The Infant and Young Child Nutrition (IYCN) Project is USAID's flagship project to improve infant and young child growth and nutritional status, HIV-free survival of infants and young children, and maternal nutrition. Building on 25 years of USAID leadership in maternal, infant, and young child nutrition, IYCN focuses on prevention of malnutrition through proven interventions that are effective during pregnancy through the first two years of life. The project is a globally funded five-year cooperative agreement led by PATH, in collaboration with CARE, the Manoff Group, and University Research Co., LLC (URC).

The goal of this COP 10 activity is to integrate, expand, and monitor safe infant feeding practices and nutrition care and counseling as essential parts of PMTCT, MCH and community-based services focused on pregnant a nd lactating women, infants and young children of HIV+ mothers, and orphans and vulnerable children (OVC) under five years. WHO Recommendations for HIV and Infant Feeding is undergoing a revision in 2009. Thus, IYCN is poised to provide technical support for the adaptation and implementation of country policies and guidelines that is focused on new options for women who breastfeed to significantly lower the risk of transmission. This includes safe feeding (exclusive breastfeeding or replacement feeding) during the first six months postpartum, and appropriate complementary feeding of infants and young children between six and 23 months to maximize HIV-free survival. In addition, IYCN will work with PEPFAR OVC partners to integrate and strengthen the nutrition content of their programs and promote a complementary food or supplement to improve the diets of infants and young children under two years.

IYCN's assistance will build on its experience in Nigeria, Zambia, Côte d'Ivoire, and Kenya to develop and update policies, programs, BCC materials, job aids, training curriculum and supportive supervision tools. To improve the environment for nutrition and HIV services, IYCN with the FMOH and partners will disseminate final national nutrition and

HIV policies and guidelines to the state, district and LGA levels of the FCT and another state to be selected. IYCN will also support community-based programs to promote and support nutrition of OVC's under five years, as well as reinforce PMTCT adherence, and increase referrals to other health and community support services.

IYCN's partner, URC, will assist with quality improvement activities by facilitating a team approach, working with PMTCT and OVC partners, the FMOH Nutrition and PMTCT Divisions and the Federal Ministry of Women Affairs to establish minimum standards for nutrition services at PMTCT sites and OVC services. After establishing consensus on these standards, IYCN will adopt an incremental approach promoting innovation and accountability for quality improvement as an internal process at PMTCT facilities.

IYCN's activities will be linked to existing wrap-around services such as micronutrient supplementation, hygiene and sanitation, family planning/reproductive health, and household food security initiatives. IYCN will assist the FMOH to demonstrate the full roll-out of activities in two states and the project will apply lessons learned to continue the scale-up to other districts and states in future years.

For all of its activities, IYCN will closely collaborate with the appropriate MOH and partner staff to increase their capacity to collect and use routine data for monitoring to promote continuous improvement. IYCN will introduce simple tools which minimize the burden of human resources and promote sustainable monitoring systems. This will include a set of user-friendly supervision tools that can be used at the facility level to monitor provider performance, identify and address inefficiencies in service delivery, and assess the quality of care provided to mothers. In addition, IYCN will introduce a complementary set of community-level monitoring tools for supervision of community-based workers and community-level nutrition activities. This approach supports and encourages linkages between health facilities and communities through the

monitoring of a two-way referral system.

IYCN will work with the FMOH Nutrition Division to provide technical assistance to PEPFAR OVC partners, the Federal Ministry of Women Affairs (FMWA) and others to assist them to integrate nutrition education and counseling as part of their OVC programs. Often programs that target OVC focus on support for school- aged and older children. The nutritional needs of infants and young children under five years who are HIV affected are often missed. In addition, adolescent girls suffer from high rates of anemia and need iron

supplementation and to eat an iron-rich diet during this stage in their development. These young children and adolescent girls are particularly vulnerable to undernutrition. IYCN will develop appropriate counseling guide for 6-23months and adolescent OVC nutrition as well as provide specialized training for Caretakers and other support groups of such children and adolescents to practice and provide optimal care and feeding of these children.

IYCN will engage a local consultant to conduct a rapid assessment of current services for OVC in the two focus states (FCT and Lagos or Kano States). The assessment will include a review the existing literature, including project reports, local and international publications on OVC and nutrition and dietary practices, and interviews of key program managers and implementing partners, in order to: understand the OVC nutrition landscape in Nigeria, specifically within the two targeted states; understand available services; describe OVC infant and young child and adolescent girl nutrition beliefs and practices; and identify gaps in information that can be examined through rapid formative research. Using the results from the assessment, IYCN will engage in a participatory process with stakeholders from PEPFAR OVC partners, NGOs, community-based organizations, and government to develop a behavior change and communications (BCC) strategy. This process will result in clear messages about infant and young child feeding and nutrition of adolescent girls that can be communicated consistently across OVC programs. It will also help develop appropriate tools such as service provider job aids and take-home materials for OVC, OVC caretakers, support groups and community in general.

To mitigate the impact of HIV/AIDS on the nutritional status of exposed infants, IYCN will design a two- way referral system to identify malnourished at-risk OVC. The referral system will link caretakers to and from nutrition, child health

and well baby clinics for therapeutic and supplementary feeding and from clinical services to community outreach or other community programs for monitoring and follow up.

IYCN will collaborate with the MARKETS project and its partners to provide young OVCs with quality dietary support. The MARKETS Project works with famers on key crops: rice, cow peas, sesame, sorghum, and cassava and with manufacturers of cereals to provide food supplements for OVCs and their host families to improve the food security of 20,000 OVC. IYCN will work with the MARKETS Project to support the identification and promotion of an acceptable complementary food that is based on locally available foods that can provide optimum nutrition to OVC age six to 23 months. IYCN will explore the use of a micronutrient powder or a local food-based nutrient-dense supplement (based on experience and in-depth food research conducted in Zambia but can be adapted to Nigeria) that could be added to the food to improve its nutritional composition. The MARKETS Project has implementing partners (local NGOs) that work in the community, training caregivers how to prepare food for OVC. IYCN will assist them with infant and young child feeding BCC and education materials that are in line with the government guidelines that would enable their partners to better support and educate families with OVC. Their staff will also be invited to participate in the training of trainers in maternal and infant and young child nutrition in the context of HIV being conducted through the MOH.

Indicator: Number of health workers who successfully completed an in-service training programs