Gathering and reviewing existing information
Establishing links with other development agencies and institutions
Developing or strengthening relationships and dialogue with the community
The preparatory phase of a participatory nutrition project in a community consists of several important and essential activities.
One of the first steps is to gather and review existing information on food and nutrition issues related to the local community. This can be done through contacting institutions that can provide nutrition-related information, identifying key contacts and discussing local nutrition issues with them individually or in groups. With this information, the -development worker can prepare an initial assessment.
Another early step is to establish or strengthen links with other development agents and institutions. This can be done through making an inventory of institutions working locally on food and nutrition-related issues and contacting them on a one-to-one basis and, when possible, in groups. Development workers can then make an inventory of the services provided by other development institutions.
Selecting a community for a participatory nutrition project will depend on whether the development worker is already working in one or more communities, on the food and nutrition needs of the communities and the potential openness of the community to a participatory project.
After selecting the community, the development worker initiates or strengthens relationships with the community and begins a food and nutrition dialogue with the people. This can be done through meetings with local leaders and with the community to discuss with them about food and nutrition issues. The development worker also identifies existing organizations in the community and the relationships between groups inside and outside the community.
The development worker may have to initiate concrete activities related to food and nutrition to stimulate community interest.
The development worker does not necessarily need to carry out all these activities on a step by step basis. Many of these activities may overlap and reinforce each other. Some may already have been done. Others, such as gathering and reviewing information, do not necessarily have to be totally completed before beginning a project, but can be continued throughout the course of the project. These guidelines are meant to be used flexibly.
This preparatory phase might take approximately three months, depending on how frequently the development worker is in contact with the community and other local development staff. A primary school teacher living in the community will need less time than an agricultural extensionist who is based in the district capital and has to travel to the community.
One of the first steps in planning a participatory nutrition project is to gather and review existing information that can give an initial picture of the food and nutrition situation in the area. This information may also help development workers to select communities for nutrition activities.
The design of a community nutrition project calls for information on food production and supply, food habits, access to health services and water supply systems, in addition to technical nutrition information, such as heights and weights of under-five children and weaning practices. It will also be useful to review other information related to food and nutrition, such as appropriate technology for food production, processing and storage or market prices of local basic foods (e.g. staples, oil and sugar).
This information can be found in published materials, reports and studies or data-collection systems. Some of this information may be gathered locally from existing institutions, such as health centres or agricultural extension services and some may be available at provincial or central level at ministries, universities, non-governmental organizations, development agencies or private sector institutions. Supervisors may be able to provide some of these materials and assist development workers to identify other materials and where to find them.
Figure
The views of local experts and leaders about the local nutrition problems are also useful. Development workers can meet local leaders individually or as a group. A meeting that gathers people from different backgrounds and fields who know the local situation has some advantages: it can help determine what specific issues need further checking and investigating and can serve as the basis for further cooperation between the institutions and/or people present.
After reviewing existing information, the development worker makes an initial assessment of the food and nutrition situation in the area.
The following checklist 1 has been developed to help development workers organize and record food and nutrition information. The checklist is meant to be used as a flexible guide. The kind and amount of information needed and/or available will vary from place to place. Gaps in information can be filled in as needed as the project develops.
Checklist 1: Information on food and nutrition
This checklist is a tool for organizing and recording the community food and nutrition information that may be needed for a participatory nutrition project. It also lists possible sources of information for each issue. Gaps in information can be filled in as the project develops.
1. Nutritional status
Sources: routine data-collection systems and nutritional surveillance from health centres, nutritionists, NGOs
- What is the prevalence of nutritional problems in the area?
low weight for age
low height for age (stunting) indicator of chronic malnutrition
low weight for height (wasting) indicator of acute malnutrition
micro-nutrient deficiency (e.g. anaemia or avitaminosis A)
- Which groups are most affected?
age
gender
community
type of household (e.g. landless, migrants, fisherfolk)
- Is the situation changing? How?
2. Food consumption patterns
Sources: Surveys from statistical units of Nutrition Institutes or Departments, rural sociologists, anthropologists, Ministry of Health, development agencies
- What are the local food practices and beliefs?
