56. Community Health and Nutrition Programs

Abstract

In community health and nutrition programs, households interact with health workers to protect and promote household members' health and nutrition, and to facilitate access to treatment of sickness. Mothers' and children's health and nutrition are a primary focus of the programs. Activities undertaken by community–based programs include the provision of prenatal care, women's health and nutrition, complementary feeding, nutrient supplementation, growth monitoring, and immunization. Because community–based programs have more regular contact with clients, and are often closer to the clients, they may be more effective in actually reaching mothers and children than facility–based programs. Such programs can accelerate the decline in child mortality by 1–2 percentage points per year, at a cost of only about US$5 to US10 per beneficiary. (Smaller expenditures are usually ineffective.)

Training, supervision, and incentives for community workers constitute critical aspects of successful programs. Effective, respected, and socially inclusive organization at the community level is also a key feature of success in launching, expanding, and sustaining community health and nutrition programs.

Contextual factors, such as improved living conditions and education, may enhance health and nutrition over time without any additional direct action. Whether a context is favorable may have important policy implications for community–based programs.

Research and evaluation of the net effects of interventions must be undertaken so that resources may be effectively allocated. Successful community health and nutrition programs in Asia and Latin America should be replicated more broadly, particularly in areas such as Sub–Saharan Africa, where application of experience to the HIV/AIDS crisis could be explored.