Nutrition News for Africa

Abstract - August 31, 2007

A discussion paper entitled, “A review of nutrition and food security approaches in HIV and AIDS programmes in Eastern and Southern Africa,” by D Panagides, R Graciano, P Atekyereza, L Gerberg and M Chopra was published in the Regional Network for Equity in Health in East and Southern Africa (EQUINET). Discussion Paper Series #48, 2007

Introduction
EQUINET, through the Health Systems Research Unit of the Medical Research Council (MRC), South Africa, initiated a programme on food security, nutrition and health in Southern and Eastern Africa. The programme explores the links between nutrition and food security interventions both at the health sector level, and in the context of a broader macro-level analysis of trade, agriculture and food security. This paper is one part of this overall project and has been produced in collaboration with Helen Keller International (HKI) and Makerere University , Uganda . The purpose of this paper is to explore the interface between HIV and AIDS and food and nutrition security, and the policy and programme implications for a comprehensive strategy to address these issues synergistically. Specifically, this paper examines and compares the policies and programmes related to HIV and AIDS and food and nutrition security that are currently in place in three Eastern Africa countries ( Kenya , Tanzania and Uganda ) and three Southern Africa countries ( Mozambique , South Africa and Zimbabwe ) and concludes with elements of a comprehensive approach.

Methods
This paper is based on a desk review of existing policies and programs in each of the six study countries. In addition, key informant interviews were conducted with persons from various government departments, United Nations (UN) agencies and non-governmental organisations (NGOs).

Results
Findings from this review suggest that, while the development of HIV and AIDS guidelines, policies or strategic plans have largely involved multi-sectoral participation, the resulting policies and plans, as well as their implementation, have tended toward highly medicalized approaches. Community-based strategies are still limited to home- or community-based care relying on medical support from the health system or external agencies, such as food aid. More innovative and entrepreneurial private sector involvement with the potential to enhance the sustainability of efforts remains limited. Furthermore, policies and plans assume that target populations have access to services or are able to follow counseling advice and guidelines without further support; this paper underscores the importance of assessing and addressing the food and nutrition dimensions of the problem, particularly the food & nutrition security of the most vulnerable target groups.

Discussion
The authors conclude that if countries in East and Southern Africa are to adopt a more comprehensive approach with a food sovereignty element within their nutrition interventions, governments are going to have to significantly improve co-ordination and communication between ministries. Individual ministries are not going to be in a position to provide comprehensive interventions unless this is done. This has at least four important implications for health systems and policy makers: 1. working with different stakeholders; 2. giving greater voice to local communities; 3. strengthening service provision at community health worker level, and 4. capacity development for management and monitoring of comprehensive interventions.