2010-2011 UNAIDS UBW World Food Programme (WFP) Broad

2010-2011 UNAIDS UBWWorld Food Programme (WFP)Broad Activity Achievement Report

WFP Broad Activity Achievement Report [2010-2011 UNAIDS UBW] Page 1 of 10

2010-2011 UNAIDS UBW World Food Programme (WFP)

Broad Activity Achievement Report

WFP 2010-2011 Total Expenditure

Total 2010-2011 Budget

2010-2011 Expenditure

Core Supplemental Global and Regional

Expenditure Country level expenditure TOTAL

243,712,034 8,738,000 24,608,178 4,896,866 218,845,366 257,088,410

Broad Activity 1: Provide evidence based technical support for the integration of food and/or nutrition security

Achievements

In 2011 WFP reached 2.5 million beneficiaries in its HIV and AIDS programmes, including children, in 47 countries. Beneficiar ies benefited from nutritional rehabilitation activities, safety nets or a combination of

these either through health facilities or communities, mitigating the burden of HIV on infected individuals and affected households. Many PLHIV may also benefit from other WFP programmes that do not explicitly

target them, but other family or community members: examples include school feeding and food-for-assets programmes.

WFP’s new HIV and AIDS policy was approved by the WFP Executive Board and endorsed by UNAIDS in late 2010. The policy guides WFP’s work in line with the UNAIDS five year Strategy (2011-2015). It aims

to ensure that people living with HIV (PLHIV) as well as people who are being treated for tuberculosis (TB) receive nutrition assessment, education and counselling (NAEC) and, when they are malnourished and/or

food insecure, appropriate food support.

In order to monitor the implementation of its new policy, WFP developed a Monitoring and Evaluation Guide, which defines the main HIV and AIDS programming categories and results frameworks. In West Africa,

11 countries were trained on the new policy and M&E guideline implementation (Burkina Faso, CAR, Cote d'Ivoire, Guinea, Guinea Bissau, Ghana, Liberia, Mali, Mauritania, Niger, and Sierra Leone). In 2012,

further roll out will take place across all regions.

WFP also developed an E-learning Strategy on HIV, food and nutrition for regional and country level staff and partners. Two web-based packages were developed and launched in 2011 in response to the

Executive Board's recommendation to develop the skills for HIV programming within WFP.

WFP worked with universities and WHO to review the evidence related to nutrition and HIV, nutrition and TB, and food insecurity and HIV. Three background papers summarizing the state of the evidence have

been published in the Food and Nutrition Bulletin Supplement: Nutrition and Food Insecurity in Relat ion to HIV and AIDS and Tuberculosis, 2010; 31: S289-S364. At the regional level, WFP published a study;

“Food Insecurity and Nutritional Barriers to Antiretroviral Therapy: Lessons from Latin America and the Caribbean”. Results of the study indicate that food insecurity and under nutrition are closely linked to quality

of life, health status and access and adherence to antiretroviral therapy in the region.

WFP highlighted South-South Cooperation in the area of HIV and Nutrition at the Global South-South Development (GSSD) Expo held in Rome, December 2011. The Lao PDR-Thai-Australia Collaboration in HIV

Nutrition (Lao-TACHIN) received a South-South Cooperation Award for Partnership during the GSSD Expo for its leading work with a triangular partnership in the area of HIV and nutrition. The ‘South-South’

collaboration is the result of project implementation between Thailand and Lao PDR. This collaborative project is directed towards building the capacity of Champasak Provincial Hospital and Dreaming of a

Brighter Future (DBF) PLHIV support group, in the area of HIV and nutrition. The project has expanded to include additional support to Savannakhet Provincial Hospital and LNP+ to integrate nutrition into HIV

services and nutrition education into monthly support groups nationally.

In Latin America and the Caribbean, WFP provided technical support to the Ministries of Health in 9 countries (Bolivia, Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Panama

and Peru) to facilitate the development and validation of guides, protocols and manuals. 4 of these countries had already published materials; 3 of these countries published their materials in 2011; and two


countries are still in the development stages.

In Namibia WFP led a food and nutrition security vulnerability assessment of pre-ART clients to inform the development of a national Food-by-Prescription (FBP) programme and consideration of complementary

social assistance (16% were found malnourished though food security challenges appeared limited). A similar rapid assessment was conducted in Djibouti among ART and DOTS clients (the profiling exercise

found malnutrition among 38% of ART clients and TB-DOTS clients).

In Zimbabwe WFP worked with its partner MSF to analyze nutrition information from patient records to determine the proxy need for nutrition rehabilitation services; information which was later used to inform the

nutrition support component of the country’s Round 10 submission to the Global Fund.

