Nutrition Programs in Thailand

National Economic and Social Development Program (NESDP) 1960 Survey found PEM problems and Vitamin A, thiamin, and riboflavin deficiencies in various regions 1960 Survey found PEM problems and Vitamin A, thiamin, and riboflavin deficiencies in various regions Six 5-year National Health Development Plans began in 1961 Six 5-year National Health Development Plans began in 1961 Only 0.6% of malnourished children were reached by the end of the Third 5-yr Plan Only 0.6% of malnourished children were reached by the end of the Third 5-yr Plan

National Food and Nutrition Plan (NFNP) First NFNP was included during the Fourth NESDP in 1977 First NFNP was included during the Fourth NESDP in 1977 Goals included: Goals included: Improving health care and hygiene Improving health care and hygiene Increasing food availability Increasing food availability Increasing nutrition education Increasing nutrition education Improving SES among vulnerable groups Improving SES among vulnerable groups Targets included rural infants, children under five, pregnant and lactating women, and school children Targets included rural infants, children under five, pregnant and lactating women, and school children 1989 survey showed that 53% of preschool children suffered from PEM 1989 survey showed that 53% of preschool children suffered from PEM

Second NFNP Similar target groups as in First NFNP Similar target groups as in First NFNP Goals: Goals: Reduce moderate malnutrition by 50% Reduce moderate malnutrition by 50% Reduce mild malnutrition by 25% in infants and preschoolers Reduce mild malnutrition by 25% in infants and preschoolers Reduce PEM by 50% in school aged children Reduce PEM by 50% in school aged children Poverty Alleviation Program (PAP) and Primary Health Care (PHC) put into place Poverty Alleviation Program (PAP) and Primary Health Care (PHC) put into place Outcomes: Outcomes: Nutrition among infants and preschoolers improved significantly Nutrition among infants and preschoolers improved significantly Severe PEM almost eliminated Severe PEM almost eliminated Small amount of moderate PEM remained Small amount of moderate PEM remained

Poverty Alleviation Plan (PAP) Objective Objective To improve the quality of life for 7.5 million poor in the northern, north-east, and southern regions To improve the quality of life for 7.5 million poor in the northern, north-east, and southern regions Activities of the National Rural Development Committee Activities of the National Rural Development Committee Rural job creation program Rural job creation program Village development projects (e.g. water, livestock) Village development projects (e.g. water, livestock) Provision of basic services (health, nutrition, water, education) Provision of basic services (health, nutrition, water, education) Agricultural production (crops for supplementary feeding) Agricultural production (crops for supplementary feeding)

PAP cont. Target Population Target Population High poverty areas including 288 districts and 38 provinces High poverty areas including 288 districts and 38 provinces Expenditure Expenditure Nutrition division, approximately $1/head/year Nutrition division, approximately $1/head/year MOPH approx. 11$/head/year (1990) MOPH approx. 11$/head/year (1990) Outcomes Outcomes Income increased Income increased Disease prevention promoted Disease prevention promoted Health services reached 80% of targeted villages Health services reached 80% of targeted villages Food security improved due to increased availability of nutritious foods Food security improved due to increased availability of nutritious foods

Primary Health Care Development (PHC) National PHC program began in 1980 (unofficially in 1960s) National PHC program began in 1980 (unofficially in 1960s) Objectives Objectives To increase coverage and to make health services more accessible To increase coverage and to make health services more accessible To utilize community resources and encourage community involvement To utilize community resources and encourage community involvement To promote the spread of health information to the people and to integrate data which signal the health needs of the community To promote the spread of health information to the people and to integrate data which signal the health needs of the community To promote the health status of those residing in rural areas To promote the health status of those residing in rural areas

