HIV-sensitive social protection: an assessment of east and southern Africa's social protection policies and programmes.

Despite notable political and financial commitment to fight the HIV epidemic, east and southern Africa (ESA) remains the world regions most affected. Given increasing calls for the implementation of HIV-sensitive social protection programmes to address the multiple individual, community and societal factors that heighten the risk of HIV infection, this article explores the extent to which social protection mechanisms in the region are HIV sensitive. The article is based on a two-phase project where the first phase entailed a desktop review of national social protection policies and programmes. In the second phase, multisectoral stakeholder consultations conducted were 15 fast-track countries in the region. The key findings suggest that social protection policies and social assistance programmes in ESA do not specifically target HIV issues or people living with, at risk of, or affected by HIV. Rather, and in line with the countries' constitutional provisions, the programmes tend to be inclusive of the vulnerabilities of various populations including people living with HIV. To this end, the programmes can be seen as generally sufficient to encompass HIV-related issues and the needs of people infected and affected by the epidemic. However, a recurring argument from many stakeholders is that, to the extent that people living with HIV are often reluctant to either disclose their status and/or access social protection services, it is critical for social protection policies and programmes to be explicitly HIV sensitive. The article thus concludes by making recommendations in this regard as well as by making a class for multisectoral partners to work collaboratively to ensure that social protection policies and programmes are transformative.

Leveraging the Scaling Up Nutrition Movement to Operationalize Stunting Prevention Activities: Implementation Lessons From Rural Malawi.

BACKGROUND: The rural district of Ntchisi is in the central region of Malawi. Among children aged 6 to 23 months, the stunting prevalence is 40% to 50%. To address this high prevalence, the World Food Programme, with cooperating partners, supported the Government of Malawi to implement an integrated stunting prevention program entitled The Right Foods at the Right Time from 2013 to 2018. OBJECTIVE: To provide implementation lessons learned from systematic documentation of how the Scaling Up Nutrition (SUN) movement, combined with other international and national initiatives and policies, was translated into tailored programming. METHODS: During program conception, early design, and implementation, this descriptive study systematically documented the process of translating SUN principles and government policies into an operational stunting prevention program in rural Malawi. RESULTS: We identified 8 factors that contributed to successful translation of policy into program activities: (1) well-structured National SUN framework, (2) reliable coordination platforms and district ownership, (3) systematic and evidence-informed program design, (4) multiple forms of data used to inform program planning, (5) multisectoral implementation approaches to stunting prevention, (6) innovation in technology to improve overall program efficiency, (7) systematic collaboration among diverse stakeholders, and (8) strong public health nutrition capacity of program team members. CONCLUSIONS: Lessons from this nutrition program in Ntchisi, Malawi, provide one case illustrating how the SUN movement, government policies, and global evidence base can be operationalized into tailored programming for improving nutrition.

Nourishing nations during pandemics: why prioritize fish diets and aquatic foods in Africa.

The COVID-19 pandemic caught the world unprepared, with containment measures impacting both global supply chains and agri-commodity flows. The public health crisis raised some urgent questions: "how can fish and other aquatic foods and supply chains be prioritized as health-related interventions to avert both a malnutrition crisis and gender inequality?" Furthermore, "what are the integrated responses, investment opportunities, and governance mechanisms to effectively address the pandemic?" As "super foods," diets of fish and aquatic foods provide animal-source protein, omega-3 fatty acids, and micronutrients, including both vitamins and minerals, necessary for both the ill and the healthy. The affordability and accessibility of fish could address food and nutrition security needs under lockdown and border closures, boost immune systems, and increase commodity trade. This analytical piece focuses on the continent of Africa, where malnutrition is pervasive, but also where local aquatic food supplies can be utilised during lockdowns and border closures. The paper provides governance insights on national budget support programs and portfolio restructuring to strengthen local aquatic foods production systems to meet dietary needs. Furthermore, the authors advocate for a coordinated multi-sectoral intervention across several well-being domains in the immediate and medium-term involving various partnerships. These integrated responses will mutually limit the contagion while providing support to functional fish value chains for healthy diets, livelihoods, cross-border trade, and long-term macroeconomic recovery.

Leveraging an Implementation- Research Partnership to Improve Effectiveness of Nutrition-Sensitive Programs at the World Food Programme.

