WFP Gender Policy 2003-2007 Enhanced Commitments to Women to Ensure Food Security 2004 Survey on the Enhanced Commitments to Women: main findings on HIV / AIDS Prepared by: Chiara Brunelli Sociologist, Ph.D. in Methodology of Social Research Consultant for the PDPG With the assistance of Faria Zaman Consultant for the PDPH 1 of 24
Table of Contents Executive Summary 3 Introduction 4 1. Country office self-assessment 4 1.1. Performance of the countries under survey on HIV/AIDS 5 1.2. An overview on specific issues 9 2. Site-level survey 12 2.1. Main findings on relief site-level survey 14 2.2. Main findings on nutrition site-level survey 16 2.3. Main findings on food for training (FFT) site-level survey 20 2.4. Main findings on food for work (FFW) site-level survey 22 Annexes with the country office self-assessment details 24 2 of 24
Executive Summary Forty-eight countries involved in the 2004 Survey on the Enhanced Commitments to Women (ECW) have been ranked on the basis of their performance with respect to HIV / AIDS using the results of the self-assessment exercise. The countries with a poor performance were Afghanistan, Armenia, Indonesia, Tajikistan, Bolivia, Niger, Azerbaijan, Honduras, Liberia, Haiti, India, Myanmar, Chad, Rep. of Congo, DRC. Those with a high performance were Rwanda, Cambodia, Gambia, Zimbabwe, Guinea Bissau, Kenya, Sierra Leone, and Mozambique. School feeding The integration of HIV prevention into formal education is considered very important for WFP programming activities. The results related to school feeding can be summarized as follows: - In Angola, Azerbaijan, Bolivia, India, Yemen, Niger, Chad, Rep. of Congo, and Sudan HIV / AIDS prevention has been poorly integrated in the curricula of the schools assisted by WFP - In Gambia, Guinea, Liberia, Malawi, Mauritania, Mozambique, Burundi, Cambodia, Uganda, Guinea Bissau, Zimbabwe HIV / AIDS prevention has been well integrated in the curricula of such schools. Relief Sensitization programmes on HIV / AIDS prevention was the activity more offered at the operational sites; other activities benefiting HIV / AIDS infected/affected individuals such as the modification of ration size, ration composition, and distribution modalities were not often provided. In Burundi, Myanmar and Chad only a small percentage of operational sites offered training / sensitization programmes. On the contrary, Zambia and Sierra Leone contemplated HIV / AIDS issues to a wide extent in their activities. Nutrition The centres operational at the time of the survey offered mother-to-child transmission programmes more often than voluntary HIV counselling/testing, opportunistic infection treatments, and home-based care. Antiretroviral treatment was hardly ever provided (2.6% of the sites provided it). In Bangladesh, Afghanistan, Mauritania, Eritrea and Southern Sudan the nutritional centres did not provide any service related to HIV / AIDS. On the contrary, performance of Rwanda, Zambia and Zimbabwe was outstanding as the vast majority of their sites implemented at least one of the measures addressed by the survey. Globally, the attendance of men/boys to HIV prevention sessions was low (in only 23.5% of the sites they participated). In particular, it was zero in Nicaragua and Bangladesh; very low in Colombia and Zambia; low in Malawi and Rwanda. Food for Training (FFT) The sites operational at the time of survey offered sensitization programmes at the food distribution points (FDPs) much more frequently than the modification of ration size, ration composition, and distribution modalities (the latter ones put in place in 1% and 0.6% of the sites respectively). Armenia, Djibouti and Bolivia are the countries where the FFT sites have the poorest performance. In particular, nothing was done in the Armenian sites; 6.3 percent of Djibouti s sites changed the ration size/composition and 12 percent of Bolivian sites provided awareness-raising sessions on HIV / AIDS. On the other hand, Indonesia and Rwanda contemplated HIV / AIDS issues to a wide extent in their activities. Overall, training/sensitization programmes on HIV / AIDS prevention have been provided more frequently at the FFT food distribution points than at the FFW food distribution points (69 percent vs 25 percent). Food for Work (FFW) Modification of ration size, ration composition, and distribution modalities (e.g.: more frequent distribution, special packaging, etc.) are extraordinary measures, almost never implemented. As mentioned above training/sensitization programmes on HIV / AIDS prevention have been provided in 25 percent of the FFW sites. In particular, they were not provided at all in Armenia, Burundi, Djibouti, Uganda, Nicaragua and they were widely provided in Sierra Leone, Angola and Rwanda. 3 of 24
Introduction The 2004 Survey on the Enhanced Commitments to Women is a comprehensive study undertaken in 48 Country Offices in order to capture the status quo with regard to the implementation of the Gender Policy 2003-2007. It is composed of two main parts: the country office (CO) self-assessment and the site-level surveys. Both the phases included questions related to HIV / AIDS and the results here reported. The first paragraph includes the results from the country office self-assessment; the second paragraph includes the results from the field level survey. 