Experiences with community based nutrition programs in Thailand Prof. Kraisid Tontisirin Institute of Nutrition, Mahidol University & Former Director of Nutrition and Consumer Protection, FAO. Presentation at the 4th National Seminar on Food Security and Nutrition Under the theme: “Child and Maternal Nutrition” Phnom Penh, Cambodia, 21-22 May 2012 1

Service Driven Programmes Vertical, many become welfare oriented Little intra/inter sectoral coordination Little people /community participation Dependency creation Not sustainable Inadequate coverage Individual Family Community Kraisid Tontisirin, Mahidol University

Elimination of undernutrition: a global deficit and priorities* *ACC/SCN 1999 Kraisid Tontisirin, Mahidol University

Agriculture/ Food supply/ Service Promotion Protection Treatment Food Nutrition Health Nutrition is a link between food and health, regarding the fulfillment of nutrient and non-nutrient requirements from food in human life cycle. Ultimate Goals Food and Nutrition Security for All Leading to Good Health and Well-being Kraisid Tontisirin, Mahidol University 4

Main Causes of Child Malnutrition Maternal poor nutrition and health lead to LBW of newborn, low milk quality and quality Declining of BF practices In adequate and in appropriate CF Poor sanitation in IYC feeding and cares Recurrent of illness i.e. diarrhea and respiratory tract infection Undesirable eating habits Kraisid Tontisirin, Mahidol University

Community-Based Approaches Is an integrated program implemented at local level (district level and below) National commitment with sound nutrition improvement strategies and goals Community actions: basic services, mass mobilization, mutual efforts/actions to reach all people and to prevent malnutrition Kraisid Tontisirin, Mahidol University

Components of a successful community based program Minimum Basic Services (Health, Education, Agr. Extension) Supportive System Training Funding Problem Solving Supervision Facilitators Menus (Activities) ANC GMP Food production Nutrition education Food sanitation & safety 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, Mahidol University

Menu Activity on ANC (to prevent maternal morbidity and mortality, and LBW) 4 ANC visits for all pregnant mothers High risk check up and treatment monitoring wt. gain Nutrition and health education Food supplementation if needed MTV, iron and folate supplementation Two tetanus toxoids Referral system and safe delivery service Kraisid Tontisirin, Mahidol University

Menu on Growth Monitoring and Promotion (GMP) Monthly or quarterly monitoring wt.& ht. Child growth education and cares Breastfeeding and CF Immunization Village based food production (+CF for IYC and supplementary food for mothers) Health and nutrition education Cooking and feeding demonstration Treatment of malnourished child Referral of severe illness and malnutrition Kraisid Tontisirin, Mahidol University

Community Food Production Home and school gardens growing vegetables, fruits, fishes and chicken for learning, consumption and income Supplementary food for pregnant mothers Complementary food for IYC food preservation and simple food processing techniques Cooperative and micro credit Kraisid Tontisirin, Mahidol University

Maternal and child health and nutrition Thailand, 1980- 2006 1990 2006 ANC coverage % 35 75 95 Anemia in preg. % 50-75 18.8 10 LBW % 16 <10 PEM (Wt/Age of U 5)% 51 20 Kraisid Tontisirin, Mahidol University

Kraisid Tontisirin, Mahidol University Conclusion 1 Interface of basic social services with strong people participation at community level is crucial for prevention and control of malnutrition. Village Health Volunteers (1 VHV per 10 HH) have been proven to be effective. Current number of VHV are over 800,000. Nutrition indicators are most useful for goal setting and follow up actions i.e. birth weight, under weight of under 5, stunting, and weight for height Research and capacity development are essential to back up the program Kraisid Tontisirin, Mahidol University 12

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