Do all the local population groups have the same eating habits?
If not, which are the main groups that share similar eating patterns?
Why?
What are the main food sources? What is a typical meal?
Intra-household food distribution: Who in the family eats what? How often a day?
How does this vary year round?
What are the local beliefs related to particular foods (including taboos)?
- What are the breastfeeding and weaning practices?
3. Prevalence and seasonality of main diseases
Source: Health clinics
- What are the main diseases (e.g. diarrhoea, measles, malaria, respiratory tract infections, AIDS)?
Who are the main sufferers?
How prevalent are these diseases?
What is their seasonality?
4. Health services
Sources: Ministry of Health, health services
- What kind of facilities are provided (e.g. health post, health centre)?
- What services are provided?
- Which are provided on a regular basis?
- Where are the health facilities located (indicate on map of the area)?
5. Agricultural data on local food production, seasonality, constraints
- What food crops are produced?
- What proportion are subsistence food crops and what proportion are cash crops?
- Subsistence food: what are the main foods produced?
Staples (e.g. cereals, roots and tubers):
Fruits and vegetables:
Animal products (e.g. meat, eggs, milk, cheese):
- Cash crops: what are the main crops in the area?
- What are the constraints to food production (e.g. climate; access to land, water, labour and other inputs; storage, processing and preparation, marketing system)?
- Is there a lean or "hungry" season?
What areas or households are most affected?
How do people deal with scarcity?
6. Food marketing
Sources: government services, such as the Ministries of Trade or Finance
- What markets, stores, retail stores exist?
- What transportation facilities exist (e.g. roads and bridges; public and private transport, such as trucks, bicycles, boats)?
- What are the market prices of essential foods (e.g. staples, oil, fruits and vegetables)?
7. Water supply systems
Sources: local public health services, engineering/water supply board
- What water supply systems exist?
traditional (e.g. open wells, water holes, rivers):
government services (e.g. tube wells, hand pumps):
other development projects:
8. General information on local development
Sources: local government, local offices of the different line ministries
- What are the national development policies related to community development and food and nutrition?
Constraints
In carrying out this work, the development worker may encounter a number of problems or constraints.
- It may be difficult to obtain materials on nutrition and food security locally. The information may not be available or the development worker may need special authorization to get it. Some institutions may not be willing to share information. Sometimes this can be avoided by careful planning of the interviews and a positive approach. It is best to respect any initial resistance. Resistance is likely to be overcome as the process evolves and communication is promoted by the development worker.
- Literature on nutrition often focuses on under-five children and pregnant and lactating women. Although this information is important, information on households in general is needed. The development worker may also have to differentiate other population groups according to their access to and consumption of food.
- The information available may be too general and/or not very recent. This can be supplemented with other information, written or verbal, collected by the development worker. This would allow the development worker to compare the local situation and the overall situation in the country and illustrate the changes that have taken place over time.
Figure
An important step in preparing a participatory nutrition project is to make contact and establish links with other development agents and institutions working on food and nutrition or related issues.
Because malnutrition has many causes, the solution to nutritional problems involves people and institutions working in different development sectors, including agriculture, health, education and community development. It is useful to make an inventory of the institutions that are working locally or supporting local activities related to food and nutrition. These can include government institutions, such as Ministries of Agriculture, Health and Education, and political and administrative authorities, as well as non-governmental organizations involved in development work. These would include, in particular, farmers' associations, trade unions and other people's organizations concerned with social issues and local development.
It is best to begin making contacts with these different institutions at an early stage. Whenever possible, it is useful to get information about the institution first. This way, the development worker can determine the best way to approach the institution. in speaking with representatives of the different institutions, development workers can:
- explain the approach they intend to follow to promote participatory nutrition activities;
- ask for suggestions on how the institutions can cooperate and assist in the activities;
- gather specific information on what services the institutions offer or can offer to the community, what their resources are and what their current plan of operations is at community level;
- find out what coordination mechanisms exist between the different organizations as a basis for future working relationships.
An inventory of services locally available to communities is very useful. This inventory can list the services provided, the name of the providing institution, its location and distance from the community, and the resources that the institution can make available. Figure 1 is an example of such an inventory. An inventory worksheet has also been provided for the use of development workers.