1. Country office self-assessment The country office (CO) self-assessment survey focused on three areas: WFP programme activities (Relief, Nutrition, School Feeding, Food for Training and Food for Work), information on the institutional situation at the country office level with regard to the implementation of WFP s Gender Policy and WFP partners agreements. The main objective of the country office self assessment survey was to realize whether the ECW are reflected in WFP approved project documents and to what extent the ECW were actually implemented in the operations to which WFP provides food assistance. Some questions related to HIV/AIDS although not directly linked to the ECW were included and the results are presented here. Data were collected at the country office with the cooperation of senior management, programme officers, gender focal points, vulnerability analysis and mapping officers, and HIV/AIDS focal points. One questionnaire was to be filled for each activity under each operation. Only one country office questionnaire was filled for each country. Countries involved in the survey are listed below: Table 1 Countries under survey Regional bureau Countries under survey ODB ODC ODD ODJ ODK ODPC Bangladesh, Cambodia, India, Indonesia, Myanmar, Nepal Afghanistan, Algeria, Armenia, Azerbaijan, Georgia, Iran, Pakistan, Tajikistan, Yemen Burkina Faso, Cape Verde, Chad, Gambia, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Sierra Leone Angola, Malawi, Mozambique, Zambia, Zimbabwe Burundi, DRC, Djibouti, Eritrea, Ethiopia, Kenya, Rep. Congo, Rwanda, Sudan, Somalia 1, Tanzania, Uganda Bolivia, Colombia, Haiti, Honduras, Nicaragua Detailed information regarding the participation of each country to the survey is reported in annex I. 1 Being information from Somalia not very reliable, it has been taken out from the report. 4 of 24
1.1. Performance of the countries under survey on HIV / AIDS In order to evaluate the overall performance of the countries under survey with respect to HIV / AIDS, a global numeric performance index has been computed 2. Table 2 reports all the countries under survey ranked on the basis of their performance (in yellow are the countries with the lower performance, in green the ones with a good performance). Table 2 to what extent topics related to HIV / AIDS have been taken into consideration in the Country Office and during the implementation of the activities. A global assessment of the countries under survey based on the self-assessment data. Name of the country Global numeric performance index Performance (*) Afghanistan 0.00 Armenia 0.10 Indonesia 0.10 Tajikistan 0.10 Bolivia 0.13 Niger 0.14 Azerbaijan 0.17 Honduras 0.19 Liberia 0.24 Haiti 0.25 India 0.27 Myanmar 0.30 Chad 0.31 Rep. Congo 0.31 DRC 0.33 Mauritania 0.35 Burkina Faso 0.37 Eritrea 0.43 Tanzania 0.44 Sudan 0.47 Ethiopia 0.48 Malawi 0.49 Algeria 0.50 Angola 0.50 Cape Verde 0.50 Georgia 0.50 Pakistan 0.50 Burundi 0.52 Uganda 0.52 Djibouti 0.53 Bangladesh 0.56 Nicaragua 0.56 Yemen 0.59 Colombia 0.60 Mali 0.61 Guinea 0.63 Iran 0.63 Nepal 0.63 Zambia 0.64 Rwanda 0.71 Cambodia 0.72 Gambia 0.73 poor medium 2 Its values are comprised between 0 and 1, 0 meaning a very poor performance and 1 a very good performance. The global numeric index is the mean of the numeric performance indices computed for each activity. 5 of 24
Zimbabwe 0.73 Guinea Bissau 0.75 Kenya 0.75 Sierra Leone 0.89 Mozambique 0.92 (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 high In table 3 all the countries under survey are divided on the basis of their performance with regard to the institutional situation at the country office. The performance index is based on the following indicators: 1) whether or not HIV prevalence by sex was considered in the VAM process; 2) existence of national/local policies addressing HIV/AIDS; 3) whether or not these policies address HIV / AIDS in the context of household food security. The answers of each country to the specific indicators/questions are reported in annex II. Table 3 To what extent topics related to HIV / AIDS have been taken into consideration in the Country Office Name of the country Performance (*) Afghanistan, Armenia Bolivia Chad, India, Indonesia, Mauritania, Myanmar, Niger, Tajikistan, Yemen, Zambia Algeria, Angola, Azerbaijan, Bangladesh, Cape Verde, Haiti, Nepal, Nicaragua, Sudan, Tanzania Burkina Faso, Burundi, Cambodia, Colombia, Eritrea, Ethiopia, Gambia, Honduras, Kenya, Liberia, Malawi, Rwanda, Uganda, Zimbabwe, Djibouti, DRC, Georgia, Guinea, Guinea, Bissau, Iran, Mali, Mozambique, Pakistan, Rep. Congo, Sierra Leone poor medium high (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 In table 4 the countries implementing relief are divided on the basis of their performance with regard to relief activities (only the provision of HIV / AIDS training initiatives has been taken into consideration for this index). The answers of each country to the specific questions are reported in annex III. Table 4 To what extent topics related to HIV / AIDS have been taken into consideration in the relief activities Name of the country Performance (*) Afghanistan, Armenia, Azerbaijan, Bolivia, Burundi, DRC, Eritrea, Georgia, Guinea, Haiti, Honduras, Indonesia, Iran, Liberia, Sudan Bangladesh, Myanmar, Nicaragua, Tanzania, Etiopía Poor (all countries score zero) Medium Algeria, Angola, Chad, Colombia, Kenya, Mali, Nepal, Rwanda, Sierra Leone, Uganda, Yemen, Zambia High (all countries score one) (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 6 of 24
In table 5 the countries implementing nutrition are divided on the basis of their performance with regard to nutrition interventions. The performance index is based on the following indicators: 1) whether or not awareness-raising sessions on HIV / AIDS have been mention in the approved project document; 2) whether or not such sessions have been actually offered. The answers of each country to the specific indicators/questions are reported in annex IV. Table 5 To what extent topics related to HIV / AIDS have been taken into consideration in the nutrition interventions Name of the country Performance (*) Afghanistan, Algeria, Chad, Honduras, Liberia, Mauritania, Tajikistan Poor Bangladesh, Bolivia, Burkina Faso, Colombia, Ethiopia, Haiti, India, Zimbabwe Medium Kenya, Nicaragua, Angola, Burundi, Cambodia, Djibouti, Eritrea, Guinea, Guinea Bissau, Malawi, Nepal, Sudan, Tanzania, Yemen, Zambia High (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 In table 6 the countries implementing food for training are divided on the basis of their performance with regard to food for training activities. The performance index is based on the following indicators: 1) whether or not awareness-raising sessions on HIV / AIDS have been offered with the activity; 2) whether or not partners offered sensitization initiatives to FFT participants. The answers of each country to the specific indicators/questions