Thailand’s public nutrition experience
Authors: Alec Stall, Amanda Pitts, Francie Picknell, Yongmei Li, Tina
Lloren, and Yara Koreissi
Overview of Presentation
Historical background of nutrition programs in Thailand
Implementation of the most recent & most successful program
Factors that led to the program’s success
Historical Perspective
National Health Plan Budget, involvement
Shift community-driven programs
What and Why
Steps to alleviate malnutrition
National development agenda
National Economic Social Development Plan (NESDP) Established goals
Community level—specific nutritional activities
After 5 year analysis still inadequate
Steps to alleviate malnutrition (cont)
Primary health care
Community-based approach
Integrated basic minimum needs Strengthened community
Defined as element of human development
Who are the main players in implementation?
Mobilizers/Volunteers
Facilitators
Community Leaders & Village Committees
Community health volunteers (mobilizers)
VHCs and VHVs
Liaisons between health personnel and villagers
Trained in primary health care
Organized health-related sessions
Ideal ratios of VHV/VHC to HH
Facilitators
Local agency or NGO workers
Train the VHVs and VHCs, and supervise progress
Help communities identify problems they face
Community Leaders& Village Committees
Chosen from the community
Work with the volunteers and facilitators to oversee planning, implementation and monitoring
Funding depends in part on the community’s participation
What did the programs deliver?
Focus – Protein-energy malnutrition in children under five and pregnant women/ lactating women Growth Monitoring and PromotionBreastfeeding and Complimentary FeedingBasic Health Services PackageAntenatal CareHome and Community Food Production
Growth Monitoring and Promotion
Quarterly weighing sessions by VHVs and VHCsChildren classified as normal or having 1st, 2nd, or 3rd degree malnutrition2nd and 3rd degrees given supplements, closely monitored and referred to appropriate health service
Breastfeeding and Complimentary Feeding
Misconceptions addressed through national breastfeeding campaign (special attention given to certain beliefs and practices)
Complementary foods improved 1st on a commercial scale, but found not to be effective for needy, so…
Introduced easily-made rice, legume oilseed combination made from locally available food and materials
Basic Health Services Package
Minimum basic health services with preventive and curative receiving equal attention
Accessible immunizations –especially to target group
Community level treatment of diarrhea and ARIs encouraged
Antenatal Care
Seen as essential to program
Began with a target of at least 4 antenatal visits
Increase coverage and compliance through encouragement of attendance in antenatal care services
Home and Community Food Production
Emphasis given to promoting the production of ingredients needed for complementary foods
Supported home gardening, pond fishing, growing fruits and vegetables and chicken raising
What technical and managerial support is needed?
Community Organization
Community Financing
Research
Facilitator Training
Management Information Systems
Political Commitment
Technical and Managerial Support
Community Organization Village Committees
Community Financing Intrinsic Extrinsic
Technical and Managerial Support (cont)
Operational Research Identification of Barriers Removal of Barriers Other types of research
Facilitator Training Hierarchical
Technical and Managerial Support (cont)
Management Information Systems Data collection Data use
Village level Central level
Political Commitment to National Policies National agenda agreed upon by all levels of
government Holistic/Intersectoral Decentralization
Success Factors
Political commitment Nutrition as a development agenda: micro and
macro level Paradigm shift from service-driven approach to
community-driven programs
Success Factors (cont)
Gaining momentum Situation analysis communication of “what”
and “why”, basic minimum needs indicators Community manpower (VHCs and VHVs)
Success Factors (cont)
Organization (planning, implementing, monitoring and evaluating; training, supervision; action)
Supporting activities: technical, managerial and financial
What can be learned and improved?
The courage to abolish superfluous non-functioning system
Can “decentralization” go further to have resources allocated to the local level?