Linking HIVAIDS Responses with Food Based Social Protection Systems

1
Linking HIV/AIDS Responses with Food Based Social
Protection Systems

• Tim Frankenberger
• TANGO International
• Durban April 15, 2005

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Why Food-Based Social Protection is Important

• Adequate food and good nutrition are important
  contributors to resisting the disease, slowing
  the progression form HIV to AIDS, and prolonging
  the life of AIDS patients
• Food is a powerful incentive to begin ARV and to
  stay in treatment programs
  
• In addition, food support mechanisms can help
  address food insecurity conditions and related
  livelihood needs of the affected
  
• Thus food-based interventions should be able to
  address the dietary requirements of PLWHA at
  various stages of the disease
  

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Purpose of This Review

• Review how national social protection systems in
  four countries can be strengthened in conjunction
  with household and community safety nets to
  support PLWHA and their affected dependents
• What are the operational considerations for the
  development of food based support systems to
  support National HIV/AIDS scale-up strategies

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Social Protection in the Context of HIV and AIDS

• An effective social protection system should be
  able to bolster the coping strategies of affected
  individuals and households across the entire
  spectrum of HIV/AIDS prevention, care, support
  and mitigation
• This will involve incorporating flexible methods
  of targeting to capture those most in need

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Social Protection in the Context of HIV and AIDS

• Multi-sector and multi-actor coordinated
  responses
  
• Ability to link treatment eligibility with social
  protection targeting in Referral Mechanisms
  
• Minimize Stigma and Discrimination
• Harmonized monitoring and evaluation systems with
  common indicators

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Social Protection Mechanisms Operate at 3 Levels

• Formal Social Protection Mechanisms are provided
  by government at the national level and are
  prescribed by law. These are medical support and
  social services provided to vulnerable
  individuals and families
• Semi-Formal Safety nets are provided by an array
  of organizations including NGOs, UN agencies,
  faith-based organizations and CBOs. These usually
  operate at the regional or district level
• Informal mechanisms are family and community
  based safety nets
  

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Swaziland

• Context
• Dealing with the triple threat of chronic
  poverty, poor governance and HIV/AIDS
  
• Given the prevalence rates in Swaziland,
  widespread food insecurity could accelerate HIV
  progression to AIDS for thousands of people
  
• This has profound ramifications for stability of
  social, economic and governance systems
  

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Swaziland

• Existing Social Protection Mechanisms
• Existing formal social protection measures are
  inadequate in terms of coverage
  
• Given the scale of the problem, community based
  safety nets are not adequately coping with the
  situation
  
• Bulk of the resources for food based support
  channeled through WFP and NGOs. Not
  institutionalized

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Swaziland

• Exiting Social Protection Mechanisms
• Targeting criteria for care and support vary
  widely and there is no common set standardized
  criteria
  
• Accountability for food and other types of
  assistance is low within the formal system
  
• The health sector is dealing with serious
  capacity constraints in providing dietary
  support to its clientele
  

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Opportunities at the National, Meso and Community
Level

• Policy Level
• Advocate for the development of a National
  HIV/AIDS Strategy stressing the link between
  food/dietary support and the ARV roll out
  
• Advocate for a centralized coordinating body for
  all donor and government HIV/AIDS programming
  (NERCHA)
  
• Comprehensive mapping of social institutions and
  organizations delivering support
  
• Strengthen national food security monitoring
  system to promote good targeting
  (institutionalize the SVAC)

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Opportunities at the Meso and Micro Level

• Promote successful models for integrating food
  based livelihood programming and community based
  targeting and care
  
• Standardize targeting criteria for care and
  support that includes socio-economic criteria to
  verify food security needs
  
• Develop nutrition guidelines for PLWHA that are
  tailored to Swazi foods and diets
  

12
Malawi

• Context
• Similar to Swaziland, Malawi has suffered from
  the triple threat of Chronic poverty, poor
  governance and HIV/AIDS
  
• Malawi provides a good model of coordinated UN
  and donor support to integrated HIV/AIDS
  activities
  
• NGOs and CBOS are taking an integrated livelihood
  approach to HIV/AIDS programming
  

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Malawi

• In terms of targeting, WFP and NGOs have already
  developed an HIV/AIDS targeting manual that
  includes social criteria for targeting vulnerable
  households for food assistance, and exit
  criteria
• A good foundation is currently in place to
  promote further strengthening of food based
  social protection measures
  

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Opportunities at the National, Meso and Community
Level

• Policy Level
• Advocate for the inclusion of nutrition and food
  security interventions in the National Strategic
  Framework for HIV/AIDS
  
• Advocate for the inclusion of food and nutrition
  interventions into the National HBC program
  (nutrition education, counseling, and
  supplementary foods)
• Strengthen links between the National AIDS
  committee and local communities through work with
  NGOs and District AIDS coordinators to support
  the integration of nutrition activities

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Opportunities (Cont.)