are reported in annex V. Table 6 To what extent topics related to HIV / AIDS have been taken into consideration in FFT activities Name of the country Performance (*) Afghanistan, Armenia, Bolivia, Burkina Faso, Burundi, Djibouti, Eritrea, Guinea Bissau, Haiti, Honduras, Indonesia, Liberia, Malawi, Myanmar, Niger, Pakistan, Rep. Congo, Tajikistan, Tanzania, Uganda Rwanda, Bangladesh Poor Medium Cambodia, Colombia, Guinea, Iran, Sierra Leone, Sudan, Zambia (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 High In table 7 the countries implementing food for work are divided on the basis of their performance with regard to food for work activities (for this index only the definition of work norms for places where HIV infected/affected individuals participate to FFW has been taken into consideration). The answers of each country to the specific indicators/questions are reported in annex VI. Table 7 To what extent topics related to HIV / AIDS have been taken into consideration in FFW activities Name of the country Performance (*) Angola, Bolivia, Burkina Faso, Cambodia, Chad, Colombia, Djibouti, DRC, Ethiopia, Guinea, Honduras, Liberia, Malawi, Mali, Nepal, Rep. Congo, Sudan, Tanzania, Uganda, Zambia poor Afghanistan, Armenia, Bangladesh, Burundi, Georgia, Guinea Bissau, Haiti, India, Indonesia, Kenya, Mauritania, Myanmar, Nicaragua, Pakistan, Rwanda, Sierra Not relevant 7 of 24
Leone, Tajikistan (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 In table 8 the countries implementing school feeding are divided on the basis of their performance with regard to school feeding activities. The performance index is based on the following indicators: 1) whether or not HIV / AIDS prevention has been integrated into the school curriculum nationwide; 2) whether or not a dialogue with local partners has been undertaken to integrate HIV educational programmes in the WFP assisted schools; 3) whether or not teachers received a special training on HIV; 4) whether or not teachers have been trained on how to communicate HIV / AIDS information. The answers of each country to the specific indicators/questions are reported in annex VII. Table 8 To what extent topics related to HIV / AIDS have been taken into consideration in school feeding activities Name of the country Performance (*) Angola, Azerbaijan, Bolivia, India, Yemen, Niger, Chad, Rep. Congo, Sudan Poor Colombia, Myanmar, Honduras, Mali, Ethiopia, Iran, Nicaragua, Kenya, Sierra Leone, Zambia, Burkina Faso, Djibouti, Rwanda, Tanzania Medium Gambia, Guinea, Liberia, Malawi, Mauritania, Mozambique, Burundi, Cambodia Uganda, Guinea Bissau, Zimbabwe High (*) poor = from 0 to 0.33 medium = from 0.34 to 0.66 high = from 0.67 to 1 8 of 24
1.2. An overview on specific issues The tables of the previous chapter distinguish the countries on the basis of their overall performance, while the tables hereinafter report on specific issues (questions) considered in the questionnaires. Such kind of information is reported in the following tables. The results refer to the countries and to the project documents (two level of analysis). From the Country Office questionnaire 48 country offices filled the CO questionnaire. Forty seven out of forty eight countries (98%) have national and/or local policies addressing HIV/AIDS. Afghanistan is the only exception. Nineteen countries reported that such national and / or local policies address HIV/AIDS in the context of household food security (see table 9). Table 9 HIV / AIDS in the national and local policies Regional Countries where national and / or bureau local policies address HIV/AIDS Countries where national and or local policies DO NOT address HIV/AIDS Not known ODB Cambodia Bangladesh, India, Indonesia, Myanmar ODC Iran Algeria, Armenia, Azerbaijan, Tajikistan, Yemen ODD Burkina Faso, Gambia, Guinea, Guinea Cape Verde, Chad, Liberia, Mauritania, Bissau, Mali Niger ODJ Mozambique Angola, Malawi, Zambia, Zimbabwe ODK Burundi, DRC, Djibouti, Eritrea, Ethiopia, Kenya, Rwanda, Uganda Nepal Georgia, Pakistan Sierra Leone Tanzania, Sudan, Rep. of Congo ODPC Colombia, Honduras Bolivia, Haiti, Nicaragua Total 19 22 7 HIV/AIDS prevalence by sex was one of the factors taken into consideration during VAM process by nine countries: Liberia, Guinea Bissau, Mali, Malawi, Mozambique, Zimbabwe, Djibouti, DRC (see table 10). Table 10 HIV prevalence by sex taken into consideration during the VAM process regional bureau HIV prevalence by sex taken into consideration during VAM process HIV prevalence by sex NOT TAKEN into consideration during VAM process ODB Cambodia, India, Indonesia, Myanmar, Nepal Not Relevant (no HIV/AIDS IA individuals among the population) Bangladesh ODC Armenia, Tajikistan, Yemen Afghanistan. Algeria, Azerbaijan, Georgia, Iran, Pakistan ODD Liberia, Guinea Bissau, Mali Burkina Faso, Chad, Gambia, Mauritania, Niger Cape Verde, Guinea, Sierra Leone ODJ Malawi, Mozambique, Zimbabwe Zambia Angola ODK Djibouti, DRC Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania, Uganda Republic of Congo ODPC Bolivia, Colombia, Honduras Haiti, Nicaragua Total 9 25 13 9 of 24
From Relief questionnaire 48 project documents (35 countries) where Relief activities were implemented have been surveyed In 19 Relief / GFD (16 countries) partners are offering HIV/AIDS training to relief beneficiaries, whereas in 24 Relief / GFD (20 countries) they are not (see table 11). Table 11 - sensitization initiatives offered by partners Regional bureau Partners are offering HIV/AIDS Partners are NOT offering HIV/AIDS Not Known training/sensitization initiatives to beneficiaries training/sensitization initiatives to beneficiaries ODB Bangladesh (1), Myanmar (1), Nepal Bangladesh (1), Indonesia, Myanmar (1) ODC Yemen Afghanistan, Armenia, Azerbaijan, Algeria, Georgia, Iran Tajikistan ODD Chad (2), Mali, Sierra Leone Guinea, Liberia ODJ Angola, Zambia Malawi ODK Ethiopia (2), Kenya (1), Rwanda, Burundi, DRC, Eritrea (2), Ethiopia (1), Tanzania (1), Uganda (1) Sudan (3), Tanzania (1) Kenya (2) ODPC Colombia, Nicaragua (1) Bolivia, Honduras, Haiti (2), Nicaragua (1) Total Relief activities 19 24 5 Total countries 16 20 4 Please note: numbers in brackets refer to the number of Relief implemented From Nutrition questionnaire 50 project/programme documents related with nutrition interventions were surveyed in 33 countries. Eighteen project documents (in 13 countries) did not state that awareness raising sessions on HIV/AIDS will be offered to participants. Twenty-nine project documents (21 countries) stated that awareness raising sessions on HIV / AIDS will be offered (see table 12). Table 12 awareness-sessions on HIV / AIDS mentioned in the project / programme document Regional bureau Project document stating that Project document NOT STATING Not Known awareness raising on HIV/AIDS prevention will be offered that awareness raising on HIV/AIDS prevention will be offered ODB Bangladesh (2), Cambodia (2), India, Nepal (2) ODC Yemen (1) Afghanistan, Algeria, Tajikistan Pakistan, Yemen (1) ODD Burkina Faso (1), Guinea, Guinea Bissau Burkina Faso (1), Chad (3), Mauritania ODJ Angola, Malawi, Zambia (2) Zimbabwe ODK Burundi (1), Djibouti, Eritrea (2), Ethiopia (1), Kenya (1), Sudan (3), Ethiopia (1), Kenya (1) Rwanda Tanzania ODPC Nicaragua (1), Haiti (1) Bolivia, Colombia, Nicaragua (1), Haiti (1) Total project documents 29 18 3 Total countries 21 13 3 Please note: numbers in brackets refer to the number of project documents 10 of 24
From Food for Training questionnaire 38 FFT activities in 30 countries were surveyed. In 19 activities (14 countries) partners are offering HIV/AIDS training / sensitization to the trainees. It worth mentioning that in Bangladesh such training is offered under all the 4 FFT implemented (see table 13). Table 13 sensitization initiatives offered by partners Regional bureau Partners are offering HIV/AIDS Partners are NOT offering Not Known training/sensitization initiatives to the FFT participants HIV/AIDS training/sensitization initiatives to the FFT participants ODB Bangladesh (4), Cambodia Myanmar Indonesia ODC Afghanistan, Armenia, Azerbaijan, Iran, Pakistan, Tajikistan ODD Guinea, Guinea Bissau, Liberia, Niger, Sierra Leone Burkina Faso ODJ Malawi, Zambia (2) ODK Sudan (2), Rep.of Congo, Rwanda (1) Burundi, Djibouti, Eritrea, Uganda (3) Rwanda (1) ODPC Colombia Bolivia, Honduras, Haiti (1) Total FFT activities 19 17 2 Total countries 14 15 2 Please note: numbers in brackets refer to the number of FFT activities implemented. From Food for Work questionnaire 57 FFW activities in 43 countries were surveyed. None of the 57 FFW activities (in 39 countries) under survey have defined appropriate work norms for HIV/AIDS infected/affected individuals participating in FFW activities. In several FFW (countries) this question was not relevant (see table 14). Table 14 definition and implementation of work norms Regional bureau Appropriate work norms have NOT been defined for places where HIV/AIDS infected/affected (IA) individuals are participating in FFW activities Not Relevant (no HIV/AIDS IA individuals involved in FFW activities) ODB Cambodia, Nepal Bangladesh (3), India, Indonesia, Myanmar (2) ODC Afghanistan, Armenia, Georgia, Pakistan, Tajikistan ODD Burkina Faso (1), Chad (2) Guinea (1), Liberia, Mali Burkina Faso (1), Guinea (1), Guinea Bissau, (1) Mauritania, Sierra Leone ODJ Angola, Malawi, Zambia (2) ODK DRC, Djibouti, Ethiopia (1), Rep.of Congo, Sudan Burundi, Ethiopia (1), Kenya (3), Rwanda (1), (3), Tanzania (1), Uganda (2) Tanzania (1) ODPC Bolivia, Colombia, Honduras (1) Honduras (1), Haiti (2), Nicaragua (2) Total FFW activities 30 25 Total countries 25 18 Please note: numbers in brackets refer to the number of FFW implemented 11 of 24
2. The site-level survey Twenty-eight countries participated also to the site-level survey whose main purpose was to verify to what extent the ECW were actually implemented in the operational sites. The site-level surveys covered the following activities: Nutrition, Food for Training, Food for Work and Relief. The unit of analysis of the site-level survey was the site operational at the time of survey. Data were collected as follows: For FFT, FFW and Relief, trained enumerators visited a sample of operational sites; interviewed site administrators and cooperating partners representatives; organized group discussions with male and female beneficiaries and filled one questionnaire for each visited site. Field visits were not required to fill the Nutrition site-level questionnaires. Upon close consultation with the Nutrition Unit in HQ, it was agreed that the information needed for the survey could have been gathered at the country office or at sub-offices (SOs), as data were often already available. Therefore, nutrition questionnaires were distributed to country office and sub-offices for completion by the programme staff/nutrition focal points. Globally, 884 FFT sites, 973 FFW sites and 935 Relief sites have been actually visited; 661 nutrition questionnaires have been filled at the COs and / or SOs. The following table reports country-disaggregated figures (see table 15). Table 15 Number of nutrition questionnaires filled, number of FFT, FFW and relief sites visited. Countries Nutrition questionnaires FFT sites FFW sites Relief sites visited timeframe filled visited visited Afghanistan 17 16 33 57 April-July 2004 Angola Not useful information 64 55 August-Sept. 2004 Armenia 38 42 32 April-May 2004 Azerbaijan 55 July-Sept. 2004 Bangladesh 80 366 140 2 May-June 2004 Bolivia 99 110 Feb.-March 2005 Burundi Not useful information 4 4 69 August 2004 Chad 35 13 October 2004 Colombia 65 21 45 50 October-Nov. 2004 Djibouti 21 17 5 Sept. 2004 Eritrea 7 69 August 2004 Ethiopia 6 139 Sept.-October 2004 Haiti 42 4 25 October 2004 Indonesia 50 59 97 October 2004 Yemen 43 1 July 2004 Mauritania 50 70 October 2004 Malawi 43 54 2 November 2004 Myanmar 23 9 108 September 2004 Nicaragua 70 70 5 Sept.-October 2004 Rep. Congo 8 29 October 2004 Rwanda 29 16 43 4 November 2004 Sierra Leone 40 34 8 12 September 2004 Southern Sudan 3 8 6 27 October 2004 Sudan 47 12 11 22 October 2004 Uganda 62 22 65 October 2004 Tanzania 35 June-July 2004 Zambia 46 110 110 26 June 2004 Zimbabwe 17 August 2004 TOTAL 661 884 973 935 12 of 24
How to interpret the data in the tables? 1. Consider the percentage of sites where a particular measure was implemented. In particular, pay attention to the column reporting the percentage of sites where at least one measure was implemented (if reported in the table). 2. Then, read the column TOTAL VALID SITES. From the technical perspective, computing percentages on a low no. of cases (e.g. N < 50) is not correct as in such situation even very few answers affect radically the results thus making the percentages not secure. However, in order to allow comparisons, between countries percentages have been computed BUT the no. of valid cases against which they have been calculated has also been reported. Remember that the lower is the no. of valid cases; the lower is the reliability of the percentages. As with regard to the no of total valid cases, please consider also the no. of sites usually operational in the countries under survey. The samples (if a sampling was done) are representatives of the sites operational at the time of survey. Nonetheless, it can be that at the time of survey the kind of activity carried out did not reflect the usual activity implemented in the countries. 3. Pay attention to the countries (or percentages) marked with two stars (**). In these cases, not only the percentages have been computed on a low number of valid cases, but there were many not known in the sample. It is suggested checking carefully these percentages before taking any action. The performance of these countries have not been reported in narrative. 13 of 24
2.1. Main findings on relief site-level survey In order to evaluate to what extent HIV / AIDS has been taken into consideration in the relief sites of the countries under survey the following issues has been addressed: Provision of training / sensitization programmes around the food distribution points (FDPs) Ration size / composition changed in order to take into account the constraints posed by HIV /AIDS Distribution modalities changed in order to take into account the constraints posed by HIV /AIDS The following table reports the percentages of sites implementing such measures (see table 16). ZAMBIA and SIERRA LEONE contemplated HIV / AIDS to a wide extent during the implementation of relief activities. As a matter of fact, in these countries most of the sites (80.8% and 91.7% respectively) implemented at least one of the measures analyzed (see table 16 for details). At the time of survey, relief was implemented in YEMEN in only one refugees camp. In such camp training / sensitization programmes were offered at the FDPs, but ration size, ration composition and distribution modalities were not changed in order to meet the needs of HIV / AIDS infected/affected individuals. In UGANDA, ANGOLA and ETHIOPIA half (49%, 51% and 56% respectively) of the sites put in place at least one of the measures under analysis. In Angola and Ethiopia only training / sensitization programmes around the FDPs were provided at the sites. 3 In Uganda there was a greater heterogeneity in the measures offered: 31 percent of the sites offered training programmes around the FDPs, 12 percent changed the ration size / composition and 29 percent modified the distribution modalities. Six countries (BANGLADESH, AFGHANISTAN, ARMENIA, AZERBAIJAN, MALAWI AND NICARAGUA) did not contemplate at all HIV / AIDS during the implementation of relief activities as none of the three measures was implemented in none of the sites. In the remaining 10 countries the extent to which HIV / AIDS was contemplated during the implementation of the activities varies greatly: in BURUNDI, MYANMAR and CHAD a small percentage of sites put in place at least one measure (namely training / sensitization programmes) in COLOMBIA, SOUTHERN SUDAN, ERITREA, HAITI, RWANDA, INDONESIA and SUDAN the percentage is greater (see table 16). Table 16 shows clearly that SENSITIZATION PROGRAMMES AROUND THE FOOD DISTRIBUTION POINTS were much more implemented than other measures. Modification of ration size, of ration composition and distribution modalities follow at a remarkable distance (overall, they are put in place in 3% and 4.6% of the sites respectively). The following table reports the results in details: The first column reports the name of the country The second reports the percentage of sites where training / sensitisation programmes were offered around the FDPs The third reports the percentage of sites where composition was changed in order to take into account the constraints posed by HIV / AIDS The fourth reports the percentage of sites where distribution modalities were changed to take into account the constraints posed by HIV/AIDS The fifth reports the percentage of sites where at least one of the 3 initiatives was put in place The latter column reports the (weighted) number of sites where HIV / AIDS is relevant and that answered to the question. 3 In Ethiopia 1.4 percent of sites changed the distribution modalities in order to meet the needs posed by HIV / AIDS. 14 of 24
Table 16-2004 Survey on the Enhanced Commitments to Women: Results from the Site Level Survey Unit of analysis: the RELIEF site operational at the time of survey. For the timeframe of data collection check table 15 name of the country In how many sites HIV/AIDS training/sensitization programmes were offered around food distribution points? In how many sites the ration size / composition was changed to take into account the constraints posed by HIV/AIDS? In how many sites distribution modalities were changed to take into account the constraints posed by HIV/AIDS? In how many sites AT LEAST ONE of the previous has been implemented? TOTAL VALID SITES (*) percentage of sites percentage of sites percentage of sites percentage of sites number of sites Bangladesh 0 0 0 0 2 Afghanistan 0 0 0 0 95 Armenia 0 0 0 0 32 Azerbaijan 0 0 0 0 55 Malawi 0 0 0 0 2 Nicaragua 0 0 0 0 5 Burundi 3.4 0 0 3.4 171 Myanmar 7.5 0 0 7.5 233 Chad 8.3 0 0 8.3 12 Colombia 13.2 2.2 0 15.4 81 Southern Sudan 16.3 0 0 16.3 64 Eritrea (**) 19.1 0 0 19.1 44 Haiti 20 0 0 20 25 Rwanda 25 0 0 25 4 Indonesia (**) 16.7 16.7 27.1 27.1 54 Sudan 27.3 0 4.5 