WFP's Urban HIV/AIDS Program

This is a continuing activity with new funding available in PMTCT to provide nutritional support to HIV-

positive pregnant women through the ongoing World Food Program (WFP) project titled "Supporting

Households, Women and Children Infected and Affected by HIV/AIDS," also referred to as "Urban

HIV/AIDS." The activity is part of WFP's Protracted Relief and Recovery Operation (PRRO), is a

continuation of activities supported in FY06 and FY07, and is linked to USAID Title II contributions for

nutritional support. Increased funding is requested in 2008 in order to reach larger numbers of food insecure

families and to expand the geographical areas covered by the project. The FY08 funding for the World Food

Program Urban HIV/AIDS program totals $8,600,000 million ($4,000,000 million for palliative care, $3.6

million for OVC and $1 million for PMTCT) which leverages $7 million in food.

This activity will complement PEPFAR resources with food resources leveraged from WFP multilateral

contributions, Title II USAID Food For Peace, and FY07 bilateral donors, including: France ($500,000),

Spain (500,000 Euros), Sweden ($1 million), and Egypt ($100,000), with additional contributions from other

donors to be confirmed. PEPFAR resources will be used to purchase food commodities for HIV-positive

pregnant mothers and their children and to cover the associated logistics costs. Approximately one third of

the proposed budget will be used for food commodities. PEPFAR resources will support improved nutritional

status and quality of life through nutrition assessments and counseling, nutrition education, and household

access to economic-strengthening opportunities. The provision of food and nutritional support through WFP

and partners is complementary with other services for OVC.

This project is currently implemented in 14 of the most populous urban areas in Ethiopia, in four large

regions, (Amhara, Oromiya, Tigray, and the Southern Nations, Nationalities and Peoples Region (SNNPR)),

and two urban administrative areas (Addis Ababa and Dire Dawa). Selection of existing and potential

additional areas for the implementation of this project is done by assessing the level of need in urban areas

and examining the HIV prevalence rate and urban poverty index. Up to 12 additional urban areas will be

selected for the project after assessments conducted by regional HIV/AIDS Prevention and Control Offices

(HAPCO) with participation and support from WFP, and based upon an increased level of contributions from

donors. Regions where the project is implemented have been consistently asserting the necessity for

extending this project to additional urban areas.

The beneficiaries of the project will be HIV-positive mothers identified through referral links from

nongovernmental organizations (NGO), community-based organizations (CBO), and ward-level HIV/AIDS

committees. Household assessments are conducted to ensure that all beneficiaries are food insecure and

require the type of food support provided by WFP. The activity is implemented by town HAPCO and NGO

partners. Each town has a coordination committee that is responsible for the selection of beneficiaries. The

committee is composed of representatives of the town, HAPCO, health-service providers, NGO partners,

and associations for people living with HIV/AIDS (PLWH). Activities include training for partners and

providers of home-based, palliative care and beneficiaries in HIV/AIDS and nutrition. The activities are

aimed at maximizing beneficiaries' abilities to improve their own nutritional status through selection and

preparation of different types of food. In order to ensure the effective consumption of the Corn Soya Blend

(CSB), a blended fortified food rich in micronutrients provided by this project, WFP has produced training

materials and handbooks in preparation and consumption of CSB that are distributed to all beneficiaries.

WFP also strengthens and provides ongoing support to town-level coordination structures by providing

information-technology equipment and training in monitoring and evaluation. Nutritional, health, and hygiene

counseling are integrated into the counseling and home-based care services supported by the project. The

structures of coordination and communication established through the WFP-supported project have had an

overall positive impact on the provision of integrated services in the urban areas where the project is

implemented, beyond the provision of nutritional support.

