Evaluating Outcomes with a Vulnerability and Food Security Study in Lesotho

June 3, 2016  | Lesotho  | Claire Gillum, LIFT II Technical Officer

LIFT’s work in Lesotho stretches back to late 2013, with the provision of a household economic strengthening (HES) workshop for community-based organizations (CBOs) in Mohale’s Hoek and Thaba-Tseka districts. Since that time, LIFT has continued to grow activities in these districts—two of the most heavily impacted by Lesotho’s HIV epidemic—providing technical assistance to support implementation of referral networks, which include linking clients from health facilities to HES services, such as village savings and loan associations (VSLAs). LIFT’s aim in establishing these clinic-to-community linkages is to improve health and nutrition outcomes, particularly focusing on PLHIV and issues of adherence and retention in HIV care. Thanks to a coordinated effort by LIFT, Building Local Capacity for Delivery of HIV Services in Southern Africa (BLC)—implemented by Management Sciences for Health (MSH) through the end of 2015—and numerous in-country partners, more than 16,000 referrals have been made since December 2014.

Lesotho has an extremely mountainous terrain - over 80% of the country is found 1,800 meters (about 1.2 miles) above sea level including both Mohale's Hoek and Thaba Tseka.

Lesotho has an extremely mountainous terrain – over 80% of the country is found 1,800 meters (about 1.2 miles) above sea level including both Mohale’s Hoek and Thaba Tseka.

Although LIFT’s direct support to the referral networks in Mohale’s Hoek and Thaba-Tseka ended in January of this year, our engagement in Lesotho continues. We are now striving to understand the value of referrals for clients by conducting a Vulnerability and Food Security (VFS) Study. This research will allow LIFT to evaluate whether clients who completed their referral experienced a change in their food security or vulnerability status since their referral, as well as to dig deeper into reasons why some clients did not complete their referral. Working with Lesotho-based organizations, Center for Impacting Lives (CIL) and Phelisanang Bophelong (PB), LIFT is following up with 240 clients from Mohale’s Hoek and Thaba-Tseka who received a referral during 2015 using two distinct tools:

Household Hunger Scale and LIFT Score Repeat Assessment: When clients are first registered into the referral system, they are asked a series of food security and vulnerability questions. These questions are taken from the commonly-used tool, the Household Hunger Scale (HHS) and a modified version of the Progress out of Poverty Index (PPI), known as the LIFT Score. Upon completion of these questions, clients can be classified into one of three food security categories (little to no hunger, moderate hunger or severe hunger) and one of three vulnerability categories (provide, protect or promote). During the VFS Study we are repeating this assessment for clients who completed their referral to document any changes in their food security or vulnerability status from pre- to post-referral.

LIFT uses this matrix to help categorize clients in terms of food security and household vulnerability,

LIFT uses this matrix to help categorize clients in terms of food security and household vulnerability,

Loss to Follow Up (LTFU) Survey: Clients who were provided with a referral but never accessed the services to which they were referred are being interviewed using a LTFU survey. This short questionnaire collects qualitative data about the reasons the client did not complete their referral and suggestions they have to improve the overall referral process.

Data collection for the VFS Study began in March 2016 and will continue through August 2016. During a recent visit to Lesotho, LIFT provided oversight to the CIL and PB data collection teams and assist them in troubleshooting some data collection challenges. Particularly difficult is the task of finding and contacting clients, many of whom received their referral at least one year ago. However, thanks to assistance from referral network partners, the data collection teams are working to ensure that as many sampled clients as possible are offered the chance to participate in the study. As of May 10, 2016, 26 Repeat Assessments and 50 LTFU Surveys had been completed, with data collection continuing daily. Once data collection is completed in August, the results will be compiled and analyzed to provide critical insight into the value of referrals for clients in Mohale’s Hoek and Thaba-Tseka. So make sure you check back regularly to see future updates!