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Tuberculosis and Nutrition
Experiences from the Integration of Food and Nutrition in
Care and Treatment Programmes
GBC Workshop on Increasing Corporate Engagement on Tuberculosis
23 February 2010
Cape Town, South Africa
• 100% voluntary funded• Low overhead costs• Mandated to respond
globally to– Emergency aid– Recovery assistance– Chronic hunger reduction
Cost estimates• US$0.25 - Feed a hungry school child per day• US$0.31 – Feed Orphan and/or vulnerable child per day • US$0.66 – to provide nutrition support to an AIDS patient plus family per day
UNAIDS Cosponsors
– UNHCR – UNICEF– WFPWFP – UNDP – UNFPA– UNODC– ILO – UNESCO– WHO – WORLD BANK
WFP’s lead role is dietary and nutritional supportWFP’s lead role is dietary and nutritional support
Background
• Southern Africa has the world's highest HIV infection rates • About one third of PLHIV in the region are co-infected with TB - TB
is the leading cause of death among PLHIV • Severe malnutrition, Body Mass Index (BMI)<16, is associated
with an increased risk of death in the first 4 weeks of TB treatment
• Drug side effects reduce TB treatment compliance• WFP and partners’ support treatment programmes in 14
countries in the region (pre-ART/OI, ART, TB) • Align with national systems for greater ownership and replication
Need to use ongoing programmes as platforms for services model development and national strategic guidance!
WFP Food Assistance ProgrammesWFP Food Assistance Programmes
Care & Treatment
Livelihoods promotion
Social Safety Nets
HIV, AIDS, TB,
Drugs, Malnutrition,
Poverty
“Drugs alone are not enough. Food and nutritional support should be an essential part of the care package for people with HIV/AIDS or tuberculosis”
‘The Lancet’, March 2007
Programme ObjectivesProgramme Objectives
Programmes are designed to achieve one or more (often closely related) objectives, including:
•Nutritional rehabilitation and/or nutrition support to improve individual well-being and treatment success•Social safety nets mechanisms to support treatment adherence and protect the household structure•Livelihood activities to encourage a productive recovery and sustain long-term adherence.
Types of Commodities
Judy Pudlowski, International Medical Corps
• Corn Soya Blend and oil for nutrition rehabilitation
• Cereals, pulses, oil, salt for household
• Other specialized products – RUTF supplied by partner agencies
Quality Assurance
TAG = Technical Advisory Group:• External, independent• Composed of experts in field of nutrition, food
safety, food legislation, consumer acceptability
• Reviews all ‘new’ products offered to WFP and advises WFP on their appropriateness for use in WFP programmes
Operational ChallengesOperational Challenges
• Commodities• Staff capacity• Infrastructure• Supply chain management
Product choices and associated operational considerations are driven by technical and services delivery parameters i.e. protocols
All operational considerations are closely linked to design decisions and vice versa
Operational Challenges: CommoditiesOperational Challenges: Commodities
•Nutritional supplements versus staple commodities (volume, packaging)• Purpose of food reflected in product type - Food as ‘medicine’ or food for social welfare • Number of specialized products for advanced care protocol – elaboration complicates product handling
Specialized nutritional
supplements easier accepted as health
products &facilitation of integration in
health protocols and supply
management
Implication of care protocols for
product choice
Operational Challenges: Staff CapacityOperational Challenges: Staff Capacity
•Integration in job description of doctors, nurses, pharmacists•Requirement for additional staff cadre•Need for integration within curriculum or on-the-job training•Encourage perspective of food as health product•Integration of nutritional care within treatment protocol
Disconnect between nutritional care,
‘prescription’ and commodity handling
discourages full responsibility by
‘medical’ staff
Food and nutrition support perceived as parallel/add-on
service
Operational Challenges: InfrastructureOperational Challenges: Infrastructure
•Staple foods often stored and handled outside the clinic due to bulk (storage volume, spillage), so as specialized nutritional supplements •Requirement for weighing or measuring equipment to determine individual and/or HH entitlements•Location and timing of food distributions do not always match clinic visits (opportunity costs)
‘Distance’ between health trigger and
food support purpose and
handling locationdilutes the health messaging on the
use of food products
Client perception of role of food!
Operational Challenges: Supply Chain Operational Challenges: Supply Chain Management Management
•Integration in medical supply chain (Proportioned supplies by manufacturers/suppliers ) •High cost of supplies to sites with limited clients (high cost/volume)•Explore commercial supply managers, including retailers (cash/voucher)
Integration is the way forward for
national programming
Products need to be adjusted to medical
supply chain parameters
Operational SuggestionsOperational Suggestions
Products for individual nutritional support:•Needs to be provided based on prescription•Should be integrated in routine patient care and case management - clinicians role and responsibility•Need for formalized protocols and training (including NAEC)•Product development (apart from specialized ‘recipe’), shelf life, portions, packaging•Product supply managed within medical supply chain•Procurement through local industries for easier access and sustainability•Quality assurance and oversight - Food standards, national/regional regulation regarding health claims
Operational suggestions, cont.Operational suggestions, cont.
Products for household support:•Distinguish purpose from specialized supplements•Handle food products (staples) outside the health sector infrastructure – civil society, retail •Consider the use of innovative social transfer modalities (cash, vouchers)•Consider linkages to livelihood enhancing activities and existing social welfare schemes •Consider (semi)-conditionality to encourage ‘graduation’
Lessons Learnt
Food and nutrition assistance • Improves nutritional status of patients• Enhances treatment adherence • Decreases treatment default rates, as food acts as an incentive for the
patient to visit the health facility• Increases patients’ access to health services including HIV counseling and
testing• RUTF more effective in severe malnutrition• CSB more appropriate for mild to moderate malnutrition
Thank you