WFP’s participation in research partnerships in Zambia (with the Centre for Infectious Disease Research Zambia, CIDRZ) has helped explore the impact of nutritional supplements and household food assistance

on treatment success as well as on social stability and livelihood protection and promotion in clien t’s households. Findings have helped inform Zambia’s Round 10 Global Fund proposal.

A 2011 study on the social vulnerabilities of PLHIV in the Republic of Congo, led by WFP with support from UNAIDS, found that upon confirmation of HIV positive status many people relocate away from their usual

support networks, lose their employment opportunities and struggle to care for children. This study is being reviewed by the Government to inform its Social Protection Policy with regards to the needs of PLHIV.

In collaboration with UNAIDS, WHO and the expert organization HISP, WFP has helped food and nutrition stakeholders in seven selected countries (Rwanda, Kenya, Malawi, Zambia, Zimbabwe, Swaziland,

Mozambique) familiarize themselves with routine patient information systems with the aim to identify opportunities for greater integration of nutrition indicators and comprehensive information management. The

exercise has built further momentum in aligning data systems among national counterparts and pursue integration of nutrition information rather than maintaining separate mechanisms; thus allowing for enhanced

programme management and evidence building around nutrition intervention effectiveness.

The benefits of solid information management are shown in Ethiopia’s Results Based Management database which showcases that nutrition support to PLHIV on treatment contributes to a high drug adherence of

97%, while OVC who received food assistance were able to attend school during 99% of schooldays. Such information, showcasing intervention success, offers critical information for national strategy

development and programme design.

In Asia, WFP signed an MOU with the Thai Red Cross. This partnership will be leveraged to train WFP staff and counterparts. A first pilot training conducted in 2010 focused on training government officials and

WFP staff from Bangladesh, Cambodia, India, Lao PDR and Timor Leste, as well as counterparts from WHO, UNICEF and UNAIDS. This was followed by several additional trainings in 2011 which were attended

by staff and implementing partners from other regions. In late 2011, the partnership has embarked on planning qualitative research to develop a new food product targeted toward malnourished PLHIV.

Lessons learned

In 2010, WFP LAC published the report: “Evaluating the Integration of Food and Nutrition with HIV/AIDS Policies in LAC,” which explores the extent to which national HIV/AIDS policies in LAC incorporate nutrition

and what progress can be observed in advancing this theme since the last policy was published. Findings revealed that LAC governments have not comprehensively incorporated food and nutrition into their

national HIV and AIDS plans, and that there exists an overall lack of knowledge about the issue at the policy making level

Most countries in the region are still in the earliest stages of policy formation in this area and those countries that are farther along in the implementation process may not be backed by an articulated policy

approach. However, with the support of WFP, there has been strong progress towards advancing the HIV and nutrition agenda in recent years, as evidenced by the adoption of national norms, protocols and

guidance on the subject in a number of countries.

Evaluation

In view of the greater need to improve and standardize outcome and impact indicators for food and nutrition interventions in HIV and TB, WFP, WHO, FANTA and PEPFAR worked on a set of global indicators for

elements such as nutrition care and HIV, PMTCT and food security and HIV. These indicators were reviewed by the MERG convened Indicator Review Panel for finalization in early 2012. Subsequent rollout of these

indicators will be undertaken in 2012.

A challenge in implementing livelihood programs is developing robust M&E system to evaluate the impact of the interventions. While the importance of these types of interventions is well recognized, adequate

indicators and means of disseminating lessons learned about these interventions are more difficult.

Expenditure

Core Supplemental Global/Regional Resources Total

$925,000 $1,150,876 $590,700 $2,666,576


Broad Activity 2: Ensure that the food and nutrition needs of PLHIV and AIDS affected households are integrated into national social protection and food security programmes, applying social safety net mechanisms (food, cash, and vouchers) and livelihood promotion strategies.

Achievements

In 2011, WFP reached 1.2 million households members affected by HIV. In Zambia and Zimbabwe food assistance programmes using electronic vouchers were elaborated following the early 2009 Zambia pilot

scheme. Household food assistance as well as other benefits (in Zambia a bar of soap is provided through the same voucher, financed by UNCEF) is provided to care and treatment clients (ART, TB, PMTCT) who

are malnourished and/or food insecure to protect household care and productive capacity during client recovery while also enhancing the wellbeing of the client. The voucher schemes serve as model for national

learning and possible future replication within national social protection strategies.

In Ethiopia, Kenya and Tanzania, livelihood opportunities are offered to care and treatment clients and AIDS affected households in conjunction with household food assistance. Ethiopia’s ‘back-to-work’ approach

allows people to explore alternative income earning opportunities in a largely urban context.

Household assistance to Care and Treatment clients complementary to individual nutrition support has also been provided in Burundi, Djibouti, DRC, Ethiopia, Ghana, Kenya, Malawi, Mozambique, RoC, Somalia,

Tanzania, Uganda, and Zimbabwe.

