Performance evaluation and assessment of USAID/Kenya nutrition and HIV program (NHP)

As a flagship initiative, NHP goal was to strengthen delivery of nutrition services in and out of hospital settings in Kenya. Objectives included: (1) build on partners expertise in HIV and nutrition, food manufacturing, and logistics, while introducing a new patient-centered concept for clinical service delivery; (2) introduce a locally produced F-100 equivalent RUTF for severely malnourished HIV+ patients and OVC; (3) link Insta (the food partner) and health facilities with care programs for HIV+ patients and OVC to extend the supply chain, improve client tracking, mitigate loss to follow-up, and increase the quality and comprehensive care; (4) scale up interventions while maintaining high quality through performance monitoring and quality assurance systems; and (5) strengthen the capacity of local partners, particularly NASCOP. The evaluators found that: (1) NHP has exceeded targets set out in the cooperative agreement for a number of key areas, including the number of sites providing nutrition assessment counseling and support (NACS) treatment and the number of clients treated by food by prescription (FBP); (2) NHP, with NASCOP, have put in place curricula, resources and training to allow the clinical service delivery of NACS; (3) rapid expansion of sites supporting NACS from 62 to 619 has at the cost of providing quality services. The evaluators make several recommendations for the future: (1) continue to invest in the expansion of NACS program infrastructure, including beyond HIV; (2) separate RFPs for "commodity component" for "service delivery component"; (3) embrace and expand public private partnerships (PPP); (4) improve NACS outcomes through efficient and effective use of FBP and increased focus on other kinds of support; (5) improve quality of NACS service provision by health care providers; (6) clarify and expand the community link component of NACS; (7) support the Government of Kenya to gradually be able to implement all aspects of NACS service provision; and (8) incorporate operations research into the next iteration of NHP. (Excerpt, modified)