Food assistance in the context of HIVAIDS in an emergency setting

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Food assistance in the context of HIV/AIDS in an
emergency setting
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Introduction and Background

• 2003, WFP responding to HIV through programmes
  and advocacy
• Goal food and nutrition support to families and
  individuals affected by food insecurity and HIV

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• 2007 WFP KCO required guidance in HIV in
  emergencies
• 2008 Consultancy HIV targeting in emergency and
  non-emergency settings
• Outputs are draft guidelines and targeting tools

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Who's guidelines?

• Personnel and organisations involved in food
  assistance in emergency and non-emergency settings

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Introduction to targeting

• Targeting?
• process by which population group's are
  selected to receive a resource that they are
  critically lacking.
• Following are the recommended steps in targeting

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Setting Targeting Objectives
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Steps in targeting

• - Needs assessment
• Type and magnitude of the problem
• -Setting targeting objectives
• Based on needs identified beneficiaries,
  quantity, quality
• Targeting eligibility
• Determining eligibility, practicing criteria

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• Verification Process
• Ensures that those selected, are actually in need
  of assistance
• Distribution
• For food and non food items
• ME of entire process

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Facility based targeting

• Predetermined selection criteria nutritional,
  clinical
• Key requirement available information
• Integrated with other services nutritional
  counselling

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Limitations of health facility

• Stigma receive food at health facility
• Lack of verification

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Community based targeting

• Targeting by community due to indepth knowledge
• Method- needs assessment, programme objectives,
  targeting criteria, beneficiary selection,
  verification, food distribution

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Limitations of community based

• Verification may be difficult due to document
  requirements
• Bias/favouritism

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Exercise

• Assessment carried out and need identified is
  that members of orphan headed households dont go
  to school but are instead engaged in casual
  labor.
• What is the programme objective?
• What assistance will be provided to meet
  objective?
• How long will assistance be given?

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Exercise

• 4.Who is eligible for this assistance?
• 5.How will they be identified?
• 6. How would you verify vulnerability?

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Response

• Objective is to members of orphan headed
  households receive food and attend school.
• A monthly take-home ration will be provided to
  orphan headed households
• All the children attend school for at least 80
  of the required days in a month
• Eligibility is an Orphan headed household defined
  as those in which a child (under 18) is
  responsible for the provision of basic needs for
  all family members.

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Response

• OVCs may be identified through communities
  (community-based targeting) or institutions
  (facility-based targeting).
• Verification may involve home visits to those
  selected, or verifying availed records

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Targeting OVCs

• Who is an OVC?
• A child below the age of 18 and
• Has lost one or both parents, or
• Has a chronically ill parent, or
• Lives in a house where in the past 12 months one
  or both of their parents/guardians died and was
  sick for at least 3 of the 12 months before
  he/she died, or
• Lives in a household where at least one adult was
  seriously ill for at least 3 months in the past
  12 months, or
• Lives outside of family care (i.e. lives in an
  institution or on the streets) or parents are
  alive but who live with relatives and
  non-relatives under strained capacity (often
  identified as social orphans) or
• Is HIV-positive, some of whom are orphans

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OVC Vulnerability
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OVC selection process

• For the purpose of the selection process, two
  types of orphans will be addressed by this
  guideline school going and non-school going
  categories.
• Do these two groups exist in your communities?

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• Non-school going OVCS are those not enrolled in
  pre-primary, primary or secondary schools because
  they have either not attained the minimum age
  required or have completed
• Do non-school going OVCs still exist?

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• Potential beneficiaries of school going age
  should be compelled to register in school in
  order to qualify for the selection i.e. food
  receipt will be conditional to attending school.
• What is your opinion on making food receipt
  conditional to attending school?

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• OVCs should be identified by a committee composed
  of community members and school management
  committee members
• What is the establishment of these committees
  possible for the targeting of OVCS?

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• OVCs identified will receive a monthly take home
  ration, and this will be pegged to a minimum
  number of days that they should have fully
  attended school.
• How many days should the OVCs attend school in a
  month for them to qualify for the take home
  ration?

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• Food distribution should be done at the community
  level with involvement of school management
  committees, so as not to turn these schools into
  distribution points.
• Where is the best place to distribute food?
  School or community? In both scenarios, who would
  be responsible for the food distribution?

