CONTENTS   behaviour change communication   school feeding programme   water and sanitation   health service provision   coordination, monitoring and evaluation

February - April 2003

Improving  village health care and nutrition

Rates of malnutrition in Trincomalee district are unacceptably high. 51% of children under five years and 48% of women are malnourished. The effects are severe. Malnutrition results into recurrent illness, poor mental and physical development and, finally, death. If the nutrition situation remains unchanged, investments in human and economic development will not show the intended results.

To respond to the multiple causes of malnutrition, single interventions are insufficient. A holistic approach is required. IFSP therefore complements measures to improve availability of and access to food with measures aiming at adequate use and utilisation. The health and nutrition component focuses on the provision of knowledge and skills to community members with regard to health behaviour and care. At the same time the provision of health service is strengthened. The following activities are implemented through the Department of Health Services and Eastern Human and Economic Development (EHED), a local NGO.

Behaviour change communication                                         top

Poor knowledge and constraining attitudes on maternal and child health are one of the identified factors contributing to malnutrition. A comprehensive communication strategy is therefore implemented to raise awareness and to provide knowledge and skills. This will help to achieve positive behavioural change.

The target group comprises (1) women as they are commonly responsible for nutrition and health, (2) men since they play an influential role on women’s behaviour, (3) school and pre-school children as it is easier to adapt good behaviour while people are still young.

Messages are disseminated through face-to-face communication supported by mass media. This is to ensure that a wider range of people is reached. Activities include ”the talk of the month” (each month a different health topic is addressed through discussions in communities and schools), exhibitions, drawing competitions, drama performances, demonstrations and special seminars on ”maternal nutrition and care”. In addition, posters, leaflets, bags and T-shirts are distributed displaying messages that recommend behaviour changes for improved health. To complement these efforts, sensitisation training for influential people such as village headmen, religious leaders and teachers are conducted. This ensures that the messages reach the village communities and helps them to adopt the recommended behaviour.

School feeding programme                                                       top

A considerable number of children only eat one meal during the day. IFSP therefore enables parents to provide an additional healthy meal to their children while attending school (Kola Kantha/Illai Kanchi). The aim is (1) to eliminate hunger during classes and to improve concentration, and (2) to increase school attendance. Both contribute to maximise the impacts of education.

IFSP applies a phased approach: The contribution of communities to the ”mid-day meal” increases, while the IFSP support decreases until communities are able to fully take over. The concept includes nutrition awareness to highlight the importance of the meal as well as the establishment of a school garden to avail the ingredients. Intense community mobilisation is required including drama performances and exposure visits amongst schools. Regular multi-sectoral stakeholder meetings are conducted to monitor the progress.

Water and sanitation                                                                   top

The prevalence of water-born diseases is high in the district due to poor personal and environmental hygiene and the lack of safe drinking water. IFSP addresses the problem and supports communities in the construction of toilets and wells.

The approach comprises a community mobilisation process including beneficiary selection, negotiating community’s contribution, site selection and, finally, construction. An integral and important part of the process is awareness creation on (1) the importance of hygiene and safe drinking water including its impact on health, and (2) the importance of proper use and maintenance of toilets and wells. To reinforce these messages, drama performances are conducted and exposure visits amongst communities are organised.

Other activities that address improved hygiene include waste disposal measures and, until the behaviour is improved, regular de-worming of school children.

Health service provision                                                             top

Health service provision is equally addressed. IFSP responds to the district-wide lack of health personnel (i.e. public health inspectors and public health midwives) through support to community based health services. The recruitment and training of Village Health Volunteers and the formation of Village Health Committees ensures availability of and access to preventive health care and, at the same time, strengthens the self-help capacity of communities.

Likewise, the quality of existing services is improved through capacity building for health service providers. This will not only help to create demand for services but also ensure adequate respond to the demand created. Capacity building is an integral part of all interventions. It is supported through special training in topics that are necessary to carry out the activities such as monitoring and evaluation, behaviour change communication, participatory methodologies and gender. Apart from that, IFSP provides equipment such as weighing scales, motorbikes, training and awareness material.

Coordination, monitoring and evaluation                              top

Multi-sectoral teams are established from community via divisional to district level. Their task is to plan, coordinate, monitor and evaluate the interventions. The structural set-up allows bottom-up as well as top-down communication. It ensures interventions based on needs and sufficient allocation of resources to do so.