April08 Reporgramming Change: Reduced $100,000.

This is a new activity under COP08 in this program area although WFP has received PEPFAR funding for

palliative care, OVC and treatment in FY2006 and FY2007.

WFP will provide support to pregnant and lactating women on an as needed basis. Two provinces will be

covered by the PL 480/Title II program, namely Zambezia and Nampula. Food assistance will be channeled

and coordinated with PMTCT and treatment partners to ensure a focused intervention (as opposed to HBC

distribution points). WFP assistance is a valuable contribution while the USG in Mozambique can ensure

that longer term solutions are available, viable, and possible according to OGAC guidance.

It is anticipated that over 6,000 will be reached with emergency individual food rations with COP08 funding.

This is a continuing activity under COP08 with an increase in funding over FY2007 of $200,000. Targets

have also been increased to reach an additional 2,400 OVC, brining the total to approximately 17,400, with

supplemental direct services consisting of short term food supplements.

In an effort to ensure that linkages are strengthened among partners and WFP in FY08, the USG program

will work directly with the FANTA follow-on to provide technical assistance and establish monitoring tools

which can improve provision of food and nutrition as one of the essential OVC services. This effort will be

undertaken in consultation with WFP to ensure that the money awarded to WFP for emergency food relief

for OVC is targeting the neediest with appropriate food supplements and that both WFP and USG can

accurately track those efforts.

The FY2007 narrative below has not been updated.

This activity is related to HBHC 9138 and HXTS 9167.

The World Food Program has worked closely with WHO efforts to develop approaches, based on the latest

available scientific evidence, to identify the macronutrient and micronutrient needs of HIV-infected peoples,

the specific nutritional needs of children infected and affected by HIV/AIDS and the nutritional needs of HIV-

infected adults and children receiving ART. It is recognized that HIV infected adults and children in general

have greater energy needs, greater presence of micronutrient deficiencies and that growth in children can

be severely impaired if infected with HIV or if they do not have access to a properly balanced diet. To

achieve the full benefits of ARV and proper growth of a vulnerable child, adequate food intake is important

and dietary and nutritional assessments are essential parts of comprehensive care.

The interest in associated food support is growing due to the rapid roll-out of ART in the country, the ever

increasing number of OVC, and the unreliable food supply in Mozambique due to droughts and floods.

Most recently, the Ministry of Health has convened several meetings to gain better clarity on program

designs and implementation approaches for clinics and households for food interventions in the context of

ART. WFP, along with USAID, is working closely with colleagues in the Ministry of Health, Ministry of

Women and Social Action and other stakeholders in the development of a programmatic model for the

provision of food in conjunction with clinical and home-based ART services.

The goal of this activity is to improve the health and nutritional status of the neediest OVC and their

caregivers at USG-supported service sites. WFP will continue to work closely with PEPFAR partners

(World Relief, World Vision, ADPP, FDC, Africare, Save the Children, Project Hope, Care, HACI and any

other new OVC partners) to determine if clients meet WFP guidelines for vulnerability and nutritional need.

Guidelines were set in collaboration with MOH, SETSAN* (Mozambique's Technical Secretariat for Food

and Nutrition Security), WHO, and other multi-lateral organizations.

The USG will fund WFP to provide logistical support to PEPFAR-funded partners to receive a specific

number of supplemental food packages for no longer than 6 months for OVC and their caregivers. The cost

of these food packages have been leveraged by the WFP through private-sector funds. The supplementary

food ration will then be distributed to OVC living in vulnerable, food-insecure households, distributed

through the PEPFAR implementing partners. This activity will provide OVC and caregivers with food rations

equivalent to one meal a day. PEPFAR partners will ensure that OVC and their caregivers on food

supplements will have available wrap-around services including nutrition information and opportunities to be

involved in food sustainability practices (home gardens) or livelihood activities to provide longer term food

security.

It is anticipated that over 15,000 OVC will be reached with emergency individual food rations and 1,000

individuals will be trained for this wrap-around activity with COP07 funding.

*SETSAN is Mozambique's Technical Secretariat for Food and Nutrition Security. The multi-secotor

Vulnerability Analysis Group (GAV) monitors food security and vulnerability with the country. Indicators

used include: i) availability - agriculture production, livestock, seeds, food aid and rainfall; ii) access - prices,

markets terms of trade, income sources; iii) utilization - nutrition, health, water, sanitation and consumption;

and iv) social protection and survival strategies.

