ASPIRES Mozambique Case Study

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ASPIRES Mozambique Case Study

Period of Performance: July 074, 2016 – November 30, 2016

Contract Type: Fixed-Price Purchase Order

Value: Not to exceed $50,000 USD

Program Background

Under the Accelerating Strategies for Practical Innovation & Research in Economic Strengthening (ASPIRES), FHI 360 has assembled a consortium of leading organizations and experts to assist USAID and the President’s Emergency Plan for AIDS Relief (PEPFAR) in improving the livelihoods and economic security of vulnerable populations. The project supports evidence-based, gender-sensitive programming and learning to strengthen the economic capacities of vulnerable individuals, families, and children, including those affected by HIV/AIDS, as well as key populations at risk of acquiring HIV. To achieve this, ASPIRES provides technical assistance and research to scale up high-quality interventions in economic strengthening (ES) such as improved access to savings and other financial services, training in money management, and support for the acquisition and use of income-generating workforce and entrepreneurship skills, as well as in social protection (SP) through interventions such as cash transfers.

The USAID Mozambique Mission has requested the assistance of the ASPIRES project in assessing the impact of social protection and cash transfer services on the vulnerability of its current and future beneficiaries at the regional and local levels, as a means of enabling more effective program targeting.

The Mission defines vulnerability as the ability of households (HH) to provide for health, education, and nutritional needs of HIV+ and HIV- household members in order to protect them against acquiring HIV, mitigate the impact of HIV, and increase their ability to cope with infection. The ultimate goal of the assessment will be to obtain accurate vulnerability data to guide the Mission and its partners’ work in:

1. An empirically-based causal model on the effects of CCP and cash transfers on child and household wellbeing.
2. In-depth case study illustrating findings.

Objective

This study aims to build the evidence on the effects of OVC programming and access to social protection on (1) the wellbeing of OVC and their caregivers and (2) on the capacity of local government and community-based service providers to meet OVC needs in Mozambique. The intended deliverables of this study are an empirically-based causal model on the effects of CCP and cash transfers on child and household wellbeing and a case study illustrating our research findings.

Primary objective: As the primary objective, this research will explore how the Community Care Program (CCP) and linkages to cash transfers and social protection (CT/SP) programs together affected OVC and caregiver wellbeing across the domains of nutrition, education, HIV health status, and household (HH) resilience.

Secondary objectives:

1. One secondary objective of this research will explore and document the effects on local community capacity built as a result of the CCP program, including sustainability of community organizations, local social capital and community participation.
2. An additional secondary objective is to gain insights into (1) the application of Most Significant Change (MSC) methods to case-study analyses for theory generation, as well as the benefits of integrating MSC with Community Capitals Framework (CCF) for program evaluation.

Study Design

This non-experimental qualitative study employs a methodological framework based on core components of the Most Significant Change (MSC) and Community Capitals Framework (CCF) of program impacts, which can be used as ‘mini-case studies’ to generate knowledge and formulate a causal model (Davies & Dart, 2005; Pawson & Tilley, 1997). The MSC approach is a participatory monitoring and evaluation technique that involves collecting and synthesizing personal stories from participants that describe how a program has affected their lives. Rather than using pre-defined impact indicators, this process allows investigators to explore program impacts in an iterative way. MSC can also be integrated into retrospective evaluative studies as a means to foster community participation in program planning and evaluation (Davies and Dart 2005).

The Community Capitals Framework is a sociological framework based on the idea that community development is facilitated by seven types of community assets, or capitals: natural, cultural, human, social, political, financial and built (Flora and Flora 2004). To examine the effects of CCP on community capacity to meet the needs of OVC, we will adopt the CCF to identify important community level domains to analyze in our study (Emery and Flora 2012). We will use asset mapping to collect and analyze data on overall community capacity and well-being.

The study will use in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the effects of CCP on OVC household wellbeing and community capacity. We will begin data collection with semi-structured key informant interviews (KIIs) with 3-4 CCP program key informants to identify community leaders, get input on our interview and focus group guides, and identify study participants who participated in CCP and received referral to governmental social protection sources.

The study will use IDIs and FGDs to capture significant change stories and examine the effects of CCP services and linkages to social protection services on the wellbeing of OVC and their caregivers. We will recruit 25-30 OVC caregivers who participated in CCP with whom we will conduct IDIs and gather significant change stories. Where possible, we will identify extreme or deviant cases where program participation was especially successful/unsuccessful using semi-structured interviews with key informant staff or through snowball sampling with OVC HH respondents.

