Prof. Kraisid Tontisirin Institute of Nutrition, Mahidol University & Former Director of Nutrition and Consumer Protection, FAO.

Experiences with community based nutrition programs in Thailand

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

Service Driven Programmes

IndividualIndividualFamilyFamily

CommunityCommunity

Vertical, many become welfare oriented

Little intra/inter sectoralcoordination

Little people /communityparticipation

Dependency creation

Not sustainable

Inadequate coverage

Kraisid Tontisirin, Mahidol University

Kraisid Tontisirin, Mahidol University

Elimination of undernutrition: a global deficit and priorities*

*ACC/SCN 1999

• Promotion• Protection• Treatment

Kraisid Tontisirin, Mahidol University

Food Nutrition Health• Agriculture/• Food supply/• Service

Nutrition is a link between food and health, regarding the fulfillment of nutrient and non-nutrient

requirements from food in human life cycle.

Food and Nutrition Security for All Leading to Good Health and Well-being

Ultimate Goals

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 habitsKraisid 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

Minimum Basic Services(Health, Education, Agr. Extension)

Minimum Basic Services(Health, Education, Agr. Extension)

Supportive System•Training•Funding

•Problem Solving•Supervision

Interface(service providers and

community leaders)•Plan/goals

•Implementation•Monitoring/evaluation

Community LeadersFamily

Individual

Basic Minimum Needs Goals/IndicatorsBasic Minimum Needs Goals/Indicators

Menus (Activities)•ANCANC•GMPGMP•Food productionFood production•Nutrition educationNutrition education•Food sanitation & Food sanitation & safetysafety•Other activitiesOther activities

Mobilizers(1:10 households)

Facilitators

Components of a successful community based program Components of a successful community based program

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 malnutritionKraisid 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 nutritionThailand, 1980- 2006

Kraisid Tontisirin, Mahidol University

1980 1990 2006

ANC coverage % 35 75 95

Anemia in preg. %

50-75 18.8 10

LBW % 16 10 <10

PEM (Wt/Age of U 5)% 51 20 <10

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

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