In West Africa, Burkina Faso and Cote d’Ivoire received support to look into setting up linkages with national social protect ion and food security programme and livelihood promotion strategies. Results of the

activity in Cote d’Ivoire are not yet available, however in Burkina Faso, WFP provided support to a total of fifteen income generating activities reaching two-hundred and thirteen HIV-affected households.

In LAC WFP included PHIV in the 2010 “Study on the Scope of Social Protection Networks in Central America and the Dominican Republic,” which made key principle recommendations for HIV programmes , that

have been incorporated into WFP’s regional 2011-2012 HIV and nutrition strategy.

Building on a renewed partnership between WFP and PEPFAR in Ethiopia, a voucher based support scheme was prepared for roll out in 2012 to facilitate urban PLHIV’s access to basic food products to maintain

a healthy and socially stable live while engaging in livelihood recovery.

In Asia, advocacy was conducted and technical assistance provided to ensure nutrition, livelihood activities and social protection are integrated in the revision of the national strategies on HIV in 4 countries.

(Bangladesh, Cambodia, India and Lao).

Lessons learned

Countries in West Africa reported that joint programming with UN and NGO partners is paramount in order to guarantee that resources for social protection and food security programmes will be available in a

timely manner to complement WFP HIV programmes.

The introduction of Nutrition Assessment Counseling and Support approaches (including Food by Prescription) has re-emphasized systems strengthening and institutional capacity enhancement in the health

sector. Although it is recognized that complementarity is needed with social assistance and livelihoods protection and promotion, these areas are less well developed.

Evaluation

The evaluation of WFP’s protracted relief and recovery operation in Ethiopia concluded that WFP’s partnership with and management of a large network of community based organizations in some of Ethiopia’s

large urban areas was commendable and a potential model for similar approaches across the region. The NGOs/CBOs are supported in their assistance to PLHIV and AIDS affected households building on their

respective strengths, while food handling, often considered to be a distracting and overburdening activity, was managed by a third party with appropriate skill and infrastructural capacity (often local government).

The WFP programme portfolio evaluation in Kenya in 2011 highlighted the importance of addressing livelihood recovery in conjunction with physical recovery. While the AMPATH-WFP-PEPFAR partnership

provides an all-inclusive approach, several NGO supported Nutrition Assessment Counseling and Support (NACS) programmes based in Government clinics require further investment in developing adequate

linkages to community based asset creation, training and productivity enhancing activities.

A similar portfolio evaluation in Zimbabwe concluded that for social and productive safety nets to effectively complement nutrition rehabilitation, they need to be informed by separate routine needs assessments.

Household assistance, though associated with the treatment/care success of ART, TB and PMTCT clients, should be clearly linked to livelihood recovery both in terms of type of activity and finite duration of

support.

In July 2011, WFP LAC conducted an evaluation “Nutritional Support for People Living with HIV & Receiving ART in Bolivia: Mid-term Project Evaluation,” to evaluate project progress, including the activity

involving establishment of a pilot transition strategy to support sustainable livelihood solutions, long-term nutritional recovery and ART adherence.


Related Case Study: The Macroeconomic Impact of HIV in Cambodia

Expenditure


$1,500,000 $14,598,183 $550,879 $16,649,062

Broad Activity 3: Support integration of comprehensive nutrition within care and treatment programmes though the provision of food and nutrition assistance for nutrition rehabilitation and improved treatment success of patients on ART and documentation and sharing evidence and best practice.

Achievements

In 2011, WFP reached almost 2.0 million beneficiaries through care and treatment programmes. WFP Kenya, Lesotho, Malawi, Mozambique, Rwanda and Swaziland invested extra efforts in staff and partner

training on Food-by-Prescription (FBP) principles, developed materials and supplied equipment to enhance the use of anthropometric measures in clinic based nutrition assessment.

In 2011, the Swaziland Ministry of Health and the National Nutrition Council rolled out a comprehensive nutrition intervention which provides fortified blended foods on the basis of clinically confirmed malnutrition

(use of anthropometric criteria): Food by Prescription in conjunction with routine Nutrition Assessment, Education and Counseling (NAEC) and household support.

In Ethiopia, Lesotho, Zimbabwe and Djibouti, WFP consulted with partners to re-strategize its HIV support programmes away from the original relief and recovery approach towards increased integration of food

and nutrition services within the health sector’s care and treatment programmes. Food-by-Prescription principles were introduced encouraging NAEC and the prescription of nutritional supplements for nutrition

rehabilitation while also providing complementary household food support. Commonalities in nutrition rehabilitation principles between maternal and child health programmes and HIV and TB related services

increasingly call for convergence in strategy, protocol and services delivery mechanisms.

