Supply and Demand Constraints in the Delivery of a National Food by Prescription Program for HIV+ Individuals in Ethiopia

Abstract

Few studies have examined the effect on health and nutrition outcomes of food offered “by prescription” to people living with HIV/AIDS. Likewise, the implementation processes conducive to achieving significant impacts and constraints to program effectiveness are not well documented. This study examines the delivery and utilization of a therapeutic Plumpy'nut ration as part of the Ethiopia National Food by Prescription (FBP) Program. Quantitative monitoring data from FBP clinic sites were analyzed to examine the proportion of patients attending ART and FBP appointments and receiving drugs and nutrition rations. 130 male and female FBP participants and medical staff were engaged in focus group discussions using participatory methods at 8 FBP program health facilities to examine factors related to program participation, adherence, and perceived changes in health and nutrition status. Approximately 50% of rations were reportedly consumed by the HIV+ index patient. Pressure to sell and share rations, negative ration side‐effects, transportation difficulties, stigma, and additional burden on health workers emerged as constraints to efficient implementation. Attention to often under‐utilized monitoring data can enable the timely resolution of critical implementation bottlenecks, leading to greater program effectiveness.