In addition to the macroenvironment, a community-based nutrition programme will be strongly influenced by factors and conditions that prevail at subnational levels. There is no clear line that can be drawn between the macrolevel and the microlevel. Arguably, the community represents the microlevel, but communities are part of higher administrative demarcations such as districts or municipalities which, in turn, are part of yet higher demarcations, regional or provincial22. Events and policies at the national levels will influence situations at the microlevel, but their impact will be modified by conditions that prevail at the microlevel.
|Is the microenvironment important?|
|Multisectoral strategies are needed [to combat malnutrition], but developing such a strategy to address all sources of the problem in traditional top-down fashion is almost impossible because of its complexity. The alternative is to bring in the beneficiaries to participate by helping them devise their own solutions, while making use of their resources to the largest extent possible.|
|From: G. Nantel and K.Tontisirin (2002).|
|“Progress has been made where community-based programs are linked operationally to service delivery structures.”|
|“Community-government partnerships need to be forged through broad-based social mobilization and communication strategies.”|
|Quotes from: K.Tontisirin and S. Gillespie (1999).|
Here are some examples of how the microenvironment can affect programme performance:
These examples illustrate the dangers of adopting a uniquely top-down approach. What is needed rather is an approach that makes available good-quality services (health, nutrition, agriculture), but at the same time accommodates local conditions and priorities. This linking of top to bottom is crucial to the ultimate success of a community-based nutrition programme.
This section shows you how to assess the microenvironment by assessing:
|Assessing the Microenvironment|
Almost all countries exhibit diversity within their boundaries. Diversity can take the form of:
Such diversity can lead to differences in the nature and extent of nutrition problems and a nutrition programme must recognize and accommodate such differences. A programme that is top-down in approach is unlikely to have such in-built flexibility. What is needed rather is a programme that on the one hand ensures good access to basic nutrition services, but on the other hand also functions at the subnational (regional, provincial or municipal) level so that local causes of malnutrition are addressed. To achieve this, a programme must firstly establish the nature of diversity in the programme area, then develop conceptual frameworks and activities accordingly (see Section I: Assessing Programme Design).
To assess diversity and the extent to which the programme accommodates diversity, you need to ask the following questions:
What are the main forms of diversity that influence the programme?
Has the programme made any effort to recognize diversity?
Has the programme made any effort to identify the causes of malnutrition associated with diverse areas or populations?
|“Some of the constraints faced [by Thailand's programme] include …... lack of accessibility to basic services in remote/border areas, migration of minority hill tribes, drought in some areas of northeast Thailand and limited accessibility of mass media to the rural communities.”|
|Quoted in: Community-based nutrition programmes - Thailand Case Study by L. Battacharjee (FAO, 2001).|
|Assessing the Microenvironment|
Closely linked to geographic and socio-economic diversity are differences in the local food economy. Agro-ecological conditions, climate, availability of, and access to, natural resources, land conditions (including access), economic activities (agriculture, industry, services) are all factors that determine household economic activities and thus a household's access to food. An important distinction is between urban and rural food economies, with usually much greater market-dependence of household income and food access in urban areas. Diversity in livelihood strategies by households are found within regions or areas, as well as in household food security outcomes and in the degree of vulnerability to food insecurity that households face. This is a broad topic and the assessment team must carefully analyse what aspects are the most relevant to the programme. For an integrated programme that has a food production component, the local food economy is highly relevant. It has less relevance for a programme with a strong primary health component, for example.
Another important aspect to consider is the local occurrence of phenomena (“shocks”) that have a negative impact on household food security and nutrition. The extent of the impact will depend on the households’ capacities to withstand the effects of these phenomena, such as floods, droughts, sudden increases in market prices, or population displacement due to civil strife or armed conflict. Such phenomena can offset any positive programme impact on food security and nutrition. The main components of the local food economy are:
In urban settings, household food production is of little relevance (although urban agriculture is currently being actively explored), while food marketing (market prices, availability of different foods) and employment (income) are. All components may be relevant in rural areas, but with differing importance.
Information about local food economies is increasingly becoming available in many developing countries, often in the form of disaggregated food economy maps and local food economy analyses24. Good sources of information are food security departments in the Ministry of Agriculture, emergency management offices in the Planning Office/Ministry, in-country offices of Save the Children Fund, Famine Early Warning Systems Network of the US Agency for International Development, Cooperative for Assistance and Relief Everywhere, and/or the Vulnerability Analysis and Mapping Unit of the World Food Programme.
In relation to programme target households, answer the following questions:
What household production patterns can be identified?
If poor households are faced with a food emergency, what coping mechanisms do they employ?
Are subsidized foods available to some groups or the whole population?
Are there programmes to facilitate access of the poor to foods, such as a price support programme for staple foods, a food stamp programme, food-for-work schemes, subsidized complementary feeding programmes for young children, school lunch programmes, etc?
In rural programme areas, how are food stocks stored?
Are the same foods purchased in the market later in the year?
How well are local food markets developed?
Which foods are subject to seasonal variation in availability?
What foods do households normally consume?
What food knowledge do households have?
Have “shocks” occurred recently in the programme area?
And if so, what measures are in place to mitigate their impact and/or to strengthen households’ capacity to withstand the effects?
|Assessing the Microenvironment|
Many internal factors influence the rate at which community development occurs and the success of community development efforts. Some are beyond the scope of a nutrition programme, but must be taken into account when assessing likely success. Here are some that may influence the rate of achieving full community development and empowerment:
There may be other important factors that are characteristic of your programme area. You should identify these and add them to the above list.
By means of key informant interviews and focus group discussions, gain an understanding of the nature of communities in your programme's catchment area. Specifically, answer the following questions:
What conditions exist in programme communities that may limit the success of programme interventions?
How has the programme sought to accommodate these conditions?
|Assessing the Microenvironment|
We have stated repeatedly that linking top to bottom is an important element of success for the programme. However successful the programme is in achieving self-reliance and empowerment within communities, communities will continue to need access to good-quality basic services and technical expertise. Indeed, if the programme is successful, demand for improved services and expertise may, and should, increase (see Section IV: Assessing Sustainability). Failure to respond to such demands can lead to alienation and disillusionment on the part of communities. Even in countries where the process of decentralization is far advanced, basic services are often provided by central government. Under decentralization, management of the services may be more localized.
|“Community participation should not be viewed as a way out of unsuccessful nutrition programmes. Communities will continue to need access to services provided by government, non-governmental organizations, the private sector or other agencies and institutions ...... As the example of Thailand has shown us, we must link the top with the bottom.”|
|Quoted in FAO's in-depth study of nine programmes (2003).|
Many countries have conducted reviews or evaluations of their basic services. If these are sufficiently recent, they should be examined in the first instance. Then, through discussions with key informants from the relevant ministries at national and subnational levels, obtain the following basic information for health and agricultural services25:
For nutrition, we suggest that you undertake a more extensive assessment. You should also undertake field visits to a number of clinics to observe activities, examine records and have discussions with clinic staff.
As a minimum, the basic nutrition services26 that should be provided are:
To assess the adequacy of basic nutrition services, assess both coverage (which is linked to access) and quality. Answers to the following questions can be found in clinic records and by observation of clinic sessions. If there are any other nutrition activities conducted by the clinics, assess these as well.
In most countries, the best technical expertise is available at the national level only. Countries that are decentralizing are struggling with providing technical expertise at subnational levels, since this is where many decisions on basic services will be taken. Moreover, if community participation is successful, communities too will need help in choosing and designing activities. Access to such expertise at the level it is most needed, however, has proved a weakness of many community-based nutrition programmes. It has led to inappropriate and ill-conceived food production and nutrition30 activities, and income generating activities that fail because no marketing or feasibility studies have been conducted, or no training in accounting and management was provided.
Making the assumption that programme-funded expertise will not be available once the programme ends, you need to obtain the following information:
The information you have gathered should help you to decide not only the adequacy of expertise today, but to what extent it is likely to be adequate in the future. This will thus help you in your assessment of sustainability (Section IV: Assessing Sustainability). Your findings will also help you answer the two key questions:
Do communities have easy access to good-quality basic health, nutrition and agricultural services?
Is good technical expertise available at the local level?
|Assessing the Microenvironment|
You will probably have gathered by now most of the information you need to assess the adequacy of local development structures or authorities32. If your programme is really community-based, it should be working in close collaboration with, or through, local development structures using a participatory approach. If it is not, or if the role of these structures is minimal within your programme, then you need to strengthen their involvement. Ultimately, it is likely to be these structures that could ‘institutionalize’ the community base of your programme. Here are the questions you need to answer:
What development committees exist at subnational levels? Which are closest to community development?
How active are they? What is their membership? Do they have an adequate budget?
How do communities identify and communicate their needs?
Does the programme work in collaboration with any local development committees?
If there are no development committees, what other formal or informal committees or systems exist to support the programme?
You should now have gathered the information you need to make an assessment of the microenvironment in which your programme is situated. Turn now to the Summary Report (Annex 1) and answer the questions in Section III. Then carry out a SWOC analysis.
Not all aspects of the microenvironment can be addressed within the nutrition programme. In some cases you must advocate for change at the national or subnational levels. Any changes to the programme must be in the direction of increased flexibility to accommodate local conditions, a reduced emphasis on a top-down approach through increased consultation, and a strengthening of community participation. Here are some actions you can take to reduce the constraints imposed by factors in the microenvironment:
Re-design programme components to accommodate local diversity and varying levels of development. For example:
Re-design credit schemes and other components of the programme to ensure that poorest families and communities are able to participate. In some cases, establishing closer links with a poverty alleviation programme may be helpful. You may need also to seek additional funding for this, and also in order to reach remote, isolated communities and households.
If basic services and access to technical expertise are inadequate:
Lobby government to provide more and better technical expertise at subnational levels. As a short term measure, the programme should provide the expertise. Provide training in community participation. Establish partnerships with relevant non-governmental organizations and other programmes.
If local development structures are inadequate (or non-existent), either strengthen these through programme activities or work with a single-sector committee, preferably health or agriculture, at the lowest level. Then lobby at the local level for multisectoral committees. As a last resort, the programme could establish such committees itself, but for the sake of sustainability it is better for local authorities to do so.
Here are some of the findings of the SWOC analyses performed as part of FAO's in-depth study of nine programmes (2003):
Constraints (and threats):
22 Terminology for administrative demarcations varies from one country to the next.
23 You need not assess diversity in-depth if it is not relevant to the programme's implementation process and impact. If, for example, your programme targets a particular agro-ecological zone or socio-economic group, then diversity may not be an issue.
24 User friendly manual for reference reading: Seaman J, Clarke, P, Boudreau, T and Holt, J. The Household Economy Approach. A Resource Manual for Practitioners. Save the Children Development Manual No. 6. London, Save the Children Fund, 2000.
25 There may be questions related to other sectors that are relevant to your programme. You should seek answers to these as well.
26 The Basic Minimum Nutrition Package proposes a list of health and nutrition behaviours to be achieved through primary health care. These are: exclusive breastfeeding for 6 months; appropriate complementary feeding from 6 to 24 months; adequate vitamin A intake for women, infants and young children; appropriate nutritional management during and after illness; iron and folate supplementation for all pregnant women; regular use of iodized salt by all families. See Annex 2 for the full reference for the Basic Minimum Nutrition Package (Tontisirin and Gillespie 1999).
27 In some countries, GMP programmes are implemented as community activities rather than clinic-based activities.
28 Attendance is usually high during the first year, when mothers bring their babies for immunization. Attendance during the crucial weaning age period (1–2 years), when the child is most vulnerable to malnutrition, is often low.
29 Dietary advice and encouragement should be provided regardless of whether the child is growing well.
30 Many nutrition activities are based on outdated science. Thus, for example, we still see an emphasis on protein deficiency, when it is now well established that protein intake is more or less constant in relation to energy intake.
31 Community-level workers, paid or volunteers, are discussed in greater detail in Section I, as part of community mobilization and the participatory approach.
32 Terminology and the nature of the structures vary substantially from country to country. In an ideal situation what you are seeking is a multisectoral coordinating committee focused on local level development. Committees may exist at different levels: regional, provincial, municipal or district (depending on the administrative structure of the country). If there is a choice, you should focus on those that are closest to communities.
33 In some cases it may be better to create a separate women's group. Women in some cultures are able to be more vocal and active in such an environment. In the future, when women have become stronger and more self-confident, they can become active members of an integrated community group, which must remain the ultimate goal.