Chapter 2: participatory appraisal of community food and nutrition
When the community is ready to carry out a participatory nutrition project, the development worker assists the community to appraise its food and nutrition situation.
This appraisal helps the community to understand its food and nutrition situation; to identify the problems and constraints to adequate nutrition and the households most affected; and to prioritize its food and nutrition problems. The appraisal also serves as the basis for people to plan food and nutrition activities together.
Development workers can use the initial assessment of food and nutrition carried out in the preparatory phase to develop a checklist of issues to pursue with the community. Marginalized households and individuals need special attention.
While the appraisal may be carried out at any time of year, the food and nutrition situation of a community may differ according to the season. Additional information gathered in other seasons will complement and complete the appraisal.
Because participatory appraisal involves dialogue among the community and with the development worker, it is a time-consuming and on-going process which can take weeks or months.
The information for participatory appraisal of community food and nutrition can be gathered in various ways, including: semi-structured individual or group interviews, visualization techniques, participant observation, listening to cultural traditions, popular theatre and role-playing, games and celebrations. Information can also be obtained from community institutions. Analytical exercises such as seasonal calendars, ranking exercises, maps and time charts are very useful.
The development worker helps the community to summarize and discuss the results of the appraisal and to prioritize the problems that emerge.
Who catches the fish? Who buys it, cleans it, smokes it and sells it? What does that cost in time, effort and cash? These are core check-list items for understanding fishing communities
Participatory nutrition projects focus on helping specific groups make informed choices so that they can ensure good nutrition of all household members.
Through dialogue between development workers and the population, participatory projects help people decide which changes, innovations or interventions are appropriate to improve their food and nutrition situation.
Solutions are likely to be most appropriate and sustainable when they are based on the problem analysis and opinions of the people concerned. The participatory appraisal process involves people in assessing their own food and nutrition situation and identifying the causes of food and nutrition problems according to their perceptions. The role of the development worker in this appraisal process is that of a facilitator.
The participatory appraisal process serves to:
- raise awareness of both the community and development workers on food and nutrition issues;
- promote the participation of different community groups (in particular, women, poor people, young people)
- provide a basis for planning food and nutrition-related activities;
- collect information for the monitoring and evaluation system;
- contribute to community empowerment.
In carrying out the participatory appraisal, three points deserve particular attention:
1. Traditional food habits end production systems and how they change over time, why they change and whether or not these changes have resulted in improved nutrition.
2. The desired food patterns, or what people would prefer to eat and why. In many cases people would like to eat more "prestige" foods which may often be nutritionally inadequate and are usually expensive.
3. The ways households cope with seasonal or unexpected food and nutrition problems and the long-term impact of these coping mechanisms on food production and consumption of the household. Marginalized households and individuals need special attention. Within a community, the allocation of resources such as land, water, labour or income among households is unequal. The poorest households are likely to have the most serious nutritional problems in the community and the least resources.
Not only do limited resources not allow these households to cover essential needs like food, shelter, clothing; in addition they may be ignored or not accepted by the community as a whole; they may be obliged to seek employment out of the community and therefore not be able to participate in the analysis of problems and in the design of activities. Gathering this kind of information will help the development worker decide what is needed to allow such households to participate in and benefit from the participatory nutrition project.
A good way to identify the poorest households is to encourage the community to agree on a list of criteria by which to identify them. These indicators of poverty will reflect the social, cultural and economic characteristics of the community and will vary from one community to the other.
BOX 6: Indicators of poverty: Kenya
In a participatory nutrition project in Kakamega district, Kenya, the communities agreed on the following indicators of poverty for households/ individuals:
- extreme malnutrition problems
- income less than Kshs. 15 a day
- less than 1/4 acre of agricultural land
- more than 7 children
- unable to educate children
- grass thatched roof that leaks during rain
- infested with jiggers (parasites)
- lack of adequate clothing
- poor hygienic conditions
- disabled people
- orphaned or abandoned children
- neglected people over 70
- outcasts (because of disease or crime)
During the participatory appraisal process, development workers facilitate the community's assessment of its own food and nutrition situation and its causes, rather than express opinions on problems and needs identified by others.
The initial assessment of the food and nutrition situation in the area, carried out in the preparatory phase will help development workers prepare checklists of issues to be investigated in the participatory appraisal. Checklist 2 gives a list of issues which may guide development workers. The checklist is intended to be used as a reference to stimulate dialogue, rather than as a questionnaire. Before using it, the development worker should try to find out from key contacts in the community which are the sensitive issues and how to deal with them.
Checklist 2: Participatory appraisal of community food and nutrition - issues of interest
This checklist of issues to be explored with the community is meant to be adapted or added to for each specific community. It is also intended to be used to stimulate dialogue about similarities and differences between households, rather than as a questionnaire.
