Attachment J.9 - USAID Uganda Results Framework Paper CDCS 2017-2021 April 5 2016.pdf

USAID/Uganda Results Framework

20172021

April 5, 2016

USAID/Uganda 20172021 CDCS Results Framework Paper

INTRODUCTION:

The overall goal of USAID/Uganda’s 20172021 Country Development Cooperation Strategy (CDCS

2.0) is to support Uganda’s national development goal of becoming a prosperous, stable and democratic society, the Government of Uganda’s (GOU) “Vision 2040”. This objective while achievable is highly ambitious, given Uganda’s current development context and the number and scale of its challenges (a detailed discussion of the context and challenges is provided in Annex 1 to this document). Uganda is currently experiencing one of the world’s fastest rates of population growth in a context of poor human development indicators (Uganda ranks 163 out of 185 countries in the 2015 United Nations Human Development Report ), weakness and dysfunction in 1 its key institutions, and a small, uncompetitive and lowproductivity economy. Demographic pressures are already overwhelming the capacity of Uganda’s economic, social and political/administrative systems to cope, and its population is currently on track to double in less than 25 years. These systems must become significantly stronger and more resilient if they are to be able to both absorb this growth and realize the longterm national development goal.

CDCS 2.0 reflects USAID’s comparative advantages and predominant capabilities as a development agency by focusing on: health systems strengthening and epidemic control;

increased literacy; agriculturalsector development, enhanced food security, and reduced household and community vulnerability to shocks; biodiversity and natural resource management and climatechange adaptation; and inclusive and accountable democratic governance. The fiveyear goal is “Uganda’s Systems are Accelerating Inclusive Education, Health and Economic

Outcomes,” where key systems are strengthened and supported to complete the first of a series of building blocks toward the Vision 2040 goal. USAID’s complementary 2040 goal for Uganda is:

“Ugandanled Inclusive and Sustainable Development.” Both the fiveyear and the 2040 goal embody a holistic approach, in recognition of the complexity of Uganda’s development context and of what is required to support its efforts to achieve sustainable development. Accordingly, the goals reflect an emphasis on strengthening those major systems whose ability to function effectively will determine whether or not Uganda will be successful in coping with its myriad, formidable development challenges challenges compounded by the virtually inevitable doubling of the population by 2040.

CDCS 2.0 applies the lenses of selectivity and focus in the sectoral and geographic distribution of the Mission’s portfolio, and an internal and programmatic management and oversight approach that builds in Collaborating, Learning and Adapting. Consistent with broader U.S. Government

(USG) foreign policy priorities in Uganda, the new strategy will maintain the 20112015 CDCS’s

(CDCS 1.0) focus on health and HIV/AIDS, economic growth through agriculturesector development, improved earlygrade literacy, sustainable natural resource management, and the promotion of accountable, effective democratic governance and protection of basic human rights for all. However, the approach under CDCS 2.0 constitutes a significant evolution from CDCS 1.0 in that its results framework is crosssectorally integrated. The high degree of integration reflects a recognition on the part of the Mission that the development challenges that it is attempting to

1 2015 Human Development Report; United Nations Development Program, New York, 2015

USAID/Uganda CDCS 2.0 Results Framework Paper 1 address through CDCS 2.0 are complex, as defined by Agency systems thinking. “Complexity” in this sense refers to an environment where multiple actors and systems many or most of them entirely beyond the control of, and of limited susceptibility to being influenced by, USAID have a significant role in creating, influencing and/or potentially resolving those development challenges.

The challenges may therefore only be effectively and sustainably addressed through engagement with these systems. A major incentive for taking this approach is that successfully applied it can yield major positive development impacts well beyond the mere cumulative effect of a given set of interventions (“oneplusoneequalsthree”). The Mission’s positive experience under CDCS 1.0 of the results from effectively integrated approaches has confirmed for it the desirability of applying this approach whenever appropriate and practical under CDCS 2.0.

This new approach under CDCS 2.0 is the product of a lengthy and rigorous learning process undertaken by the Mission. That process began in the spring of 2013 with a midpoint stocktaking of the experience [then] to date of implementing CDCS 1.0. Other key learning experiences included: an independent, thirdparty evaluation of the accuracy of the CDCS 1.0 development hypothesis; numerous highquality activity/program evaluations; consultations and learning events involving Ugandan stakeholders and USAID implementing partners; a rigorous, problembased analysis of Uganda’s development context using a sophisticated multivariateanalysis tool to forecast development trends using longitudinal data; a climate 2 change vulnerability assessment; an environmental threats and opportunities assessment

(including 118/119 analyses); an indepth Ugandan political economy analysis; and conflict vulnerability, inclusive development and resilience analyses and assessments. This learning yielded several key themes that informed and shaped CDCS 2.0; namely:

● The single biggest challenge to Uganda’s ability to achieve longterm sustainable development is a present rate of population growth that is far beyond the absorptive capacity of its current economy, social structures, and governance system;

● Given a demography where 75 percent of the population is under the age of 35, the current deplorable state of the Ugandan child and the related issue of the youth bulge as a potentially destabilizing force signify that youth must be a core consideration in USAID’s strategic planning and program design;

● While the transformation required to set Uganda firmly on a path to sustainable development is necessarily a longterm affair measured in decades, rather than years it has immediate consequences for USAID’s strategic choices in the short term;

● As Uganda’s most critical development challenges are both highly dynamic and closely interrelated, so must be USAID’s programmatic response to them;

● USAID’s understanding of the development context must be sophisticated and datadriven, and subject to continuous interrogation of assumptions and development hypotheses;

● Given the dynamic nature of the development context, USAID must make organizational learning and adaptive capacity top priorities in its management decisionmaking;

● Development assistance will be most successful when it is based on a complete and accurate understanding of the political economy and its systems, and the catalytic role that leadership can play in achieving the type of change required; and

2 Advancing development in Uganda: evaluating policy choices for 201621 and selected impacts to 2040, The Frederick S. Pardee Center for International Futures, Josef Korbel School of International Studies at the University of Denver, September, 2015.

USAID/Uganda CDCS 2.0 Results Framework Paper 2

● In order to obtain this understanding and, with it, a clear understanding of what, where and how USAID can plausibly contribute to its resolution, the Mission must actively involve all of its staff, its implementing partners, and major stakeholders in a continuous learning process.

The learning process also led to the establishment of a series of Guiding Principles for strategy development and for program design and management. These principles (Annex 9 to this document) codify the most important considerations, best practices and lessons learned. One of the most significant is that “the process is as important as the product,” meaning that the way in which the CDCS was developed will itself contribute to its success by fostering an organizational culture that promotes continuous learning, critical thinking, teamwork, leadership opportunities for all, adaptability and openness to change, and a high tolerance of uncertainty all invaluable assets in the highlycomplex development context that is Uganda.

THE RESULTS FRAMEWORK

USAID’s goal for the end of the fiveyear CDCS 2.0 period is: “Uganda’s Systems are Accelerating Inclusive Education, Health and Economic Outcomes.” The Development Hypothesis is that by supporting transformational change and resilience in key systems and in communities across the country, a sustained shift toward slower population growth, more resilient households and communities, and more effective economic, social and governance systems will occur.

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The CDCS 2.0 results framework’s (RF) three development objectives (DOs) and their respective intermediate results (IRs) are in fact interdependent, reflecting the complex interrelatedness of Uganda’s core development challenges: weak economic and governance systems; rapid population growth; and low community and household resilience. The complexity of the Ugandan context and the multifaceted nature of our enterprise demands that Mission programs be designed to manage this complexity with deliberation, creativity and flexibility. In recognition of the fact that sustainable development impact cannot be achieved without fully taking into account all of the factors that can help or hinder its achievement, the IRs are interdependent both within and across DOs (the mapping of IR interdependencies is detailed in Annex 6 to this document). Major Presidential Initiatives such as the President’s Emergency Program for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI), Global Climate Change (GCC) and Feed the Future (FtF) have been woven throughout this results framework, and are therefore not confined to one IR, or even one DO. The relationship between initiatives and earmarks and the integrated IRs is discussed in Annex 5 to this document. This arrangement is in recognition of the multiple contributions of their programming, and their potential as means to leverage greater impact from each other and from other, noninitiative resources.

Consistent with current Agency thinking regarding individual operating units’ (OUs) accountability for results and the need for plausibility in their claims of contribution to highlevel development outcomes (such as the DOs), the results framework implicitly recognizes the role that other

USAID/Uganda CDCS 2.0 Results Framework Paper 4 development actors such as the GOU, other donors, private enterprise, civilsociety organizations, communities and individuals play in helping or hindering those outcomes, and their respective priorities, incentives and motivations. It also recognizes that, while donors are numerous in Uganda, the resources that they bring to bear even when combined within a given sector are in most sectors insufficient to fully meet the corresponding development need. This creates an imperative consistent with aideffectiveness principles that USAID accurately identify and act on those points where it can achieve maximum leverage while avoiding duplication of effort and other counterproductive, costineffective investments and outcomes. This includes leveraging the resources both financial and technical of other donors such as the United Kingdom’s Department for International Development (malaria, family planning), the Danish aid agency DANIDA (agriculture), the World Bank (GOU policy reform), and the United Nations Children’s Fund (maternal and child health, HIV/AIDS).

