Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013

Details for Mechanism ID: 7141
Country/Region: Kenya
Year: 2013
Main Partner: FHI 360
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $0

Nutrition and HIV Program (NHP) is a cooperative agreement that provides technical guidance and coordination in the integration of nutrition interventions in palliative care and support at various service points within health facilities. NHP also provides support for capacity building and commodities by i) strengthening technical and management capacities for Nutrition Assessment Counseling and Support (NACS) and Food by Prescription (FBP) service for managing clinical malnutrition in participating facilities; and ii) expanding provision of fortified blended food and Ready to Use Therapeutic Food formulations to 250 primary sites and reach at least 25,000 beneficiaries per year by 2012/13. NHP also establishes linkages between facilities providing FBP services and communities through CBOs and FBOs providing health related services. While implementing their programs, NHP also aims to improve data capture and management and its use in decision-making.

NHP is designed as a national mechanism to support nutrition services in all care and treatment sites. Therapeutic and supplemental nutrition formulations are provided to most vulnerable patients to improve nutritional recovery (weight gain, growth and reconstitution) and improve adherence and compliance to use of ARVs and other medicines that the patients are receiving. Efforts will go towards ensuring direct reporting and ownership of the program by MoH.

This partner has not used PEPFAR funds for vehicle purchase and is not requesting funds for vehicle purchase in FY12. This partner is using two vehicles purchased by previous prime implementer and a vehicle donated to project from within the organization (FHI 360). This activity supports GHI/LLC and is completely funded with pipeline funds in this budget cycle.

Funding for Care: Adult Care and Support (HBHC): $0

In collaboration with the MoH/NASCOP, NHP supports a 5-day in-service training for frontline health care workers on Nutrition and HIV as the platform for delivery of Nutrition Assessment, Counseling and support (NASCS) with Food by Prescription for malnourished patients as part of the comprehensive care package. This training is designed for nurses, clinical officers, nutritionists, pharmacists and other cadres. In regard to mentorship, onsite training of health care workers is being provided at facility level by the trained staff through continuous medical and nutrition education. A standardized CME package is under development for use in facilities to augment mentorship and on-the-job training.

The target population for supplemental and therapeutic nutrition services are vulnerable and malnourished people living with HIV. Malnourished PLHIV adults BMI < 18.5, pregnant and post-partum MUAC < 23 cm and OVC WHZ < -2 are beneficiaries.

NHP carries out site monitoring to sample primary sites. This is carried out in collaboration with the nutrition leaders and focal persons at the district and province. Materials are periodically distributed and updates are provided during the visits. On job refresher training is also carried out during the site visits to address challenges being experienced.

NHP evaluates service delivery and outcomes though analysis of patient data from the facilities. Performance is evaluated based on enrolment levels, clients receiving services including assessments, counseling and FBP and those being discharged after recovery.

The partner provides nutritional commodities for supplemental and therapeutic prescription in the management of malnourished clients under care and treatment in 200 central sites and over 300 satellite sites across the country. Estimates provided cover training and commodities for managing non-pregnant and non-lactating adult clients served in the CCCs and the HBHC clients.

The partner has facilitated decentralization services to lower level facilities including health centers and dispensaries for improved access. The partner has also engaged local CBOs to do active case finding of malnourished clients by supporting the training of community health workers to screen OVCs using MUAC and refer the malnourished clients to nearby health facilities for nutrition services including FBP. Follow up of clients at community level is also done by the CHWs that have been trained.

The outcome of these services will include improved adherence to drugs, and including a reduction of loss to follow up of clients on HIV care and treatment as well as improvement of the quality of life for the malnourished clients.

Funding for Care: Orphans and Vulnerable Children (HKID): $0

The goal is to increase access to care and support for OVC in early childhood, primary school age and secondary school age through improving access to nutrition services at the community and health facilities level. The main outcomes are elimination of clinical malnutrition among OVC who are enrolled in the program supported by community health units (CHUs) and further facilitate optimal nutrition for the OVC to achieve full growth and development potential. The service package comprises anthropometric screening and periodic assessment of household food insecurity. This is achieved through increasing the number of CBOs/FBOs and community health units (CHU) supported by NHP. In each CBO or facility based outreach with the extension nutrition services strategy, a social workers-CHW and facility based CHEW-CHW interfaces with respective communities are and strengthened through capacity building. The latter comprises of training on screening for malnutrition (active case finding), nutrition education and referrals as well as simplified household food security assessment. These activities are carried out in collaboration with other USG and non-USG implementing partners. It is expected that these measures will extend community level NACS services to over 10,000 OVCs across the country and provide useful experiences to accelerate scaling up of similar services to other CHUs and CBO/FBOs. OVC service delivery is fragmented at the CHU with CBOs being weak with respect to organic growth. The services collapse once the partner withdraws support. Collaboration among partners is central to successful programming at community level to avoid duplication and confusion, weak linkages with health facilities and verticalization of community development. Partner coordination and greater involvement of the local community are key to successful OVC programming. Monitoring of service delivery is carried out using registers and data extractions are carried out monthly.

Funding for Care: Pediatric Care and Support (PDCS): $0

NHP has decentralized services in health facilities from the comprehensive care clinics to the maternal child clinics in order to reach children and the pregnant and post-partum women. Staff from the MCH have been trained to provide nutrition services and equipment, IEC materials, data tools and commodities which are being provided at the MCH service point.

Pediatric participation is ensured through supporting service delivery to OVCs under maternal and child health and nutrition. The services supported are NACS and FBP for those suffering from clinical malnutrition. These services are offered to children > 6 months and < 18 years irrespective of HIV status.

Expansion of services to community level through CBOs will increase the coverage of older children and adolescents whose service use has remained relatively lower than that of under 5-year olds and adults. Harmonization of FBP, OTP and SFP will strengthen integration of nutrition services into MCH. NHP is providing technical assistance to local CBOs that are being supported by other USG partners to identify malnourished individuals through MUAC screening and refer the malnourished OVCs to the health facilities for nutrition services. Data tools, MUAC tapes, and IEC materials are provided after the training and follow up of the identified clients. Routine supervision of the CHWs is also done at site level. This should eventually lead to identification of most vulnerable households for bi-directional linkages between sites and community services. These activities should translate into improved access and adherence to care and treatment including prevention of malnutrition.

It is expected that MOH and partners will support development of common reporting tools for the three intervention strategies but most importantly use one NACS reporting tool. This will further strengthen the ongoing reporting of nutrition status of children from facilities and the implementation of the community strategy.

NHP advocates for greater integration of nutrition service in mentorship and supervision visits. Scaling up quality improvement support under health care improvement initiative with several partners will gradually fuse with HIV quality improvement program. Monitoring and evaluation are nested in the NACS/FBP data at facility and community levels.

Site supervision visits are carried out jointly with the national, provincial and district nutritionists. A site monitoring check list serves as a guide to address specific challenges and gather data on status and site performance as well as gaps. Data is routinely collected by the implementers at clinical sites. Monitoring the quality of services is done through assessing the quality of field data as well as service utilization patterns.

Subpartners Total: $0
Insta Products: NA
Phillips Pharmaceuticals: NA
Key Issues Identified in Mechanism
Increase gender equity in HIV prevention, care, treatment and support
Child Survival Activities
Military Populations