In order to track the wider impact of the project, WFP uses PEPFAR resources to conduct Results-Based

Management (RBM) Monitoring. Quarterly reports on commodity flow and numbers of beneficiaries

receiving food and nutritional support, as well as on complementary activities, are submitted by partners in

each of the implementation areas. Annual RBM surveys are conducted by WFP and partners to measure

the impact of the project on a range of indicators. WFP also engages in qualitative forms of monitoring and

evaluation, including the identification of best practices in particularly successful towns. It also sponsors

experience-sharing workshops for all partners.

WFP will collaborate with PMTCT programs to pursue and implement sustainable food security options

while simultaneously providing food inputs. These sustainable options will focus on increasing household

assets through market-driven economic strengthening activities, such as small business development,

savings and loan schemes, and micro-credit. Partnerships with economic-growth programs will be

established or expanded to provide needed technical expertise and linkage to viable market options. WFP

uses public and private contributions to strengthen partners' ability to implement economic strengthening

options. WFP experience in the area of income-generation for beneficiaries includes provision of small

loans that have led to increased household assets through small business development.

A strategy to stabilize the food security status of HIV-affected households and transition them from food aid

is under development for implementation in FY08. This strategy is being planned with Government of

Ethiopia and other stakeholders. Graduation from food aid will be managed by partners at the town level

and is supported by economic-strengthening opportunities.

This is a continuation of a FY06 and FY07 activity that provides nutritional support to food insecure and

malnourished PLWH, including HIV-positive mothers and their children in the ongoing "Urban HIV/AIDS"

project in the World Food Program's (WFP) Protracted Relief and Recovery Operation (PRRO) in Ethiopia.

Funding has been increased to reach increased numbers of clinically malnourished and food-insecure

PLWH and expand the geographical areas in the project. The FY08 funding for the World Food Program

Urban HIV/AIDS program totals $8,600,000 million ($4,000,000 million for palliative care, $3.6 million for

OVC and $1 million for PMTCT) which leverages $7 million in food.

This activity will complement PEPFAR resources with food resources leveraged from WFP multilateral

contributions, the USAID Title II Food for Peace Program and bilateral donors. In 2007, these resources

include $US 500,000 from France, 500,000 Euros from Spain, $US 1,000,000 from Sweden, and $US

100,000 from Egypt, with additional contributions from other donors to be confirmed.

PEPFAR resources will cover the logistics costs associated with food delivery and distribution of

commodities to clinically malnourished PLWH and mothers participating in PMTCT programs and their

infants. PEPFAR resources will increase the quality and linkages in the project by supporting an integrated

support package designed to improve nutritional status and quality of life of PLWH, PMTCT mothers and

their infants through nutritional assessments and counseling, psychosocial support and nutrition education

within community and home-based care (HBC) services. The program will also support linkages with health-

facility-based pre-ART and ART services, PMTCT services and capacity development of local HIV/AIDS

committees and town HIV/AIDS Prevention and Control Offices (HAPCO). This activity is linked to other

PEPFAR supported programs including ART, HBC, and income-generating activities (IGA). Nutritional

support will also be linked to the new facility-based Food by Prescription (FBP) activity funded by PEPFAR.

Malnourished PLWH, including women participating in PMTCT receiving Ready-to-use Therapeutic Food

(RUTF), will be linked to longer-term, community-based food and nutrition and livelihood support, provided

by WFP, with leveraged resources to support family members who may not qualify for support per PEPFAR

guidelines. This will help ensure that severely malnourished PLWH benefit to the maximum from the RUTF

provided, supporting patients to recover from acute malnutrition in the short term, while the provision of the

WFP food basket ensures longer term nutritional support, and minimizes consumption of RUTF by family

members. This provision of nutritional support is complementary with other HIV/AIDS services, contributing

to wider goals of increasing access to prevention, care, and treatment services by creating incentives to

access services and promoting treatment efficacy.

This project is currently implemented in 14 urban and peri-urban areas, where rates of HIV infection are

particularly high and urban poverty is acute. These are located in four regions, Amhara, Oromiya, Tigray,

and the Southern Nations, Nationalities and Peoples (SNNP), and two urban administrative areas, Addis

Ababa and Dire Dawa. Selection criteria include the HIV prevalence rate, the urban poverty index, numbers

of patients accessing ART, and the number of PLWH receiving HBC.-based on similar criteria and in

collaboration with regional HAPCO, in FY08 WFP will initiate activities in up to 12 additional urban and peri-

urban areas, assuming additional donor funding is forthcoming.

The beneficiaries of the project are PLWH, including HIV-positive women and their infants participating in

PMTCT programs accessing HIV treatment and care services with clinical signs of severe malnutrition as

demonstrated by low Body Mass Index (BMI), and their household members. Beneficiaries are identified

through referral links from hospitals and health centers, PLWH associations and nongovernmental

organizations (NGO) providing HBC services. Household assessments are conducted to ensure that all

beneficiaries are food insecure and require the type of food support provided by WFP. Each site has a

coordination committee composed of representatives of the town, HAPCO, health service providers, NGO

partners and PLWH associations that is responsible for the selection of beneficiaries. Beneficiaries are

monitored through a tracking system that is managed by the participating NGO, government partners, and

health service providers. This approach increases the linkages between clinical and community-based care

services.

WFP conducts a range of complementary activities that are directly linked to the provision of food support

and are funded by PEPFAR contributions. These activities include training for partners, home-based

palliative caregivers, and beneficiaries in HIV/AIDS and nutrition concepts and methods to maximize

beneficiaries' abilities to improve their own nutritional status through selection and preparation of

appropriate foods. For example, in order to ensure effective consumption of the Corn Soya Blend (CSB), a

blended fortified food rich in micronutrients provided by this project, WFP has produced training materials

and handbooks in preparation and consumption of CSB that are distributed to beneficiaries.

WFP establishes, strengthens, and provides ongoing support to town-level coordination structures through

the provision of information technology (IT) equipment and training in monitoring and evaluation. Nutritional,

health, and hygiene counseling are integrated into HBC services supported by the project and PLWH and

HIV-positive PMTCT clients are encouraged and supported to access available services available from

palliative care providers.

To understand the wider impact of the project, WFP uses PEPFAR resources to conduct results-based

management (RBM) monitoring. Quarterly reports on commodity flow and numbers of beneficiaries

receiving nutritional support and complementary activities are submitted by partners in each of the

implementation areas. Annual RBM surveys are conducted to measure the impact of the project on a range

of indicators, including the nutritional and self-reported health status of beneficiaries and drug adherence of

patients on ART, and the birth weight of infants born to HIV-positive women accessing PMTCT services and

receiving WFP supplementary food. These surveys have shown high rates of ART adherence for

beneficiaries, as well as a perception by beneficiaries that their nutritional status has improved. WFP also

engages in qualitative forms of monitoring and evaluation, including the identification of best practices in

particularly successful towns. These experiences are shared through workshops for all partners.

For pregnant and lactating mothers accessing PMTCT services, nutritional support aims to provide a food

supplement to meet additional nutritional requirements during pregnancy and lactation, support and

facilitate feeding for infants during this period of higher nutritional risk and infection (age 6-24 months), to

support mothers to attend antenatal care (ANC) regularly, utilize PMTCT and follow appropriate

breastfeeding guidelines, and to act as a resource transfer to alleviate economic stress and allow

beneficiaries to spend more on other essential needs.

Activity Narrative:

This activity is directly aligned to support ART services provided by other PEPFAR partners in the

implementation areas, integrating nutrition assessments of PLWH into pre-ART and ART services. The

activity then provides the additional energy requirements PLWH need to fight opportunistic infections and to

tolerate ART, The ration also contributes to ensuring that they receive the Recommended Daily Allowance

(RDA) of micronutrients. Standard referral formats are provided to ART service providers and are used to

refer malnourished PLWH for nutritional support and the provision of complementary HBC, counseling and

training. Nutritional assessments are conducted on a regular basis and linked to a defined graduation

strategy.

