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Community based nutrition programmes –Thailand

Community based nutrition programmes –Thailand. Dr. Lalita Bhattacharjee Training on Comparative Review of the Nutrition Situation and Policies in Selected Countries and with particular reference to Bangladesh 27 March to 6 April 2014. Introduction Nutrition issues and challenges

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Community based nutrition programmes –Thailand

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  1. Community based nutrition programmes –Thailand Dr. Lalita Bhattacharjee Training on Comparative Review of the Nutrition Situation and Policies in Selected Countries and with particular reference to Bangladesh 27 March to 6 April 2014

  2. Introduction • Nutrition issues and challenges • Community based approaches and strategies • Conclusion

  3. Nutrition Promotion Protection Treatment Food Health Agriculture/ Food supply/ Service Nutrition is a link between food and health, Fulfillment of nutrient and non-nutrient requirements from food in human life cycle. Ultimate goals are food and nutrition security for all

  4. Food and nutrition security Food-based dietary guidelines Health service & Caring practices Food & Nutrition Programmes • Prevent & control malnutrition • School meals, etc. Nutrition labelling Consumption Consumer protection Individual/Family & Community as Core Utilization Food processing Food production Monitoring and Surveillance Food combinations Fortification Rice/cereals Legumes Fish Chicken Eggs Vegetables Fruits Dairy

  5. Nutrition strategies/Interventions • Supplementation with micronutrients/food (food to food enrichment) • Food fortification • Food regulation and legislation • Nutrition education/communication (BCC) • Food based approach: ensuring food security/consumption of safe and nutritious food • Public health measures: basic services, immunization, sanitation, deworming … • Community based (integrated) approaches

  6. Service driven programmes - Vertical, many become welfare oriented - Little intra/intersectoral coordination - Little people /community participation - Dependency creation - Not sustainable - Inadequate coverage Individual Household Community

  7. Community based nutrition programmes require*: • Community ownership • Adequate population coverage • Targeting • Central/local support e.g. training, supplies, information *Source: Mason, J, Tontisirin K (2000)

  8. Components of Ten Nutrition programmes-Summary*by village workers and/or in facilities • Ante-natal care • Women’s health and nutrition • Breastfeeding • Complementary feeding • Growth monitoring (and promotion) • Micronutrient fortification • Supplementary feeding-external supplies/local supplies • Oral rehydration therapy (ORT) • Immunization • deworming *Mason, J, Tontisirin K (2000)

  9. Central (with local components)* • Fortification • Infant formula code • National information, education, and communication e.g. FBDGs, food labelling • National (FS&N) information systems

  10. Forging the linkbetweengovernment and community

  11. Facilitators Are service providers (government, NGOs) in health, agriculture, education, rural development and so forth at village, sub district and district level providing training, information, supervision, and support community based programs

  12. Mobilizers • Could be village/community volunteers or block representatives or any support groups • Ideally, selection should be based on sociogram (1 per 10-20 HH), followed by training and supervision and support • Act as “change agents” linking service providers/facilitators and people, and also act as “communicators” • Help to reach the unreachable and increased coverage e.g. ANC, GMP, and immunization

  13. Basic Minimum Needs (BMN) • A set of goals which could be used as indicators for individuals and community • Maybe also called essential minimum needs (EMN) • MDGs goals, targets and indicators could be adapted to be used as BMN • Once BMNs have been achieved, other indicators could be emerged e.g. prevalence of overweight and obesity, D.M

  14. Basic Minimum Needs (BMNs) • Some examples of BMNs: -ANC and safe delivery services coverage -prevalence of LBW -prevalence of under wt. and stunting of under 5 -IDD goiter rate or urinary iodine -Immunization coverage -HH with hygienic latrine -Adequate clean drinking water -Literacy rate in adults -primary and secondary education rate -Etc… Kraisid Tontisirin 2007, Mahidol University

  15. Thailand’s Nutrition Security Compact • Eliminate severe, moderate and mild protein-energy malnutrition (PEM). • Monitor growth among all pre-school children and provide food supplements where needed • Mainstream nutrition in health, education and agricultural policies • Encourage breast feeding and organise school lunch programmes • Promote home gardening, consumption of fruits and vegetables, aquaculture and food safety standards • Introduce an integrated food safety net with emphasis on household food and nutrition security. • Retrain and retool existing staff and mobilise community volunteers. Choose one community volunteer forevery 10 -15 householdsand build their capacity.

  16. Under the umbrella of the Poverty Alleviation Plan (PAP) targeting to the poor areas to achieving BMN Primary Health Care (PHC) and Food and Nutrition Plan (FNP) have been incorporated in the PAP Nutrition has been used as a goal and indicator Multisectoral-community based approaches since 1981 Kraisid Tontisirin 2007, Mahidol University

  17. Menu activity on ANC(to prevent maternal morbidity and mortality, and LBW) • 4 ANC for all pregnant mothers • Nutrition and health education • Food supplementation if needed • MTV, iron and folate supplementation • Two tetanus toxoids • High risk identification and treatment • Referral system and safe delivery service • Etc.. Kraisid Tontisirin 2007, Mahidol University

  18. Breastfeeding and complementary feeding • Promotion, support and protection of BF • Adequate and appropriate CF, food prepared at HH, community, and also at commercial level • Growth monitoring and promotion (GMP) -monitor wt and ht gains -follow up actions based on nutritional status Kraisid Tontisirin 2007, Mahidol University

  19. HH and community food production • Home and school gardens growing vegetables, fruits, fish and chicken for learning, consumption and income • food preservation and processing • Proper marketing for surplus products • Cooperatives and micro credit

  20. Nutrition and health education • Counseling on nutrition and health e.g. food for pregnant and lactating mothers, BF/CF, child growth and development • Resource allocation in home and outside • Promote FBDGs • Access to health services

  21. Life course approaches in nutrition promotion Nutrition in schools • Nutritional assessment/surveillance • Food services--school lunch/meals • Basic food, personal and environmental hygiene • School gardens • Nutrition education • Promotion of physical activity and exercise • Positive school environment for healthy diets Life course approaches in nutrition promotion

  22. Kraisid Tontisirin 2007, Mahidol University

  23. Components of a successful community based program Minimum Basic Services (Health, Education, Agr. Extension) Supportive System • Training • Funding • Problem Solving • Supervision Facilitators • Menus (Activities) • Food production • Nutrition education • Food sanitation & safety • ANC • GMP • BF/CF • Other activities Interface (service providers and community leaders) • Plan/goals • Implementation • Monitoring/evaluation Mobilizers (1:10 households) Community Leaders Family Individual Basic Minimum Needs Goals/Indicators Kraisid Tontisirin 2007, Mahidol University

  24. Sustainability • Top down policy support • Strengthening district and village level leadership • Training of critical mass of community collaborators • Expanding network of community collaborators

  25. Conclusion • Community based approach to prevent and control malnutrition is an integrated program implemented at local level, below district level • National and local leadership and commitment to nutrition improvement, policies and goals, must be combined with basic services, mass mobilization to reach the unreachable, people empowerment and actions at community level

  26. Conclusion Successful experience of community based approached should be adapted/revitalized in prevention and control of double burden of malnutrition (DBM) and NCDs

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