CDCS 2.0s results framework is predicated on certain critical assumptions, and on the mitigation of certain risks that have gamechanging potential with regard to its results achievement, namely:

Critical Assumptions:

● Overall Mission program funding levels and composition, the number, size and requirements of Presidential Initiatives and earmarks, and the corresponding required staffing levels, do not change (reduce) significantly from current levels;

● The outcome of the 2016 Ugandan national election is widely accepted, or only peacefully contested and through legal means;

● GOU, and other donors’ and key actors’, investments are adequate to provide the complementarity necessary for USAID’s investments where required by CDCS 2.0;

● Population growth and urbanization do not accelerate beyond current projected rates;

and

● USAID/Uganda will be able to address staffing and space constraints within the New Embassy Compound through outsourced support arrangements.

Risks:

● The quality of the USGGOU partnership deteriorates to the point of directly impacting USAID’s ability to carry out its assistance program;

● There is a significant shift in USG foreign policy toward Uganda, including changes in foreign assistance levels and composition; and

● Civil unrest or conflict emerges on a scale that impacts USAID’s ability to implement its activities.

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Geographic Focus

Drawing upon the lessons learned from CDCS 1.0, USAID/Uganda will apply a systematic “geofocusing” approach to the “where” of its program planning, meaning that it will apply geospatial analysis to identify those regions, districts and specific sites of intervention (those that are not otherwise determined by initiatives such as PEPFAR, or national ministry strategies supported by USAID) where its investments are likely to yield the greatest, most costeffective development impact (see the adjacent Venn diagram). This analysis is problembased, highlighting the spatial dimension of the interrelationships among development challenges and their relevant systems; for example, the geographic concentration of, and high correlation between, low literacy, high poverty levels, and poor maternal and child health in certain regions that make these challenges mutuallyreinforcing, and therefore unable to be tackled in isolation from each other if lasting impact is to be achieved. Geospatial analysis can identify the spatial points of intersection of development need and potential. It can also be utilized to identify those locations with the greatest opportunities for programmatic convergence where crosssectoral integration of specific projects and activities in specific locations has the greatest potential for achieving significant impact beyond the mere sum of different interventions: the “oneplusoneequalsthree” paradigm.

In recognition of the fact that not all geographic areas lend themselves to such integrated approaches, and that the geographic distribution of activities under certain USAID presidential initiatives is based on other USG policy considerations, CDCS 2.0 applies a threetiered approach to geofocusing (Annex 2) that reflects these realities yet fosters opportunities to maximize results through geographic convergence whenever and wherever appropriate.

USAID Forward and Science, Technology, Innovation and Partnerships (STIP)

USAID/Uganda will continue to advance the objectives of the USAID Forward internalmanagement reforms as it learns and adapts organizationally to meet the management requirements of CDCS 2.0. In terms of Talent Management, this includes leveraging maximum leadership potential, professional development and technical contributions from its staff in program management and oversight, supplementing these resources with external support when and where appropriate. As part of its continuous learning efforts, the Mission will maximize the quality of its activity and project evaluations to ensure that they produce accurate, reliable and actionable data. Acquisition and assistance will be optimized for effective program management and oversight, while reducing the number of management units to the smallest number that this approach requires.

The Mission will continue in its present role as a STIP focus mission, working closely with the USAID Global Development Lab and PPL Bureau to apply and model promising new approaches to development assistance planning, design, management and oversight, and to ensure that Washingtonbased programming in Uganda complements bilateral programming. Mission

USAID/Uganda CDCS 2.0 Results Framework Paper 6 management will prioritize adaptability in Mission management structures and processes by fostering an environment that rewards innovation and leads to improved program results. It will advance aid effectiveness principles by coordinating and partnering with other donors to Uganda maximize program impact at the country level and to ensure that USG policy priorities are wherever possible advanced along with those of likeminded donors. It will expand and diversify its range of implementing partners particularly local ones wherever and whenever appropriate and practicable to enhance results, in order to promote greater sustainability for its investments.

The narrative that follows lays out the CDCS 2.0 results framework by DO and IR, and including the logic behind the choice of DOs and IRs, the relationships between them, and the overlay of the different Ugandan systems that are implicated in achievement of the different IRs. In order to provide a comprehensive approach to development, USAID will strengthen the systems needed for longterm, sustainable growth (DO3)that can reinforce resilience in communities and households in select areas (DO1) and also positively affect the conditions and human behaviors (DO2) that are key drivers of unsustainable population growth. This integrated approach to development reflects how, in the next five years, USAID will approach development differently to yield sustainable results.

Annex 7 to this document, “Management Approach,” will provide some illustrative examples of how this results framework will be operationalized through projects, including examples of the different ways in which projects interface with the RF; e.g., within and across DOs, comprising one or more IRs, or a series of subIRs. To achieve the integrated DOs, USAID will leverage financial and human technical resources across traditional sectors (detailed in Annex 8.) As many current Mission activities will continue from CDCS 1.0 into CDCS 2.0, examples of where they will “reside” within the new RF. Annex 3 will demonstrate, in matrix form, these relationships, as well as the relationships of major Presidential Initiatives to the new RF also in matrix form.

