This activity is linked to HBHC MoHSS, ITECH, and HTXS MoHSS/Red Cross Nutrition supplementation.

Food and nutrition interventions improve HIV treatment and care outcomes and prevention of mother-to-

child transmission and are an important component of comprehensive care and support for people living

with HIV and AIDS (PLWHA). Appropriate nutrition counseling, anthropometric assessment, monitoring,

multi-micronutrient supplementation, rehabilitation and referral of severely malnourished PLWHA, and safe

infant and young child feeding (IYCF) strategies in the context of HIV/AIDS are critical program gaps in

Namibia. Program experience indicates that health workers in key HIV/AIDS service delivery sites

(especially ART and PMTCT) lack training, time, or incentive to conduct basic clinical nutrition assessments

and recommend appropriate nutrition strategies for HIV-positive adults, children, and infants, as well as HIV

-positive pregnant and lactating women. With only one registered dietician in the country, consistent gaps in

human resources for clinical nutrition persist for the Namibia Ministry of Health and Social Services

(MoHSS) and other line Ministries, NGO and private sector partners.

In response to requests from the MoHSS, PEPFAR is supporting the Food and Nutrition Technical

Assistance (FANTA) Project to provide technical support to the Namibian Government in COP 2007 to

assess food and nutrition needs of Namibian PLWHA and the types of support that facility, community, and

home-based service providers require to provide quality nutritional care for PLWHA. This exercise will be

complete by February 2008, and results will feed into the development of an MoHSS strategy and

operational plan for nutrition and HIV in Namibia. Assessment results will also improve understanding of the

food and nutrition needs of PLWHA in Namibia, on the basis of which future policies and programs can be

designed. In COP2007, FANTA is also partnering with the MoHSS and ITECH to produce materials and job

aids which support nutrition assessment and counseling by health workers in both facility and community-

and home-based care settings. Support is also underway to develop and integrate a follow-up training and

quality assurance monitoring component for the ITECH and MoHSS 4-day training course for health

workers on nutrition and HIV. FANTA is working to build the capacity of the MoHSS and ITECH to

implement and integrate the quality assurance component into their existing programs. With the Clinton

Foundation supporting a ready-to-use therapeutic food (RUTF) to treat severe acute malnutrition in HIV

infected Namibian children and PEPFAR support for food supplementation of severely malnourished ART

clients, the MoHSS will be coordinating a food program for PLWHA. In response to increasing demands on

the MoHSS to provide technical direction for the RUTF program and for nutritional supplementation in ART

sites, FANTA will provide technical assistance to the MoHSS for the design and operationalization of a

nutritional supplementation program for PLWHA which can be integrated into service provision.

In COP2008, FANTA will build on COP2007 program successes to support the MoHSS to integrate

indicators for nutrition and HIV into the national HIV M&E framework. This activity will involve identification

of indicators to be used, adaptation of tools for data collection and use, and technical assistance for

application of the tools. Incorporation of nutrition in M&E systems will enable collection and analysis of

accurate and consistent data on nutritional status and on coverage and progress of nutrition interventions

for management of HIV. This information will be used to strengthen the design and refinement of HIV

treatment and care interventions, to support counseling and screening for interventions, and to strengthen

results reporting. Support will also be provided to develop educational DVDs on food demonstrations and on

nutrition and HIV to be shown in waiting rooms of ART clinics. The DVDs will complement other existing HIV

media which has been developed for waiting rooms and will make use of a key opportunity and availability

of client time to improve knowledge about nutrition and HIV.

As part of a USG-supported partnership between I-TECH, MoHSS and FANTA, an extended nutrition and

HIV short-course with follow up mentoring will be developed in COP2008 to equip at least 13 regional health

workers (one per region) with knowledge and skills to strengthen and supervise clinical nutrition in ART

sites. The trained regional health workers will supervise trained health providers in clinical nutrition

assessment, improved counseling on nutrition and HIV for ART clients and safe infant and young child

feeding, expanded education on management of HIV symptoms, and effective nutritional management with

ART. Initial planning and consultations for the nutrition and HIV short-course are underway in COP2007;

however, the development of the course will begin in COP2008. I-TECH will provide a trainer to facilitate the

short-course and materials development and secure training venue, and FANTA will provide technical

assistance to the MoHSS and I-TECH for for development of the course and its integration into the

University of Namibia (UNAM) or the Polytechnic of Namibia (PoN). ITECH, FANTA and the MoHSS will

also work with either UNAM or PoN to review final content of a diploma in nutrition which will be integrated

into an MPH degree program. This activity will result in a cadre of Namibian professionals with a high level

of nutritional knowledge who will fulfill the consistent clinical nutrition human resource gaps for the MoHSS

and other line Ministries, NGO and private sector partners.

This longer-term strengthening of human resource capacity in nutrition will provide a critical foundation for

food and nutrition interventions to improve HIV treatment and care.