BACKGROUND: Nutrition-sensitive programs can accelerate progress in addressing malnutrition. However, evidence gaps exist related to their effectiveness and how to optimize program design and implementation. OBJECTIVE: We present the process the International Food Policy Research Institute and the World Food Programme (WFP) used to develop nutrition-sensitive program guidance and plans for improving program effectiveness and contributing to the evidence base through rigorous evaluations. METHODS: A 5-step process, using principles of design thinking (a systematic, iterative analytical approach to problem solving), was used to develop, test, and refine WFP's nutrition-sensitive guidance. The guidance focuses on improving nutrition outcomes for nutritionally vulnerable groups across the life cycle: women and children in the first 1000 days, preschoolers, schoolchildren, and adolescents. RESULTS: Through iterative consultations, we created WFP's nutrition-sensitive guidance that includes harmonized theories of change across WFP's programs; 7 opportunities to enhance the programs' nutrition-sensitivity; and mapping of these opportunities to WFP programs and key evidence gaps. This guidance has been rolled out to WFP's offices worldwide to support improved nutrition outcomes. Finally, several evaluation designs have been proposed to fill identified evidence gaps. CONCLUSIONS: By leveraging our implementation-research partnership, we expect that WFP's programs will be more effective and cost effective for improving nutrition. This can be assessed through coupling newly designed nutrition-sensitive programs with rigorous evaluations. Evaluation results will be used to refine WFP's nutrition-sensitive guidance and improve their programs globally. This guidance, and creation process, could be useful for others interested in designing nutrition-sensitive programs and increasing program effectiveness for nutrition.

Physical and sociocultural facilitators and barriers to access and utilization of a nutrition program in rural Malawi: a qualitative study.

Childhood stunting holds consequences for child development. A nutrition program delivering small-quantity lipid based nutrient supplements (SQ-LNS) to children 6-23 months and child feeding messages was implemented in Malawi to reduce stunting. This study sought to understand the facilitators and barriers to program participation using in-depth interviews, pile sorts, direct observations, and focus group discussions with caretakers, village leaders and program volunteers. Perceptions of the LNS were positive, and visible changes in child health contributed to program participation. Conflicting priorities that prevented monthly collection of SQ-LNS and limited knowledge of child feeding messages constituted barriers to program participation.

Patterns and determinants of small-quantity LNS utilization in rural Malawi and Mozambique: considerations for interventions with specialized nutritious foods.

Small-quantity, lipid-based nutrient supplements (SQ-LNS) show promise to improve the quality of maternal and child diets, particularly during the first 1000 days of life. The potential of SQ-LNS to impact positively upon nutritional status relies on numerous factors, including complementary dietary intake, disease prevalence and dynamics of household utilization, including sharing practices. Therefore, this study sought to elucidate the patterns and determinants of SQ-LNS utilization among children 6-23 months and potential sharing practices of other household members prior to intervention development. In Ntchisi, Malawi and Cabo Delgado, Mozambique, both rural, agricultural settings, we conducted two home-feeding trials of 8 and 6 weeks, respectively, nested within a larger multi-phase, emergent formative research design. Multiple methods, including in-depth interviews (n = 38), direct meal observations (n = 80), full-day child observations (n = 38) and spot checks of SQ-LNS supply (n = 23), were conducted with households (n = 35 in Malawi; n = 24 in Mozambique). Overall, the SQ-LNS was utilized contrary to its recommended use, with 50% of households in Malawi reporting running out of stock too early and 87% of households in Mozambique either overusing or underusing the product. Utilization of SQ-LNS was manifested in four patterns of overuse and two of underuse and was determined by factors at multiple levels of influence. Maternal and child health efforts need to consider the reasons behind choices by households to overuse or underuse SQ-LNS and design intervention strategies to increase the likelihood of its appropriate utilization.

Identifying the Sociocultural Barriers and Facilitating Factors to Nutrition-related Behavior Change: Formative Research for a Stunting Prevention Program in Ntchisi, Malawi.

BACKGROUND: As the Scaling Up Nutrition (SUN) movement gains momentum globally, more attention and resources are being given to integrated nutrition interventions. In 2013, the Government of Malawi, with support from the World Food Programme and partners, initiated such an intervention in Ntchisi District. Aimed to reduce the prevalence of stunting, the intervention has several components, including the provision of a small-quantity, lipid-based nutrient supplement (SQ-LNS) for children aged 6 to 23 months. OBJECTIVE: This paper describes formative research findings derived from a Rapid Assessment Procedures (RAP) approach to inform the integrated nutrition intervention. METHODS: With a three-phase, emergent research design, this study utilized ethnographic methods including in-depth interviews, direct meal observations, and full-day child observations. Free lists and pile sorts were conducted to define food and illness domains through cultural domain analysis. Participants included community leaders, caregivers, health surveillance assistants, and children aged 6 to 23 months. RESULTS: Community members felt that nutrition-related illnesses were less salient and threatening than other illnesses, and food quality was less important than food quantity. Household food allocation occurred in predictable patterns and varied by type of household member and season. Considered an energy-giving food, the SQ-LNS was accepted, but health education and communications tailored to local understanding of nutrition and health are necessary to ensure its appropriate utilization. CONCLUSIONS: Tailoring a communications strategy to Ntchisi, Malawi could only be done through formative research to understand the sociocultural factors influencing nutrition-related behaviors. A RAP approach allowed for a comprehensive understanding of this local environment.