27.3 22 Uganda 31.1 11.6 29.5 49 189 Angola 51.5 0 0 51.5 99 Ethiopia 54.5 0 1.4 55.9 449 Zambia 11.5 69.2 0 80.8 26 Sierra Leone 91.7 0 0 91.7 12 Yemen yes no no no 1 (only 1 refugees camp) OVERALL 26.5 3 4.6 30.4 1677 (*) TOTAL VALID SITES: are the sites where the answer was provided and relevant. Percentages computed by taking into account only the valid sites. In some countries data were collected in a sample of sites, not in all the sites operational at the time of survey. The representativeness of the samples is guaranteed by a system of weights. So - for some countries - the no. of valid sites corresponds to the weighted number. In order to allow comparisons between countries, percentages were computed even against a low no. of valid cases. It is suggested taking into account also the no. of valid cases as a percentage computed on a low no. of cases is less secure. (**) In these countries (marked with a double star) the low number of valid cases and the relevant incidence of "not known" affect the reliability of the percentages. 15 of 24
2.2. Main findings on nutrition site-level survey In order to evaluate to what extent HIV / AIDS has been taken into consideration in the nutrition centres of the countries under survey the following issues have been addressed: Services: Provision of voluntary HIV counselling and testing Mother-to-child transmission prevention Provision of home based care Provision of HIV opportunistic infection treatment Provision of antiretroviral treatment Awareness-raising: Provision of awareness raising session on HIV prevention Attendance of men and boys to awareness raising sessions Attendance of pregnant or lactating women to awareness raising sessions The following 2 tables report the percentages of sites implementing such measures (see tables 17 and 18). In BANGLADESH, AFGHANISTAN, MAURITANIA, ERITREA AND SOUTHERN SUDAN the nutritional centres operational at the time of survey did not provide any service related to HIV / AIDS. ETHIOPIA, MALAWI, HAITI and DJIBOUTI did a lot against HIV / AIDS: in these countries a high percentage of nutritional centres (67% in Ethiopia, 69% in Malawi, 90% in Haiti and Djibouti) implemented at least one of the measures addressed by the survey. Performance of RWANDA, ZAMBIA and ZIMBABWE was outstanding as the vast majority (or all) of nutritional centres operational at the time of survey implemented at least one of the measures (95%, 99%, 100% respectively). In NICARAGUA, all the sites (100%) provided mother-to-child transmission prevention but they did not provide at all the other services. Table 17 shows clearly that MOTHER-TO-CHILD TRANSMISSION PROGRAMMES were the most implemented measures. Globally, such programmes were provided by 43 percent of the sites. Voluntary HIV counselling/testing, provision of opportunistic infection treatment and home based care follow at a rather distance (they were in place in 19.8%, 14.8% and 12% of the centres) whereas antiretroviral treatment was rarely provided (2.6% of the sites). The following table reports the results in details: The first column reports the name of the country The second reports the percentage of sites providing voluntary counselling and testing The third reports the percentage of sites providing mother-to-child transmission prevention The fourth reports the percentage of sites providing HIV opportunistic infection treatment The fifth reports the percentage of sites providing at least one of the above services The latter column reports the (weighted) number of sites where HIV / AIDS is relevant and that answered to the question. 16 of 24
Table 17-2004 Survey on the Enhanced Commitments to Women: Results from the Site Level Survey Unit of analysis: the nutritional site operational at the time of survey. For the timeframe of data collection check table 15 name of the country How many sites provided voluntary HIV counselling and testing? How many sites provided motherto-child transmission prevention? How many sites provided home based care? How many sites provided HIV opportunistic infection treatment? How many sites provided antiretroviral treatment? How many sites AT LEAST ONE of the previous services was provided? TOTAL VALID SITES (*) percentage of sites percentage of sites percentage of sites percentage of sites percentage of sites percentage of sites number of sites Bangladesh 0 0 0 0 0 0 290 Afghanistan 0 0 0 0 0 0 17 Mauritania 0 0 0 0 0 0 164 Eritrea 0 0 0 0 0 0 7 Southern Sudan 0 0 0 0 0 0 3 Sudan 23.4 2.1 10.6 8.5 0 29.8 47 Colombia 30.3 29.4 10 2 0.4 35 246 Chad 5.7 5.7 0 34.3 0 37.1 35 Yemen 0 39.5 0 2.3 2.3 41.9 43 Sierra Leone 2.6 39 20.3 0 0.9 47.8 116 Ethiopia 16.7 0 0 66.7 0 66.7 6 Malawi 42.4 32.6 42.7 60.3 24.2 68.9 90 Haiti 85 58.3 15.6 50.6 6.4 90.2 206 Djibouti 4.8 90.5 4.8 4.8 4.8 90.5 21 Rwanda 82.4 29.9 46 44.5 7 94.7 57 Zambia 19.2 38.9 72.2 68.2 6.8 98.9 88 Zimbabwe 52.9 58.8 88.2 82.4 5.9 100 17 Nicaragua 0 100 0 0 0 100 462 OVERALL 19.8 43.3 12 14.8 2.6 56.2 1915 (*) TOTAL VALID SITES: are the sites where the answer was provided and relevant. Percentages computed by taking into account only the valid sites. In some countries data were collected in a sample of sites, not in all the sites operational at the time of survey. The representativeness of the samples is guaranteed by a system of weights. So - for some countries - the no. of valid sites corresponds to the weighted number. In order to allow comparisons between countries, percentages were computed even against a low no. of valid cases. It is suggested taking into account also the no. of valid cases as a percentage computed on a low no. of cases is less secure. (**) In these countries (marked with a double star) the low number of valid cases and the relevant incidence of "not known" affect the reliability of the percentages. 17 of 24