In Mozambique the nutrition support to HIV and TB related patient groups will be fully integrated within the national nutrition rehabilitation programme (PRN).

In Kenya, WFP partners with Family Health International (FHI) in the provision of complementary food and nutrition support to PLHIV on ART (FHI provides individual supplements while WFP provides the

household support). A research partnership with FHI AED to explore the relative impact of individual and household food assistance is also under discussion.

WFP and RAND Health collaborated with national actors to develop operational research and pilot initiatives for PLHIV in Honduras and Bolivia. The initiatives aim to demonstrate the effectiveness of integrating

food and nutrition strategies with ART and PMTCT to increase treatment adherence, improve treatment outcomes, and support nutritional health.

In West Africa, 11 countries (Burkina Faso, Central African Republic, Cote d’Ivoire, Guinea, Guinea Bissau, Ghana, Liberia, Mali, Mauritania, Niger, and Sierra Leone) implemented nutrition programmes in support

of ART. Regular M&E results and anecdotal evidence from implementing partners have shown that in general, nutrition support enhances treatment success and better nutritional status reduces mortality risk

especially in the first months of the initiation of the treatment.

In East and Southern Africa, WFP implemented PMTCT activities in Congo, Ethiopia, Lesotho, Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zambia.

WFP explored possibilities for integration of nutrition support to PMTCT with MCHN for alignment with national intervention strategies (Mozambique, Rwanda, Zambia,). This involves consultation with Government

counterparts, review of national PMTCT and MCH strategies and operational considerations with implementing partners at all levels.

In Cambodia to promote positive nutritional behavior among PLHIV and the use of the ‘Good Food Toolkit’, a series of refresher trainings were conducted for the Self -Help Groups/Home-Based Care Team

(SHG/HBC) operated by the Caritas, Save the Children and Cambodian HIV and AIDS Education and Care (CHEC) in f ive provinces. Knowledge gained from the above trainings has been translated into close

follow-up of the BMI status by the SHG/HBC through the BMI Assessment Approach.

Lessons learned

In East, Central, and Southern Africa regions, WFP has effectively engaged the support of strong and sustainable community-based implementing partners. However, client selection appeared inconsistent and

linkages to complementary livelihood services were found to be weak.

A key issue that has emerged from East Africa as a result of the ongoing monitoring Food by Prescription (FBP) programmes in Kenya are the relatively large number of people (up to 15-20%) relapsing into a

state of malnutrition well after they have recovered on FBP and having stabilized on ART. The causes for this relapse are not yet well understood but are thought to be associated with both failure to do well on first

line treatment, lack of long term adherence to the drug regimen or possibly the underlying poverty and food insecurity of the client and household.


Further analysis and interpretation are required. A possible misinterpretation of re-enrollment of pregnant and lactating women into the programme when actually newly pregnant should also be carefully reviewed.

Operational challenges such as those highlighted in the Rwanda programme evaluation are also critical for further review in 2012-13 such as to facilitate the integration of nutrition services within national health

and social sector programmes.

Given the increasing nuance in the nutrition rehabilitation protocols for ART-clients questions are raised regarding the effectiveness of different food products available for this purpose.

As most products in use were originally designed to address malnutrition in children, their appropriateness for use among adults is questioned, both on nutritional grounds as well as palatability considerations. As

advanced ready to use products (RUFs) come at a considerable cost to the programme, the actual consumption of these products is to be carefully monitored. Combination ‘treatments’ using both RUFs and

Fortified Blended Foods are currently being tried by practitioners in several countries.

Evaluation

The evaluation of the country portfolio of WFP in Rwanda highlighted some critical operational challenges often observed in the introduction of nutrition support in clinical programmes. Challenges included food

handling and supply management of small quantities to a large number of scattered clinics, routine and reliable nutritional assessment, education and counselling, and delayed discharge due to general food

insecurity considerations even though clients were no longer malnourished. A similar evaluation of WFP’s development programme in Tanzania found that food provided through HIV/AIDS interventions has

reduced stigma among HIV-positive individuals, improved the food and livelihood security of beneficiaries, improved weight gain and adherence to treatment regimes.

IFPRI research activities in partnership with The AIDS Support Organization (TASO) in Uganda (a long term partner to WFP) showed that food assistance to PLHIV not yet on ART had a significant positive

influence on weight gain.

Related Case Studies

Djibouti Rapid Assesment

Integration of Food and Nutrition in Treatment Programmes_East, Central and Southern Africa

Madagascar TB ppt

Namibia ART VAM assesment

ROC VAM Study

Swaizi ART Poster

TACHIN

Uganda

Expenditure


$3,000,000 $5,000,000 $981,500 $8,981,500

http://ubw.unaids.org/RWSERVICES?/Applications/UBW2008/ReportBAAByAgency









Broad Activity 4: Provide technical assistance and training to the health care sector and develop appropriate procedures for the integration of food assistance and nutritional support (i.e. specific food supplements) in HIV/TB the three I's and assess its impact.

