Community-based food and nutrition programmes have been implemented in many countries. They have in common nutrition or nutrition-related objectives, be it the broad objectives of reducing the prevalence of malnutrition or improving household food security, or more specific objectives related to a single micronutrient or a single nutrition activity such as the promotion of breastfeeding. There are now a number of successful programmes, and a close examination and analysis of these can help us to understand the process of achieving success.
In recent years there have been a number of studies of ongoing programmes (ACC/SCN, 1996; Iannotti and Gillespie, 2001; Mason et al, 2001; ACC/SCN 2001). These global assessments of national and subnational nutrition programmes have examined, based on a number of country case studies, how macrolevel economic growth and social investment factors contribute to downward trends in the prevalence of child undernutrition. Key factors that were identified based on these country studies include: poverty-alleviating and equitable growth strategies, and increasing levels of investment in health and education. Iannotti and Gillespie (2001) state that: “Successful community-based programmes are not islands of excellence, existing in an imperfect world. Rather, part of their success relates to contextual factors that provide an enabling or supportive environment.” The information from these country case studies does not permit a detailed assessment of community-level factors, though in general, community involvement, participation, ownership and empowerment seem strongly related to effective community-based food and nutrition programmes. Shrimpton (1995) has attempted to assess such community events in some programmes. UNICEF too has produced case studies of individual programmes (see reference list). The Thailand experience (Tontisirin and Gillespie, 1999) has highlighted the importance of both macro and microlevel factors in securing the success and sustainability of a nutrition programme.
The literature on community participation is now substantial. It comprises mostly extensive guidelines on the methodology (Rifkin and Pridmore, 2001; Rifkin et al, 1988; Jewkes and Murcott, 1996), and more recently, a debate on whether the methodology really achieves what it purports to achieve (Cooke and Kothari, 2001). Cooke and Kothari (and the authors in the book they have edited) question whether facilitators external to the community in fact succeed in encouraging decision-making, or do not rather override existing decision-making procedures; whether group discussions do not reinforce a pre-existing power structure; and whether the popularity of participatory methods has forced the exclusion of other more effective methods. They also suggest that communities may articulate felt needs that they know the donor agency is likely to support, thereby accommodating donor priorities rather than addressing their own real problems. In broad terms, the critique suggests that proponents of the methodology are at best naïve, and that far from empowering communities, it places them even more firmly in the control of the existing power structure. These are harsh criticisms that not all accept and the authors propose no alternatives to community participation for development.
There is no doubt that there are many misconceptions and misapplications of participatory methods. One misconception is that communities are homogeneous and another is that with successful participation and the use of local resources, governments are at least partially relieved of their obligation to provide services to communities. Another common misconception is that a community-based nutrition programme, almost by definition, employs a participatory approach. Achieving true participation is time-consuming, and there have therefore been efforts to devise ‘rough and ready’ methods, such as rapid rural appraisal, or some forms of rapid participatory appraisal, for at least some of the components of the methodology. These are useful for the initial stages of programme development but should not be seen as a replacement for the full methodology. Levels of participation have been defined, ranging from passive participation when community members are simply informed of what is to happen, to self-mobilization when communities are empowered to take initiatives and make their own choices. While it may be pragmatic to start at the lowest level, to be both successful and sustainable, programmes must strive towards attaining the highest level of participation. Certainly there are many pitfalls and setbacks in the application of the participatory methodology, but the various assessments and case studies of programmes have shown also that much can be achieved with the investment of time and effort and that the investment is worth making.
Although recent global and individual assessments are useful in pointing to macrocontextual factors to explain the decreasing prevalence of malnutrition, there is a need for a comprehensive and coherent methodology that allows countries to undertake an in-depth assessment and analysis of their own community-based food and nutrition programmes. Such assessments and analyses should be undertaken by national and subnational governments (province, district and village) in partnership with non-governmental organizations and community groups. The purpose is to understand what works and what does not work and why, and how such programmes can be expanded, strengthened and redesigned, if needed. The assessments can also provide inputs into the reformulation of sector policies at different levels. The particular focus on community-based programmes is highly relevant, as many countries are undergoing a process of decentralization, thereby increasing (though not always) the autonomy in decision-making of local governments, and opening new political and social spaces for partnerships between government and civil society organizations. As social services are increasingly provided on a cost-sharing basis, client participation becomes important to ensure that those services are of high quality and respond well to their clients’ needs.
This is some of the thinking that preceded FAO’s decision to undertake this exercise. The ultimate aim is to improve the quality of community-based nutrition programmes by constructing and making available a simple tool that nutrition programme planners and implementers can use to assess the likely success and sustainability of an ongoing or planned programme, so as to be able to redesign it or make adjustments for improvement. The steps employed in this exercise are as follows:
This report brings together the main findings of nine in-depth case studies and three desk reviews. The objectives of the report are firstly, to summarize the main features and findings of the case studies, secondly, to highlight, analyse and discuss the main lessons learned from the case studies and desk reviews, their strengths, weaknesses, constraints and the opportunities they present, and the implications these findings hold for programme design; and thirdly, to provide the theoretical and practical background for the preparation of the assessment tool.
The report begins with summaries of the in-depth case studies in Section B. Section C presents lessons learned from the case studies, under four headings: macrocontextual factors, community-level factors, programme design features, and sustainability. Section C then proceeds to the results of the SWOC1 analyses performed on the programmes. Where appropriate, region or programme-specific features are highlighted. Section D uses the findings of Sections B and C to suggest ways by which community-based nutrition programmes can be improved so as to become more sustainable and have a greater positive impact on nutritional status and food and nutrition security. Section E concludes the report and is followed by the reference list. Summaries of desk reviews and full case studies are provided in Annexes 1 - 4.
1 SWOC (or SWOT) = Strengths, Weaknesses, Opportunities, and Constraints (or Threats).