organizing nutrition health programmes copaigne
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Undoubtedly much change has stemmed from scientific advances, immunization being a prominent case. However, the organizational aspects of health and nutrition protection are equally critical. In the past several decades, people's contact with trained workers has been instrumental in improving health in developing countries. This factor applies particularly to poor people in poor countries but is relevant everywhere; indeed, it is a reason that social services have essentially eliminated almost all occurrences of child malnutrition in Europe (where, when malnourished children are seen, it is caused by neglect).
Community-based programs under many circumstances provide this crucial contact. Their role is partly in improving access to technology and resources, but it is also important in fostering behavior change and, more generally, in supporting caring practices (Engle, Bentley, and Pelto 2000; UNICEF 1990). Such programs may also play a part in mobilizing social demand for services and in generating pressure for policy change.
In community-based programs, workers—often volunteers and part-time workers—interact with households to protect their health and nutrition and to facilitate access to treatment of sickness. Mothers and children are the primary focus, but others in the household should participate. Commonly, people go regularly to a central point in their community—for example, for growth monitoring and promotion—or are visited at home by a health and nutrition worker. The existence, training, support, and supervision of the community worker—based in the community or operating from a nearby health facility—are indispensable features of these programs. Thus community organizations are a key aspect of community-based health and nutrition programs (CHNPs).
This chapter focuses on large-scale (national or state) programs. Although these programs are primarily initiated and run at the local level, links with the national level and levels in between are necessary. Both horizontal and vertical organizations are needed. Local organizations make action happen, but they need input and resources, such as training, supervision, and supplies, from more central levels.
The experience on which this chapter is based comes from a considerable number of national and large-scale programs. Most of these programs include both nutrition and health activities, aimed particularly at the health and survival of reproductive-age women and children. We draw on these experiences as we try to put forward principles on which future programs can be based—programs that may have broader health objectives for other population groups and diseases.
As of 2001, some 19 percent of global deaths were among children—and 99 percent of all child deaths took place in low- and middle-income countries. The disability-adjusted life years (DALYs) lost attributed to zero- to four-year-olds—plus maternal and perinatal conditions, nutrition deficiencies, and endocrine disorders—amount to 42 percent of the total disease burden (all ages, both sexes) from all causes for developing regions. ).
Rapid improvements in health and nutrition in developing countries may be ascribed to specific, deliberate, health- and nutrition-related interventions and to changes in the underlying social, economic, and health environments. This chapter is concerned with the contribution of specific interventions, while recognizing that improved living standards in the long run provide the essential basis for improved health. Consideration of the environment as the context for interventions is crucial in determining their initiation and in modifying their effect, and it must be taken into account when assessing this effect.
Undoubtedly much change has stemmed from scientific advances, immunization being a prominent case. However, the organizational aspects of health and nutrition protection are equally critical. In the past several decades, people's contact with trained workers has been instrumental in improving health in developing countries. This factor applies particularly to poor people in poor countries but is relevant everywhere; indeed, it is a reason that social services have essentially eliminated almost all occurrences of child malnutrition in Europe (where, when malnourished children are seen, it is caused by neglect).
Community-based programs under many circumstances provide this crucial contact. Their role is partly in improving access to technology and resources, but it is also important in fostering behavior change and, more generally, in supporting caring practices (Engle, Bentley, and Pelto 2000; UNICEF 1990). Such programs may also play a part in mobilizing social demand for services and in generating pressure for policy change.
In community-based programs, workers—often volunteers and part-time workers—interact with households to protect their health and nutrition and to facilitate access to treatment of sickness. Mothers and children are the primary focus, but others in the household should participate. Commonly, people go regularly to a central point in their community—for example, for growth monitoring and promotion—or are visited at home by a health and nutrition worker. The existence, training, support, and supervision of the community worker—based in the community or operating from a nearby health facility—are indispensable features of these programs. Thus community organizations are a key aspect of community-based health and nutrition programs (CHNPs).
This chapter focuses on large-scale (national or state) programs. Although these programs are primarily initiated and run at the local level, links with the national level and levels in between are necessary. Both horizontal and vertical organizations are needed. Local organizations make action happen, but they need input and resources, such as training, supervision, and supplies, from more central levels.
The experience on which this chapter is based comes from a considerable number of national and large-scale programs. Most of these programs include both nutrition and health activities, aimed particularly at the health and survival of reproductive-age women and children. We draw on these experiences as we try to put forward principles on which future programs can be based—programs that may have broader health objectives for other population groups and diseases.
As of 2001, some 19 percent of global deaths were among children—and 99 percent of all child deaths took place in low- and middle-income countries. The disability-adjusted life years (DALYs) lost attributed to zero- to four-year-olds—plus maternal and perinatal conditions, nutrition deficiencies, and endocrine disorders—amount to 42 percent of the total disease burden (all ages, both sexes) from all causes for developing regions. CHNPs address about 40 percent of the disease burden. In terms of prevention, Mason, Musgrove, and Habicht (2003) estimated that eliminating malnutrition would remove one-third of the global disease burden. Comparative studies by Ezzati, Lopez, and others (2002) and Ezzati, Vander Hoorn, and others (2003) have reemphasized malnutrition as the predominant risk factor and improvement of nutrition as playing a potentially major role in reducing the burden. Clinical deficiencies contribute directly to malnutrition, but even more, malnutrition is a risk factor for infectious diseases (table 56.1). Furthermore, changes in child malnutrition levels in developing countries are closely related to the countries' mortality trends (Pelletier and Frongillo 2003).