• Geographic Consolidation-integrate food
  assistance with other complementary inputs to
  bring about effective change (ART, care and
  support, ag assistance, school feeding, skill
  training)
• Concentrate on building up the assets of the
  chronically ill families to improve food and
  livelihood security
  
• Begin by identifying cohesive communities that
  that demonstrate good leadership and management
  skills and that take their own initiatives

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Tanzania

• Context
• Vulnerable to 2 categories of crisis
• Food insecurity resulting from natural shocks
• Influx of refugees from neighboring countries
• Many households suffer form multi-causal
  vulnerability associated with concurrent shocks
  and stresses, one of which is HIV/AIDS
  
• No evidence of HIV/AIDs induced hunger and
  poverty at a national scale
  

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Tanzania

• Existing Social Protection Measures
• The current social protection mechanisms are not
  coordinated by any national strategy
  
• Few implementing agencies have experience with
  food management and distribution and a bias
  against it
  
• Targeting practices vary widely across
  organizations
  
• Food security and nutrition are not well
  integrated with HIV/AIDS activities (cash vs.
  food)
  
• Referral mechanisms not well coordinated or
  managed

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Opportunities at the National, Meso and Community
Level

• There is consensus among government and other
  implementing partners that a national social
  protection strategy is needed
  
• Need for a thorough institutional mapping
  exercise of safety net providers
  
• Vulnerability assessments can be the entry point
  for furthering the dialogue on food and nutrition
  security linked to HIV/AIDS
  
• In situations where food is needed, it should be
  introduced in a phased approach that links food
  support to longer term livelihood programs

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Opportunities (cont.)

• District and community level organizations are
  the best entry point for implementing safety
  nets
  
• For programs working with PLWHA, there is a need
  to support community-based targeting approaches
  using wealth and asset ranking criteria for
  screening for food insecurity
• To manage an expanded level of food support to
  HIV/AIDS programs, coordination and management of
  logistics needs to be strengthened at the local
  level
• Locally procured foods should be high in
  nutritional value and appropriate to the needs of
  PLWHA
  
• Need for better indicators to track changes in
  food and livelihood improvements in HIV/AIDS
  affected families

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Mozambique

• Context
• High prevalence of absolute poverty and
  widespread food insecurity making large parts of
  the country vulnerable
  
• Mozambique depends on donor support for its
  budget-not likely to have sustainable safety nets
  in the near term
  
• Government formal safety nets and informal safety
  nets are not integrated
  
• Although most of the safety net activities are
  done through NGOs and UN Agencies, there is a
  lack of a formalized structure to coordinate
  these activities
• Each agency uses its own targeting criteria

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Mozambique

• There is no overall safety net policy that would
  guide the provision of various inputs from the
  different actors geographically and thematically
  
• Partner organizations do not focus on areas where
  they have a comparative advantage in food
  programming
  
• Although the national NGOs and faith based
  organizations have the greatest outreach, they
  are in the weakest position to deal with food
  planning and handling

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Opportunities at the National, Meso and Community
Level

• Policy
• Advocate for the inclusion of HIV/AIDS nutrition
  and food security interventions in the Policy
  Reduction Strategic Plan, National Policy on Food
  Security and policy and strategy on safety nets
• Advocate for a common set of criteria and
  procedures for geographical targeting and
  selection of beneficiaries building on the work
  of SETSAN
• Develop an institutional map to identify
  important players providing safety nets and
  identify their comparative advantages

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Opportunities (cont.)

• Non-formal safety nets at the community level
  should be strengthened and supported by formal
  and semi-formal social protection initiatives
  
• To minimize the risk of creating dependency,
  social support should be combined with and
  replaced by programs that increase food security
  and resilience through community driven
  development
• To monitor and demonstrate results, their should
  be consensus on the types of indicators that can
  be used to measure program impact