From 2013 to 2014, FANTA provided technical assistance to the nutrition department of Lesotho’s Ministry of Health (MOH) under the auspices of USAID’s Partnership for HIV-Free Survival (PHFS), which aims to reduce maternal-to-child-transmission of HIV (MTCT) to less than 5 percent, and increase survival of HIV-exposed infants. FANTA assisted the MOH to develop a PHFS work plan, select PHFS indicators, and launch nutrition assessment, counseling, and support (NACS) activities. Through the development and delivery of a new NACS training of trainers (ToT) workshop, FANTA assisted the MOH to train the first national and district leaders with the knowledge and skills to effectively support high quality implementation of NACS services in health facilities. The project finalized the curriculum and the MOH began training additional health staff. In addition, to support the MOH’s need for counseling materials for people with HIV, infant and young child feeding (IYCF), and maternal nutrition, FANTA initiated development of social and behavior change communication materials.

As part of an initiative to mitigate the effects of the El Niño drought in five targeted districts, FANTA began providing technical assistance to the MOH and PEPFAR implementing partners in 2016 with the objective of strengthening implementation and monitoring of nutrition services for people living with HIV. FANTA developed, piloted, and finalized NACS counseling cards to use in the targeted districts, and delivered a NACS counseling ToT on effective use of the cards. FANTA also worked with the MOH and partners in four districts to train pharmacists and pharmacy technicians in NACS. The project also worked with partners to train staff of community-based organizations to screen for severe acute malnutrition (SAM) using mid-upper arm circumference, and refer clients for nutrition assessment linked to HIV services. In addition, FANTA procured equipment for health facilities and select community sites that provide NACS services linked to HIV services, thereby building capacity of facility staff to perform proper nutrition screening and assessment.

FANTA provided technical assistance to the MOH to improve the quality of NACS services through the following activities:

• Reviewing and updating key national-level training resources, tools, and job aids for service providers
• Developing supervision, management, and coaching tools and processes
• Strengthening coordination between prevention of mother-to-child transmission of HIV (PMTCT), nutrition, and quality improvement stakeholders 
• Supporting cross-district and cross-country learning through engagement with the Partnership for HIV-Free Survival, which aims to accelerate adoption of the 2010 WHO guidelines on PMTCT and on HIV and infant feeding
• Providing NACS training to facility health workers, including using NACS counseling cards
• Providing training in nutrition data monitoring for district nutritionists
• Providing training in SAM screening and referral to nutrition and HIV services
• Supporting proper nutrition assessment at facility level through equipment and tool procurement