We define “Sickle Cell Livelihoods” as the capacity and capability of patients and their households to acquire the necessities to live and thrive with sickle cell. Sickle Cell Disease negatively affects livelihoods. There is significant economic burden faced by patients and their household due to out-of-pocket healthcare expenses, and lost income due to work absenteeism. In many SSA countries, up to 80% of SCD-related health costs are paid out-of-pocket (World Bank, 2021). Families often resort to borrowing, selling assets, or taking children out of school to pay for healthcare. Mothers are often the primary caregivers, bearing the brunt of unpaid care work. They experience strain, hardship and disrupted employment. In Kenya, caregivers (especially mothers) often miss work or drop out of the labour market entirely. A study in Kisumu Kenya (Oyieko et al., 2022) found 65% of caregivers lost more than 10 working days/month and 72% reported income reduction. A Ugandan study (Ndeezi et al., 2018) found that 78% of mothers of children with SCD had reduced work hours or lost jobs, compared to only 24% of fathers. These women often become economically dependent on spouses or family, increasing financial vulnerability and stress. Frequent absences due to chronic illness and disabilities cause barriers to employment and education. Limiting attainment and competitiveness in the job market. Children with SCD miss an average of 20–40 school days per year due to pain crises or hospitalizations (WHO Africa, 2023). Adolescents with SCD often drop out of school due to pain, stigma, or unaffordability, reducing their future earning potential. In Nigeria, 41% of youth with SCD aged 15–24 were not in education, employment, or training (NEET) (Osagie et al., 2022). Employer discrimination limits potential and employment opportunities for adults with SCD. A 2021 study in Tanzania showed that employers perceive people with SCD as “unreliable” due to frequent sick leave, reducing their chances for employment and promotion. Low income is significantly associated with food insecurity. In Kenya, Ghana, Nigeria, and Uganda, caregivers report skipping meals to afford hospital visits or medications. People with SCD have increased basal metabolic rates (up to 16–20% higher than peers) due to chronic haemolysis and elevated energy use for red blood cell production. SCD patients need to maintain healthy weights and strong immune systems. This requires 3+ healthy nutritious meals daily. A 2022 study in Uganda found tha 60% of families with a child with SCD experienced moderate to severe food insecurity, which was strongly associated with increased hospitalization due to infections and crisis episodes.(Ndeezi et al., 2022). Many families cannot consistently afford well balanced meals for SCD. The combination of chronic illness, healthcare costs, job loss, and limited education creates a cycle of poverty for families affected by SCD, particularly in rural or underserved areas. To address this need ASCO established The Sickle Cell Livelihood Fund.