In-depth interviews will focus on the caregivers’ and children’s experiences of the program, with particular attention to changes in child wellbeing and HH resiliency as influenced by SP/CT services. First, we will ask participants what they found most important about the CCP program, and whether/how it continues to affect their lives. Next, we will ask about the suite of SP services they received through the CCP program and if they got a referral to CT. Probing questions will ascertain the impact of services received on their health status, personal wellbeing, and the wellbeing of their household. If respondents indicate negative or minimal/no impact from the program, additional questions would gather data on how/why, as well as any related challenges or barriers.

We will invite identified CCP participants identified through the roster provided by CCP’s local CBO partner, CONFHIC, including those who participated in IDIs as well as those who were not selected for interviews, to participate in two focus groups of approximately eight participants each. FGD participants will be gathered during the IDI phase. The FGD will provide comment on preliminary analyses, perceptions of linkages between programs and outcomes, and input on drafting an empirically-based causal model. The resulting model will identify most significant changes and capture compelling lessons learned to inform the case study, subsequent programmatic decisions, and develop an initial theory of change.

We will also use community asset-mapping during FGDs for our secondary objective to explore the effects of CCP on local community capacity. Two stakeholder FGDs of five to six participants each will be held with representatives from CONFHIC, community leaders, and government program personnel and another including CCP field staff. The focus groups comprised of representatives from CONFHIC, government personnel, and community leaders (n=~5-6 people for each group) will discuss impacts on capacity building as related to CCP programs. The focus groups will examine the impact of program activities on local community problem-solving capacity. Building on community development theories, the focus groups will discuss impacts at the local level across all relevant community capitals—social, cultural, natural, political, human, financial, and built. Analyses will identify community assets through appreciative inquiry. These assets will be reported in the case study to inform future programmatic decisions.

Using a stratified multi-stage randomized sampling design, the Service Provider will conduct a HH survey to collect data that FHI 360 will use to evaluate the refined items and to also validate the scale. The study will be conducted in the district of Marracuene in Maputo Province. Marracuene is one of the sites where CCP was active and has a total population of approximately 119,000 (INE, 2013). As of 2009, Maputo Province had the second-highest rate of poverty out of the 11 provinces of Mozambique at 67.5%, about 13% higher than the country’s average (JICA, 2011). About 19.8% of residents in Maputo Province have HIV, making up roughly 12% of all Mozambicans living with HIV (PEPFAR, 2012b).

Target Population and Study Sample and Recruitment

The MSC sampling technique follows a purposive sampling model to capture participants that will yield information-rich cases for programmatic learning. All study participants for the IDIs and FGDs will be selected using purposive sampling, a non-probabilistic sampling approach intended to identify a set of research participants who will be knowledgeable about the research topic, rather than aim for a statistically representative sample. Eligible participants will be selected as follows:

• Key informants, who will be local activistas involved in CCP’s programming in Mozambique and potentially government staff involved in local public health programs such as through the MOH, will be identified by headquarters and/or local CCP staff and invited to participate in the study through activistas working with CONFHIC. As with the other participant categories, participation will be voluntary. If they agree to be contacted, study staff will contact the key informants by phone or in-person to confirm their eligibility and invite them to participate in interviews. A list of up to 10 key informants who agree to participate will be retained by study staff, who will arrange interviews with 3-4 of them. Recruitment of and interviews with key informants are expected to take place in the first month of data collection and should not exceed a period of two weeks. All data collection will be done in a private location.
• Community leaders/influencers and CCP program staff who meet the eligibility criteria (people in the community age 18 or older considered to help shape community programs, services and activities, e.g., leaders of community groups and religious leaders) for inclusion in the FGDs will be identified and recruited through referral by activistas, CCP program staff, other local health facility staff, GOM staff, and possibly community members. We will hold one FGD with community leaders and one with CCP staff from CONFHIC. Participants in the community leader group are not expected to be difficult to identify because they will be people well-known in the community. These potential participants will be contacted by the referring person either in person at home, in writing through formal letters, or by phone and invited to participate in FGD. Willing participants will then be contacted by research firm staff. Recruitment and interviews with community leaders/influencers will be conducted at the beginning of the period of data collection as part of the community sensitization about the study. This data collection effort will be conducted at a private location and will not exceed a period of three weeks.
• Households with OVCs who meet the eligibility criteria will be purposively recruited for IDIs and FGDs with the assistance of CCP program staff and activistas using locally developed strategies. These may include CCP program staff and activistas who have been briefed about the eligibility criteria approaching eligible clients identified from a CONFHIC roster listing CCP participants with information about the study and referring them to study staff. If the client agrees to be contacted, study staff will then ensure eligibility and arrange for qualifying, interested clients to take part in the informed consent process and IDIs in a private location of their choice. Another option is for CCP program staff to approach eligible clients with information about the study, assess their interest in participating, and for interested participants only obtain the client’s contact information so that research staff can then contact them. If the potential participant agrees, research staff will then ensure eligibility and arrange for the informed consent process and IDI to be conducted in a private location of the client’s choosing. Snowball sampling through referral from other research participants may also be employed to identify extreme cases, in which case the research participant would provide introduction to the research team. Recruitment of OVC HH participants is expected to take place beginning in the first month of the data collection and will last until all participants are recruited. All data will be collected in a private location based on the respondent’s choice.
• Two groups of 6-8 caregivers for OVC HH will be selected from the list of those who were recruited and agreed to be contacted by study staff to participate in FGDs to validate causal models developed through the analysis of IDIs. All participants in the IDIs will be invited to participate in the FGD at the end of the IDI data collection. Participants who agree will be put into one selection pool, and from the pool study staff will randomly select two groups of 6-8 people to participate in a focus group at a central study site location. All identified participants will be included in a master list where we will randomly select from those whom we interviewed and those we did not, but who agreed to be contacted by study staff. Study staff will provide information to selected participants on the scheduled time and location of the focus group. The two focus groups will include an equal number of study participants/non-participants in each (n = ~8 people per focus group). All FGD data will be collected in a private location.