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Proposed method for OVCs

• Stage 1 Community Based Selection Method
• Communities should select their committee
  members with supervision from implementing
  partners.
• These selection committees should constitute
  community members and school representatives.
• The number of the committee members may differ,
  but ideally 8-12 members constitute a good size
  for discussion and consensus building

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• The selection committee should be gender and
  region sensitive and be composed of the following
  members
• - Community leader (at least 3) e.g. community
  elders, religious leaders
• - Community members (at least 4)
• - School representatives (at least 4)
• Coordination with government agencies at the
  local level
• What is your opinion on a) the process of
  selecting committee members and b) the
  composition and number of selection committee
  members?

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OVC selection process

• Potential beneficiaries will be identified either
  from the community side or school side
• Implementing partner may sensitize schools and
  community groups that they were in the process of
  recruiting OVCs for food support and request for
  lists to be submitted to the selection committee
  by a given date
• The selection committee will list potential OVCs
  in the geographical area they represent, and
  discuss to build consensus on who actually
  deserves support.

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OVC selection Process

• In case of lack of consensus home visits should
  be done by the selection committee.
• The selection committee will then present the
  list to representatives of the organizations
  implementing the food assistance programme
• Where are there loopholes, biases, or no clarity?
  How best can these be overcome?

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Stage 2 Using Score-Based Selection Method

• A second tool increases probability that those
  selected are indeed vulnerable
• An individual is scored against a coded factor.
  Scores from different factors will then be summed
  up for each OVC to add up to the total number of
  scores.

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• The total score is then calculated as a
  percentage of possible maximum score and will
  guide in the classification of the OVC as
  follows
• - Those who score 75 and above (upper quartile)
  are considered most vulnerable
• - 50-74- seriously vulnerable
• - 25-49- moderately vulnerable
• - 0-24 (lower quartile)- Lower vulnerability

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OVC Scoring tool
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Selection of PLHIV

• Nutrition Indicators
• Severely malnourished HIV-positive children under
  five years should be admitted into therapeutic
  feeding programmes
• Those with medical complications admitted at
  inpatient care and those without medical
  complications admitted into outpatient care
• Severely malnourished PLHIV above five years
  should be admitted in hospital and therapeutic
  programmes where feasible.

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The Community-Based Selection Method

• Community-level institutions include
• - CBOs, NGOs dealing with PLHIV
• - HIVAIDS Support groups
• - Health centers and hospitals (medical partners)
• - VCT centers
• - Home based care groups

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• Activities in the community-based approach will
  include
• - Identification of community-based institutions
  by WFP cooperating partner
• - Listing of potential beneficiaries using a
  defined criteria
• - Submission of the list to the WFP cooperating
  partner
• - Confirmation of HIV status
• Compilation of final list of those who qualify
  for the scoring method of selection
• Identify the loopholes or biases? How best can
  these be overcome?

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The Score-Based Selection Method

• Refer to OVC section

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Handling complaints

• The appeal steps are thus as follows
• - The complainants report to community
  institutions that initially identified them
• - Assessment of the validity of the complaint by
  institution
• - Committee to give a recommendation on whether
  the individual needs re-scoring
• -Re-scoring done, check accuracy of the responses
  given in the first assessment
• Is process practical and necessary?

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PLHIV selection tool
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Targeting in Emergencies

• Emergency?
• a situation that acutely threatens the lives and
  well-being of a population
• Rapid and slow onset

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Targeting in Rapid Onset

• non targeted interventions - entire population is
  entitled to benefit.
• Additional targeted programs for those in
  increased need e.g. PLHIV, chronically ill,
  children, pregnant and lactating mothers, the
  elderly and orphaned children.

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Targeting in camp populations

• Key determinants
• - Health facilities offer integrated health
  services including ARVS, MCH etc
• - Trauma counseling centers for continuous
  psycho-social counseling and support to those
  infected and affected by HIVAIDS.
• - Undertake continuous health sensitization
  forums in the camps
• - a broad based selection criterion because
  displacement is already a vulnerability factor,
  and HIV aggravates the situation
• - Blanket targeting should be applied at the
  beginning of displacement, followed by
  identification of populations with special needs
• Suggestions on targeting the HIV affected in
  camps. What other services are necessary for
  adequately serving the HIV affected?

