The TBD will work through district councils and community structures to promote nutrition to address the needs of PLHIV, prioritizing HIV positive women and children. Objectives of the TBD will be to integrate nutrition assessment, counseling and support (NACS) with the PMTCT acceleration; strengthen be-way referrals and linkages between facility and community programs; strengthen the M&E component for nutrition assessment; and document the activity costs and achievements of the program.

The activity will contribute to the first goal of the PF which relates to service maintenance and scale-up. In addition, the TBD also addresses the GHI strategy objective of increasing access to quality comprehensive services for women and children.

Priority interventions include building the capacity of selected district councils to provide essential nutrition services; bringing NACS tools into application to standardize nutrition information provided to mothers; intensifying community case finding and management, referrals, and linkages; and improving household resilience through strategic wraparound activities with economic strengthening and food security initiatives.

This activity will also demonstrate the importance of positive deviant heart approach on behavioral changes, where vulnerable households learn from other households that are doing well within similar contexts.

The TBD prime partner will be a local partner while an international TA partner will be the sub-partner providing TA on key USAID grants and management regulations. Outcome indicators will be tracked at the project level. The data will be consolidated to contribute towards national targets.

One vehicle will be purhased to suppport daily logistics for a TBD prime local partner.

The TBD funds will be used to engage a local TA mechanism for provision of the nutritional assessment counseling and services (NACS) in community settings. The TBD will work with HBC, OVC, and PMTCT implementing partners to develop messages and interventions addressing NACS, including linkages with the PMTCT/NACS integration plan.

Activities for the TBD will include: (1) Providing TA to URT and selected district councils on NACS/PMTCT integration, including planning, supervision, monitoring, and evaluations;

(2) Supporting the review of NACS tools and guidelines, printings, and dissemination of materials;

(3) Facilitating national dialogues and consultations on nutrition and HIV/AIDS, including infant and young children feeding;

(4) Providing TA to USG/T implementing partners on nutrition and HIV/AIDS;

(5) Ensuring quality improvement and standards, including tracking and reporting of key nutritional indicators;

(6) Monitoring the availability of key nutrition supplies and providing advice to the respective institutions and bodies, such as to the medical store departments to reduce stock outs of essential nutrition commodities; and

(7) Promoting and leveraging agriculture investments for nutrition through coordinating and collaborating with other initiatives, such as Feed the Future initiative to benefit more PLHIV and OVCs with food security and income growth.

$150,000 - The TBD will work at the national level to support the URT. These funds will be used to demonstrate and scale best practices in community nutrition that will benefit orphans and vulnerable children through community structures. This will include bringing the NACS tools into universal application at the community levels. Also, the best practices from within the region and surrounding areas could be replicated and evaluated to meet the needs of MVCs. The funds will be used to implement innovative, cost-efficient approaches to screen and support referrals for sick and malnourished children. By developing peer-to-peer relationships using the positive deviant heart approach, knowledge and skills will be transferred to child-headed households and other vulnerable households.

Para-social workers will be trained as part of strengthening the social services system to recognize the signs of malnutrition, such as severe wasting, oedema, dehydration, and micronutrient deficiency. Coordination with community health workers will be key to providing basic health services at community levels, as well as making and managing referrals.

This activity will build on the wealth of potential indigenous knowledge, skills, and resources that communities utilize as a line of response to build resilience and reduce their vulnerability. This may include promoting foster parenting and mentoring for MVCs, community early childhood development and psychosocial stimulation, which could be fostered through integrating the development of playgrounds with outreach growth monitoring.

$300,000 - Funds for this particular TBD will support the screening of OVCs as well as linking them to pediatric care from the community level to facilities. Implementation of community-level BCC on caring for HIV infected children will be a main activity, along with collaborating with PACT to pilot the GBV one-stop center.

These funds will be used to:

(1) Intensify undernourished case findings at the community level and improve linkages and referrals to the appropriate facilities and community programs;

(2) Promote positive behavioral changes through a positive deviant heart approach (facilitating households or group visits to learn best practices from each other);

(3) Implement community food-based approaches to rehabilitate moderate malnourished children by using local food resources and promoting food-based value chain interventions at the community level for stabilizing vulnerable household consumption;

(4) Procure anthropometric tools and equipment, such as MUAC tapes and print essential simplified NACS tools for usage by parasocial workers and other lay counselors and volunteers at the community level; and

(5) Map community initiatives that respond to the food and income needs of MVCs and older caregivers, promoting BCC at the community level to care for vulnerable families (using a foster parenting approach).