THE 20172021 CDCS DEVELOPMENT OBJECTIVES (DOs):

DO 1: Community and Household Resilience Increased in Select Areas and Target Populations

Over 70 percent of the population experiences multidimensional poverty, or lives at constant risk of backsliding into poverty. This drives the inability of households and communities to adapt to shocks and stresses; in other words, their low resilience and high vulnerability. Chronically poor households comprised of people living on less than $1.25/day represent 37 percent of the national population. Some of these chronicallypoor households are particularly affected by recurrent and complex crises and emergencies. Many have been affected by conflict, and remain vulnerable to renewed conflict. Climate change and variability negatively affects these communities because of their reliance on subsistence agriculture, and their lack of adequate buffers against declining soil fertility and increasing population pressure on land and water. As a result, food insecurity and malnutrition increase. Similarly, as economic security in households declines, education and health choices are affected. While poverty in Uganda may be more pervasive in rural areas, migration to urban areas offers no panacea. These ruraltourban

3 Moyer, J.D., et al., Advancing development in Uganda: evaluating policy choices for 20162021 and selected impacts to 2040. 2015, Frederick S. Pardee Center for International Futures:

Denver, Colorado, USA.

USAID/Uganda CDCS 2.0 Results Framework Paper 7 migrants lack literacy and skills and, as a result, have few employment opportunities and remain at high risk of continued poverty. DO1 will promote an integrated approach to increase resilience beyond rural households, to include urban migration centers.

Poverty and health status are closely correlated, particularly for those living in absolute poverty.

Chronically poor people are often unable to access quality and timely care. HIV/AIDS presents a clear example of this cycle. People living with HIV or AIDS place a greater strain on a household’s ability to recover quickly from the effects of illhealth. If the head of the household dies, dependants often experience great difficulty maintaining the household. The HIV/AIDS pandemic has also resulted in many orphan and grandparentheaded households, typically characterized by a high degree of vulnerability.

Health shocks and the pressures of high population growth on land can undermine the ability of households and communities to cope. Of the six types of significant and most prevalent shocks in 4

Uganda, natural hazards (defined by drought, floods, landslides, fire) and health shocks (defined by illness or death) have the greatest impact on households. However, household vulnerability varies with geography and with the composition of the household. USAID/Uganda’s Inclusive Development Analysis revealed that femaleheaded households are more vulnerable than maleheaded households. Gender inequities play out in livelihoods, income, use of natural resources, decisionmaking and realization of basic rights, all of which affect, and are in turn affected by, gender power dynamics. Key interventions will maximize USAID’s overall efforts to achieve greater household resilience, and will focus on increased participation of women and girls in healthcare, education, and economic opportunities including land rights and agriculture.

Given the interwoven nature of the issues that Ugandans face, an integrated solution is necessary to achieve sustained impact. The Development Hypothesis underlying DO1 is that by increasing the capacity of households and communities to adapt to stresses and shocks, they will be better able to promote inclusive growth and lessen chronic vulnerability. Ultimately, DO1 will lessen both extreme poverty and also the scale and impact of those households and communities who are backsliding into poverty. Under this DO, USAID will support a participatory, communityled approach to development, focused on building resilience through an integrated mix of interventions to increase household income, improve health, and achieve better education outcomes. In addition, projects will be geographically focused to maximize convergence of programming at the household and community level. DO1 will support Ugandans who are often geographically isolated from public and private networks of social services. USAID will implement integrated programming at the community and household levels that link closely to activities under the other DOs, but that bridge the gap in social services left by the failure of Uganda’s systems to adequately address the needs of all citizens.

DO1 addresses vulnerability on multiple levels, recognizing first that there is a difference between the drivers of vulnerability and the ability of households and communities to adapt and respond to circumstances before, during and after shocks occur. The following IRs harmonize through an approach to empower individuals and their communities to increase resilience through adaptive, absorptive, and transformative strategies.

4 The six most prevalent types of shock in Uganda include: natural hazards, health shocks, price shocks, employment shocks, asset losses and crime/safety shocks.

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Intermediate Results under DO are outlined below, with technical/sector alignment per IR detailed in Annex 3.

IR 1.1: Key Drivers of Vulnerability as Identified By Beneficiaries Addressed

While underlying causes of vulnerability differ across communities, sustained resilience cannot be achieved without gains in household and community capacity to increase income and improve health status such as literacy, nutrition, and other health and sanitation services. Drivers of vulnerability include food insecurity, youth unemployment, genderbased violence, degradation of natural resource systems, climate change and variability, political, social and economic marginalization, and conflict, and the psychosocial damage to individuals’ ability to cope.