The following table summarizes and aligns study objectives, methods, target population, sample size and eligibility criteria.

Table 1. Summary table of objectives, methods, target population and sample size

• 18+ years old
• CCP Program field staff
• NOT family member of program recipient

• 18+ years old OVC caregiver
• Program recipient
• NOT family member of CCP program field staff

• Program field staff, CBO Staff, and local community leaders including religious, civic, and educational leaders as well as local government and elected officials
• NOT family member of CCP program field staff

Scope of Work

The Service Provider will be responsible for all coordination and logistical tasks related to the planning, scheduling, and relationship-building necessary for successful completion of data collection. It is expected that the Service Provider will provide 3 data collectors and 1 supervisor to complete the data collection, and data transfer to FHI 360. The Service Provider will work closely with the Research Coordinator from FHI 360, who will provide monitoring and oversight throughout data collection. The Research Coordinator will also handle translation of study instruments into Portugueges and Changana as well as IRB submission .

We require the supervisor be physically present during the data collection, and the Service Provider may suggest an alternative staffing plan with appropriate justification. The Service Provider will make arrangements for the training of all personnel, which will be led by FHI 360. The Service Provider will also provide logistical support to FHI360 personnel who will accompany the data collection team in the field. Project deliverables include electronic copies of all data collection documents and notes, fully transcribed interviews, transcribed templates for all FGDs, all audio recordings, and meeting notes.

Specific responsibilities and tasks include:

• Provide feedback on protocol and instruments
• Recruit and supervise data collectors
• Ensure all data collectors and supervisors complete and pass the test for the online FHI 360 research ethics training curriculum

• Arrange for data collector training
• 1 week (5 consecutive business days) in length
• The first 3 days will be classroom-based and FHI 360 trainers will need simultaneous translation services (English to Portuguese)
• Arrange for a pretest of the IDIs and Community Leaders FGD during the last 2 days
• Introduce study to the communities
• Arrange for and obtain key informant input on the draft instruments (approximately 4 key informants). FHI 360 will supply a data collection tool for the Service Provider to record stakeholders input.
• The pretest will involve arranging for and conducting 5-6 IDIs (1 hour in length each) with OVC HHs in the study location
• Service Provider will identify the OVC HHs, arrange for the interview at HH, conduct informed consent, interview, tape record interview, and transmit audio file of interview, and completed transcript of interview to FHI 360.
• Conduct 30 HH interviews (1 hour in length). Data collectors will travel to the HH, introduce the study, conduct informed consent, conduct the interview, and transfer audio file and data to supervisor. All data will be collected for the study site Marracuene.
• Conduct three FGDs as follows:
• OVC HH FGD with 10-12 participants from IDI data collection
• 5-6 Community leaders FGD to discuss community capacity
• 5-6 CBO leaders, including CCP and CONFHIC field staff, to discuss community capacity
• Data collectors will compile daily field notes on all data collection activities and transmit these notes to supervisor daily.
• Transcribe all interviews, then translate all interviews into English
• Transcribe focus groups using templates provided by FHI 360, then translate templates into English
• Supervisors will perform data quality checks, facilitate transcription and translation, transmit audio files and transcripts to FHI 360 daily, and back-up all data onto thumb drive daily
• Conduct dissemination meeting at the close of research activities to highlight lessons learned for system improvement.

Responsibilities of FHI 360: