KHANA – the Alliance’s linking organisation in Cambodia – has been operating a home-based care programme for orphans and vulnerable children (OVC) and people with HIV since 1996. In an attempt to improve the food security of families affected by HIV and to help meet the nutritional needs of people with HIV and OVC, KHANA entered into a cooperative agreement with the World Food Programme in 2003 to integrate food support into the comprehensive package of home based care.
The programme aims to:
- prevent and mitigate the impact of HIV
- ensure regular school attendance
- ensure stable food intake for affected families
- help people to avoid selling things they own that they rely on to make a living
- stop children dropping out of school
- integrate with education and vocational training based on gender-specific priority needs.
The programme currently operates in 14 provinces of Cambodia through 29 of KHANA’s NGO partners. It provides a standard monthly food ration of 30kg of rice, 1kg of fortified vegetable oil and 0.5kg of iodised salt. As of July 2006, 5,291 households with people with HIV and 8,539 orphans and vulnerable children households were being reached.
This study, which took place in July and August 2006, analysed the difference between intervention and control areas in six provinces, and established a baseline for newly planned areas for the programme.
In the intervention areas, some of the findings include:
- Households with people with HIV are taking out loans less frequently.
- Loans taken out by OVC households are from safer community sources.
- Households are spending less on food and medicine, and more on agriculture and schooling, as proportions of total expenditure.
Food security, nutrition and health
- More food groups are being consumed in OVC households.
- OVC households are consuming more animal protein and oil.
- Fewer OVC households are experiencing rice shortages.
- Higher mean weight-for-height of OVC aged 5-10
- Higher body mass index of OVC aged 11-17
- Shorter duration of missing school years in girls in households with people with HIV and in OVC households
- More girls from OVC households are enrolled in school.
- More OVC are participating in a variety of life skills training
- There are more OVC girls fostered.
Further feedback has shown that social stigma has been decreasing since the start of the programme, and no cases of employment being denied based on discrimination have been reported. Furthermore, the food quality and type is culturally acceptable and appropriate. Current rations are adequate for families of four or five, however for large families, rations last for approximately two weeks rather than the full month.
Recommendations for the next phase of the integrated programme
The study recommends the continuation of the food support programme as it has a positive impact on food security, nutrition and livelihoods. It also points out that integrating home based care with food support has great potential to link with wider development activities that will help vulnerable communities – such as income generation, water supplies and sanitation – and suggest that KHANA should seek additional partners with experience and expertise in these fields.
Despite the programme improving nutrition, the general nutritional status of people with HIV and orphans and vulnerable children remains lower than in the general population and requires special attention. A nutritionally targeted programme that provides nutrient support along with the provision of rations is highly recommended.
Finally, exit criteria for food support and nutritionally targeted support should be set up through a careful participatory planning process, to avoid dependency and to aim at sustained development.
Further information can be found in the report Food Support to PLHA and OVC with Home Based Care: Evaluation and Baseline Survey – 2006, the culmination of data collection in July and August 2006. A five page summary of the report is also available here.