Communities and households are often vulnerable precisely because there are limitations to the degree to which they can participate in local systems, and to the extent to which they may require support. Activities under this IR identify and address constraints as identified and experienced by vulnerable populations and provide a compliment to systems strengthening under DO3. USAID will help to ensure more inclusive services by strengthening local health, education, agriculture and other systems. USAID recognizes that stresses and shocks can erupt as crises; as such, it is imperative to address these chronic vulnerabilities in parallel to strengthening local systems, before vulnerabilities become full crises. Under this IR and as an intermediate building block to achieving this DO, USAID will work with beneficiaries to identify and address the drivers of vulnerability within USAID’s programming purview.

Although urban areas have, on average, lower overall poverty, higher consumption levels, and better access to basic infrastructure, urbanization also increases pressures on education and health services, and on infrastructure. Lowincome earners in urban areas face challenges accessing even minimallyadequate housing or basic sanitation. Youth unemployment is also higher in urban compared to rural areas. Uganda’s urban population is increasing by an average of 300,000 people per year, while urban congestion restricts economic movement, housing and social services.

USAID will target urban and rural communities and households to identify, assess and prioritize the chronic issues and challenges that make them more vulnerable to shocks and stresses and less resilient. USAID, with local organizations, will plan and implement strategies to address these vulnerabilities including, e.g. urban communities addressing sanitation needs, providing resources and support for family planning, promoting conflict mitigation structures, improving electrification through Solar Home Systems (Power Africa), or providing protection and/or advocacy services for victims of violence, and establish a flexible, communitylevel and householdlevel framework to respond to these many drivers of vulnerability.

Selfidentification of the drivers of vulnerability is imperative for any development impact to be sustainable, and achievement of this IR is integral to the entire framework. However, this IR is particularly important to the achievement of IRs 1.2 (riskmanagement capacity increased), 1.3 (enhanced disease prevention and treatment [among the most vulnerable]), and 3.2 (active citizen participation in development.)

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IR 1.2: Capacity to Manage Risk Increased

For communities and families living in or under constant threat of poverty, having the capacity to manage risk is essential to increasing resilience and reducing the risk of crises. Under this IR, USAID will assist communities and households to mitigate and manage the risk of damage from crises through effective planning for community and household responses to stresses and shocks.

Investments will build social capital and strengthen networks of actors within and across communities, with the specific goal of mitigating and managing risk, thereby reducing the need for emergency assistance.

The HIV/AIDS pandemic affects the economic stability of families and of the children in their care by interrupting income streams, depleting assets, introducing labor constraints, and increasing dependency ratios.

To manage these risks, Orphans and Vulnerable Children (OVC) programs will prioritize approaches that strengthen the economic and food security of HIV/AIDSaffected families to mitigate extreme vulnerability, improve household welfare, and prevent future risk exposure.

Climate change and climate variability pose severe threats at both a local and a national level. Better information, better planning and a deeper capacity to understand these threats is essential to enabling communities and households to effectively respond. Climaterisk screening will be conducted throughout the USAID Program Cycle, ensuring that interventions account for specific risks in their design and implementation.

USAID seeks to equip communities and local stakeholders to more effectively recover from, and respond to, complex challenges by finding or catalyzing successful local solutions, share them with other vulnerable communities, and build a groundbreaking community of practice and platform for collaborative learning. USAID will support earlywarning mechanisms in order to reduce vulnerabilities to environmental threats.

Although the risk of organized violence remains low in Uganda, unaddressed legacies of past conflicts and grievances rooted in ethnic identity, land disputes, the exploitation of mineral and natural resources, lack of productive opportunities for youth, and perceptions that government is unaccountable and corrupt are all key conflict drivers. USAID will adopt a twopronged approach in responding to conflict risk. First, it will engage directly in conflict mitigation through support to prevention and earlywarning mechanisms, promoting dialogue between conflicting parties, and strengthening local capacity for peaceful conflict resolution. Second, USAID will adopt a conflictsensitive approach to development in all sectors that assesses the conflict risk in a planned development intervention, and identifies means to mitigate that risk.

Humanitarian and development assistance interventions using USG Food for Peace (FFP) resources still have an essential role to play in assisting communities and households to build resilience and to recover from shocks such as natural disasters. These resources can also be used to build longerterm resilience and better absorptive and adaptive capacities. FFP development assistance

USAID/Uganda CDCS 2.0 Results Framework Paper 10 will be provided in a way that builds community and household assets, protects both lives and livelihoods and contributes to future risk reduction. With other donors and GOU, USAID will also support the development of additional social protection systems to mitigate risk and provide essential support when needed.

Given the complexity of variables that vulnerable populations live with, an integrated technical approach is imperative. When communities are able to better mitigate risk, they are empowered to improve other areas of their lives. Accordingly, this IR will positively influence the achievement of IRs 1.3 (enhanced disease prevention and treatment), 1.4 (Increased household assets), 2.2 (improved child wellbeing), 3.1 (development leadership supported) and 3.2 (active citizen participation in development).