Achievements

Overall in 2010-2011, WFP provided nutritional TB treatment support to 28 countries representing 30 percent of all food based support in care and treatment. The food was provided as individual and/or household

rations, reaching nearly a million beneficiaries.

In 2011 WFP started to work with private sector and academic partners to develop a new product more suitable for treating moderate acute malnutrition amongst adult PLHIV/TB on treatment. The collaboration

first seeks to conduct qualitative research to improve our knowledge of which product types, textures and flavours are mostly preferred by adults in the early stage of treatment, both in an Asian and African

context. Based on this research, 1-2 products with appropriate nutrient composition for treating wasting among adults will be developed.

In most countries in East, Central, and Southern Africa, discussions and programme review activities in context of Food-by-Prescription have also reached out to TB programmes, seeking increased convergence

and alignment of approaches. Continued programme rationalization will show greater integration of different treatment groups into common nutrition support services.

Key achievements have been made in the recognition of the role of nutrition support in conjunction with TB-DOTS in and Djibouti and Swaziland, where food and nutrition support were included in the Round 10

Global Fund TB proposals, both of which were endorsed. Following WFP’s critical technical support to the proposal development, Governments of both countries have also requested that WFP play an important

role in the design and implementation of integrated food and nutrition activities

WFP’s programme in Madagascar has changed its approach towards more routine nutrition assessment and provision of specialized products to accelerate nutrition recovery of TB-DOTS clients receiving their

drugs during daily clinic visits. Staple food products continue to support the household during the client’s recovery process.

Food assistance to TB patients in Malawi is also being aligned with the national Food by Prescription approach already in place in most ART sites and in 2012 will shift from a household treatment support package

to a nutrition rehabilitation approach.

In an effort to integrate food assistance and nutritional support in HIV/TB programmes, technical assistance and training were provided in Guinea, Ghana and Sierra Leone. In Guinea 60 health sector staff

members were trained in M&E. The training module included indicators for food/nutrition programmes for PLHIV and TB, collection of data, and M&E forms

In Asia, Bangladesh, Cambodia, India, Lao and Myanmar have integrated TB/HIV co infection into current HIV activities including providing regular updates to HIV focal points across the region about

programmess integrating food and nutrition support into HIV/TB care and support.

In Sudan food vouchers for TB programmes were piloted in two states in Northern Sudan (7000 patients) to facilitate an easy transition of ownership by the national authorities.

In Georgia, WFP provided technical assistance to the Georgian National AIDS Programme, the National TB Programme and key stakeholders to develop a national strategy on nutrition support for PLHIV/TB in

Georgia

Lessons learned

Food assistance programming in support of TB has traditionally focused on the incentive effect of the food basket in supporting regular return of clients to the clinic for follow up screening and repeat prescriptions.

Increased appreciation of the disease-nutrition interactions as well as the drug-nutrition interactions are calling for greater understanding and associated programming of targeted nutrition interventions.

WFP in Sudan reported that a continuous follow-up is needed to ensure the newly acquired knowledge on nutrition, HIV, and TB is brought into practice by the TB patients. There is also a need to understand the

nutritional values of locally grown food to integrate them as part of the nutrition counseling package. Support to the Ministry of Health is required to develop nutrition guidelines and protocols for children,

adolescents and adults that are applicable to South Sudan because unless WFP provides the food and nutrition assistances, the government is not ready to take over these responsibilities as the whole care

package for HIV in country is still at the early stage of development and implementation.

Evaluation

An impact evaluation study in Madagascar was completed in 2010. The research paper is still pending with the academic research institute involved, however preliminary findings shared in March 2010 indicate

that over the study period 2004-2009, food assistance had a positive influence on defaulting (6.27% reduced risk among those who received food assistance) and on cure (7.04% increased chance

Although food assistance has not had a proven influence on weight gain, it appears to have greatly increased treatment uptake, particularly in urban areas (+125% in study period). The role of food appears to be

more associated with a social safety net than a nutrition supplement to the patient. It was suggested to rationalize the food basket (currently the size of one person’s daily requirements only) and to introduce

comprehensive nutritional assessment using both weight and height because currently only weight is documented.


Related Case Studies: Madagascar: Do food assistance programmes improve TB treatment outcomes

Expenditure

Core Supplemental Global/Regional Resources Total $1,200,000 $847,834 $307,900 $2,355,734

Broad Activity 5: Provide technical and programme support to facilitate integration of food security and nutrition as part of social protection response for children; build evidence and expand innovative partnerships to address livelihoods needs.

