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?