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Targeting PLHIV in camps

• Identification of organization/institutions
  offering health services to the PLHIV in the IDPs
  and may include
• - Health services (medical partners) such as
  ARVs, MCH
• - Voluntary Counseling services
• - Home based care services
• - HIVAIDS psychosocial support groups
• - Networks of PLHIV

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• - Listing of beneficiaries by identified
  institutions - will provide the numbers required
  for an additional selective feeding programme
• - Comparison of different lists to eliminate
  double registration..
• - A master beneficiary list developed to
  eliminate double registration
• What has been left out in the process? And
  identify biases or incorrect assumptions

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Targeting OVCs in camps

• The use of the same institutions identified above
  for the PLHIV
• Identification of organizations/institutions
  offering health services to the PLHIV in the
  IDPs.
• Listing of OVC by identified institutions.
• - Comparison of different lists
• A master list should be developed to facilitate
  elimination of double selection.
• Again, What has been left out? And identify
  biases or incorrect assumptions

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Targeting in Flood situations

• - Speedy response to health preparedness to
  minimize disease outbreaks
• - Partnerships forged with agencies that have
  worked previously in flooding conditions to
  assist in the selection of the most vulnerable
  PLHIV
• Include areas to flood responses that have been
  left out.

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Targeting in slow onset

• Targeting in drought affected regions is based on
  livelihood vulnerabilities defined by
  geographical boundaries.
• Where there is an ongoing populationwide
  targeted food support programme, targeting
  systems should be sensitized to identify and
  prioritize vulnerabilities of the HIV affected.
• PLHIV targeted through MCHNs/PMTCTs and TB
  control programmes to promote uptake of services

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Targeting in High Stigma settings

• Pregnant and lactating women
• through MCHN/PMTCT services available at
  antenatal care services
• MCHN is more effective in high stigma areas, to
  reduce the risk of discrimination among clients.

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Using Proxy Indicators

• Proxy indicators include chronic illnesses and
  household hosting orphans or orphan headed
  households
• Not used in isolation

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TB as a proxy indicator

• HIV positive person is 100 times at risk of
  contracting TB
• Perceptions on using TB as a proxy?

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Necessary Non-Food Interventions

• Alongside food support programmes, particularly
  in high stigma areas
• intensified awareness campaigns,
• sensitisation programs,
• open forums about the HIV pandemic and
• increasing access to VCT services and
• networks for PLHIV
• are very necessary programmes for stigma
  reduction.

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• Religious leaders including pastors, Sheikhs,
  imams, play a significant role as agents of
  change in rural communities.
• They are well listened to, and play a critical
  role in intensifying stigma reduction and
  promoting acceptance of PLHIV by communities and
  families.
• What are the other necessary interventions?

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Effective exit criteria

• What is an exit strategy?
• A strategy that involves a plan on how a client
  will be discharged from a food assistance
  programme.

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OVC Beneficiary Exit Criteria and Strategy

• Proposed Criteria for exiting OVCs include
• - At the time when the food program period ends
• - When the OVC exceeds the age limit for OVC (18
  years)
• - When the OVC has died
• - If a child moves to an able household, able to
  take care of his/her food and other needs, then
  the OVC should also be exited from the program.
• When the OVC gains access to other reliable food
  support programs

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• - OVCs exiting due to attaining the age limit of
  18 years to be linked to vocational training
  courses, micro credit finance and training
• Is the above criteria comprehensive enough? What
  possible scenarios have been left out?

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PLHIV Beneficiary Exit Criteria and Strategy

• - An initial 6 months
• -Evidence shows food support for 3 month is a
  sufficient to stabilize a HIV patient
  incapacitated by the illness.
• - six months allows patients to fully regain
  their productive capabilities and resume
  livelihood activities.
• - After six months, a socio-economic review (by
  medical partner) for a possibility of another 3
  months food support should be done to determine
  if continued food support is necessary

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• Beneficiaries graduate into livelihood support
  interventions, three months after enrolling in
  food support programmes.
• Agencies supporting livelihood initiatives should
  work closely with beneficiaries to ensure
  sustainability and prosperity after exiting

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• Pregnant mothers maintained in MCHN/PMTCT
  programmes until six months after delivery
• - Support nursing womens access to nutrient rich
  food to encourage lactation,

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The exit strategy should ensure

• Right from the beginning of the program, all
  beneficiaries are informed that within the next
  6-9 months they will have exited the program.
• The PLHIV are linked to livelihood support
  programs to recover and build their livelihoods.
• Based on your experience or available evidence
  are these exit time lines practical, how else
  could they be improved?
• What else would ensure effective exit strategies?