Globally, 60 percent of the nutritional centres operational at the time of survey offered sessions on HIV prevention. Nonetheless, table 18 shows clearly that there were countries offering sessions in the vast majority of sites (NICARAGUA, ETHIOPIA, SIERRA LEONE, RWANDA, MALAWI, HAITI and ZAMBIA) and countries where none (Mauritania) or a small percentage of centres offered such sessions (Yemen, Djibouti, Afghanistan, Bangladesh and Chad). Attendance of men/boys and level of participation of the assisted pregnant and lactating women have been measured in those sites providing sessions on HIV prevention. Unfortunately in several countries the no. of nutritional centres under survey was rather low and very few sites provided sessions on HIV. In such countries (Yemen, Djibouti, Afghanistan, Chad, Eritrea and Southern Sudan) few recommendations can be made on the basis of this information. Therefore their results are not reported in narrative. As with regard to ATTENDANCE OF MEN/BOYS, globally their participation was low (in only 23.5% of the sites they participated). It was zero in Nicaragua and Bangladesh; it was very low in Colombia (9.8% of the sites) and Zambia (7.4% of the sites); low in Malawi (17% of the sites) and Rwanda (29% of the sites). Only in Haiti and Sierra Leone the majority of sites (73.7% and 60% of the sites respectively) involved men/boys in the sessions on HIV prevention. Unfortunately, only in few countries the monitoring system of the nutritional centres allows to check whether AT LEAST HALF OF THE ASSISTED PREGNANT AND LACTATING WOMEN participated to the sessions. If we consider only the reliable figures, we notice that in Malawi the 50 percent target suggested by the Gender Policy 2003-2007 (ECW I.3) was reached in only 31 percent of the sites; such percentage increases in Zambia (79%) and Sierra Leone (79%). In Ethiopia, Nicaragua and Haiti all the sites achieved the target. The following table reports the results in details: The first column reports the name of the country The second reports the percentage of sites providing awareness raising sessions on HIV The third reports the percentage of sites where men and boys participated to the sessions The fourth reports the percentage of sites where at least half of the pregnant and lactating women assisted participated to the sessions. 18 of 24
Table 18-2004 Survey on the ECW: Results from the Site Level Survey Unit of analysis: the nutritional site operational at the time of survey For the timeframe of data collection check table 15 AT THE SITES WHERE SESSIONS WERE OFFERED name of the country How many sites offered sessions on HIV/AIDS prevention? In how many sites men/boys participated to the sessions? In how many sites at least half of the PLW assisted participated to the sessions? percentage of sites percentage of sites percentage of sites Mauritania in none of the sites NR (sessions not offered) NR (sessions not offered) Yemen 2.3 (only one site out of 43 surveyed) yes no Djibouti 4.8 (only one site out of 21 surveyed) no yes Afghanistan 5.9 (only one site out of 17 surveyed) no yes Bangladesh 9.6 0 77.6 (**) Chad 17.1 (6 sites out of 35 surveyed) 33.3 no info What happened at the sites where Colombia 37.6 9.8 58.3 (**) Zimbabwe 52.9 (9 sites out of 17 surveyed) 33.3 50 (**) sessions were in none of the 2 sites they Southern Sudan 66.7 (2 sites out of 3 surveyed) offered? participated no info Eritrea 71.4 (5 sites out of 7 surveyed) 0 20 Sudan 72.3 44.1 in 8 sites yes, in the other 26 sites no info Zambia 88.5 7.4 79.5 Haiti 89.4 73.7 98.8 Malawi 94.7 17.4 31.2 Rwanda 98.2 29.2 84.8 (**) Sierra Leone 100.0 60.4 78.9 in one site they participated, in Ethiopia 100.0 (all the 6 sites surveyed) the other 5 no info 100 Nicaragua 100.0 0 100 OVERALL 60.9 23.5 87.8 (**) Low no. of valid cases PLUS many NK/missing in the sample. Percentages have a low reliability. 19 of 24
2.3. Main findings on food for training (FFT) site-level survey In order to evaluate to what extent HIV / AIDS have been taken into consideration in the FFT sites of the countries under survey the following issues have been addressed: Provision of training / sensitization programmes around the food distribution points (FDPs) Ration size / composition changed in order to take into account the constraints posed by HIV /AIDS Distribution modalities changed in order to take into account the constraints posed by HIV /AIDS The following table reports the percentages of sites implementing such measures (see table 19). INDONESIA and RWANDA contemplated HIV / AIDS to a wide extent during the implementation of FFT activities. As a matter of fact, in Indonesia all the sites provided awareness raising sessions on HIV and half of them (48%) changed the ration size/composition in order to face the constraints posed by HIV. In Rwanda the vast majority of the 16 operational sites (81.3%) provided such sessions and few (18.8% and 12.5%) changed the ration size/ composition and the distribution. Also in Bangladesh and in Sierra Leone a very high percentage of FFT sites provided awareness-raising sessions (80.4% and 78.9% respectively) but none of them changed the ration size/composition or the distribution modalities. Armenia, Djibouti and Bolivia are the countries where the FFT centres have the poorest performance. In particular, nothing was implemented in none of the Armenian sites; 6.3 percent of Djibouti s sites changed the ration size/composition and 12 percent of Bolivian sites provided awareness raising sessions. Table 19 shows clearly that SENSITIZATION PROGRAMMES AROUND THE FOOD DISTRIBUTION POINTS were the most implemented measures. 4 Overall, modification of ration size/ration composition and distribution modalities were put in place in 1% and 0.6% of the sites respectively. In particular, changes in ration size/composition were implemented a lot in Indonesia (48.1%) and partially in Rwanda (18.8%); distribution modalities were changed in a few sites of Rwanda (12.5%), Sudan (8.3%), Zambia (5.7%) and Uganda (2.2%). The following table reports the results in details: The first column reports the name of the country The second reports the percentage of sites where training / sensitisation programmes were offered around the FDPs The third reports the percentage of sites where composition was changed in order to take into account the constraints posed by HIV / AIDS The fourth reports the percentage of sites where distribution modalities were changed to take into account the constraints posed by HIV/AIDS The fifth reports the percentage of sites where at least one of the 3 initiatives was put in place The latter column reports the (weighted) number of sites where HIV / AIDS is relevant and that answered to the question. 4 Similar result for Relief and FFW sites. 20 of 24