Achievements

Support to children affected by HIV (OVC) is provided through schools, community and vocational skills centers, care homes and, mostly, through community and home based assistance.

With a shift in programme portfolio in Lesotho, where WFP OVC food assistance complemented cash grants provided by UNICEF; OVC support was terminated in 2011. WFP has refocused on addressing high

chronic malnutrition among children in Lesotho, improving the quality of nutrition rehabilitation services and strengthening Early Child Care and Development through preprimary school activities.

In Swaziland food assistance to children attending early childhood care and development services through neighborhood care points (NCPs) is increasingly managed through a division of labor between WFP and

World Vision, overseen and financed by the national AIDS Authority NERCHA. WFP’s support to OVC in Mozambique will continue to complement the national social protection framework through its focus on

community based management of social welfare.

WFP provided technical and programme support to Benin, Central African Republic, Cote d’Ivoire Ethiopia, Kenya, Lesotho, Malawi, Swaziland, and Tanzania to implement social protection activities for children.

An innovative approach in CAR allowed for children to remain with foster families but under the supervision of a specialized instructor that provides food and other needed support to the foster families. This

approach guarantees that the children remain in a family environment while they benefit from care and other services provided by the relief organization. In addition, this approach can play a role in prevent cases

of child abuse encountered in some foster families.

In Cambodia, technical assistance is mainstreamed through series of consultations with the Ministry of Social Affairs (OVC Taskforce meetings and Consultancy), Veterans and Youth Rehabilitation, WFP and

UNICEF, in which, food and nutrition has been included in National Standards for the Care, Support and Protection of Orphans and Vulnerable Children. This National Standard will provide guidance about the key

needs of children and help to advocate for service providers to implement consistent, quality, evidence-based activities that will improve the lives of children, especially the orphans and vulnerable children and

their families. Partners such as CHEC, KHANA, and Caritas have substantially promoted the above linkage to address livelihood needs in many provinces.

Lessons learned

In Cambodia, WFP food assistance provided to the orphans and vulnerable children (OVC), together with NGO partners that also provide integrated livelihoods/income generation support and other human basic

minimum needs as mentioned in the National Social Protection Strategy, has built good precedents in the development of the national standard for OVC.

Lessons from Sudan included that caregivers need counseling to address special needs of affected OVC. In areas where stigma is high, orphans impacted by AIDS are at a higher risk of dropping out of school to

support families and/or fend off chronic hunger. While food assistance provides leverage to partners to follow up on children, involvement of social workers enhances the outcome.

Strong advocacy is also needed so the social welfare department and community address the needs of the growing number of OVC to complement food and nutrition security furnished by the aid agencies.

Additionally, addressing food security in households with AIDS impacted orphans should be part of the prevention and care strategy.

Evaluation

Although WFP in Zimbabwe does not support OVC specific food assistance programmes, it was found that 80% of the families supported through its relief and recovery programme for ‘highly vulnerable households’

host orphaned children.

Related Case Studies: Food Assistance and its effect on the Weight and Antiretroviral Therapy Adherence of HIV Infected Adults: Evidence from Zambia


Expenditure


$750,000 $596,997 $304,200 $1,651,197

Broad Activity 6: Mainstream and integrate considerations of PLHIV in emergency preparedness and response framework through advocacy, technical support and partnership developments. Integrate the relationship between HIV and food security/nutrition into emergency response and interventions utilising assessment tools such as Vulnerability and Assessment Mapping (VAM)

Achievements

In March 2011, in line with the new UNAIDS DoL, the UNAIDS Secretariat transferred the responsibility of representing HIV and AIDS (as a cross-cutting issue within the global humanitarian coordination

mechanism - IASC) to the two cosponsors leading this thematic area, i.e. UNHCR and WFP. The IASC task force on HIV was disbanded following at the 79th IASC working group meeting in July, 2011

The DoL area ‘Addressing HIV in Humanitarian Emergencies’ lays the foundation to ensure the special needs of PLHIV and their families in emergencies are taken into account in major humanitarian crises. The

DoL area is now being implemented through an IATT both at the global and regional level. Potential interventions go far beyond WFP’s traditional expertise on food and nutrition and speak to our broader

humanitarian mandate. Typical issues are maintaining the supply chain for antiretroviral medication, access to health care as well as access to prevention and broader care and support services

Support to PLHIV was integrated in DRC and Somalia emergency operations, Kenya, Tanzania and Zambia refugee operations, Zimbabwe and Uganda protracted relief and recovery and Kenya’s protracted relief

and recovery operation for arid and semi-arid regions.

Through it emergency operation in Haiti, WFP reached 92,000 HIV positive beneficiaries in its post-earthquake response. This includes both a safety net as well as a Food by Prescription activity. WFP also

participated in the CERF in Honduras, providing family rations to 460 PLHIV for three months.