IGA support for food insecure PLWH is an important priority for the Government and other partners in

Ethiopia, supporting long-term sustainability of HIV/AIDS services and the self-reliance of PLWH. Most

PLWH have seriously degraded asset bases, as many have lost any savings they had and converted all

household assets to cash. Government food security and poverty programs do not operate in high-HIV

prevalence urban areas. PLWH require additional support in order to be assisted to return to work or

develop sustainable livelihoods through IGA schemes. It is important that physical recovery be linked to

economic security. Equally important is promoting productive and positive images of PLWH, which assists

in countering stigma and discrimination and helps ensure that PLWH are fully integrated members of their

communities. WFP uses contributions from donors and private individuals to strengthen partners' ability to

support IGA. The IGA content is agreed after a capacity-building process of training in life skills and

business management for implementing partners, PLWH associations, and individuals. The proposed IGA

is assessed for economic viability and if approved, seed money in the form of loans is provided.

Graduation from the project is managed by partners based upon access to ART and opportunistic infection

treatment, improved health and nutrition status and access to improved livelihoods for PLWH. Women

accessing PMTCT are guaranteed to receive nutritional support until their infants reach age two.

Assessments are conducted after patients have been receiving ART and nutritional support for six months.

Urban HIV/AIDS Nutrition Program

This request is for the orphans and vulnerable children (OVC) component of the ongoing World Food

Program (WFP) project titled "Supporting Households, Women and children infected and affected by

HIV/AIDS", also referred to as "Urban HIV/AIDS". The activity is part of WFP's Protracted Relief and

Recovery Operation (PRRO), is a continuation of activities supported by COP 06 and 07 and is linked to

USAID Title II contributions for nutritional support of OVC. Increased funding is requested in 2008 in order

to reach larger numbers of food insecure OVC and to expand the geographical areas covered by the

project. The FY08 funding for the World Food Program Urban HIV/AIDS program totals $8,600,000 million

($4,000,000 million for palliative care, $3.6 million for OVC and $1 million for PMTCT) which leverages $7

million in food. This activity will complement PEPFAR resources with food resources leveraged from WFP

multilateral contributions, Title II USAID Food for Peace and bilateral donors, including in 2007, 500,000

USD from France, 500,000 Euros from Spain, 1million USD from Sweden and 100,000 USD from Egypt,

with additional contributions from other donors to be confirmed. PEPFAR resources will be used to

purchase food commodities for orphans and vulnerable and to cover the associated logistics costs.

Approximately one third of the proposed budget will be used for food commodities. PEPFAR resources will

support improved nutritional status and quality of life for OVC through nutrition assessments and

counseling, psychosocial support, nutrition education, and household access to economic strengthening

opportunities. The provision of food and nutritional support through WFP and partners is programmed to be

complementary with other services for OVC. WFP also ensures complementarity with other United Nations

(UN) system partners' activities under HIV/AIDS, where OVC programming is done in collaboration with the

United Nations Children's Fund (UNICEF) and the United Nations Educational, Scientific and Cultural

Organization (UNESCO).

This project is currently implemented in 14 of the most populous urban areas in Ethiopia, in four large

regions, Amhara, Oromiya, Tigray and the Southern Nations, Nationalities and Peoples Region (SNNPR),

and two urban administrative areas, Addis Ababa and Dire Dawa, where numbers of orphans are high and

poverty is acute. The selection of existing and potential additional areas for the implementation of this

project is done by assessing the level of need in urban areas, examining the HIV prevalence rate, urban

poverty index and numbers of OVC enrolled in educational and other support programs. Up to 12 additional

urban areas will be selected for the project after assessments conducted by regional HIV/AIDS Prevention

and Control Offices (HAPCO) with participation and support from WFP, and based upon an increased level

of contributions from donors. Regions where the project is implemented have been consistently asserting

the necessity for extending this project to additional urban areas.

