Economic strengthening (ES) is a core component of several key programs in USAID/Ethiopias PEPFAR portfolio, which is consistent with updated PEPFAR guidance for OVC, food and nutrition, care and support and prevention programming. A recent portfolio review and situation assessment by the USAID/LIFT program found several weaknesses in the ES interventions, approaches, capacities, and results of programs active at that time. The LIFT assessment resulted in the following strategic shifts: explicit commitment to the standards of practice for ES; new projects and previous (e.g., Yekokeb Berhan, World Food Program, MULU and TransACTION) conducting vulnerability analyses and market assessments to inform intervention strategies; focus on savings-led microfinance as a foundational intervention and entry point for other ES assistance; a technical advisory group to provide mutual technical support/advice and promote coordination, knowledge and experience sharing; and networking through inter-agency linkages among governmental, non-governmental organizations and other development partners within the sphere of ES. Specialized technical assistance and capacity building will be required to sustain, accelerate, and expand this initial progress.

One of the key relations of ES interventions to prevention interventions is that when the income of commercial sex workers increases, their negotiation capacity to have safe sex will improve. Additionally, ES activities, in particular the saving approach, can serve as an entry point for strengthening social capital, reducing risky behavior, and eventual behavioral change.

The HIV pandemic affects the economic stability of families and the children in their care by interrupting income streams, depleting assets, introducing labor constraints, and increasing dependency ratios. Approaches to strengthen the economic security of families affected by AIDS need to be a part of the continuum of response to preempt a descent into more extreme vulnerability, improve household welfare, and prevent future risk exposure.

The overall goal of this program is to build assets, income and livelihoods of people living with HIV/AIDS through different economic strengthening activities and to increase resiliency to the socio-economic effects of HIV/AIDS, thereby contributing to treatment adherence.

This includes increasing livelihood opportunities (i.e. through income generating activities) for households affected by HIV and AIDS, strengthening referral linkages with HIV/AIDS community service providers for economic strengthening activities, and incorporating economic risk reduction into livelihoods programs. Household-level beneficiary needs assessments will be conducted by implementing partners in collaboration with GOE/HAPCO and support provided based on agreed upon criteria including household food security and nutrition, poverty indicators including assets. Moreover, this is aligned with the Global Health Initiative strategy to increase linkages with other sector programs opportunities including Feed the Future and Asset and livelihood and Transition programs.

The Household ES intervention is one of the main activities in the OVC programs. Hence, the new ES mechanism will provide technical assistance (TA) for our OVC programs and the Government of Ethiopia (GOE) to make more effective, efficient and sustainable ES activities.

Hence, the new mechanisms expected outcomes are: Increased technical capacity of implementing partners in economic strengthening (including international and local as well as prime and sub-partners); more supportive supervision practices used by USAID with prime partners and by prime partners with their sub-partners regarding economic strengthening activities; improved coordination, referral, and joint activity design/planning/implementation among implementing partners and other service providers (especially from GOE); stronger capacity, ownership, and leadership for economic strengthening among relevant GOE agencies; and an expanded evidence base for economic strengthening. Specifically, OVC partners will receive TA to conduct vulnerability analyses, market assessments, and feasibility analyses, improve skills development, and update ES intervention strategies and approaches.

The evidence base has expanded rapidly in recent years, pointing to savings promotion, saving-led micro enterprises, and cash transfers as key approaches that are appropriate for PEPFAR's highly vulnerable children and effective for addressing the socioeconomic determinants of vulnerable households. Additionally, the new partner will provide mutual technical support/advice for and promote coordination, knowledge and experience sharing, and networking through interagency linkages among governmental, non-governmental organizations and other development partners within the sphere of economic strengthening.

Baseline research, impact evaluation, operational research and ethnographic research (using rigorous financial diaries methodologies) will be conducted to understand the social economic vulnerability of the OVC and Household in relation with the ES interventions.

The goal of combination prevention is to reduce transmission of HIV by implementing a combination of behavioral, biological, and structural interventions that are carefully selected to meet the needs of a population. PEPFAR names economic empowerment as one of the five structural interventions. This mechanism will provide technical assistance (TA) to local sub-grantees and prime partners implementing combination HIV prevention. The project will also provide TA and sub-grants to relevant Government of Ethiopia (GoE) agencies such as the HIV/AIDS Prevention and Control Office (HAPCO) and the Small and Micro Business Enterprise Agency. The project will help to standardize and implement targeted ES activities to at-risk and highly vulnerable populations, which are prime targets of HIV prevention in Ethiopia. This approach is in keeping with lessons learned from other PEPFAR countries, in particular Tanzania and Mozambique, regarding ES activities. The overall aim of this ES program is to prevent and mitigate the impact of HIV/AIDS on economically vulnerable households and reduce risky sexual behaviors fueling the epidemic in Ethiopia.

Expected outcomes from the new ES mechanism include providing TA for TransACTION, PSI and their local implementing partners, and the GOE to strengthen ES activities/interventions. The new partner will support partners to implement the PEPFAR/ LIFT ES assessment recommendations and strategies, in particular conducting a vulnerability analysis, analyzing market linkages, standardizing ES indicators, improving coordination and collaboration for ES, referral, and joint activity design/ planning/ implementation among implementing partners and other service providers, building GOE capacity and leadership for economic strengthening among relevant GOE agencies and ministries, and expanding the evidence base for ES. The program will also include pilot implementation activities such as asset transfer and life-skills for economically vulnerable transactional and commercial sex workers to enhance their negotiating capacity and reduce risky sexual practices.

Baseline research, impact evaluation, operational research and ethnographic research (using rigorous financial diaries methodologies) will be conducted to understand the saving and expense behavior in relation to reduce risky behavior. Based on piloting outcomes, promising practices and results will be scaled up by PEPFAR Prevention implementing partners and stakeholders. In addition, efforts will be made to address gender violence and gaps in accessing livelihood and economic strengthening activities