Table 19-2004 Survey on the Enhanced Commitments to Women: Results from the Site Level Survey Unit of analysis: the FFT site operational at the time of survey. For the timeframe of data collection check table 15 name of the country How many sites offered HIV / AIDS training / sensitization programmes around the FDPs? How many sites changed the ration size / composition for constraints posed by HIV? How many sites changed distribution modalities for constraints posed by HIV? In how many sites AT LEAST ONE of the previous has been done? TOTAL VALID SITES (*) percentage of sites percentage of sites percentage of sites percentage of sites number of sites Myanmar (**) 0 0 0 0 20 Afghanistan (**) 0 0 0 0 12 Armenia 0 0 0 0 38 Djibouti 0 6.3 0 6.3 16 Bolivia 12 0 0 12 573 Colombia (**) 22 0 0 22 44 Southern Sudan (**) 33.3 0 0 33.3 6 Uganda 46.9 4.4 2.2 46.9 140 Burundi 50 0 0 50 4 Sudan 50 0 8.3 50 12 Zambia 55.7 0 5.7 56.6 444 Rep. Congo 62.5 0 0 62.5 8 Sierra Leone 78.9 0 0 78.9 57 Bangladesh 80.4 0 0 80.4 4096 Rwanda 81.3 18.8 12.5 87.5 16 Indonesia 100 48.1 0 100 92 OVERALL 69 1 0.6 69.1 5578 (*) TOTAL VALID SITES: are the sites where the answer was provided and relevant. Percentages computed by taking into account only the valid sites. In some countries data were collected in a sample of sites, not in all the sites operational at the time of survey. The representativeness of the samples is guaranteed by a system of weights. So - for some countries - the no. of valid sites corresponds to the weighted number. In order to allow comparisons between countries, percentages were computed even against a low no. of valid cases. It is suggested taking into account also the no. of valid cases as a percentage computed on a low no. of cases is less secure. (**) In these countries (marked with a double star) the low number of valid cases and the relevant incidence of "not known" affect the reliability of the percentages. 21 of 24
2.4 Main findings on food for work (FFW) site-level survey Table 20 shows clearly that in the Food for Work (FFW) sites MODIFICATION OF RATION SIZE/COMPOSITION AND OF DISTRIBUTION MODALITIES are extraordinary measures almost never implemented (see table 20 for details). Overall, TRAINING/SENSITIZATION PROGRAMMES on HIV / AIDS have been provided more frequently around the FFT food distribution points than around the FFW food distribution points (69 percent vs 25 percent). Awareness raising sessions have been provided in all the eight sites operational at the time of survey in SIERRA LEONE; in a good percentage of sites in ANGOLA (70%), RWANDA (63%) and ZAMBIA (54%). On the contrary they were not provided at all in ARMENIA, BURUNDI, DJIBOUTI, UGANDA, NICARAGUA and they were rarely provided in BOLIVIA (1.3%), MAURITANIA (1.9%), COLOMBIA (3.5%) and SUDAN (9.1%). The following table reports the results in details: The first column reports the name of the country The second reports the percentage of sites where training / sensitisation programmes were offered around the FDPs The third reports the percentage of sites where composition was changed in order to take into account the constraints posed by HIV / AIDS The fourth reports the percentage of sites where distribution modalities were changed to take into account the constraints posed by HIV/AIDS The latter column reports the (weighted) number of sites where HIV / AIDS is relevant and that answered to the question. 22 of 24
Table 20-2004 Survey on the Enhanced Commitments to Women: Results from the Site Level Survey unit of analysis: the FFW site operational at the time of survey. For the timeframe of data collection check table 15 name of the country How many sites offered HIV / AIDS training / sensitization programmes around the FDPs? How many sites changed the ration size / composition for constraints posed by HIV? How many sites changed distribution modalities for constraints posed by HIV? TOTAL VALID SITES (*) percentage of sites percentage of sites percentage of sites number of sites Myanmar (**) 0 0 0 3 Armenia 0 0 0 42 Burundi 0 0 0 4 Djibouti 0 0 0 5 Uganda 0 0 0 22 Haiti (**) 0 0 0 3 Nicaragua 0 0 0 297 Bolivia 1.3 0 0 643 Mauritania 1.9 0 0.5 189 Colombia 3.5 0 0 134 Sudan 9.1 0 0 11 Rep. Congo 14.3 0 0 28 Afghanistan (**) 16.5 0 0 55 Malawi 18.8 0 0 186 Bangladesh 31.9 0 0 1484 Tanzania 48.7 0 0 67 Zambia 54.1 0 6.1 452 Rwanda 62.8 0 0 43 Angola 69.9 0 0 126 Southern Sudan (**) 75.0 50 0 4 Indonesia (**) 100.0 0 0 22 Sierra Leone 100.0 0 0 8 OVERALL 25.2 0.1 0.7 3828 (*) TOTAL VALID SITES: are the sites where the answer was provided and relevant. Percentages computed by taking into account only the valid sites. In some countries data were collected in a sample of sites, not in all the sites operational at the time of survey. The representativeness of the samples is guaranteed by a system of weights. So - for some countries - the no. of valid sites corresponds to the weighted number. In order to allow comparisons between countries, percentages were computed even against a low no. of valid cases. It is suggested taking into account also the no. of valid cases as a percentage computed on a low no. of cases is less secure (**) In these countries (marked with a double star) the low number of valid cases and the relevant incidence of "not known" affect the reliability of the percentages. 23 of 24
Annexes annex I: Participation of the countries to the survey annex II: Institutional situation at the country office annex III: Self assessment of relief activities annex IV: Self assessment on nutrition interventions annex V: Self assessment on food for training activities annex VI: Self assessment on food for work activities annex VII: Self assessment on school feeding activities annex VIII: Self assessment numeric performance indices for each activity and global index 24 of 24