The beneficiaries of the project are OVC accessing complementary forms of support funded through

PEPFAR and Global Fund-sponsored activities, including the Save the Children USA implemented Positive

Change: Children, Communities and Care (PC3) project. In particular, OVC identified for food support are

receiving complementary educational support from UNICEF and other partners and are regularly attending

school as a result. Beneficiaries of the project will be linked through referral systems to health sector

partners supporting pediatric care and child survival programs including immunizations. This will be

achieved by linking the nutritional support program through regular referrals to hospitals and health centers

in urban areas participating in the WFP Urban HIV/AIDS activity. Referrals will be followed up by home-

based care (HBC) providers who care for and mentor OVC. When necessary HBC providers will

accompany OVC during visits to hospitals and health centers, particularly in the case of HIV-positive OVC

accessing treatment for HIV/AIDS and related opportunistic infections. OVC beneficiaries are identified

through referral links from nongovernmental organizations (NGO), community-based organizations (CBO)

and ward HIV/AIDS committees. Household assessments are conducted to ensure that all beneficiaries are

food insecure and require the type of food support provided by WFP. The activity is implemented by town

HAPCO and NGO partners. Each town has a coordination committee composed of representatives of the

town, HAPCO, health service providers, NGO partners and people living with HIV/AIDS (PLWH)

associations that is responsible for the selection of beneficiaries.

In order to ensure quality services, WFP will apply newly developed Standards of Services for OVC in

Ethiopia. WFP conducts a range of complementary activities that are directly linked to the provision of food

support and are funded by PEPFAR contributions. These activities include training for partners and home-

based-palliative care providers and beneficiaries in HIV/AIDS and nutrition, aimed at maximizing

beneficiaries' abilities to improve their own nutritional status through selection and preparation of different

types of food. In order to ensure the effective consumption of the Corn Soya Blend (CSB), a blended

fortified food rich in micronutrients provided by this project, WFP has produced training materials and

handbooks in preparation and consumption of CSB that are distributed to all beneficiaries. WFP also

strengthens and provides ongoing support to town-level coordination structures through the provision of

information technology (IT) equipment and training in monitoring and evaluation. Nutritional, health and

hygiene counseling are integrated into the counseling and HBC services supported by the project and OVC

and their caregivers are encouraged and supported to access other forms of support. The structures of

coordination and communication established through the WFP-supported project have had an overall

positive impact on the provision of integrated services in the urban areas where the project is implemented,

beyond the provision of nutritional support.

In order to track the wider impact of the project, WFP uses PEPFAR resources to conduct Results Based

Management (RBM) Monitoring. Quarterly reports on commodity flow and numbers of beneficiaries

receiving food and nutritional support, as well as complementary activities, are submitted by partners in

each of the implementation areas. Annual RBM surveys are conducted by WFP and partners to measure

the impact of the project on a range of indicators including OVC school attendance and drop out rates. WFP

also engages in qualitative forms of monitoring and evaluation, including the identification of best practices

in particularly successful towns. It also sponsors experience sharing workshops for all partners.

WFP will collaborate with OVC programs to pursue and implement sustainable food security options while

simultaneously providing food inputs. These sustainable options will focus on increasing household assets

through market-driven economic strengthening activities such as small business development, savings and

loan schemes, and micro-credit. Partnerships with economic growth programs will be established or

expanded to provide needed technical expertise and linkage to viable market options. WFP uses public and

private contributions to strengthen partners' ability to implement economic strengthening options. WFP

experience in the area of income generation for beneficiaries includes provision of small loans that have

Activity Narrative: resulted increased household assets through small business development.

A strategy to stabilize the food security status of OVC households and transition them from food aid is under

development for implementation in FY08. This strategy is being planned with Government of Ethiopia and

other OVC stakeholders. Graduation from food aid will be managed by partners at the town level and is

supported by economic strengthening opportunities.