Malawi suffers from chronic poverty and repeated food insecurity. Nearly half of Malawi's population of 14 million people struggle to live on less than US $1 a day. More than 90 percent of those most affected by extreme poverty live in rural areas and depend on subsistence farming for their daily livelihoods. Malawi is predominantly an agriculture-based economy and has only one growing season, which limits the overall annual crop yields. Farming remains strongly attached to, and heavily reliant on, maize-crop production.

Further, Malawi has one of the highest levels of malnutrition in sub-Saharan Africa, with 22 percent of children under weight for age, and 53 percent of children under height for age. HIV/AIDS in the community increases food insecurity by taking the lives of the young adults and leaving behind an imbalance of orphans and the elderly. Food insecurity also increases the level of risk behavior among women and children who may trade sex for food or enter into early marriage as a means to improved food security. As the traditional coping mechanisms of communities reach the breaking point,

the impact on children is manifest in multiple, overlapping ways including loses in economic productivity, less access to education and nutrition, and potential long-term psychological effects.

The Feed The Children Alliance, a public-private partnership, will implement Nutrition NOW, a five year project providing targeted, supplemental nutritional commodities and water purification packets, supported by technical training, mentorship, and assistance to HIV affected communities in nine districts (Salima, Chitipa, Dowa, Lilongwe, Mzimba, Nkhata Bay, Ntcheu, Rumphi, and Nkhotakota) in northern and central regions of Malawi. The project seeks to improve the nutritional status and psychosocial well being of OVC attending community based child care centers (CBCCs); strengthen the capacity of CBCCs to provide services to children; and support household economic strengthening and improved agricultural practices for households with OVC.

The Alliance consists of leading NGOs with extensive experience in Malawi, including Feed The Children (FTC), Family Health International (FHI), World Relief (WR), Orphans Support Africa (OSA) and Total Landcare (TLC). Nutrition NOW will be implemented in close collaboration with the Ministry of Gender, Child Welfare and Community Development, Ministry of Health, and Department of Nutrition, HIV and AIDS, with the National AIDS Council, district and local authorities, communities, PLHIV, and national and international private sector institutions. The Alliance provides a greater than 1:1 match of resources for the project.

NuSkin, Inc., a private sector company based in the United States, will provide 1,323 tons of VitaMeal, made with locally produced and purchased corn and soy, and fortified to specifications with added vitamins and minerals to 27,644 OVC in 315 CBCCs in the project communities. This will supplement the nutritional intake of vulnerable children. VitaMeal is important because it is made with locally produced and purchased corn and soy, and is fortified to ensure that beneficiaries receive not only calories, but important nutrients and vitamins. Proctor and Gamble will provide 5.5 million PUR (point of use) water purification packets to be distributed to targeted communities with unsanitary water sources to provide immediate protection for OVC and their families. The Alliance partners will also support long term and sustainable clean water sources through well-rehabilitation and upgrading. These private donations will be complemented by complementary technical assistance in training, community mobilization, psychosocial services, income generation, gardening, agricultural system strengthening and other areas to assure high quality interventions in CBCCs and surrounding communities, and reduce dependency on donated food. Project inputs will also include construction materials, cooking kits, seeds, fertilizers, wells, and irrigation systems. This combination of interventions and inputs will result in small scale garden/food production, construction and/or renovation of CBCCs, including toilet and kitchen facilities, and improved nutrition status and well-being of target populations. Nutrition NOW supports Goal 3 of the Partnership Framework, which is to mitigate the economic and

psychosocial effects of HIV and AIDS and improve the quality of life for PLWHA, OVC, and other affected individuals and households. It also supports Malawian leadership and ownership of the national response to HIV/AIDS.

Nutrition NOW will measure progress against defined project indicators that include key PEPFAR Next Generation indicators. The project will also collaborate with activities of the GOM, USAID/M, Global Fund, UNICEF, the Funders Collaborative and other funders in data collection and analysis. M&E data will be reviewed quarterly by Nutrition NOW partners and program decisions made based on findings. Baseline studies, midterm and final evaluation results, lessons learned and best practices will be shared in workshops held with this wide range of stakeholders.

Budget Summary PFIP Year 1 Funding - $1,000,000 PFIP Year 2 Funding - $2,056,000

I. Budget Code: HKID

$1,000,000 - Year 1 $2,056,000 - Year 2

PEPFAR funds to Feed the Children will support interventions that improve the nutritional status of children attending CBCC, strenghten the capacity of CBCCs to provide services to children; and support household economic strenghtening for OVC households.

