Thailand stands out as a unique occurrence for a moderately large developing country (61 million population) which has been successful in rapidly reducing the prevalence of malnutrition on a country-wide basis, and has been sustaining that effort for almost 20 years. One key to this success has been the development and implementation of a Poverty Alleviation Plan that focused strongly on people’s participation, instead of leaving the government to shoulder the burden. A primary health care approach was used as a practical, community-based and participatory mechanism to address the problems of health and malnutrition. After some trial and error with strategies, it became increasingly apparent that malnutrition had multiple causes and that its prevention required a multisectoral collaboration involving Public Health, Agriculture, Education and Interior. Following a frank evaluation of unsuccessful initial efforts, the first observation was that ministry actions were vertical, with virtually no multisectoral collaboration. In addition, efforts were entirely dependent on government-provided services, with the result that only a small proportion of the population was being reached. Communities were also ill-prepared for a participatory process, there were insufficient human resources to reach a large proportion of households and there was a poor understanding of the significance of malnutrition among communities and households.
Planners recognized that malnutrition was a symptom of poverty and that efforts directed to alleviating poverty needed to focus on improving nutrition as one of its principle indicators. Good nutrition was not a goal in itself but a means of promoting development. To increase the human resources capacity, health volunteers were selected by means of a sociogram process, resulting in a ratio of about one volunteer (mobilizer) per ten households. Village health communicators (facilitators) were trained and made responsible for the mobilizers. Today there are some 500,000 mobilizers covering almost every village in the country.
The poverty alleviation plan was broad, being directed towards quality of life that included health and well-being. The strategy used was based on a series of indicators based on the concept of “Basic Minimum Needs”. These ranged from the needs to meet physiological needs related to food security and nutrition, food variety, adequate clean water, but also included social needs such as adequate housing, a clean environment and care of public properties. Thus, this highly participatory and multisectoral process which was put in place for the purpose of improving the well-being of all was the key to Thailand’s success. The initial setting up of the process required considerable effort, time and energy, but once in place the system became relatively easy to sustain with a low operational cost.
The VAC - Vuon-garden or orchard, AO - fish pond and CHUONG - pigsty or poultry shed, is basically an agricultural project that promotes the integrated farming system in an environmentally sustainable way. It is an intensive method of small scale farming built upon the traditional methods of farming developed in the Red River Delta.
Objectives of the programme include: to improve the cropping pattern in traditional gardening and to introduce new technology and management systems in VAC gardening. Implicit objectives include improving the nutritional status of the members of the targeted families and increase in income through production of marketable commodities.
Through this project a non-government organization known as VACVINA (Vietnamese Community Action Programme Against Hunger, Malnutrition and Environmental Destruction) has evolved. From an initial coverage of two provinces since its formal establishment in 1986, there are now more than 150,00 farming families participating in 44 of Viet Nam’s 53 provinces and the programme is still expanding. Aside from households directly targeted by VACVINA, cooperatives, factories, schools, churches and pagodas have also benefited from the programme.
Programme components include the provision of material inputs for farming for establishment of productive VAC gardens, skills training of farmers and “nutrition education”, provision of capital/loans through the rural credit scheme and land use rights given to farmers. Production of VAC materials as part of training is also undertaken.
The programme receives financial support from international organizations like UNICEF and FAO but is largely financed by funds generated from membership fees and the Vietnamese government. It has also set up a technical services group that provides training at minimal cost as well as produces seedlings and animal stock for sale at a low profit margin. This group has also linked with other overseas companies for processing and marketing of VAC products.
Reported achievements of the VACVINA projects include substantial increases in food production. Improved nutrient intakes were also claimed to have taken place as well as increase in income.
This project has been technically supported by FAO with donor funds from the Belgian Survival Fund. The programme is located in Luapula Valley in the Northern Province, and was started in 1997. It is about to embark on a second phase. Population is estimated at about half a million. The overall objective is to improve year-round access to a balanced diet that is sufficient in energy and micronutrients, including vitamin A. The main focus is on agriculture and health, and involves community action planning and the identification, formulation and implementation of microprojects. Major activities include oil palm nurseries, seed multiplication, small-scale irrigation, dry season vegetable gardening, and health and nutrition education. Institutional participation involves the Ministries of Agriculture, Health, and Community Development, as well as NGOs and participating communities. Community participation takes place in project implementation and evaluation, while continuous interaction between the communities and extension workers is being promoted. A recent external evaluation pointed to the fact that during the first project phase, a number of achievements were attained. These include: formation of community groups that undertake problem identification and action planning, increased awareness at village level about food, health and nutrition issues, emergence of community facilitators who are active in multiple community-based actions, as well as increased seed availability, improved oil palm production, changes in cultural attitudes and behaviour as a result of the introduction of gender sensitive approaches and the adoption of inter-sectoral approaches by government institutions.