In Thailand, the Basics of Need.

• Author: Tontisirin, K.
• Position: Brief Article

Thailand, with a population of 6l million, has been highly successful in rapidly reducing the prevalence of malnutrition, a relatively rare occurrence in the developing world. One key to the very significant and rapid progress came with the fifth development plan (1982-1986), which focused firmly on the people's participation, instead of leaving the Government to shoulder the entire burden. The primary health care approach was seen as a practical community-based and participatory mechanism to address persistent health problems, including malnutrition. This led to the training of village health communicators and health volunteers or mobilizers who, at the ratio of one mobilizer per ten households, can be found in virtually every rural village with a countrywide force of over 500,000.

At the time, it had become known that malnutrition had profound effects on child growth, cognitive development, work performance and productivity. It also became increasingly apparent that malnutrition had multiple causes and its prevention would require collaboration between the sectors of health, agriculture, education and community development. The challenge was to orchestrate programmes in all of those sectors.

A first National Food and Nutritional Plan (1977-1981) was developed. It was "multi-sectoral" by virtue of the fact that it involved the Ministries of Public Health, Agriculture and Cooperatives, Education and Interior, which shared responsibility for implementing the programmes. Although it did not show any impact in reduction of malnutrition, the Plan raised nationwide awareness and contributed to building up and expanding a number of sector-specific targeted programmes to address problems of malnutrition at community level. The participation of each ministry in this Plan was vertical, however, without horizontal communication, and this resulted in an inadequate multi-sectoral collaboration. An evaluation of the Plan's impact had resulted in the following conclusions:

* Efforts to alleviate malnutrition depended solely on government-provided services, so that relatively few were able to benefit;

* Communities were inadequately prepared and did not participate significantly. Government and community personnel had conflicts of interest;

* There was insufficient manpower to cope with needs at the household level;

* There was low community awareness and understanding of the significance of malnutrition.

As a result of this very frank evaluation of the...