Figure 1: Example of an inventory sheet of services that are locally available to a community
Services provided |
Institution responsible |
Location |
Distance from community |
Resources available |
Agriculture extension services |
................. |
............ |
..................... |
.................. |
Livestock extension |
................. |
............ |
..................... |
.................. |
Health services Primary health care |
................. |
............ |
..................... |
.................. |
Small credit support |
................. |
............ |
..................... |
.................. |
Water supply |
................. |
............ |
..................... |
.................. |
Sanitation |
................. |
............ |
..................... |
.................. |
Women's development services |
................. |
............ |
..................... |
.................. |
Forestry extension |
................. |
............ |
..................... |
.................. |
A map can help visualize where in the community or area these services are available. Map 1 gives an example of how this can be done. It shows the location of services provided by different development institutions in a rural community in the Philippines.
Organizations working locally can be very useful sources of information. A visit to their projects can be a good way to find out more about the area. Their training modules and materials may also be useful for the participatory nutrition project.
Developing good relationships and cooperation with local government authorities from the start will help ensure their long-term support to the participatory nutrition project, an essential ingredient to its success and sustainability. Sharing the information gathered with the local administration will improve the dissemination of information and increase the awareness of government staff on nutrition and food security issues. It is good to involve professionals at the decision-making level because they are well placed to see that information flows both from the field to the national level and from the central level to the field.
In countries where district planning cells exist, the process of developing cooperation is simpler. Development workers can go to the district planning cells for assistance when gathering and analyzing information and for discussions with the agents of the various technical ministries who are usually found at this level.
As a complement to one-to-one meetings with staff from each institution, it is very useful to organize a joint meeting of the most important organizations working at local level. In this meeting the development worker can present the participatory nutrition project, answer questions, give further explanations, ask for suggestions on how those present can contribute to the project and promote cooperation between government, NGOs and the community.
It is also a good idea to start gathering information on possible funding sources for community development activities. This information will come in very handy later if financial resources are needed.
BOX 1: Meeting with other development agencies: the Philippines
In a participatory nutrition project started by the International Institute of Rural Reconstruction in the Philippines, an initial inter-agency workshop brought together staff from the Department of Health, the Department of Agriculture, the Department of Social Welfare and Development, the Department of Local Government and Community Development and the Sangguniang Bayan representative to discuss the activities to be implemented in the village of San Francisco. A map was drawn to show where the activities of the agencies were located in the area. During this meeting, a detailed plan of operations was drawn up and the participants agreed to carry out clearly defined activities by a given date.
Map 1: Location of services in a village area in The Philippines.
If development workers are already working in one or several communities, community selection may simply mean deciding with which community to start discussing food and nutrition. Sometimes, however, development workers have to decide or help decide in which community to start promoting a participatory nutrition project.
A variety of factors can contribute to this decision. One is the food and nutrition needs of the people of the community as perceived by the people or by outsiders. Sometimes the community is already aware of these needs and members or groups in the community might even request, formally or informally, food and nutrition-related activities. When the community is aware of the food and nutrition problems they face, the overall participatory process is easier.
Communities are not often aware of their food and nutrition needs and problems. Needs may, however, have been assessed on the basis of nutrition data, such as acute chronic malnutrition, micro-nutrient deficiencies; or health related data, such as high infant mortality rate; or awareness of a specific stress situation affecting food supply, such as drought, population pressure or major economic constraints.
The development worker will also consider the openness of the community to a participatory project. It is more difficult to foster a participatory approach in communities where top-down development activities have been or are being carried out. Small and remote communities that have received little or no external support are likely to provide more successful entry points for a participatory nutrition programme.
Focusing on a group of communities in a given geographical area rather than on only one community at this stage will allow flexibility. If one community proves not to be really interested in the participatory nutrition project, another can be selected in its place.
BOX 2: Identifying and Selecting Poor Communities: Sri Lanka
In a people's participation project in Sri Lanka, the project coordinator asks the-village level officials to fill a printed form for each village with information on: the number of food stamp receivers, the total amount of paddy and high lands available, the total head of livestock owned and the ownership pattern and the availability of irrigation water. They are also requested to make a sketch indicating the location of the village and key elements such as the major service centres or approach roads.