1. Local food systems and recent changes
(For each social group identified in the preparatory phase)
- How do households obtain their food?
What do they produce?
What do they purchase?
- Has this situation changed in the last years?
- How are these charges perceived?
2. Food habits, preferences and related beliefs
- How many meals do the different household members eat a day?
In which season?
What do they eat?
Any snacks in between?
Do children eat differently?
What age groups (e.g. infants, school age children)?
- Has this changed lately?
How are changes perceived?
- Coping mechanisms: how do eating patterns change in times of scarcity?
How is food obtained in such cases?
- If the household had more resources, what foods would they like to eat more or more often?
- What foods are considered especially good or to be avoided in certain circumstances?
3. Activities of household members related to food and nutrition
(e.g. food collection, food production, food processing, purchasing, preparation)
- What are these activities?
- Who performs them:
- How much time does it take them a day?
- Does this vary?
Why? (season? other factors?)
4. Production for household consumption
- What foods are produced by the household?
How many months do staples last?
During which months do they eat the other foods?
- Has this changed in the last ten years?
- How are these changes perceived?
- What are the problems encountered?
- What are the periods of food scarcity?
For which foods?
What efforts do people make to overcome these?
5. Processing of local foods
- Which foods produced are processed? How?
At household level?
At community level?
6. Food storage
- What foods are stored? How?
At household level?
At community level?
7. Food purchasing
- How much of the household income is spent on food and cooking, directly or indirectly (e.g. fuel, water)?
- What are the other essential purchases in the family budget? Are these permanent or occasional?
- What are the foods purchased? Which are considered as essential?
Which as luxury?
- How have purchasing habits changed in recent years?
8. Food preparation and usage
- How is food prepared at household level? Where? On what kind of stove?
Are any special foods prepared for small children? How?
For other members of the family? Constraints?
- How is food portioned out within the household? At mealtimes?
- What happens to leftovers?
9. Water supply and usage
- Where does the household get its water from:
For food preparation?
For agricultural uses?
- What are the problems for each of these uses?
- What happens to waste water?
10. Environmental aspects
- How many rooms does the household have for living in?
How many people (adults, children) live in these?
- What are people's practices regarding defecation?
- What are people's hygiene practices in relation to food preparation, consumption and storage?
11. Nutritional status
- Is malnutrition a familiar notion to the community?
What does the community perceive as malnutrition?
How important is it?
- How are there many thin children or adults are there in the community?
How do people describe and explain this?
What do they do about it?
12. Diseases, causes and cures
- What are the prevailing diseases in the community?
Who suffers from them?
When do people suffer from them most?
What causes them?
- How do people deal with disease?
- What support is available? Traditional healer? Community health worker? Health services?
13. Caring capacity
- Who looks after small children and infants?
- Who feeds them? How often?
14. Social aspects
- Which are the poorest households within the community?
- Do they have any specific food and nutrition problems?
- Who are the most influential people in the community?
Seasonal changes affect the food and nutrition situation of the community, and the information provided during the appraisal will be influenced by the time of year selected to carry it out. The information, therefore, must be interpreted according to when it was obtained. Further information can be gathered at other times of the year. Appraisals of household food and nutrition during hungry periods are particularly useful for identifying major problems and how people cope with them.
The appraisal process requires time for interaction among community members and between community members and the development worker. In planning the appraisal, the development worker needs to keep in mind that some activities can only be carried out in comparatively slack periods when people have more free time or do not mind being interrupted.
The appraisal process is an ongoing one. On the basis of the community's initial understanding of the constraints they face, the development worker will help them to plan activities. This process may go on at intervals over two to three months. As the project progresses, the community and the development worker may both revise their perception of problems, reorient food and nutrition activities and develop new ones.
The participatory process needs trust between the development worker and the community. This takes time. It is therefore necessary for a development worker to work with a community for some time to implement and carry through a participatory project. A minimum of two years is considered necessary.
Fish-smoke, 3 discuss the household food budget of one member, written in chalk on the table
The development worker can assist the community in using different methods to gather information on food and nutrition.
The development worker can encourage the community to designate a person or a group of people to collect existing information. Many institutions, such as health posts, routinely collect information which may relate to the food and nutrition situation of the community. When necessary, the development worker can facilitate contacts between the institution and the community. For example, arrangements can be made for a health worker to explain why what information is collected by the health centre as a basis for discussion.
Much of the information will be verbal. Any encounter or meeting can be used for this purpose, from informal chatting to formal community gatherings.