Joint collaboration with UNHCR and UNAIDS was initiated end of 2011 to support country-level workshops for the dissemination of IASC guidelines for addressing HIV in Humanitarian Settings. These guidelines

take into account, among other things, the growing understanding that ART and related medical care can be provided in low-resource settings, including in conflict zones, as well as the latest normative guidance

on food security, nutrition and livelihoods. WFP supported the roll out of the IASC guidelines in Haiti and provided advocacy in the regional humanitarian platform (REDLAC). Colleagues in DRC and Zimbabwe

were actively involved in the initiation and roll out of familiarization training around the Inter-Agency Standing Committee (IASC) guidelines for HIV in emergency settings.

Several workshops for Addressing HIV within the National Humanitarian Response were conducted in Nepal, Sri Lanka, CAR, DRC, Zimbabwe and Panama in order to develop national ownership of the field

guide to integrating HIV into humanitarian situations (UNAIDS, UNDP, UNHCR, WHO, IFRC/RCS, 2009) and translate the recommendations into national policies and strategies. The roll-out of the workshops in

the region will continue to be supported by WFP in 2012-2013.

PLHIV considerations were integrated into emergency operations in Chad and Cote d’Ivoire. In Chad, planned activities were not implemented because of the absence of implementing partners. In Cote d’Ivoire,

5151 malnourished ART clients were provided with nutrition support, resulting in 46% nutrition recovery.

To mitigate the impact of the 2011 floods on vulnerable households affected by HIV and AIDS, an additional 320 MT of food was allocated to PLHIV/OVC households in flood-affected areas under the WFP

Country Programme in Cambodia.

At the country level, ODP has supported the incorporation of HIV, nutrition and emergencies into departmental contingency plans in Colombia, and has supported the implementation of a workshop on HIV and

emergencies with civil society and government actors in Bolivia.

Lessons learned

UNAIDS and WFP collaborated in a joint review of integration of HIV, and food and nutrition responses in emergency settings in Kenya and Ethiopia. The review identified the disconnect in coordination mechanisms as

key challenge as well as the overriding food needs irrespective of HIV status thus making HIV specific targeting difficult.

Evaluation

UNAIDS and WFP collaborated in a joint review of integration of HIV, and food and nutrition responses in emergency settings in Kenya and Ethiopia. The review identified the disconnect in coordination mechanisms as

key challenge as well as the overriding food needs irrespective of HIV status thus making HIV specific targeting difficult. HIV sensitive programming in food and nutrition interventions was highlighted.


Related Case Studies: Protracted Relief and Recovery Operation (Myanmar)

Expenditure


$250,000 $179,331 $367,400 $796,731

Broad Activity 7: Support the provision of HIV prevention services to mobile transport workers through policy guidance, technical support and strategic partnerships.

Achievements

At a regional level, North Star Alliance, which was founded by WFP jointly with TNT, in consortium with partner organizations, is a sub-recipient of a major SADC grant from the Global Fund to address HIV at 32

cross-border locations throughout southern Africa. By the end of 2011, seven Member States had signed MOUs with SADC and health services are being provided through existing Roadside Wellness Centres

while a new fleet of mobile clinics is being outfitted.

By the end of 2011, North Star Alliance was operating 23 Roadside Wellness Centres in 10 countries and welcomed a sixth core partner, PharmAccess. Over 268,405 people visited the clinics, 8120 STIs were

treated (4026 men/4094 women) and 39,740 HIV tests were done (23,797 men/15,943 women) in 2011. WFP continues to play an active role on the North Star Counsel of Strategic Partners (formerly the Board of

Directors) and works closely with the organization in many of its African country offices.

In conjunction with UNAIDS, WHO and Fleet Forum in Geneva, North Star Alliance launched its travelling “Road Show”, a 40-foot model clinic and multi-media exhibition that gives visitors a glimpse of a real

roadside Wellness Centre in Africa.

The UNAIDS Web Communications team featured North Star Alliance twice on the home page when they covered the “Road Show” in February and then again in December for North Star’s partnership with Art

for AIDS International and a series of HIV workshops with truck drivers, sex workers and youth in Zimbabwe.

In Zimbabwe, WFP and North Star Alliance supported a series of HIV prevention workshops led by Art for AIDS International that combined fact-based information, stigma-reduction techniques, group activities and

the creation of individual art collages. The original signed art created by truck drivers, sex workers and youth was reproduced and prints will be sold to benefit girl-friendly activities.

In Southern Africa, the WFP regional logistics team invited North Star Alliance to participate in a strategy workshop to identify ways in which they could work together to improve the health of transport workers and

mitigate the impact of communicable diseases along the transport corridors.

