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Receipt of Food Security Services

Export Indicator

The number and percentage of HIV-affected households that receive food security services. HIV-affected households are defined as households with people living with HIV (PLHIV), households with HIV-affected orphans and vulnerable children (OVC), and househ
What it measures

The purpose of this indicator is to determine whether HIV-affected
households are benefiting from participation in programs that address the food security needs
of vulnerable populations.

HIV can cause or worsen food insecurity by reducing income, depleting assets or savings,
reducing availability of household labor, diverting human and financial resources to health care,
severing intergenerational transfer of skills and knowledge, and constraining community coping
mechanisms. Food insecurity may also worsen the impact that HIV has on individuals and households, for example when food needs limit the resources available to spend on health care
or reduce the availability of household members to care for sick individuals, or negatively affect
adherence and treatment.

Interpretation. The indicator is interpreted to measure coverage of food security services
among HIV-affected households. The indicator does not inform about the quality or impact of
the food security services, only whether services are reaching clients. The indicator does not
measure how many households are vulnerable to food insecurity, so it is not possible to
determine coverage of households in need of food security services. When used in conjunction
with a comprehensive assessment of household food insecurity using a measure such as the
Household Hunger Scale, it may be possible to calculate coverage of food insecure, HIV-affected
households.

Rationale

Uses. The indicator can be used at the global level to track the extent to which food security
services are reaching HIV-affected households, and to identify countries or regions where gaps
may exist. Similarly, at the national level, governments or donors can use this indicator to track
coverage and identify gaps that require greater efforts or additional resources. At the program
level the indicator provides information to managers about the extent of coverage being
achieved with food security services among HIV-affected households.

Numerator

The number of HIV-affected households receiving food security services at any point during the reporting period

Denominator

The total number of HIV-affected households identified during the same period

Calculation

Numerator / Denominator

Method of measurement

Method of measurement. The indicator is measured using records from programs providing
food security services. When the number of households receiving food security services is being
measured, the value of the indicator is the number of HIV-affected households covered by the
services during the reporting period. When the percentage of households receiving services is
being measured, the numerator is the number of HIV-affected households receiving food
security services at any point during the reporting period. The denominator is the total number
of HIV-affected households identified during the same period. The duration of the reporting
period is determined by the facility or program reporting on the indicator.

Data collection method. Most food security programs maintain records of services provided to
clients and information on households receiving services. To the extent possible, these records
can be used to identify which households meet criteria for the above definition of HIV-affected
households. Additional information may need to be collected about whether households are
HIV-affected. Additional inputs into the denominator may come from household surveys to
identify HIV-affected households using the definition above. Collecting data for this indicator
through national surveys would only be possible if the surveys identify which households are
HIV-affected and which are not.

Frequency of measurement and reporting. Data on the number of HIV-affected households
receiving services are recorded when clients receiving services are registered. Compilation of
the data and reporting of the indicator can occur as frequently as needed. Generally, more
frequent compilation is desirable so as to maintain up-to-date and accurate records, while bi-
annual or annual reporting should be sufficient.

Disaggregation. Because this indicator is measured at the household level, disaggregation at
the individual level is not possible. Programs may decide to disaggregate the indicator based
on categories that are relevant to their target groups and services, e.g. by geographic region or
by type of food security services received. Where programs target clients through a referral
process (for example, referrals from HIV care and treatment clinics), the indicator may be
disaggregated by the referral source.

Measurement frequency

Continuously

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

Strengths: A strength of the indicator is that most programs already collect data on their service
coverage so in many contexts additional data may not need to be collected. A second strength
is that the indicator is easily understood by all stakeholders and can be immediately
interpreted.