IR 1.3: Enhanced Prevention and Treatment of HIV, Malaria and Other Epidemics Among the Most Vulnerable

Individuals and families affected by infectious diseases are extremely vulnerable to economic shocks and social isolation. USAID will identify population groups and geographic locations with the greatest health vulnerabilities, and will build resilience by providing health services and increasing health staff to key and priority populations, including services to adolescent girls that promote healthy behaviors that help them to stay in school and complete their educations.

Activities under this IR will support prevention and treatment of diseases and epidemics in line with USG global health initiatives such as the Presidential Malaria Initiative (PMI) and PEPFAR.

USAID will scaleup costeffective disease prevention and treatment by providing antimalarial bed nets and indoor residual spraying, especially in highrisk communities. Programs will support GOU efforts to immediately link HIVpositive patients to care (Test & Start), including provision of Antiretroviral drugs (ARVs), and will provide routine tuberculosissymptom screening for HIVpositive patients. Outreach events for safe voluntary medical male circumcision will contribute to prevention of sexually transmitted diseases, including HIV. Programs will support the scaleup of GeneExpert HIV testing, improve the prevention of mothertochild transmission, as well as increase the retention of motherbaby pairs in HIV treatment. Activities for orphans and other vulnerable children (OVC) will continue to focus on comprehensive socioeconomic community based packages contributing to community case finding, enrollment and retention of HIV+ children and family members. Most importantly, OVC programs will build family resilience to reduce risks of HIV infection and achieve PEPFAR prevention, treatment and care outcomes for affected children and their families, especially young adolescent girls 1019.

By improving disease treatment and prevention among vulnerable populations, household and community resilience will increase in many other areas of life. This IR will therefore contribute to the achievement of IRs 1.1 (drivers of vulnerability addressed), 1.4 (increased household assets),

2.1 (healthy behaviors and practices adopted), 2.2 (improved child wellbeing), 2.3 (improved girls’ education), 2.4 (increased youth economic productivity), and especially 3.3 (key systems’ elements strengthened; specifically, strengthened health systems). This integrated approach is imperative to addressing both the immediate needs of the population and to improving the longterm institutional capacity and sustainability of Uganda’s health sector.

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IR 1.4: Community and Household Assets Increased and Diversified

Community and household assets are defined as both the resources that increase community and household income and that protect community and household livelihoods. Increased incomes and diversified household and community assets, including natural resources, reinforce resilience in vulnerable populations.

The agriculture sector employs 70 percent of the labor force and is also the main pathway out of poverty for Ugandans: agricultural growth contributed to 70 percent of the poverty reduction between 2006 and 2010 . However, many households remain vulnerable due to food insecurity. 5

Lack of resources and limited access to affordable credit constrains privatesector investment at all levels of the value chain. The virtual nonexistence of a government extension service is a result of limited and poorly utilized publicsector resources.

Under the Food for Peace initiative, USAID will support the diversification of household incomes;

examples include beekeeping and mango orchards. By diversifying household income sources and assets, communities and households become more resilient and less susceptible to different types of shocks.These activities mitigate the risk associated with singlecommodity value chains, which are susceptible to price fluctuations and climate change, leaving them more food insecure.

However, specializing in one or two high value crops crops can increase income for households and communities. To that end and in support of the Feed the Future initiative, USAID will support investments in specific value chains. To decrease vulnerability and to increase household assets, value chain investments will reflect assessments of climate vulnerabilities, cropspecific risks, and infrastructure risks.

Gender roles play an important part in influencing household vulnerability. Women are responsible for subsistence farming and cooking, and are more likely than men to engage in unpaid work. Engaging women and taking a gender perspective on the diversification of assets and income will change household power dynamics and lead to a better health outcomes.

As farmers are the ultimate beneficiaries of an efficient agricultural market system, they are also those most negatively impacted by an inefficient system. The choices farmers make are often rational, based upon their knowledge and experience of the choices available to them. An important goal of an improved agricultural market system is to create incentives for other actors within the system to improve services (input provision, advice, market access) for farmers.

Achievement of this IR will directly and positively influence the achievement of 1.2 (addressing drivers of vulnerability), 2.3 (reduced economic barriers to education), and of 3.2 (citizen participation in development) and 3.3 (enabling environment supporting functional systems), particularly as they relate to market and socialprotection systems.

Economic strengthening for OVC will include a layered approach that employs livelihoods, village savings and loans interventions layered with parenting, education, food security and child protection support services, among others. Programs will utilize proven methodology including

5 Kaminski and Christiansen, 2014 6 USAID/Uganda Inclusive Development Analysis

USAID/Uganda CDCS 2.0 Results Framework Paper 12 individualized household case management plans and postgraduation monitoring to help prevent relapse into vulnerability.

