1. Barriers to Scale Up, treatment success and ensuring food security and nutrition in the long term By Christine Nabiryo TASO, Uganda

2. 2 Presentation outline Barriers to scale up Barriers to scale up Background on Uganda and TASO Background on Uganda and TASO TASO context and experience on Food security and sustainable livelihoods programming TASO context and experience on Food security and sustainable livelihoods programming Challenges Challenges Recommendations Recommendations

3. 3 UN General Assembly June 2006 Commitment to scale up of comprehensive HIV prevention, Care and treatment by 2010, addressing obstacles to scale up Commitment to scale up of comprehensive HIV prevention, Care and treatment by 2010, addressing obstacles to scale up

4. 4 Known Barriers to scale up Inadequate Health systems readiness- infrastructure, Logistics and supplies Inadequate Health systems readiness- infrastructure, Logistics and supplies Human resources Human resources Stigma & discrimination Stigma & discrimination Inadequate focus on high risk groups Inadequate focus on high risk groups Other basic needs - Food security, transport to access points Other basic needs - Food security, transport to access points Overwhelming numbers of new infections Overwhelming numbers of new infections

5. 5 2008 Report on global AIDS Epidemic Study in Botswana & Swaziland (women who lack sufficient food and those who are food secure) –Among those who lack sufficient food 70% less perception of control in sexual relationships 70% less perception of control in sexual relationships 50% likelihood for intergenerational sex 50% likelihood for intergenerational sex 70% more likely to engage in unprotected sex 70% more likely to engage in unprotected sex

6. 6 Uganda High burden of HIV/AIDSHigh burden of HIV/AIDS First cases detected in 1982First cases detected in 1982 High morbidity and mortality affecting the country ’ s socio-economic gainsHigh morbidity and mortality affecting the country ’ s socio-economic gains Uganda

7. 7 TASO Context NGO established in 1987 to respond to the epidemic NGO established in 1987 to respond to the epidemic Compliments national health system efforts in the fight against HIV/AIDS Compliments national health system efforts in the fight against HIV/AIDS Core business in psychosocial support, medical care and treatment, community capacity building for HIV prevention, care and support Core business in psychosocial support, medical care and treatment, community capacity building for HIV prevention, care and support

8. 8 TASO Context 70 % of TASO clients are female 70 % of TASO clients are female 50% of the females are widowed 80% of clients are unemployed earning less that a dollar a day

9. 9 New clients by Gender

10. 10 TASO Context Psychosocial Needs ranking: Psychosocial Needs ranking: –Health –Food Security –Support for their children – education –Sustainable Livelihoods

11. 11 Screening for ART readiness - TASO HIV status HIV status WHO staging & CD4 WHO staging & CD4 Psychosocial readiness Psychosocial readiness –Beneficiary commitment to start –Medicine companion –Food security ( cited among the common client concerns about starting treatment)

12. 12 Impact of Food support and ART on new clients Registration at TASO Food Support ART

13. 13 Noted Effects of ART Good treatment outcomes ( CD4 raise, mortality rate less than 10% in first year, 95% adherence for over 90% of clients, improved health 80% of beneficiaries) Good treatment outcomes ( CD4 raise, mortality rate less than 10% in first year, 95% adherence for over 90% of clients, improved health 80% of beneficiaries) Increased food intake noted during first 3 months Increased food intake noted during first 3 months –Increased demand for food against background of chronic food insecurity

14. 14 Survey among TASO clients on food support program Most of their income was spent on food Most of their income was spent on food 29% supported by relatives 29% supported by relatives –These statistics describe a population affected by poverty

15. 15 Household Food Insecurity Access Scores - Prevalence at one TASO center Missing 16.1% Food Secure 2.4% Mildly Food Insecure 2.0% Moderately Food Insecure 10.8% Severely Food Insecure 68.7%

16. 16 Ensuring food security and nutrition in the longer term….. Ensuring food security and nutrition in the longer term…..

