National policy on nutrition and HIV, including a postnatal nutritional care and support policy

The country has adopted policies, as demonstrated in frameworks, guidelines, and monitoring and evaluation (M&E) plans, that reflect the WHO and UNICEF recommendations on nutrition and HIV, including a postnatal nutritional care and support policy (WHO/UNICEF, 2003; WHO, 2004; FANTA, 2008).

The WHO/UNICEF (2003) policy recommendation on nutrition and HIV counseling for mothers and their infants is stated as:  “All HIV-infected mothers should receive counseling, which includes provision of general information about meeting their own nutritional requirements and about the risks and benefits of various feeding options, and specific guidance in selecting the option most likely to be suitable for their situation.”

The following interventions are included in pre- and postnatal nutrition and HIV care and support guidelines: nutritional assessment; counseling and education; therapeutic and supplementary feeding; and preventing mother-to-child transmission (PMTCT) of HIV (PEPFAR, 2006; FANTA, 2008). Each type of intervention entails curricula development, training, quality assurance measures, and establishing a system for M&E.

Evidence of policies, frameworks, guidelines and M&E plans that include nutrition and HIV care and support.  Supporting documentation should include copies of the policy, framework, guidelines, M&E plans, where or by whom these were issued or published, and what the actual recommendations were.

Surveys, reports, and interviews from Ministry of Health and collaborating programs (including private and non-governmental organizations) on written nutrition and HIV policies, frameworks, or guidelines.

In order for nutrition and HIV care and support recommendations to be fully integrated into HIV and reproductive health services and programs, they must be mainstreamed into polices, frameworks, guidelines, and plans for M&E.  This outcome indicator measures the success of advocacy efforts to increase nutrition and HIV awareness and education among policy makers leading to the adoption and formalization of recommendations at the national, provincial, and district levels.

WHO has recommended that any comprehensive program for HIV/AIDS include nutritional support (WHO, 2003). Adequate nutrition for people living with HIV helps maintain the immune system, sustain physical activity, and is essential for improving treatment outcomes with antiretroviral drugs.  Women of reproductive age with HIV are a critical population for health and nutrition interventions. According to UNAIDS data from 2009, women account for over 50 percent of global HIV infections and over 19.2 million women live with HIV. The nutritional status of HIV-infected women before or during pregnancy and during lactation influences both the women’s health and the health and survival of their infants. WHO and UNICEF (2003; 2007) have recommended the provision of postnatal nutritional care and support to minimize HIV transmission while at the same time maximizing child survival. For more background on recommendations, interventions and indicators for nutrition care and support, infant feeding and preventing mother-to-child transmission of HIV, see  FANTA (2007); FANTA (2008); WHO/UNICEF (2007); PEPFAR (2006); UNAIDS (2010); and WHO/UNICEF/UNAIDS (2011).  

Evaluators may have difficulty obtaining evidence of nutrition and HIV care and support policies incorporated into government frameworks, guidance, and M&E documents.  Once nutrition and HIV policies have been formally adopted, evaluators need to follow-up to verify how these recommendations are being operationalized, which cannot be determined by this indicator.

policy, nutrition, integration, HIV/AIDS, health system strengthening (HSS)

FANTA (Food and Nutrition Technical Assistance) Project. 2007. Recommendation for the Nutrient Requirements for People Living with HIV/AIDS, Washington, DC: USAID/Academy for Educational Development.

FANTA (Food and Nutrition Technical Assistance) Project.  2008.  A Guide To Monitoring and Evaluation of Nutrition Assessment, Education and Counseling of People Living with HIV.  Washington, D.C.: USAID/Academy for Educational Development. 

PEPFAR, 2006, Report on food and Nutrition for People Living with HIV/AIDS, Washington, DC: USAID/PEPFAR.

UNAIDS, 2010, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS.

WHO, 2003, Nutrient requirements for people living with HIV/AIDS: Report of a technical consultation, May 13-15, Geneva: WHO.

WHO, 2004, Nutrition Counseling, Care and Support for HIV-infected Women, Geneva, Switzerland: World Health Organization.

WHO/UNICEF, 2003, Global Strategy for Infant and Young Child Feeding, Geneva: WHO.

WHO/UNICEF, 2007, Planning Guide for national implementation of the Global Strategy for Infant and Young Child Feeding, Geneva: WHO.

WHO/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO.