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.
There have been a number of studies (ACC/SCN, 1996; Iannotti and Gillespie, 2002; Mason et al, 2001) of national and subnational nutrition programmes. These have examined 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. The information from these 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.
In recent years, there has been an increasing recognition of the need to engage target communities in the process of nutrition programme planning and implementation. Almost by definition, most nutrition programmes are ‘community-based’, but the community participation approach, in its true anthropological sense, is not necessarily implicit in this label. There appears to be a mixed understanding of the term community participation: interpretations range from informing people what is to be done in their communities, through requiring their participation in pre-defined activities, to involving communities in their own situation analysis, decision-making and planning.
Equally important is the macroenvironment within which the programme finds itself. Although external to the programme, it is acknowledged that it has a major impact on the programme's functioning, level of achievement and sustainability. Of primary importance is the recognition, at the highest national level, of nutritional well-being as both an outcome and an indicator of national development, and the acceptance of nutritional status to monitor the extent to which the basic needs of a population are being met. The term sustainability is frequently used, often with little appreciation of its meaning, or its implications for programme design.
It is against this background that FAO initiated the process that has led to the development of this Nutrition Programme Assessment Tool. The process began with the preparation of a methodological framework to guide the review and analysis of programmes as in-depth case studies. At a workshop held in Rome in October, 2001, the framework was reviewed and revised, the case studies selected, and the process defined and agreed upon. Following the workshop, the in-depth case studies were undertaken and subsequently analysed together to form the basis of the companion volume to this Assessment Tool: “Community based food and nutrition programmes: what makes them successful. A review and analysis of experience” (FAO, 2003). This integrated report of the nine in-depth case studies (and three desk reviews) provides key background reading for users of the Assessment Tool. Much of the methodology developed for the Assessment Tool is based on the lessons learned, strengths and weaknesses of nutrition programmes as illustrated in the case studies and which are brought together and analysed in FAO's integrated report.
The draft version of the Nutrition Programme Assessment Tool was discussed at a user's workshop held in June 2002 in Cape Town, South Africa, and modifications were made in line with the recommendations of the workshop. The modified version was piloted prior to finalization and publication as this final version. FAO would appreciate receiving your comments and suggestions for improving the Tool, based on your practical experience of using it. Such input would be invaluable in the preparation of further revised editions. Comments can be sent to the address provided in Annex 2 (see “Some Useful Information”), which can also be used if you seek assistance.