Development workers can find out a great deal by observing the way people live, asking for information on what they see, analysing the answers and discussing this analysing with the people. This approach, sometimes called participant observation, can also stimulate discussion about routine activities which people otherwise take for granted and never question.
Semi-structured interviews can be conducted with different sized groups and key contacts in the community. A semi-structured interview is an informal but guided interview session, prepared by the development worker, in which only some of the questions are predetermined and new questions or lines of questioning arise during the interview, in response to answers from those interviewed.
Small group meetings allow more in-depth discussions on issues of common concern. For example, a group of pregnant and lactating women is likely to be interested in discussing children's diet. The development worker can encourage the community to identify such focus groups. An appropriate size for a small group discussion is between 6 to 12 people.
Many people find it difficult to participate in group discussions with the result that meetings tend to be dominated by a limited number of speakers. In literate communities, the development worker can improve participation and protect confidentiality by having participants write down the points they consider essential for the discussion. Such visualization techniques can also be adapted for use by illiterate people, particularly with maps, representative diagrams, or ranking exercises. For writing, groups can be organized so that there is one person in each group who can write down the group's points.
One-to-one dialogues are particularly useful in eliciting the views of individuals too shy to speak in public.
BOX 7: Assessing wasting thinness in children
One method used with ease even by illiterate community members to asses the prevalence of wasting among under-five children, is based on the fact that a mid-upper arm circumference inferior to 12,5 cm is a sign of severe malnutrition.
The Child- to-Child Foundation suggests whittling a branch or finding a cylinder which is about 10 cm long, with a 12.5 cm diameter: this allows rapid comparison with the mid-arm circumference of under-fives. This device was successfully used by older school children during a rapid appraisal of the food and nutrition situation of a fishing community in Kabak, Guinea (West Africa).
Observing and listening to oral traditions can yield a wealth of information on food habits, social uses of food and changes in food patterns. The development worker can ask people to recall stories, songs and rituals related to food. This will also provide entertainment and stimulate debate on food and nutrition.
Popular theatre and role-playing have proven effective in raising community awareness of food and nutrition issues and promoting participation of both actors and spectators in the community.
Organizing games and celebrations is another way to increase participation and opportunities to exchange opinions about food and nutrition.
A variety of analytical visualization exercises can also be used to stimulate the interest of the participants and to clarify information. These include seasonal calendars, ranking exercises, maps and time charts.
Calendars can be prepared by specific groups in the community (e.g. women, farmers, landless labourers). The topics can include cropping patterns, food availability, price of foods, expenditures planned, prevalence of diseases, labour demand (in particular for women), and show how these change during the year. Calendars help clarify seasonal constraints on adequate nutrition (nutritional stress periods) and constraints on solving them.
Examples of two different kinds of calendars are shown in Figures 3 and 4. Calendars will be useful to refer back to at a later stage of the participatory nutrition project during the selection of activities when establishing their timing and phasing. They can also help identify time-dependent opportunities, such as when new crops could be grown. Comparison of calendars drawn up by different population groups may reveal differences in perception and can lead to useful discussions and new information.
Figure 3: Seasonal calendar of a community in The Philippines.
Figure 4: Nutritional stress calendar for small-scale fish-smokers in Chokomey and Oshiyie, Ghana.
Ranking exercises are useful as a way find out people's preferences, or as an alternative to quantitative data. In a ranking exercise, people can use available materials such as stones, beans or sticks of varying sizes to express their preferences, or to answer questions such as: Which is the busiest month for agricultural work? When is a specific food item most expensive in the market? Which is the most profitable occupation? The information gathered can be recorded and used with other data-gathering methods, for example in preparing a seasonal calendar. Ranking exercises are also useful at a later stage in defining priority problems and selecting priority activities. Wealth-ranking helps identify target groups for different activities
Maps drawn by different population groups can help clarify problems, raise discussion and identify possible solutions. These maps can indicate the location of houses, food production and gathering sites, sites for collection of fuelwood, sites for food distribution, water sources and health facilities. Map 2 provides an example from a community in a participatory nutrition project in the Philippines.
Map 2: Map of a community in The Philippines showing locations of households, road, wells, etc.
Figure 5: Time chart of daily activities of a fish-smoker.
Time charts of daily, monthly or yearly activities of historical events can help the population clarify their roles, identify problems and help the community assess the feasibility of possible solutions. Different time charts can be drawn up as needed according to gender, main occupation or age, and according to the time of year An example of a time chart is given in Figure 5
Preparing a time chart:
The relative amount of time is indicated by me number of beans or other objects (stones, stacks, etc.) next to the activity. The largest numbers of objects are placed next to the activity that takes the most amount of time.