DO 2: Demographic Drivers Affected to Contribute to Long Term Trend Shift

Uganda’s population is one of the fastestgrowing in the world, doubling between 1993 and 2015 to nearly 40 million. The population is projected to double again to 80 million in 2040, and reach

105 million in 2050. While Uganda is relatively stable and has shown positive economic gains, this growth is insufficient to support the needs of the present population, which already overwhelms the absorption capacity of government services and the economy. Climate change, degradation of natural ecosystems and growing urban populations place additional pressures on Uganda’s capacity to thrive. Weak institutional frameworks and services for vulnerable populations mean that many people are excluded from full participation in national development. If Uganda is to achieve its Vision 2040 goal of uppermiddle income country status and economic modernization, the GOU and its development partners must consider the implications of demographic trends for every sector in which they operate, as well as their effects across sectors.

Uganda has yet to complete its “demographic transition” that is, the shift to sustainable birth and death rates. While child mortality (and overall mortality) has declined steadily over the past three decades, total births also known as the total fertility rate (TFR) have remained high, with an average of 6.2 live births per woman . Additionally, the TFR between the highest economic quintile and the lowest economic quintile is the highest in Africa (7.9 vs. 4 live births per mother).

Uganda is currently demonstrating how unequal progress in fertility decline particularly where progress is slowest among those least able to support large numbers of children can have grave consequences for a country’s demographic trajectory and ultimately, its development prospects.

Culturallyrooted gender inequities and women’s disempowerment are among the major drivers of persistently high levels of fertility among the poor, and the large unmet need for family planning is closely linked to highly unequal negotiating power between genders at the household level. More than 40 percent of births were unplanned in 2011, according to the Uganda Demographic and Health Survey, which pointed to gaps in both contraceptive availability and ability of women to negotiate family planning.

However, availability and use of family planning is only one part of a larger equation: the drivers behind population growth are crosssectoral, and reinforce each other. Improving child wellbeing, particularly reductions in infant and child mortality through better healthservice delivery, social protection, and nutrition positively impact demographics by reducing family size.

Increasing household income and economic growth through more equitable opportunities plays a vital role in addressing demographic growth. Finally, removing barriers to, and encouraging the continuation of, girls’ education into secondary level will reduce early marriage and fertility rates.

The development hypothesis underlying DO2 is that if the key drivers of fertility begin to shift, then Uganda will begin to reap benefits from a true demographic transition. The key drivers that fall under USAID’s manageable interest are the adoption of safe and effective reproductivehealth practices, improved child wellbeing, improved girls’ education (referring to both retention and literacy) and increased youth economic productivity.

7 Uganda Health Demographic Survey

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Intermediate Results under DO2 are outlined below, with technical/sector alignment per IR detailed in Annex 3.

IR 2.1: Adoption of Healthy Reproductive Behaviors and Practices Increased

The low use of modern contraception, combined with high unmet demand, results in increasingly high birth rates . USAID will promote the adoption of reproductivehealth behaviors and practices supportive of reduced household poverty and improved health using a multipronged approach.

Increasing access to reproductive health services, including voluntary family planning, has been shown to have profound health, economic and social benefits for families and communities, such including mitigating the negative impacts of unsustainable population growth on economic opportunity, the natural resource base, and government stability.

USAID will empower adolescent girls to make informed reproductive/healthy behavior choices through enhanced communication and education on reproductive health issues, as well as reinforcement of positive social behaviors and training in life skills and decision making. With the high rate of fertility prevalent among women in Uganda, it is also critical to address the reproductive health needs of HIVinfected women in ways that are inclusive and provide opportunities for informed choice.

Because fertility rates do not decline unless women and couples voluntarily choose to have smaller families and have access to health services that allow them to do so, access to family planning services will be expanded through a variety of activities such as increasing the choice of contraceptive products and reproductivehealth services provided; reducing physical and financial barriers to the use of health care services for specific populations, including adolescents and youth; integrating family planning into HIV/AIDS and other health services; and implementing highimpact facility and communitybased interventions.

Health communication plays an important role in improving health status on a sustainable basis by encouraging individuals, families and communities to adopt healthier lifestyles and positive healthseeking behaviors. Using a combination of evidencebased and bestpractice health communication strategies, including targeted media, interpersonal communications, community mobilization, USAID healthcommunication activities will build on past successes and also directly support the achievement of IRs 1.3 (enhanced disease prevention and treatment) and 1.4

(increased and diversified community and household assets); 2.2 (improved child wellbeing) and

2.3 (improved girls’ education); and especially 3.1 (development leadership supported) and 3.2

(active citizen participation in development).