Activity 1: VitaMeal distribution, management and use at CBCCs FTC will work with its Alliance partners, other NGOs and other implementing agencies to develop the overall Nutrition NOW plan for VitaMeal supplementation that will best meet the needs of the CBCCs. This planning will involve in-depth discussions with producers and suppliers, relevant local and national government officials, CBCC and community committees, and all project stakeholders. FTC will draw upon its extensive experience and strong ties with the private sector members of the Alliance to manage and oversee the VitaMeal input. Nutrition NOW will distribute VitaMeal to 315 CBCCs in the nine project districts. The provision of VitaMeal will be made to the CBCC based on the high prevalence of OVC enrolled and the ability of the CBO networks to adequately manage this resource. All CBCCs receiving VitaMeal will be trained in the development and use of supply inventories and distribution lists.

Activity 2: Distribution and Education with PUR In cooperation with the U.S. CDC, Proctor &Gamble developed PUR Purifier of Water, a powdered household water disinfectant that comes in small, affordable, and easy-to-use packets. Like safe water solution and other chlorine disinfectants, PUR inactivates viruses, bacteria, and protozoa, removes arsenic and turbidity (dirt) from water, leaving the water clear and safe to drink. PUR educes the incidence of diarrhea in young children by around 50%, and meets WHO standards for potable water. PUR will be distributed alongside the VitaMeal, and through the initial assessment, will be provided to those communities that lack reliable access to clean and safe water. Nutrition NOW will also distribute powdered PUR water purification packets to 5,100 households in addition to CBCCs.

Activity 3: CBO orientation All local CBO partners and other community development structures will be provided an orientation to the proposed program, and will be provided information about the project, expectations about community participation, and the need to develop a sustainability plan jointly from project outset. Community obligation requirements are important to mitigate institutional dependency on outside food provision. This will enable CBOs to more effectively support implementation of Nutrition NOW, as well as the CBCCs themselves. The program start up meetings will be followed up by regular visits from the Nutrition NOW field staff.

Activity 4: Training and Support for CBCC Care Givers Nutrition NOW will train caregivers initially and in refresher courses in 315 CBCCs on growth monitoring and psychosocial services for children in CBCCs using the curriculum approved by the Ministry of Gender, Child Welfare and Community Services. Training will also be provided to groups of CBCC caregivers and CBCC committees on psychosocial support services and on management of CBCCs. Nutrition NOW will organize a one day training-of-trainers (ToT) for groups of 20 caregivers (minimum of seven trainings) on growth monitoring and recording, preparation and use of VitaMeal. These trainers will then be able to provide on-going training for their CBCCs. Each CBO with a ToT can then provide new volunteer training in smaller segments. Other key topics for trainings to CBCC staff include:

MOGCCD Minimum quality standard for OVC programming; OVC care and support, using nationally approved curricula and OVC advocacy and care manual Let Your Light Shine; Child care and protection services; Communicating age-appropriate messages on proper health and nutrition; Recognizing the signs and symptoms of severe malnutrition and other illnesses and ensuring proper referrals to medical services; and general care giving skills. A cascade approach will be used to train CBO staff and CBCC leadership first, who can in turn provide training (formally and informally) to other CBCC caregivers. Trainings will be refreshed throughout the life of the project and assessed to determine if caregivers felt there were any gaps in their training.

Activity 5: Equip Health Surveillance Assistants to provide nutritional assessments Health Surveillance Assistants (HSAs) periodically visit CBCCs to monitor the health of the children and perform routine primary health services. The Nutrition NOW project will assess whether HSAs require any training to improve the quality of their services and, if required, provide such a training to also include training on nutritional assessments.

Activity 6: Extending nutrition knowledge and support Nutrition NOW will work with its local CBO partner organizations to mobilize communities to support CBCCs. This will include establishing/strengthening CBCC parents' committees, CBCC volunteer care givers, and community members to ensure they are trained in the storage and preparation of VitaMeal and other foods, proper feeding for young children, able to provide basic psychosocial support, and able to use other commodities (i.e. PUR). Nutrition NOW's mobilization model encourages community participation, empowerment and ownership of these supportive interventions. Nutrition NOW will also train Home Care Providers (HCPs) i.e. CBO community volunteers to provide nutrition and health education to families in their homes during their biweekly follow up visits. Wherever possible, the messages being delivered at CBCCs will be extended into homes and families where OVC spend the majority of their time.