BOX 8: Participatory food and nutrition appraisal: Guinea
In the fishing community in Kabak, Guinea (West Africa) mentioned in Box 7, the participatory appraisal of the food and nutrition situation identified the following problems:
- meals are infrequent and monotonous
- children are weaned too late
- beaches are filthy (refuse from fish preparation and indiscriminate defecation)
- the water for drinking is dirty
- households are constantly indebted
This led to discussions on possible solutions such as establishing a rice bank, protecting the wells, cleaning the beaches (which could be organized locally) and improving health services by introducing a mobile clinic to complement the fixed post.
The development worker should summarize and discuss the information gathered at intervals and share the outcome of group analysis among different groups and the community as a whole. This helps to ensure that the community is in agreement on the interpretation of the information collected and to identify needs for further information.
An impact diagram or a "problem tree" can be used as a visual summary of the information gathered, to point out the origins of problems and show the causes of malnutrition and their interconnections. It can provide a good basis for discussions and subsequent planning of interventions. An example of an impact diagram is shown in Figure 6.
Analysing the information gathered will help the community to identify population groups and/or households at risk for each of the nutrition problems identified, as well as which households are most seriously affected by a problem.
Six months is not unduly long for this appraisal process, when carried out at the pace set by the community. The time will depend on the availability and interest of community members and on the frequency and duration of the interaction between the development worker and the community.
Figure 6: "Problem Tree" identifying causes of malnutrition (in selected communities of Kakamega District, Kenya)
The appraisal and information-gathering process will continue throughout the project, and project activities will be identified as the appraisal progresses: activities will be fine-tuned and modified as new information and community needs emerge.
After the community has identified a series of food and nutrition-related problems, the underlying causes of these problems, and the groups/households affected by these problems, the result of this community analysis can be compared with the initial assessment carried out in the preparatory phase. Any discrepancies and contradictions between the two can be discussed with the community in order to elicit further information and improve understanding of the problems.
Some of the problems that development workers consider important may not be recognized as such by the community at this stage. Forcing people to take up problems which they do not understand or agree with would be counter-productive. It is best to concentrate on problems agreed upon by the community. However, as the project progresses, the understanding of both the community and the development worker will evolve and there will be more mutual understanding between them and interest in each others' perspective.
The development worker may want to discuss with other people working in the area the points of disagreement over perceptions and priorities with the community in order to compare experiences and approaches. This can provide insights on how to address these issues in future.
BOX 9: Identification of food and nutrition problems: Kenya
In a participatory nutrition project in Kakamega district, Kenya, food and nutrition problems were found to be caused by:
- land scarcity related to increasing population pressure
- changes in agricultural patterns, in particular progressive abandonment of traditional food crops such as millet and sorghum, leading to inappropriate farming techniques
- high financial demands on households from December to February
- lack of alternative income-generating activities
-competition within a limited household budges between food expenditures. and other requirements (e.g. funerals)
- increasingly difficult access to fuelwood
- inadequate food preparation and distribution among household members
- poor marketing and distribution system in the area (too few markets, absence of village food stores), aggravated by a poor road network
- poor water supply
- lack of sanitation and basic hygiene
- insufficient health services and problems of existing health facilities (lack of medicines).
The next step in the participatory appraisal of food and nutrition is to prioritize the problems. Discussing the following issues will help the community to set priorities:
- What is the most serious problem? Why?
- Who should be helped first? Why?
- What should be done first? Why?
In order to ensure the full participation of all members of the community, it might be necessary to organize separate discussions with specific groups, such as women, young people or marginalized households. Community priorities can be compared with the priorities identified in the initial assessment.
Vietnamese farmers discuss the meets of different possible sites for a clinic
- People's perceptions of what is or is not a problem often differ from that of the development worker. For example, the perception of thinness varies a great deal from one culture to another. In some people's eyes, thinness may not be related to nutrition. Likewise many people do not relate clinical signs of malnutrition to their eating habits. Linking nutritional problems to inadequate consumption may be unacceptable to parents who feel that their ability to satisfy their children's needs is being questioned.
Using technical approaches which the community does not understand or accept can block the participatory process.
- Given the diversity of topics considered in the participatory appraisal, the analysis may become so broad that people lose sight of the more specific food and nutrition issues. The development worker's role is to bring the process back on course every now and then, taking care not to impose views and undermine the participatory process.
Steps in the participatory appraisal of community food and nutrition
The development worker helps the community to:
1. Analyse its food and nutrition situation.
2. Identify its own nutrition-related problems and major constraints to adequate nutrition.
3. Identify vulnerable households in relation to each problem and determine those most affected.
4. Prioritize their food and nutrition problems.
5. Summarize and agree on the outcomes of the appraisal.