Project Duration: 1997–2006

• Download a complete copy of World LINKAGES/East and Southern Africa
• Download counseling cards developed by LINKAGES and its country program partners
  • Visit AED's Food and Nutrition Technical Assistance Project (FANTA) website for more materials developed by FANTA and LINKAGES
• Download Nutrition Job Aids for Regions with High HIV Prevalence (developed in East Africa)
• Download Nutrition Job Aids for Regions with Low HIV Prevalence (developed in East Africa)
• Download Nutrition and HIV/AIDS: A Training Manual
• Download Successful Community Nutrition Programming: Lessons from Kenya, Tanzania, and Uganda

Background
Malnutrition is decreasing in every region of the world except sub-Saharan Africa. Countries continue to report high prevalence rates of stunting, wasting, and undernutrition, and poor rates of exclusive breastfeeding, timely initiation of breastfeeding, and timely complementary feeding. The region is also plagued with related health and food security problems. Each year, approximately 2.4 million people in sub-Saharan Africa die from AIDS, 600,000 from tuberculosis, and 1 million from malaria. For children, the situation is especially serious: 800,000 die from diarrhea, 1.2 million from pneumonia, 500,000 from measles, and 600,000 from malaria. Malnutrition is associated with 60 percent of these deaths. The burden of disease and malnutrition in the region is exacerbated by drought, conflict, and a depressed economy.

Program Design and Implementation
LINKAGES began working in east and southern Africa with USAID's Regional Economic Development Services Office for East and Southern Africa (REDSO/ESA) under the Greater Horn of Africa Initiative (GHAI) to combat these trends, concentrating its efforts in nutrition and HIV/AIDS, and in infant, young child, and maternal nutrition. The project enhanced the region's capacity to improve health systems by offering technical and program support to the Regional Centre for Quality of Health Care (RCQHC) in Kampala, Uganda, and the East, Central, and Southern Africa Health Community Secretariat (ECSA HCS) in Arusha, Tanzania.

The technical foci for the regional initiative were nutrition and HIV/AIDS and an integrated package of essential nutrition actions (ENA) to improve infant, young child, and women’s nutrition. LINKAGES offered technical assistance in ENA, improved feeding practices to prevent mother-to-child transmission (PMTCT) of HIV, and nutritional care for HIV-infected women and children. Programming priorities included: 1) pre-service curricula development and training; 2) policy, advocacy, and national guidelines development; and 3) community-level programming tools.

LINKAGES worked with RCQHC, ECSA-HCS, the FANTA Project, and others to develop four extensive pre-service training courses, two on the essential nutrition actions and two on nutrition and HIV. The project organized three regional ENA courses for pre-service instructors, program managers, and trainers. Instructors from training institutions in the region collaborated closely in the development of training manuals on nutrition and HIV and AIDS for medical, nutrition, nursing, and midwifery students.

In the area of nutrition policy and advocacy, LINKAGES supported four workshops using PROFILES. This nutrition advocacy process used country-specific data and computer-based models to project the consequences of sub-optimal feeding and dietary practices on mortality, illness, health care costs, and fertility. A regional PROFILES workshop and country-level workshops in Kenya, Uganda, and Tanzania helped strengthen the capacity for nutrition advocacy in the region.

LINKAGES also contributed to the development of community programming resources by documenting better practices in community nutrition programs in Kenya, Uganda, and Tanzania; sponsoring a child survival forum for participants from 11 countries on Taking Child Survival to Scale; and developing a set of job aids and counseling materials.