1. Thailand’s public nutrition experience Authors: Alec Stall, Amanda Pitts, Francie Picknell, Yongmei Li, Tina Lloren, and Yara Koreissi

2. 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

3. Historical Perspective National Health Plan Budget, involvement Shift community-driven programs What and Why

4. 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

5. Steps to alleviate malnutrition (cont) Primary health care Community-based approach Integrated basic minimum needs Strengthened community Defined as element of human development

6. Who are the main players in implementation? Mobilizers/Volunteers Facilitators Community Leaders & Village Committees

7. 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

8. Facilitators Local agency or NGO workers Train the VHVs and VHCs, and supervise progress Help communities identify problems they face

9. 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

10. What did the programs deliver? Focus – Protein-energy malnutrition in children under five and pregnant women/ lactating women Growth Monitoring and Promotion Breastfeeding and Complimentary Feeding Basic Health Services Package Antenatal Care Home and Community Food Production

11. Growth Monitoring and Promotion Quarterly weighing sessions by VHVs and VHCs Children classified as normal or having 1st, 2nd, or 3rd degree malnutrition 2nd and 3rd degrees given supplements, closely monitored and referred to appropriate health service

12. Breastfeeding and Complimentary Feeding Misconceptions addressed through national breastfeeding campaign (special attention given to certain beliefs and practices) Complementary foods improved 1 st 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

13. 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

14. 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

15. 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

16. What technical and managerial support is needed? Community Organization Community Financing Research Facilitator Training Management Information Systems Political Commitment

17. Technical and Managerial Support Community Organization Village Committees Community Financing Intrinsic Extrinsic

18. Technical and Managerial Support (cont) Operational Research Identification of Barriers Removal of Barriers Other types of research Facilitator Training Hierarchical

19. 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

20. Success Factors Political commitment Nutrition as a development agenda: micro and macro level Paradigm shift from service-driven approach to community-driven programs

21. Success Factors (cont) Gaining momentum Situation analysis  communication of “what” and “why”, basic minimum needs indicators Community manpower (VHCs and VHVs)

22. Success Factors (cont) Organization (planning, implementing, monitoring and evaluating; training, supervision; action) Supporting activities: technical, managerial and financial

23. 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?