OVC, HIV, Food Security and Nutrition A look at where we stand By Kara Greenblott & Kate Greenaway For UNICEF and WFP

Situation of OVC &Targeting Findings Understand terminology Accept global ambiguity Orphanhood vs nutrition Differences in orphanhood Discrimination Family capacity Targeting Costly, labour intensive & complex Steps in targeting

© UNICEF/Andrew

Situation of OVC & Targeting Recommendations Focus on local situation Understand situation and purpose in defining terms Expand growth monitoring and promotion & nutritional rehab services Seek out paediatric hospices/day care, transition and foster care programmes Enhance support to PMTCT and PMTCT+

Programming Findings Food/nutrition integral to comprehensive programme Higher malnutrition in HIV+ children Forming/supporting viable partnerships Reaching out-of-school youth Dependency and sustainability Keeping parents alive Challenges of scaling up

Programming Recommendations Revitalise nutrition/nutrition education Adapt growth monitoring and care programmes Improve access to ready to use therapeutic food through local production Focus on ECCD: for nutritional supplements, de-worming, psycho-social support & treatment of HIV+ children

Monitoring & Evaluation Findings Emphasis on care and protection Standardised food security indicators Childrens views are important Time and financial constraints

Monitoring and Evaluation Recommendations Develop holistic child vulnerability indices/scales Engage children in measuring vulnerability Develop qualitative approaches Improve monitoring Seek out opportunities for prolonged follow-up

Overall Findings No documented successes: a dearth of honest analysis & exposure of lessons learned Lack of attention to nutritional issues Whats available is contradictory: done to attract media attention & donor funding No evaluations of exit strategies/ graduation Categories of interventions identified: further investigation, scalability, replicability

Possible Models for scaling up/replication/promotion Livelihoods & skills training for out-of school youth PMTCT+ programmes Integrated growth monitoring, promotion and care programming: adapted to low & high HIV prevalence Comprehensive, community-led OVC care Alternative primary education for out-of-school youth Above all: M&E important in all of the above Focus on graduation and exit strategies

Issues for Consideration (1) More research on proposed models Need for different kinds of guidance materials Revitalise nutrition/nutrition education Measure nutritional status of HIV-positive infants and children Increase funds for targeting Targeting in urban settings

Issues for Consideration (2) Ensure sustainability of OVC programming Experience to date with food to encourage guardianship Use of food to enhance enrolment and attendance in secondary schools Capitalize on the attention to food insecurity and poor nutrition in the global AIDS debate

Next Steps? Form an IATT sub-working group to follow-up on these issues and more Identify members, prepare Terms of Reference What else?