17. 17 Food security and nutrition needs of clients have led to emphasis on Food, Nutrition security and livelihoods programming in TASO programming Food security and nutrition needs of clients have led to emphasis on Food, Nutrition security and livelihoods programming in TASO programming Nutrition, Food and Livelihoods programming is implemented through partnerships e.g TASO/WFP and other livelihoods focused partnerships Nutrition, Food and Livelihoods programming is implemented through partnerships e.g TASO/WFP and other livelihoods focused partnerships

18. 18 Moving Up: A Holistic Approach LOANS and SAVINGS CONDITIONAL MICRO-GRANTS: TRICKLE UP AGRO-BUSINESS: HEIFER PROJ. INTL. ACDI/VOCA FOOD SECURITY COMMUNITY PROJECTS FOOD AID FOOD SUPPORT/ SOCIAL WELFARE CONTRACTS MARKETING SKILLS TRAINING JUMP START SUSTAINABILITY Clients will always need TASO counseling and medical care, but they may not always have to depend on food support or welfare. Imagine if poor clients could graduate from social welfare as they move towards economic independence.

19. 19 TASO Sustainable Livelihoods programming Goal : To empower TASO clients to be self reliant in their livelihoods 6000 client beneficiaries to date 6000 client beneficiaries to date

20. 20 Benefits of Food security & livelihoods programming in scale up Clients attendance and retention Clients attendance and retention Enhanced drug adherence Enhanced drug adherence facilitates support to OVC facilitates support to OVC Improved health and nutrition status Improved health and nutrition status Improved agricultural productivity of clients Improved agricultural productivity of clients

21. 21 Demonstration garden at a TASO center

22. 22 Clients representatives training in backyard farming

23. 23 A client supported by a partner agency ( FADEP) in farming

24. 24 Family involvement

25. 25 A herd of goats belonging to one client – A success story Aidah - Client at TASO Jinja: Has 1 cow -12 L of milk/day, 49 mature goats, 36 local chicken layers 1st born child at University 2nd born child in Secondary school Other 4 benefiting from UPE Able to pay for transport for regular follow up

26. 26 Challenges Few partners to support program-huge demand Few partners to support program-huge demand Taking the efforts to scale Taking the efforts to scale –from jump starts to effective sustained family projects at individual level –Reaching all 80,000 active clients

27. 27 Challenges Seasonality – climate change Seasonality – climate change Rising food prices Rising food prices Limited focus on nutrition and food security as a priority in HIV programming Limited focus on nutrition and food security as a priority in HIV programming Missed opportunities – formal linkages between treatment programs and food security programs Missed opportunities – formal linkages between treatment programs and food security programs

28. 28 Examples of TASO Partnerships for Livelihoods UNWFP UNWFP ACDI VOCA (USAID) ACDI VOCA (USAID) Heifer International Heifer International FADEP, Farm Africa, Africa 2000 FADEP, Farm Africa, Africa 2000 JIDDECO, SOCADIDO, MADDO JIDDECO, SOCADIDO, MADDO Research partnerships- IFPRI, GWU Research partnerships- IFPRI, GWU

29. 29 Recommendations Sustainable livelihoods needs to be included as a component of comprehensive care for PHAs Sustainable livelihoods needs to be included as a component of comprehensive care for PHAs Partnerships and resources for PHAs livelihoods needs to be mobilized Partnerships and resources for PHAs livelihoods needs to be mobilized Advocacy to address exclusion of PHAs from development programs Advocacy to address exclusion of PHAs from development programs

30. 30 Recommendations Any short term food aid programming should incorporate longer term nutrition sustainability planning to be communicated from start of project Any short term food aid programming should incorporate longer term nutrition sustainability planning to be communicated from start of project Need to incorporate gender programming in sustainable livelihoods programming Need to incorporate gender programming in sustainable livelihoods programming

31. 31 With Partnerships (HIV/AIDS & Food security programs) and commitment to address PHAs needs as a holistic package, We can register even greater success in treatment scale up as we focus on ensuring food security & nutrition in the long term

32. 32 THANK YOU