Once the information is received at the division level, the villages are selected on the basis of scarcity of resources and remoteness by the divisional secretary and other officials such as extension and health staff. Among those selected villages, clusters of 5-6 neighbouring villages are then identified as a project area.
One of the main advantages of this method, beyond ensuring a selection of the very poor villages, is that it involves the administrative staff at division level from the start. This contributes to effective cooperation between the project and the divisional secretary and staff and to developing and strengthening formal links between higher institutional levels and the divisional secretary. These are crucial for sustainability of the project.
A participatory nutrition project is based on dialogue between the development worker and the community. In talking together, each will contribute to a better understanding of the food-and nutrition issues in the community. The understanding and view of these issues will evolve and grow in the course of the project.
How can the development worker begin or strengthen relationships with the community? If the worker is already familiar with the community, a good place to start is with existing relationships. It is also good to involve community leaders and educated people (traditional leaders, elders, school teachers, religious authorities, women's group leaders, representatives of people's organizations) right from the start. These people are keys to communication with others in the community: they can provide useful information and suggestions and can help the development worker make contacts with others. The support of community leaders also lends credibility to the project and helps ensure its success and sustainability.
From these initial contacts, the development worker can identify the issues that are most likely to raise the interest of a significant part of the community and the people most likely to be interested.
Once the contacts are made and the issues identified, it is good to hold a general meeting with the community. If the community as a whole meets regularly or is meeting for another purpose, the development worker can ask to speak during this meeting. Or, the community leaders can be asked to call a special meeting. The first meeting is a time for introducing the development worker and the food and nutrition issues. In the following days or during the next visit, the development worker can continue the discussions with individuals or small groups.
In these discussions, the development worker needs to take care not to foster misunderstandings and unrealistic expectations. The community should be aware of the development worker's intentions and resources (e.g. time, money) from the start.
It is essential to involve as many people as possible in the dialogue on food and nutrition. The development worker needs to be aware of the daily schedule of activities of the different groups in the community, such as men and women, youth and adults, in order to plan with the community the times for visits and meetings when these groups can participate. Other arrangements may also be needed in order to make it possible for people to attend. Women, for instance, may need childcare arrangements. Such arrangements can also be discussed and planned with the community.
Women usually play a decisive role in starting the participatory nutrition process because of their leading role in food and nutrition in the household. In most countries women are responsible for food-related activities: production, gathering, processing and storage, purchasing, preparation, intra-household distribution and consumption. Women are usually those most concerned with household food security; that is, with having a sufficient supply of food for their families year round.
The households and individuals that most need assistance are usually not involved in consultations and decision-making processes in the community. This isolates them even more from development opportunities. Other social groups, such as young people are also often excluded. The development worker can try to identify such groups from the start and actively promote their involvement in the participatory nutrition project.
As soon as they know in which community they plan to promote the participatory nutrition project, development workers can start gathering information on formal or informal organizations in the community and on their links with external institutions. They can find out whether there are already trained community workers, such as community health workers. They can also try to obtain information on past development activities in the community and whether they were successful or not and the reasons why.
It may be useful to visualize the interaction of external institutions with the community as a whole and with its different groups by having the community make a diagram of these. An example is given in Figure 2, called a Venn diagram. This consists of a series of circles of various sizes. The major circle stand for the community and each circle inside or outside the major circle represents an individual, a group or an institution. The size of the circles indicates their importance, and the overlapping between them indicates the degree of interaction. Constructing such a diagram during meetings with community groups, provides an opportunity to discuss existing problems and opportunities for assistance to the community. The development worker can compare the diagram with the inventory of locally available community services to help assess the efficiency of such services.
Figure 2: Venn diagram showing interaction of external institutions with the community of Ikolomani, Kenya
Constraints
- Development workers sometimes use - technical terminology when speaking about nutrition problems (for example kwashiorkor, vitamins, proteins), or concepts which the community does not understand. This obstacle to dialogue can be avoided by using terms that the people do understand and that can be translated in the local language.
- Certain groups in the community may feel threatened by the participatory nutrition process or its outcomes, since it might raise questions on resource allocation and power structure within the community. Being aware of this and improving the exchange of information throughout the participatory process can help ease these fears.
Figure
In some cases, food and nutrition are central concerns of the community and community response is immediate, particularly when the community actually faces increasing or regularly occurring food scarcity. In many cases, however, development workers may find that community members are not very interested. The people may not share the same views on food and nutrition issues as the development workers and they may not see how these are related to improving their overall welfare. They may actually view outsiders' interest in this field as a waste of their own time. Then the efforts of the development worker can get bogged down due to the lack of interest of the community.
How can the development worker overcome this lack of interest and get things moving in the community? One successful approach is to initiate such activities requested by some community members to stimulate and crystallize community interest in food and nutrition and give proof that the development worker is ready to support concrete actions beyond the initial study phase.
BOX 3: Starting Community Dialogue: Mexico
In a participatory nutrition project in Mexico, development workers encountered difficulties in establishing a dialogue with the community selected. Although the people showed signs of chronic malnutrition, they had little awareness of any nutritional problems. After exploring different ways to generate people's interest in food and nutrition issues, the project staff found that the most successful way was to introduce new dishes to vary the monotony of the usual daily diet. Some communities organized themselves to pay for demonstrators to show how to prepare new dishes. Since the dishes were prepared with locally available foods, opportunities end con-constraints regarding local production of such foods were then discussed. These demonstrations thus provided an opportunity for debating food and nutrition-related issues.
BOX 4: Food and nutrition activities: Kenya
In Kakamega district, Kenya, households rely mainly on maize for their subsistence. Population pressure has led to overworking the increasingly scarce land, and to insufficient maize production per capita and food supply problems. In order to improve their food and nutrition situation, small farmers first asked development workers for support to increase maize production. Demonstration plots using hybrid maize and a comparatively high-input technology were therefore set up. Further discussions on the best use of existing resources led them to discuss alternative land use. They progressively shifted production towards agro-forestry and horticulture using big-intensive technology. This provided a more diversified food base and generated income to buy maize.
Sometimes communities request activities, such as agricultural or food preparation demonstrations, which may appear inappropriate to the development worker. However these can provide occasions for community members to meet and discuss food and nutrition issues.
Routine data collection activities can also be used to start discussions and lead households to question their food related habits.
BOX 5 : Using growth monitoring to start discussions: Tanzania
In a UNICEF-supported project in Iringa, Tanzania, the widespread use of growth-monitoring charts for under-five children provided an entry point for Village Health Committees to discuss the food and nutrition problems faced by households with one or more malnourished children. This led to the identification and implementation of community or household activities such as home-gardens, promotion of drought-resistant crops, training in agro-forestry, promotion of income-generating activities, organization of child care, training in food processing and preservation or improvement of food preparation.
Communication activities on food and nutrition, such as popular theatre, use of video recording and rural radio are means of participatory education that can also provide entertainment, distraction from the daily routine and opportunities to meet. The development worker can try to identify institutions with communication experience and resources in the area or in the country to explore possible cooperation. Development communication will be useful throughout the participatory nutrition project.
Figure
Steps in the preparatory phase
1. Gathering and reviewing preliminary information
· contacting institutions likely to provide nutrition-related information
· identifying key contacts and discussing with them local nutrition-related issues
· holding joint meetings with key contacts
· preparing an initial assessment
2. Establishing/strengthening links with other local development institutions
· making an inventory of institutions working on nutrition related issues
· promoting joint meetings of institutions at local level to present participatory nutrition concept
· making an inventory of resources available
3. Selecting a community
· identifying possible sites establishing criteria in decision making.
4. Initiating a food and nutrition dialogue with the community
· meeting with local leaders to discuss possible collaboration with the community on issues of food and nutrition
· informing the community at large about food and nutrition
· identifying existing organizations within the community
· identifying the different relationships between groups inside and outside the community
5. Stimulating interest in food and nutrition issues
· starting small-scale activities
· using means of communication (e.g. radio, theatre and video)
