EXECUTIVE SUMMARY

National governments and donors alike have placed emphasis on the progressive realization of access to food and good nutrition as a human right. Reducing food insecurity and improving nutrition have acquired importance within the context of poverty reduction strategies. We need to address not simply the immediate causes of malnutrition, but also their underlying and basic factors if we are to achieve nutritional well-being and reach functional and productive capacity in a population. It is thus imperative that food and nutrition programmes succeed and that success is sustained. This is why countries need to undertake assessments of their programmes to improve outcomes, cost-effectiveness, efficiency and sustainability.

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. Much can be learned from the experience accumulated with community-based nutrition programmes in developing countries.

To assist countries in this endeavour, FAO started a process aimed at developing a methodology that allows them to carry out in-depth assessments of their community-based food and nutrition programmes. The purpose is to understand what works, what does not work, why, and how such programmes can be expanded, strengthened and redesigned, if needed. Understanding these relationships require new approaches, new ways of thinking about familiar issues.

It is these issues that this case study report considers. It is based on an in-depth assessment and analysis of three programme cases per region (Africa, Asia, and Latin America) and three desk reviews. The objectives of the report are:

1. to summarize the main features and findings of the case studies;
2. to highlight, analyse and discuss the main lessons learned from the case studies and desk reviews and,
3. to provide the theoretical and practical background for the preparation of a methodological guide entitled Improving Nutrition Programmes: An Assessment Tool for Action.

This case study report is a companion volume to the former. The report is divided into five sections (A-E), plus annexes.

Section A provides the background and rationale for FAO’s decision to undertake this exercise. It stresses that the ultimate aim is to improve the quality of community-based nutrition programmes by constructing and making available a simple tool that nutrition programme planners and implementers can use to assess the likely success and sustainability of an on-going or planned programme, so as to be able to redesign it or make adjustments for improvement. This section also describes the steps followed in this exercise.

Section B presents criteria for selecting countries and three programmes per region for in-depth case studies. The programmes selected are:

It also presents brief summaries of the key features of the nine in-depth case studies.

In addition to the in-depth case studies, three desk reviews of programmes, two of which had received FAO support, were prepared by FAO staff. These desk reviews are of the following programmes:

Thailand:	National Nutrition Programme
Viet Nam:	Household Food Security for Nutrition Improvement
Zambia:	Improving Household Food Security and Nutrition in the Luapula Valley

Summaries of desk reviews and full case studies are provided in Annexes 1 - 4.

Section C analyses the main findings of the in-depth case studies and desk reviews by drawing out the main lessons learned from the experiences of the programmes, under four headings: macrocontextual factors, community-level factors, programme design features and sustainability.

It then proceeds to the results of the SWOC/T analyses (Strengths, Weaknesses, Opportunities and Constraints or Threats) performed on the programmes. Common features to all or many of the programmes are presented and some interesting findings of individual programmes are highlighted.

Section D uses the findings of Sections B and C to suggest ways in which community-based nutrition programmes can be improved so as to become more sustainable and have a greater positive impact on nutritional status and food and nutrition security. The success of a programme lies, on the one hand, in its ability to achieve its objectives and, on the other hand, its ability to sustain these achievements. Based on the findings of the case studies and their practical implications, this section discusses how success is to be achieved.

Section E concludes the report by advising the reader that many of the conclusions are inevitably based on judgement and assessment. The future of nutrition programming holds its own challenges, some of which are briefly highlighted: the nutrition transition; the needs of older people; the complexities of massive urbanization and the decentralization processes. Nutrition planners need to keep abreast of scientific advances and new technologies. There is a need for nutrition programmes to develop partnerships with NGOs, academic and research institutions and the private sector. Nutrition planners are advised that the challenge for them is to take from this report what is appropriate in their country context and to use it to improve their existing programmes or to design better programmes.

To help in this process, FAO has produced the companion volume “Improving Nutrition Programmes: An Assessment Tool for Action”.

Concluding remarks also stress that malnutrition is an impediment to development and that it is not only the result of insufficient food but also a consequence of other conditions. Thus, reversing the process is complex and there is no single solution for all but rather general guidance on directions to pursue. Experience from lessons learned shows that considerable time is needed to redress a situation, and that a strong supportive political and policy environment remains essential throughout the period. Once achieved, however, the effect is likely to become permanent, offering a substantial return on investment.