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Ethiopia[1999-Present] In Ethiopia, FANTA has provided ongoing assistance to help the Mission, the Government of Ethiopia, PEPFAR Partners and Title II Awardees improve food security and integrate nutrition into the national health system and HIV programs. The project’s work has included developing guidelines, strategies, tools and training materials, as well as strengthening program monitoring, evaluation and assessment. Recently, FANTA-2 helped lay the groundwork for a Food by Prescription (FBP) program for people living with HIV (PLHIV) and supported quality assurance and improvement. Nutrition Care and Support for PLHIV: FANTA worked with the Government of Ethiopia, USAID/Ethiopia and its PEPFAR Partners to develop guidelines and tools for the clinical nutrition care and support of PLHIV. The materials include the Ethiopian Guide to Clinical Nutrition Care for Children and Adults with HIV: A Three-Day Training Course for Clinical Care Providers (Trainer and Trainee Manuals); the Ethiopian National Guidelines for HIV/AIDS and Nutrition, Revised September 2008; a national strategy, titled the Ethiopian National Nutrition and HIV/AIDS Implementation Reference Manual; and tools such as posters, counseling cards, an algorithm for management of malnutrition among PLHIV, a BMI chart and reference materials on drug-food interactions and managing symptoms. FANTA also helped strengthen nutrition assessment and counseling at HIV care and treatment sites as well as coordination of nutrition and HIV activities in the country. FBP Program: At USAID’s request, FANTA-2 is helping to design an FBP program in Ethiopia. FANTA-2 provided information on protocols and food products, including specifications for the fortified blended food needed for the program. Clinical Nutrition and HIV Care Training: Scaling up training in the clinical management of malnutrition in PLHIV in Ethiopia, FANTA-2 helped train 350 service providers from USAID’s Management Sciences for Health/HIV Care and Support Project (MSH/HCSP) HIV treatment facilities in urban and peri-urban areas, including clinical mentors from the regions and implementing partners. Coordinating the nutrition and HIV training with the MSH/HCSP’s HIV/AIDS Care and Treatment training has allowed FANTA-2 to train a total 551 health workers and 44 clinical mentors, also from MSH/HCSP-supported sites, since 2009. Also, in collaboration with the Federal Ministry of Health, FANTA-2 organized a national training of trainers on clinical mentoring and clinical nutrition care for 33 HIV care and treatment mentors from all over Ethiopia. Quality Improvement Methods in Nutrition Care: At the request of USAID/Ethiopia and in collaboration with University Research Corporation (URC) and the FMOH, FANTA-2 conducted a situation assessment to determine the needs and opportunities to incorporate quality improvement (QI) into nutrition and HIV services among PEPFAR IPs in Ethiopia. The assessment revealed a number of opportunities for future collaboration and coordination on incorporating QI activities into nutrition services for PLHIV. FANTA-2 and URC developed a report on the assessment findings and a plan for implementing QI activities. Review of Essential Nutrition Actions (ENA): The ENA package is an approach to expand the coverage of seven affordable, evidence-based actions to improve the nutritional status of women and children, especially those under 2 years old. FANTA’s Review of Incorporation of Essential Nutrition Actions into Public Health Programs in Ethiopia found that the approach has been incorporated into the Federal Ministry of Health system and multilateral and NGO programming but that improved training and other steps are needed. Community-Based Management of Acute Malnutrition (CMAM) Program Review: FANTA worked closely with USAID’s Office of Foreign Disaster Assistance (OFDA) in Washington, D.C., and in the field to review CMAM program implementation in Sub-Saharan Africa (Ethiopia, Malawi and Niger) to identify lessons learned and contextual factors that facilitate and/or constrain integration of CMAM in post-emergency and development settings. FANTA produced country reports with key lessons learned, then synthesized the findings from the three countries into Review of Community-based Management of Acute Malnutrition (CMAM) in the Post-emergency Context: Synthesis of Lessons on Integration of CMAM into National Health Systems. Field Validation of Alternative Sampling Designs in Emergency Settings: FANTA, in collaboration with Catholic Relief Services, Save the Children/US and Ohio State University, applied Lot Quality Assurance Sampling (LQAS) methods to develop three new sampling designs to respond to the data collection priorities of emergency settings. In field tests in Sudan and Ethiopia, these alternative sampling designs were shown to provide rapid and statistically reliable methods for assessing the prevalence of global acute malnutrition, in addition to a number of other child and household level indicators. The study, A Field Test of Three LQAS Designs to Assess the Prevalence of Acute Malnutrition, was published in the International Journal of Epidemiology in May 2007. Refining Indicators and Data Collection: FANTA developed a methodology for collecting key indicator data to be used by the Mission under the Government of Ethiopia's Productive Safety Net Program (PSNP). This methodology, which uses Percent of Household Emergency Needs Met by the Disaster Prevention and Preparedness Committee (DPPC), will reflect the relative success of the Mission to build the capacity of the Ethiopian Government's DPPC to respond to food emergencies. Layers Methodology: Implementation of the Layers methodology has allowed the Mission to better monitor its activities, identify potential problems and ensure that food aid is being delivered to the intended populations. In Ethiopia, FANTA developed Layers modules to verify the quality of infrastructure built under Food for Work activities. These modules have been adapted and used other countries as well. Nutrition Advocacy: In recent years, the focus for Title II programming has shifted from nutrition interventions to a strong focus on food and cash transfers to chronically food-insecure areas. FANTA-2 is continuing FANTA's work here, using DHS data collection and the ongoing work on the National Nutrition Strategy to advocate for a reassessment of health and nutrition priorities in Ethiopia. One method for such advocacy is through PROFILES workshops, a process for nutrition policy analysis and advocacy that uses spreadsheet models to estimate the functional consequences of malnutrition, quantified in terms of work productivity, health and survival.
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