WFP Kenya supported three Roadside Wellness Centres along the northern corridor with contributions from DFID through the UNAIDS joint programme, that provide health services and HIV prevention to long

distance truck drivers, sex workers and community members. The Government of Kenya considers the clinic in Mlolongo to be a model approach and is supporting the combination prevention and treatment for

HIV and a range of both communicable and chronic diseases.

North Star Alliance and WHO/StopTB along with the National TB Programmes in Kenya and Uganda began planning for a 2012 pilot project to test the feasibility of using GeneXpert for the rapid detection of TB in

mobile populations along the northern corridor.

WFP Kenya and ILO joined with North Star Alliance to conduct day-long HIV trainings for transport owners and managers.

In Kenya, North Star Alliance and IOM joined the Task Force for the National Strategy for HIV Combination Prevention along the Transport Corridors led by the Government of Kenya.

Lessons learned

In Kenya, excellent engagement and support have been shown by the Ministry of Public Health and Sanitation at both national and provincial level, Kenya Ports Authority and local businesses. As shown in

Mlolongo, the Ministry of Health can build out from the wellness centres to expand access to a wider range of health services including TB screening, antenatal services and immunizations. Cooperation with

transport unions is critical to help increase awareness of the services and their physical locations. More demonstrated support from business sector is needed to sustain the existing RWCs and ensure

expansion of the network.

Effective health service delivery for mobile populations must be designed with their specific needs in mind. Health services must go to where people congregate. The services must offer more than HIV

prevention in order to be relevant and responsive to the particular needs of people on the move and their direct and indirect contacts.


Expenditure


$275,000 $156,120 $126,900 $558,020

Broad Activity 8: Support the inclusion of nutrition and food security in national implementation plans, budgets and PRSP etc. through advocacy, technical assistance and partnership with national governments and other counterparts.

Achievements

WFP has continued to provide technical support in order to integrate food and nutrition security to HIV and AIDS programming. 24 countries integrated HIV and nutrition and food security into Poverty Reduction

Strategy Papers, national development plans, national budgets, Medium-Term Expenditure Frameworks and sectoral plans. In Zambia, WFP aided the development of national plans in order to incorporate

nutrition to national guidelines.

Technical assistance was also provided to CAR, Cameroon, Bangladesh, Cambodia, Lao PDR, and Ghana to strengthen the role of nutrition in the National HIV and AIDS Strategy Framework (NSF). WFP

provided support to the government in order to carry out nutrition sector gap analysis, attend nutrition working groups and provided technical support in drafting of the nutrition component of the NSF. Strengthening

the NSF was also used as a prerequisite to a subsequent integration of food support and nutrition in the Global Fund Round 10 submissions.

WFP conducted a joint effort to better understand how to integrate food and nutrition in Global Fund proposals. This included nine country visits (Cambodia, Liberia, Sierra Leone, Djibouti, Ethiopia, Ghana, Lao

PDR, Swaziland, Zimbabwe) before and during the Round 10 application process. While all countries were successful at integrating food and nutrition into the proposals (Lao PDR chose not to apply), Djibouti

succeeded at positioning WFP as a Secondary Recipient of funds. In Swaziland, WFP both managed to become sub-recipient for the R10 TB grant, while also being selected as recipient of unspent R4/R7 funds

for PMTCT activities. As a result of the 2010 work, WFP now has a manual which has been used for continued support to countries. . WFP also produced a toolkit in partnership with PEPFAR, FANTA II (the

USAID funded Food and Nutrition Technical Assistance Project) and WHO, which includes joint focus countries as well the refinement of tools which can further help countries to be more successful at integrating

food and nutrition with their Global Fund proposals.

In Latin America and the Caribbean, WFP also placed technical consultants to work with Ministries of Health in 9 countries including Bolivia, Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala,

Honduras, Panama, and Peru. The regional and country offices provided technical support and other capacity development activities to National AIDS Programmes, civil society and other national stakeholders. A

partnership with the Caribbean Food and Nutrition Institute was formalized to roll out capacity development activities in the Caribbean sub-region.

Lessons learned

One of the main recommendations of the joint effort to integrate food and nutrition into Global Fund proposals is the importance of starting the process early. Moreover it is important to demonstrate a long-term

commitment to HIV care and support in a country, rather than engaging at the last minute. The importance of conducting this work in partnership was also noted.

Increased investment in recruiting, training and supporting national staff has significantly increased WFP’s capacity to identify and respond to country needs and advocate for the role of food and nutrition in the HIV

response.

Continued and strengthened participation in JURTA/JUNTAs in West Africa and Latin American and the Caribbean has resulted in a regional prioritization of the importance of food and nutrition in the response to

HIV and AIDS.

Expenditure


$600,000 $844,159 $321,400 $1,765,559

Documents

2010-2011 UNAIDS UBW World Food Programme (WFP) Broad