Community-based programmes: Success factors for public nutrition derived from the experience of Thailand

Abstract

Thailand has faced the major nutritional problems of protein-energy malnutrition and micronutrient deficiencies, notably iron, iodine, and vitamin A deficiencies. For decades, the problem was addressed through the national health planning system. Its alleviation was embedded in a service-driven approach, which not only consumed a disproportionate share of the government budget, but also restricted participation by the people and depended heavily on centralized planning. This approach failed, resulting in a paradigm shift to community-driven programmes, which were seen as investments for the health of the Thai population. Nutrition was framed as part of the National Economic and Social Development Plan. A comprehensive situation analysis was undertaken and the results were used for community mobilizing, organizing, and financing, using basic minimum needs indicators to guide the process. Critical to the success of the community-based approach was the village-level volunteer system, which featured manageable ratios of mobilizers, facilitators, and households, interacting to define the needs of the communities and propose solutions.