Weaknesses: Since program records are used for the data, there may be inaccuracies in the
reported indicator values if the quality of data is poor. In particular, it may be difficult to collect
accurate information about whether households are HIV-affected. Similarly, in many settings it
may be difficult to collect accurate information about the total number of HIV-affected
households in order to calculate the denominator when the indicator is measured as a
percentage. Also, and as mentioned above, the indicator does not provide information about
the quality of food security services received. Different countries or programs may define HIV-
affected households differently, which could pose challenges for cross-country or cross-
program comparisons. To the extent this occurs, the indicator may be better suited as a
program-level indicator than an indicator aggregated at the global level. A final weakness is
that the indicator does not measure how many households are vulnerable to food insecurity, so
it is not possible to determine coverage of households in need of food security services.

Resources required. Since most food security programs already collect data about coverage of
their services, very few resources are needed to collect information about the number of
households served. For programs that do not already collect information about HIV status,
collecting information about whether households are HIV-affected will require some additional
resources, especially given the potential sensitivity of this information. When the indicator is
calculated as a percentage of HIV-affected households, measuring the total number of such
households will likely require time, either through review of existing data or – if necessary and
possible – through collection of additional data.

Further information

Castleman, Tony, Megan Deitchler and Alison Tumilowicz. A Guide To Monitoring and
Evaluation of Nutrition Assessment, Education and Counseling of People Living with HIV.
Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project, Academy for
Educational Development, 2008. www.fantaproject.org/publications/NAEC.shtml

Food and Nutrition Technical Assistance (FANTA) Project. 2006. Compilation of Monitoring and
Evaluation (M&E) Indicators Used for Food and Nutrition Interventions Addressing HIV/AIDS.
Washington, D.C: Academy for Educational Development.

Paton NI, S Sangeetha, A Earnest, and R Bellamy. The impact of malnutrition on survival and the
CD4 count response in HIV-infected patients starting antiretroviral therapy. HIV Medicine 2006,
7: 323-330.

The President’s Emergency Plan for AIDS Relief. Next Generation Indicators Reference Guide.
Version 1.1, August 2009. www.pepfar.gov/documents/organization/81097.pdf

The President’s Emergency Plan for AIDS Relief. “Policy Guidance on the Use of Emergency Plan
Funds to Address Food and Nutrition Needs”. September 2006.

Tumilowicz, Alison. Guide to Screening for Food and Nutrition Services Among Adolescents and
Adults Living With HIV. Washington, DC: Food and Nutrition Technical Assistance II Project
(FANTA-2), Academy for Educational Development, 2010.
www.fantaproject.org/publications/Screening4FNS.shtml

Van der Sande MAB, MFS van der Loeff, AA Aveika, S Sabally, T Togun, R Sarge-Njie, AS Salabi, A
Jaye, T Corrah, and HC Whittle. Body Mass Index at Time of HIV Diagnosis: A Strong and
Independent Predictor of Survival. J Acquir Immune Defic Syndr 2004, 37:1288–1294.

WFP. 2009. The M&E Guide for Food-Assisted Programming (Draft). Rome, Italy: Nutrition,
MCH, and HIV/AIDS Units. World Food Program.

WHO. Guidelines for an Integrated Approach to the Nutritoinal Care of HIV-Infected Children (6
months – 14 years). Geneva, 2010.
www.who.int/nutrition/publications/hivaids/9789241597524/en/index.html

WHO. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health
Workers. Geneva, 1999. whqlibdoc.who.int/hq/1999/a57361.pdf

WHO. “Nutrition and HIV: Report by the Secretariat to the 59th World Health Assembly”. May
2006.

WHO. “WHO Child Growth Standards”. 2007.www.who.int/childgrowth/en/

WHO and UNICEF. WHO Growth Standards and the Identification of Severe Acute Malnutrition
in Infants and Children: A Joint Statement by WHO and UNICEF. Geneva, 2009.
www.who.int/nutrition/publications/severemalnutrition/9789241598163_eng.pdf

WHO (World Health Organization). 2003. Measuring Change in Nutritional Status: Guidelines for
assessing nutritional impact of supplementary feeding programmes for vulnerable groups.
Geneva, Switzerland: World Health Organization.
Cogill, Bruce. Antrhopometric Indicators Measurement Guide. Food and Nutrition Technical
Assistance (FANTA) Project. Academy for Educational Development. Washington, D.C., 2003.