IR 2.2: Child WellBeing Improved

While many subSaharan African couples still desire large families, cultural norms related to family size are changing, and research indicates that couples will choose to have smaller families when they know that each child has a better chance of surviving. When parents have fewer children, 8 Demographers and health professionals use the term “unmet need” to indicate the number or percentage of married women who say they prefer to avoid a pregnancy but are not using any method of contraception.

9 Shareen Joshi, reproductive Health and Economic Development: What Connections Should We Focus On?

USAID/Uganda CDCS 2.0 Results Framework Paper 14 they are better able and often more willing to invest in their children’s health, education, and wellbeing. Under IR 2.2, USAID will sharpen its focus on highimpact bestpractices for lowering neonatal and child mortality. In 2010, the most commonly diagnosed causes of underfive mortality included neonatal deaths (28 percent), malaria (13 percent), pneumonia (16 percent), and diarrhea (10 percent), while undernutrition contributed to 50 percent of these deaths.

Programs will also strengthen child protection systems so that children especially the most vulnerable, such as orphans can live lives free of violence, exploitation and sexual abuse. USAID will also work to ensure that children not only survive, but also thrive, through improved child protection case management, including response and referrals. Programs will help to prevent and respond to violence, exploitation, and neglect, as well as strengthen child protection policies.

Child wellbeing must start at the household and activities must emphasize familycentered socioeconomic care with a focus on strengthening families as primary caregivers of children.

Ensuring prioritized, focused interventions that address children’s most critical needs is a crosscutting effort that starts with improved parenting skills, improved nutrition and community networks that link the household to community services including health and education.

In 2013, the GOU committed to an intensified plan for increasing child survival, called “A Promise

Renewed.” In support of GOU’s strategic shifts and in line with Presidential Initiatives including

PEPFAR, USAID will focus geographically on districts where HIV/AIDS prevalence is high, and where the most underfive deaths occur. Activities will focus on highburden populations through the scaleup and integration of service delivery packages at the community and facility level.

Interventions will target those at highest risk to prevent disease, and will adopt a multisectoral approach to harness the structural and social determinants of health.

Given the close correlation of child wellbeing with education and health, IR 2.2 will directly support the achievement of IRs 1.1 (key drivers of vulnerability addressed), 2.1 (adoption of healthy behaviors and practices), 2.3. (improved girls’ education), and 3.1 (development leadership supported).

IR 2.3: Girls' Education Improved

Empirical research conclusively links girls’ education to reduced fertility rates, lower infant and child mortality rates, lower maternal mortality rates, improved nutrition, protection against

HIV/AIDS infection, reduced rates of early marriage, increased women’s labor force participation rates and earnings, increased political participation, and a “virtuous circle” of intergenerational education benefits. Despite this, United Nations Educational, Scientific and Cultural Organization

(UNESCO) estimates that 68 percent of children in Uganda who enroll in primary school are likely to drop out before finishing the prescribed seven years. USAID will support investments in highquality education, increased literacy and retention in schools, and cuttingedge workforce development to create a skilled and efficient workforce that is capable of meeting the labor needs of the economy.

USAID will continue to strategically focus education resources to support earlygrade literacy as the basis for girls’ and boys’ success and retention in school, and for the multitude of health and

USAID/Uganda CDCS 2.0 Results Framework Paper 15 http://www.unesco.org/new/en/dakar/about-this-office/single-view/news/42_of_african_school_children_will_drop_out_before_the_end_of_primary_education/#.VSfJ5vAqiCk other socioeconomic benefits demonstrated to follow from girls’ education. To further improve retention, USAID will also invest in an improved learning environment for girls by ensuring there are motivated and trained teachers, an evidencebased curriculum, quality teaching materials, adequate and private sanitation facilities , and protection from sexual violence. In addition, USAID will engage local communities and empower them to participate in the education and safety of their children. Ensuring that schools are safespaces is an integral part of improving girls education in Uganda.

Girls’ education is critical to Uganda’s longterm development prospects, and therefore achievement of this IR also directly contributes to the achievement of IRs 2.1 (adoption of healthy behaviors and practices), 2.2 (improved child wellbeing), 2.4 (increased youth economic productivity), as well as 3.1 (development leadership supported) and 3.2 (active citizen participation in development).

10 An estimated 30 percent of girls leave school when they start their periods, often because of a lack of sanitary pads.

USAID/Uganda CDCS 2.0 Results Framework Paper 16 http://www.newvision.co.ug/news/645725-30-of-girls-leaving-school-for-lack-of-sanitary-pads.html http://www.newvision.co.ug/news/645725-30-of-girls-leaving-school-for-lack-of-sanitary-pads.html

IR 2.4: Increased Youth Economic Productivity

The youth bulge, combined with high rates of unemployment and economic dependency, perpetuates the cycle of poverty. Whether Uganda’s burgeoning population is a “demographic dividend” or an incipient threat to national stability is dependent to a great…