International Nutrition Communication Service (INCS) : consultant report for Thailand (January 5-22, 1983)

Special evaluation, funded under project 9311010, was prepared in-country in 1/83. Pertinent strategy issues are whether the innovative fund to encourage village-level production of supplementary foods can be economically successful and whether the project is geared excessively to curative care (see below). Key management issues are the dire need, especially at the village level, for coordination among various Ministry of Public Health (MPH) programs and the need for a monitoring system to ensure program continuity. Although the training methodology innovatively focuses on the village situation, the training itself, especially at the village level, follows a conventional lecture instead of a participatory model. This is due to the fact that managers, not trainers, are conducting the training. Communications activities are in general on target, but an overall strategy is lacking and particular areas need improvement. The weighing program, for example, is still being used by some health workers only to identify malnourished children, an approach that would make the program totally curative. Further, weighing is done only quarterly instead of monthly and is done in excessively large groups, while weight charts are sometimes used only to record children's anthropometric measurements and not as a communication and education tool for mothers. A large quantity of well-designed nutrition education materials have been produced and distributed, but further work is needed to refine their content and more use should be made of radio and television. Recomendations are to: carry out monthly weighing and stress promotive educational activities, not just surveillance; strengthen coordination within the pertinent MPH Divisions and develop a comprehensive supervision scheme for these Divisions at the district and township levels; stress participation in the training and communications programs; develop a community-based, responsive monitoring system; and improve nutrition manpower capabilities at the provincial and district levels.