PHC cont. Comprised of fourteen target elements Comprised of fourteen target elements Stage 1 Stage 1 Train Village Health Volunteers and Communicators Train Village Health Volunteers and Communicators Outcome: 588,555 VHCs and 62, 075 VHVs in almost every village within Thailand (98.4% coverage) Outcome: 588,555 VHCs and 62, 075 VHVs in almost every village within Thailand (98.4% coverage) Stage 2 Stage 2 Fixed financial funds provided to target villages that developed a strategy to improve nutrition and generate revolving funds Fixed financial funds provided to target villages that developed a strategy to improve nutrition and generate revolving funds 1985 – Health Card Scheme 1985 – Health Card Scheme Stage 3 Stage 3 Community hospitals (lower status) linked with general and regional hospitals (higher status) Community hospitals (lower status) linked with general and regional hospitals (higher status)

Third NFNP Began during the Sixth NESDP Began during the Sixth NESDP Continued using PHC approach and added wage laborers and elderly to target groups Continued using PHC approach and added wage laborers and elderly to target groups Basic Minimum Needs (BMN) approach was introduced Basic Minimum Needs (BMN) approach was introduced 500,000 VHC’s and 50,000 VHV’s trained, covering almost all villages in the country 500,000 VHC’s and 50,000 VHV’s trained, covering almost all villages in the country Prevalence of severe malnutrition almost eliminated by the end of the Sixth NESDP Prevalence of severe malnutrition almost eliminated by the end of the Sixth NESDP

Basic Minimum Needs and Quality of Life Movement Rural populations were targeted Rural populations were targeted Indicators Indicators adequate food and nutrition adequate food and nutrition proper housing and environment proper housing and environment adequate basic health and education services adequate basic health and education services security and safety of life and properties security and safety of life and properties efficiency in food production by the family efficiency in food production by the family family planning family planning people participation in community development people participation in community development spiritual or ethical development spiritual or ethical development Developed to facilitate community participation Developed to facilitate community participation

BMN cont. It is carried out by communities with government support in a 3-part process: It is carried out by communities with government support in a 3-part process: Data collection from households Data collection from households Village Level information Village Level information Used for nation wide planning, prioritization, and decision-making Used for nation wide planning, prioritization, and decision-making Outcomes Outcomes 95% of villages are using BMN as a means to measure status and achievements 95% of villages are using BMN as a means to measure status and achievements

FNSS: Food and Nutrition Surveillance System Coordinated by National Economic and Social Development Board and supported by UNICEF Coordinated by National Economic and Social Development Board and supported by UNICEF Goals Goals Consolidate all databases to create an information system to be used as an early warning system of potential problems and for planning, decision making, and management at all levels Consolidate all databases to create an information system to be used as an early warning system of potential problems and for planning, decision making, and management at all levels Utilize data for decision making by province level bureaucrats as well as for writing proposals for funding on a community level Utilize data for decision making by province level bureaucrats as well as for writing proposals for funding on a community level Other Surveillance System: Growth Monitoring System for Children Under Five Other Surveillance System: Growth Monitoring System for Children Under Five

Other Programs Supplementary Food Programs Supplementary Food Programs During 5th NESDP, communities were responsible for a village based supplementary food program During 5th NESDP, communities were responsible for a village based supplementary food program Food Coupons introduced in 1988 and given to children of 2nd and 3rd degree malnourishment redeemable in stores for certain food items Food Coupons introduced in 1988 and given to children of 2nd and 3rd degree malnourishment redeemable in stores for certain food items Combined 2nd and 3rd degree malnourishment dropped from 2.3% in 1987 to 1.1% in 1991 Combined 2nd and 3rd degree malnourishment dropped from 2.3% in 1987 to 1.1% in 1991 School Lunch Program School Lunch Program Targeted towards children from poor families who cannot afford to buy lunch Targeted towards children from poor families who cannot afford to buy lunch As of 1991: 40,879 children helped for 1.85 baht ($0.076) per head As of 1991: 40,879 children helped for 1.85 baht ($0.076) per head

Why Did These Programs Succeed? Successful Application Successful Application Appropriate leadership and attitude on the part of gov’t workers/community leaders Appropriate leadership and attitude on the part of gov’t workers/community leaders On-going and realistic financial and tech support from ministries On-going and realistic financial and tech support from ministries Community consciousness among villagers Community consciousness among villagers High level of community responsibility High level of community responsibility Effective management of community resources Effective management of community resources Successful collaboration Successful collaboration