Activity 7: Income generating activities in support of CBCC communities Nutrition NOW will support several income generating activities (IGA) at the community level. FTC will provide rabbits to 10 CBCC groups of ten female- or child-headed households as an income generating project. As the rabbits multiply, the initial recipients will be required to distribute a male female pair of rabbits to other CBCC households in the same CBCCs or in other CBCCs. FTC will work with community CBCC committees to help select households. FTC discussed this activity with the Ministry of Agriculture and received a commitment of support for the training and technical guidance, especially for those committees and households first to initiate the rabbit activities. Income from the sale of rabbits can be used to purchase other food stuffs in vulnerable households and will serve as a high protein food to improve food availability in these vulnerable households. Other low-cost income generating prospects include petty trade, and procurement and distribution of hand-cranked peanut shellers; livestock rearing with appropriate technical guidance and support; agricultural development and small-scale farming projects. Orphan Support Africa will provide farm inputs (fertilizer and seed) to CBCC communities to enable them to produce maize and groundnuts and increase food availability. Small grants will also be provided to communities to plan and manage their own IGA projects. TLC will provide training in agriculture at demonstration plots to community volunteers; and training in business management. These activities will be targeted to caregivers or female/child headed families and will be linked with Malawian microfinance and savings institutions in order to gain access to micro-credit.

Activity 8: Strengthen CBCCs' capacity to effectively provide services to children in their catchment areas To effectively serve children, CBCCs must be equipped with basic management techniques that will improve the efficiency and range of the services they offer. To ensure project sustainability and improve the capacity of CBCCs, Nutrition NOW proposes to train and mentor CBCCs Management Committees to improve the operational and financial management of the centers, including, but not limited to: Volunteer management; data collection; Infrastructure support and maintenance; and Community garden management (How to make use of agricultural extension offices). Nutrition NOW partner World Relief will also ensure effective management of CBCCs through their network of Church based volunteers. OSA will also use its unique participatory to train CBO committees in financial and organizational management income generating activities and food production, OVC psychosocial services, training support for CBCCs and provides grants for income generation defined by the community.

Activity 9: Construction and renovation of CBCCs Nutrition NOW will work with its network of CBOs for community mobilization for the construction or renovation of CBCCs. Communities will provide labor, bricks, sand, gravel and some local materials, and Alliance partners will fund the purchase of corrugated sheets, iron bar and cement needed for the construction/renovation. The Alliance Partners will follow the GOM technical specifications & national standards for CBCC construction, and bricks will be made in an environmentally friendly way which does

not require the destruction of trees. FTC can commit to 10 construction/renovation projects each year. World Relief can commit to 10 construction/renovation projects, and in 50 CBCCs, WR will also mobilize communities to construct an extra 10 CBCCs, 50 toilets and 50 kitchens using their own resources (100% community contribution). OSA will also supply cooking and eating utensils, play and educational supplies to 27 CBCCs. The educational supplies will support the CBCC committees, volunteers and others to support and strengthen early childhood development activities and other psychosocial activities for children attending the CBCCs. These kits also enhance CBCCs' ability to prepare VitaMeal and other food served at the CBCC.

Activity 10: Construction of shallow wells FTC unique contributions will also include the mobilization for the rehabilitation of 10 shallow wells near CBCCs in Lilongwe, Ntcheu and Dowa, and introduce low-tech, low-lift pumps to improve the quality of the water available at CBCC and their gardens. FTC will provide the pumps and the community will contribute the local labor and materials needed. Where repairable boreholes exist, FTC will work with technicians from the GOM water department to provide the technical guidance and support the communities' rehabilitation of these wells and train committees on the pumps maintenance.

Activity 11: Agricultural Technical Assistance and Improved Irrigation systems Total Landcare's unique inputs will include agricultural technical assistance that are well suited to the agriculture environment: irrigated dry season high value crop production and conservation agriculture (CA) for maize and other crops. Irrigated agriculture provides both a more diversified diet as well as increased production during the long dry season. CA is labor saving, as annual hilling and much of the weeding is eliminated by the use of mulches to inhibit weed germinations. In HIV affected areas, labor is significantly reduced due to adult mortality, thus CA returns allow either more land to be cultivated or permits the adult population to carry on other duties. Also, CA has shown improved maize yields, directly benefiting food security. Finally, CA reduces soil erosion, and important benefit to sustaining agricultural productivity. Other low-cost irrigation systems will also be promoted to increase food security, nutrition and incomes during the winter or dry season. This activity will be implemented in the districts of Dowa in year 1 and expanded to Salima, Ntichisi, Nkhotakota or Nkhata Bay in the second year of the project. The aim of irrigated agriculture is to build the capacity of target communities to become more self sufficient and to take better care of their children. Systems promoted will include: Treadle pumps for pumping water manually to farms; river or stream diversion; or conservation agriculture. TLC will target a total of 500 with these systems.