Reprogramming August08: Funding decrease $153,000. Funds were originally allocated to SCMS to cover

pediatric formulations in COP 08 charged under the OVC. Further guidance from OGAC has indicated that

drug commodities can't use this budget code. As pediatric treatment is a priority activity and given a recent

no-cost extension to WFP, it was decided that the funds allocated to WFP would be better utilized to cover

expenses related to pediatric treatment.

April08 Reporgramming Change: Reduced $140,000.

This is a continuing activity under COP08.

WFP will continue to provide support to people living with HIV/AIDS who are currently on ART and meet

PEPFAR criteria. Nutritional supplementation is critical as it is number one complaint amongst those on

ART who have either defaulted or are experiencing reprecussions from sub-optimal nutrition while on ART.

Two provinces will be covered by the PL 480/Title II program, namely Zambezia and Nampula. Food

assistance will be channeled and coordinated with treatment partners to ensure a focused intervention (as

opposed to HBC distribution points). WFP assistance is a valuable contribution while the USG in

Mozambique can ensure that longer term solutions are available, viable, and possible according to OGAC

guidance.

It is anticipated that over 20,000 ART clients will be reached with emergency individual food rations witih

COP08 funding.

The FY2007 narrative below has not been updated.

This is a follow-on to the FY06 activity and is related to HKID 9124 and HBHC 9138. This activity duplicates

other activities because food subsities will be provided to currents clients of OVC and ART services.

Therefore, no separate targets are provided.

With the rapid roll out of ART in the country, the ever increasing number of OVC, and the unreliable food

supply in Mozambique due to droughts and floods, the interest in associated food support is growing. Most

recently this has been given impetus by a request from the Minister of Health for urgent clarity on the design

and implementation approach of appropriate food based interventions in the context of ART both at the

clinical setting and within the household. WFP along with USAID is working closely with colleagues in the

Ministry of Health, Ministry of Women and Social Action and other stakeholders in the development of a

programmatic model for the provision of food in conjunction with clinical and home-based ART services.

The goal of this activity is to improve the health and nutritional status of PLWHA receiving ART at USG-

supported sites in order to improve treatment adherence and reduce any potentially negative effects of the

drugs. WFP will continue to work closely with PEPFAR partners (HAI, Columbia University and EGPAF and

any other new treatment partners) to determine if clients meet WFP guidelines for vulnerability and

nutritional need. Guidelines were set with assistance from WHO, SETSAN*, MOH, and other multi-lateral

organizations and bi-lateral missions. PEPFAR-funded NGO partners will contract with WFP to provide a

specific number of supplemental packages for no longer than 6 months for PLWHA on ART and their

families. Patients will be assessed clinically on a regular basis and taken off the supplemental foods earlier

than 6 months if warranted. WFP will provide a supplementary food ration to PLWHA on ART living in

vulnerable, food-insecure households, distributed through the PEPFAR-supported Day Hospitals where

patients go for initial assessment, CD4 counts and ART follow-up. This activity will provide PLWHA

receiving ART and their families (an average family size of 5) with family food rations consisting of 1200g

cereals, 200g pulses, 100ml Vitamin A-enriched oil, and 600g corn-soya blend per person daily for one

meal per day. PEPFAR partners will ensure that clients on food supplements will have available wrap-

around services including nutrition information (which is part of the curriculum for home-based care

providers) and opportunities to be involved in food sustainability practices (home gardens) or livelihood

activities to provide longer term food security. If studies are published that suggest a different combination

of supplemental foods, any new guidelines will be incorporated into the food rations. Monitoring of clients

that receive food supplements will be carried out by WFP to determine the effectiveness of the supplements

and related assistance on ARV treatment reactions and treatment adherence.

With COP07 funding support it is anticipated that WFP, along with treatment partners in Mozambique, will

assist all PLWHA initiating treatment and deemed to need nutritional support based on clinical criteria with

food and nutritional support. It is estimated that ½ of people starting ART will need food supplements to

ensure proper uptake and adherence.

*SETSAN is Mozambique's Technical Secretariat for Food and Nutrition Security. The multisectoral

Vulnerability Analysis Group (GAV) monitors food security and vulnerability within the country. Indicators

used include: i) availability - agriculture production, livestock, seeds, food aid and rainfall; ii) access -

prices, markets terms of trade, income sources; iii) utilization - nutrition, health, water, sanitation and

consumption; and iv) social protection and survival strategies.