salvation Army - Evaluation of Economic Strengthening For OVC in Uganda (April 2010 UPDATED VERSION)

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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

LINKAGES TO AN OVC ECONOMIC STRENGTHENING FRAMEWORK 30

The WORTH Model

Understanding the Role of WORTH in Improving OVC Welfare

Box 1: Non-Economic Benefits of Empowerment in WORTH Program

 BETTER SELF-IMAGE: Increased knowledge and self-confidence enables beneficiaries to

Household Survey of Caregivers and OVC

Respondents: Participants in the WORTH program Table 1: Survey Respondents

Qualitative Data from Final

A final layer of analysis for this report has been

I. General Findings on OVC Welfare and Empowerment

Table 2: Caregiver Participation in WORTH & Primary OVC Beneficiaries

Box 2: General Evidence of WORTH Participation Benefiting OVC

Box 3: Empowering Changes in the Lives of WORTH Participants

 EMPOWERMENT THROUGH SUPPORT NETWORK: WORTH caregivers have a wider

 EMPOWERMENT THROUGH LITERACY: WORTH caregivers show clear gains in literacy

 EMPOWERMENT THROUGH IMPROVED CARE-GIVING CAPACITY: Finally, WORTH

The underlying message is that the impact of WORTH

Nutrition Differences Between WORTH and non-WORTH respondents:

1. NUMBER OF MEALS: WORTH OVC were nearly twice as likely to

Table 3: Number of Meals Eaten Yesterday by OVC Figure 2

2. DIET: Overall WORTH OVC had a more nutritious diet, and

Table 4: Food Categories Eaten Yesterday by OVC

Table 5: Percentage Food Grown At Home (Food Security)

When this evidence is analyzed in light of the observations of the interviewers it

Table 8: Care OVC Received for Diarrhea Received Medicine

Table 9: Care OVC Received for Vomiting Received Medicine

Table 10: Care OVC Received for Fever Received Medicine

 Toothbrush Table 11: OVC Have the Following Item at Home

 WORTH caregivers are 12 percent more

 WORTH caregivers are much more willing to

1. Savings & Loans Activity: While 100 percent of

2. Business Activity: While 86 percent of WORTH

Table 14: Biggest Source of Income 3. Emphasis on Business:

5. Financial Literacy: Finally, one of the

WORTH Works: Moving up the Economic Ladder

Table 15: Literacy & Numeracy Assessment Results

Box 4: Benefits of Literacy and Numeracy Skills

 Financial Management: Greater appreciation for the importance of accounting in

 Self-Education and Improvement: Ability to better participate in trainings on business,

2. Increased Income: WORTH

Table 18: Description of Household Wealth in Comparison to Other Households

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

 Behavior: Greater awareness of how to reduce risky behavior for OVC

 Relationships: Improvements in the relationship between the caregiver and OVC

Nearly all of these issues are reflected in the findings

Table 20: OVC Support Fund Activity

Table 21: Nutrition Support

Table 22: Education Support

Table 23: Medical Support

 Caregivers in the TSA OVC project were more

 Caregivers in the TSA OVC project were 2 to

4. OVC Hygiene Items (Shoes and Blankets): A higher

Table 27 on the next page illustrates the stages of economic

Stage Strategy7 WORTH Activity or Outcome

Areas for Improvement

 Expand Opportunities for Income and

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