RE: [pronut-hiv] Topic 1 Wk 2: Promising Approaches in Nutrition-HIV Integration

["Tadayo Hanna" <ctungo@yahoo.com>]

Dear colleagues and friends,

Thank you Robert for your summary. The experiences from all are informative and we can learn some lessons to improve our systems. The challenges as highlighted in many countries revolve around human resource capacity building and development. Some of our systems do no provide adequate number of nutritionists to health facilities. This has forced the systems to change into TASK SHIFTING whereby other health care providers have to be trained to provide several services that include nutrition services. If there is no linkage of pre -service with in- service trainings then, nutrition messages will always be miscomunicated. Linkages to community level is another alternative, but to be able to support nutrition services, The community workers definately require some level of training on Nutrition ( basic and refresher as well as on going mentorship)Some of the other personel trained already have primary
 duties( Core business)in the health facility and nutrition ranks 2nd, 3rd or 4th......

CONCERNS

1.Will the clinical officer, nurse, doctor, pharmacist etc trained for 5days on nutrition HIV or IYCF be comfortable to provide the proper messages on nutrition to clients?

2. Will they be ablle to carry out nutritional assessments(ABCDE), adequately as well as interprate the messages, record and report?

3. Will they be able to provide proper nutritional counseling and education with regards to other complications( HIV, diabetes, IYCF,hypertension,malnutrition etc)?

4. For countries providing nutritional commodities to PLHIV and other patients(supplemental or therapeutic) will they be able to do this adequately as core business post the 5 day training?

5. Will the community workers be able to provide nutrition services, monitor and refer patients to health facilities in addition to other duties, 

RECOMMENDATIONS
1. Policy issues on human resource to be addressed by governments and stakeholders through budgetary allocation( increase number of nutritionists in order to achieve quality work)

2.There is need to clearly define job descriptions ( who does what, where, when and how)- facility and community

3. Intergrate nutrition as part of basic training in pre -service curriculums - this will reduce the amount of time and resources required to train personel  while providing services ( CNE or CME can be utilized)

4. Intergrate nutrition into other sectors- Education, agriculture etc

I appreciate the fact the the health workforce is challenged as far as nutrition personel issues are concerned. In as much as we procure nutrition commodities, as well as data measuring and reporting tools for all facilities, we have to address issues of increasing nutritionists to provide services as well as intergrate the trainings in pre -service training for all health care cadres.

Please note that the same health care provider has to attend other trainings that include VCT, IMI, IMCI, PMTCT, ART,DTC, PITC, and many more therefore not be in their workplace consistently to provide nutrition services. 

All the trainings/programs above also have leaders/ stakeholders who expect data to be forwarded to them for other purposes ( Planning, programing, research etc)


I look forward to your contributions


Hanna





---  Dr. Robert Mwadime wrote:

Friends

We enter our second week of discussing the promising practices in Nutrition
and HIV integration.

This week we look at the human capacity challenges faced in integrating
nutrition care into HIV interventions. 
A number of services have to be offered (found in the guidelines), normally
as a package: 
*	Assessment of the clients (mainly anthropometric measures; but also
biochemical and dietary assessments)
*	Education on key messages (and demonstrations can be made) and
counseling (whether group or individual)
*	(targeted?) Provision of nutrition supplements, whether
micronutrients or food supplements
*	Linkage to other services (e.g. food security or livelihood, child
survival, reproductive health, etc)

If in your case these services are offered in care and treatment clinics,
who offers the services? If the workload is very high do we expect
nurses/clinical staff to offer these services? How does this work in
reality? How does it work in the community/HBC? 

Let us hear of THE innovative ways that countries are taking to address the
human capacity challenges (at all levels--national, sub-national and
facility/program).

Wish you good discussions.

Robert Mwadime (Ph.D, MPH, MSc)
Regional Senior Nutrition and HIV/AIDS Advisor
Academy for Education Development (AED)
Food and Nutrition Technical Assistance (FANTA) Project