Applying a Family-Level Economic Strengthening Intervention to Improve Education and Health-Related Outcomes of School-Going AIDS-Orphaned Children: Lessons from a Randomized Experiment in Southern Uganda

Abstract

Children comprise the largest proportion of the population in sub-Saharan Africa. Of these, millions are orphaned. Orphanhood increases the likelihood of growing up in poverty, dropping out of school, and becoming infected with HIV. Therefore, programs aimed at securing a healthy developmental trajectory for these orphaned children are desperately needed. We conducted a two-arm cluster-randomized controlled trial to evaluate the effectiveness of a family-level economic strengthening intervention with regard to school-attendance, school grades, and self-esteem in AIDS-orphaned adolescents aged 12–16 years from 10 public rural primary schools in southern Uganda. Children were randomly assigned to receive usual care (counseling, school uniforms, school lunch, notebooks and textbooks), “bolstered” with mentorship from a near-peer (control condition, n=167), or to receive bolstered usual care plus a family-level economic strengthening intervention in the form of a matched Child Savings Account (Suubi-Maka treatment arm, n = 179). The two groups did not differ at baseline, but 24-months later, children in the Suubi-Maka treatment arm reported significantly better educational outcomes, lower levels of hopelessness, and higher levels of self-concept compared to participants in the control condition. Our study contributes to the ongoing debate on how to address the developmental impacts of the increasing numbers of orphaned, and vulnerable children and adolescents in sub-Saharan Africa, especially those affected by HIV/AIDS. Our findings indicate that innovative family-level economic strengthening programs, over and above bolstered usual care that includes psychosocial interventions for young people, may have positive developmental impacts related to education, health, and psychosocial functioning.

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

“…A broad consensus is emerging to suggest the need to differentiate between the impairments inflicted by poverty [134] and the avenues to address poverty, which include conditional and unconditional incentives (i.e. cash transfers); food security and livelihood support; and social protection programmes [135,136]. Social protection is generally understood as public actions to address poverty, economic shocks, and social vulnerability [137].…”

Effects of Financial Incentives on Saving Outcomes and Material Well‐Being: Evidence From a Randomized Controlled Trial in Uganda

“…In Uganda, the geographical focus of our study, Child Development Accounts (CDAs) in particular, along with financial education workshops and mentorship, have been associated with improved school performance (Curley, Ssewamala, & Han, ; Ssewamala & Ismayilova, ; Ssewamala et al., ), reductions in sexual risk‐taking behavior (Ssewamala, Han et al., ), decreases in depressive symptomology (Ssewamala et al., ; Wang, Ssewamala, & Han, ), and improved mental health functioning among adolescents affected by AIDS (Han, Ssewamala, & Wang, ; Ssewamala, Han, & Neilands, ). In the United States, CDAs have demonstrated positive effects on children's socioemotional development (Huang et al., ), students’ math scores (Elliot, Jung, & Friedline, ), and college enrollment and completion (Elliot, Song, & Nam, ).…”

A School Support Intervention and Educational Outcomes Among Orphaned Adolescents: Results of a Cluster Randomized Controlled Trial in Kenya

“…Orphans are at increased risk for poor educational outcomes, with inadequate household funds for educational expenses being one of the most common reasons for school absence and dropout (Bicego, Rutstein, & Johnson, 2003; Case, Paxson, & Ableidinger, 2004; Evans & Miguel 2007; Ssewamala et al, 2016). At the same time, school may be particularly important for orphans.…”