Scaling-up Community-Based Program for Management of Child Malnutrition in Rural Thailand

Full text: Despite efforts to address child malnutrition at scale since 1970s, management of child illnesses focused on treatment of common infections. In the fifth National Economic and Social Development Plan (NESDP) (1982-1987), effective scaled-up child nutrition policy and program was implemented, through Primary Health Care (PHC) and Poverty Alleviation Plan (PAP). The PAP provided the mechanism to streamline government resources to poverty stricken areas. Almost 300 districts were identified and sectoral programs implemented in the same priority areas. Provincial planning is the key to allocate the government budget, while the district level implemented and supervised actions at the community level. PHC was implemented with the principle of self-help care and nutrition was one of the PHC elements. Community participation was strengthened through manpower mobilization and capacity building, village financing and organization. As a result, there is an alignment of national resource allocations and micro-level actions. Scaling-up of community-based nutrition program was implemented by adopting the PHC principle, using community participation strategy, namely, mobilization and capacity building of village health volunteers, financing and organization. Growth monitoring, promotion of infant and young child feeding and joint financing via a 'nutrition fund' was implemented in rural areas, particularly in the poorest areas of the northeast and north. Child malnutrition was strategically managed at the community level, whereby differential actions were taken according to the severity of malnutrition. Management of severe and moderate malnutrition was by monitoring growth monthly, with support of basic health services to manage infections and other curative needs. Food assistance for complementary feeding using appropriate technology for village level processing was an integral part of child malnutrition management. Children with mild malnutrition or normal were monitored quarterly and provided with nutrition education and other nutritional supports as determined by the community. Nutrition education included breast feeding promotion, complementary feeding guidelines, and maternal and child nutrition. Maternal nutrition focused on promoting supplementary nutritious foods and iron/multivitamin-mineral supplementation during pregnancy to prevent low birthweight and iron deficiency anemia. Subsequently, nutrition in primary health care evolved to become an integral part of the basic minimum need (BMN) approach, which provided a holistic development framework for the community. Thirty two simple indicators were developed and tested for various components (e.g., nutrition, food production, income, community participation) aiming at improved quality of life of individual, family and community. Child anthropometry was included in the BMN indicators. In terms of process, community was empowered to identify their problems, take initiatives and participate in integrated actions as relevant to a specific community. Technical and financial inputs were obtained or facilitated by frontline government personnel. BMN is an iterative process which helped to facilitate the bottom-up planning and indicators were used for monitoring progress. Within the first five years, child malnutrition declined significantly, and severe malnutrition was practically eradicated. Moderate and mild undernutrition continued to decline and from 1990s, stunting/underweight was about 12-14%; wasting 5-7%, despite social and economic challenges in subsequent years. (author)