Une approche collaborative à l’évaluation, le counseling, et le soutien nutritionnel en RDC

The project was launched in 2013 and was funded by USAID. The main objective of FANTA III was to integrate nutrition counseling and support (NACS) into routine HIV care and treatment services. The project focused on three key areas: nutrition counseling and support, economic strengthening, and food security. FANTA provided technical assistance and resources to implement NACS in health facilities, while LIFT connected clients to economic strengthening services, and ASSIST helped health facilities improve the quality of NACS implementation. The projects worked closely with the Ministry of Health (MOH) to ensure that each area of expertise was considered during training, material selection, and other forms of support. A critical component of NACS implementation was the close collaboration between the projects and the MOH, as well as with PEPFAR partners. The projects provided resources and guidance to MOH officials to strengthen their capacity to lead NACS integration into health services. Using a checklist of NACS readiness developed by FANTA, the MOH and USAID Mission in DRC selected 15 health facilities in Kinshasa and Lubumbashi to serve as pilot sites for NACS integration. The evaluation of the selected facilities' readiness revealed that provider training, work tools, and support materials, as well as equipment procurement, were necessary. The three projects designed a joint training plan for NACS and provided the necessary materials. FANTA provided balances, measuring tapes, MUAC bands, and demonstration cooking kits to enable the selected facilities to begin taking anthropometric measurements and providing nutrition education to clients. The training provided by FANTA focused on strengthening the skills of healthcare providers to respond to the nutritional needs of individuals living with HIV and reinforcing the capacity of MOH officials to supervise the integration of NACS into HIV care and treatment services. The training provided by ASSIST focused on improving quality to address the weaknesses identified in NACS service delivery. The training provided by LIFT focused on strengthening the capacity of NACS providers to use a bidirectional referral system between health facilities providing NACS and community-based economic strengthening and food security structures. The results of the first NACS training in May 2014 showed that FANTA and ASSIST helped the MOH and health facilities establish internal and external coaching teams to guide healthcare staff in using proven quality improvement methods and tools. The internal coaches were NACS service providers from the 15 selected health facilities, while the external coaches were technical experts from the MOH and projects. The internal and external coaches met regularly to explore ways to improve their work. Given the importance of regular data collection, analysis, and sharing in identifying problems, the MOH required facilities to collect data on the implementation process daily and present it monthly to the MOH's S&E officer. Using a database developed by ASSIST, the S&E officer compiled monthly information and shared it with the projects and coaching teams to enable them to evaluate facility performance. The facilities began implementing NACS shortly after the training in May 2014 and achieved notable results. Between May 2014 and March 2015, the percentage of individuals living with HIV whose nutritional status was assessed and correctly classified increased from 0 to 99% and 96%, respectively, in the 12 facilities that reported results. Similarly, the percentage of clients who received nutrition counseling and a nutrition care plan increased from 0 to 96% among individuals living with HIV whose nutritional status was assessed in the 12 facilities. The percentage of pregnant women living with HIV whose nutritional status was assessed in the 12 facilities increased from 0 to 94% during this period. An external evaluation by the PEPFAR team, using the SIMS evaluation tool, found that the implementation of nutrition activities in a sample of 5 out of 15 facilities met or exceeded expectations. The references and establishment of links to economic strengthening and food security services aimed to have a positive impact on nutrition and health outcomes for NACS clients. Clients identified through nutrition assessment and counseling were offered referrals to available services, such as village savings and credit associations and food assistance provided by the World Food Programme through its partners. As a result, clients gained access to food assistance in the form of maize-soy blend, vegetable oil, and legumes, and joined village savings and credit groups. The Ministry, FANTA, LIFT, and ASSIST continue to collaborate to address persistent problems, including data quality issues, nutrition counseling skills, bidirectional referrals, and other problems identified during data analysis. They also aim to better support government officials in operationalizing new PEPFAR orientations, focusing on improving client engagement, adherence, and retention in HIV care and treatment services. Furthermore, given the success of NACS in Kinshasa and Lubumbashi, the Ministry, projects, and PEPFAR implementation partners plan to explore ways to scale up NACS in other