NACS – The First Step to a Solution
Tim Quick
USAID Senior Technical Advisor for HIV/AIDS & Nutrition
PEPFAR Co-Chair, Food & Nutrition Technical Working Group
Harnessing the Power of Cross-Sectoral Programming to
Alleviate HIV/AIDS and Food Insecurity
March 6, 2013
Harnessing
the Power of
Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Washington,
DC
Insecurity
HIV/AIDS:
•Loss of appetite
•Increased nutrient requirements
•Impaired nutrient absorption
•Altered nutrient metabolism
Malnutrition:
•Weakened immune system
•Increased susceptibility to
opportunistic infections
•Wasting & increased mortality
•Poorer adherence & response
to treatment
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
HIV/AIDS:
•Loss of productivity
•Increased OVC and female- &
child-headed households
•Increased medical costs
•Depletion of productive assets
Food Insecurity:
• Increased high-risk sexual
practices & HIV infection
• Increased under- & malnutrition
• Decreased adherence & retention
in care & treatment
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
WHO Consultation on Nutrition and HIV/AIDS
in Africa: Evidence, Lessons and
Recommendations for Action Durban, South
Africa, 10–13 April 2005
… called for “the integration of nutrition into the
essential package of care, treatment and support
for people living with HIV/AIDS and efforts to
prevent infection.”
2006: The World Health Assembly passes a
resolution calling on Member States “to develop
evidence-based policies and programs on
HIV/AIDS and nutrition.”
Policy Guidance on the Use of Emergency Plan Funds to
Address Food and Nutrition Needs
September 2006
The Emergency Plan has a clear responsibility to support
prevention, treatment and care for people living with HIV/AIDS
(PLWHA), but comprehensively addressing issues of food
insecurity is beyond the scope of the Emergency Plan.
Key precepts of the Emergency Plan include remaining focused
on HIV/AIDS, maximizing leverage with other partners that
provide food resources and providing support for limited food
assistance in defined circumstances.
Kenya Food
by
Prescription
Program
NACS =
Nutrition Assessment,
Counseling & Support
Clinical Management
Assessment
Support
Community
Surveillance,
Referral,
Counseling &
Support
Counseling
Clinic
Community
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
Standard of
Nutrition Care
Assessment
Counseling
Support
Continuum of
Nutrition Care
Infants & Young Children
Women in Pregnancy & Postpartum
Adults & Adolescents
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
NACS
Integrated Household
Livelihood & Economic
Strengthening Support
Clinical Mgmt
CB
O
Service
Mapping
Assessment
Counseling
Clinic
Support
Service
Strengthening
Household
Assessment
& Service
Referral
Promotion
vocational training, IGAs,
microcredit
Protection
household food
production, savings
Provision
social grants, food
assistance
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
Phased Implementation of NACS
Early Implementation
Nigeria, DR Congo, Lesotho, Vietnam
Program Expansion
Côte d’Ivoire, Ghana, Ethiopia,
Uganda, Tanzania, Mozambique
Namibia, Zambia, South Africa,
Haiti
Implementation at National Scale
Malawi and Kenya
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
Why NACS?
• Links vulnerable to clinical services -- reciprocal impact
between health & nutrition
• Corrective (MAM/SAM)  chronic nutrition management:
Continuum of Care across the Life Cycle
• Clinics “anchor” nutrition support within communities
• Link patients to support groups & community nutrition &
health services
• Referrals of patients & families to economic
strengthening, livelihood & food security support
• Health system strengthening -- NACS is a HSS approach
to integrate nutrition within health services for entire
population, not just within HIV/AIDS programs
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
NACS =
Clinics & Communities as a
Single Operational Unit
Clinic
Community
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
Questions &
Challenges for LIFT
• Can we establish a system that provides ES/L/FS support through
individual household assessment & referral to a range of provision,
protection & promotion services within each community?
• Does this case management ES/L/FS approach lead to better
adherence and retention in health care, as well as improved food
security and household resilience?
• If clinics anchor NACS within the health system, what will give
permanence to NACS ES/L/FS support within communities?
– How do we foster, strengthen CBOs to assume the nexus role
between the health system and ES/L/FS services?
– Is there a role for local government in this system?
• Are their specific ES/L/FS approaches that will recognize &
capitalize on gender differences and lead to better health, nutrition,
food security and economic outcomes for NACS families?
Harnessing the Power of Cross-sectoral Programming to Alleviate HIV/AIDS and Food
Insecurity
Thank
You!