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In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 51-9.The objectives of nutritional surveillance were published in 1976 by the World Health Organization and subsequently elaborated upon by the Cornell Nutritional Surveillance Program (CNSP) in 1984. The uses of nutritional surveillance are: 1) problem identification and political sensitization; 2) policy formulation and planning; 3) program management and evaluation; and 4) timely warning and intervention. The vast majority of countries embarking on nutritional surveillance did so without having performed the prior steps of identifying decision-makers and the type of surveillance systems required. The most common type was nutritional monitoring, which could not facilitate decisions on immediate action. Ancillary data were adequate only for confirming that locations with a high prevalence of protein-energy malnutrition (PEM) also have a high prevalence of socioeconomic deprivation without pinpointing specific factors. Rapid assessment procedures (RAP) face similar problems, which could be improved by the development of guidelines. Another reason for linking qualitative methodologies to nutritional surveillance is that the infectious disease model of surveillance is not the most appropriate one for nutritional surveillance because of the complex etiology of chronic PEM. Timely warning and intervention systems (TWIS) are relevant in warding off possible food crises, as the case of Central Lombok District of Indonesia illustrated. Qualitative information methods were used in collecting agro-meteorological indicators by extension workers; assessing household food consumption patterns; alerting of district officials to an impending food crisis; and evaluating the extent to which this system triggered decisions. Nutritional surveillance for policy and planning is difficult to implement, as the examples of Costa Rica and Kenya showed. In the former, a national sample survey of low-weight-for-age children stratified according to father's occupation revealed the highest rate of malnutrition in sugar cane and banana plantations because of poor water and high food prices. This finding led to legislative action.
Adaptation of anthropological methodologies to rapid assessment of nutrition and primary health care.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 25-38.The history and current status of rapid assessment procedures (RAP) are reviewed from the perspective of one of the most well-known leaders of the methodological approach. Both the accomplishments of RAP to date and its limitations are described. The first methodology for rapid assessment came from rural sociology, called rapid rural appraisal, primarily applied to agriculture and rural development. Anthropologists working in public health also began to systematize their own practical approach to program planning, which led to the UN University 16 Country Study and to the development of the RAP field manuals. The objective of the 16 country health studies was to assess nutrition and primary health care programs from the household perspective and as rapidly as possible. The application of anthropology to program planning assumes that there are other tools than the large survey and field trips. These include observation, participant observation, formal and informal interviews, conversation, and group discussion (focus groups) to evaluate health programs. The traditional approach of one person or a team at a site for 1 year had to be altered for the evaluation of nutrition and primary health care programs. The UN study plan was contingent on 1) researchers already familiar with the language and the culture and 2) working with a limited list of objectives or data collection guidelines. The RAP guidelines were designed to allow anthropologists to spend 6 weeks in a community where primary health care was in place and to obtain household views on the health service. The beliefs and behaviors across 514 households in 42 communities in 16 countries were described, indicating that all used indigenous practitioners and various indigenous and Western biomedical health resources. The mother was the primary diagnostician of health-seeking behavior; and all used herbs for prevention and treatment. RAP does not replace traditional anthropology, it is an additional method.
Food emergency in wonderland: a case study prepared by the League of Red Cross and Red Crescent Societies for the training of relief workers.
In: Advances in international maternal and child health, vol. 4, 1984, edited by D.B. Jelliffe and E.F. Jelliffe. Oxford, England, Oxford University Press, 1984. 110-23.This monograph chapter is an exercise whose aim is to help relief workers to be better equipped to solve the practical problems of an emergency relief operation. Its events and contents are imaginary, but are drawn from direct experience. It has been used extensively in Red Cross training projects in several countries, and is designed, 1st, to be complemented with other types of educational media, and 2nd, to be adapted to the training requirements of diverse types of project, through "biasing" in favor of health, nutrition, sanitation, or logistics. A description is given of the management of the case study educational setting, based on real experience with the use of the material; the best results appeared achieveable through a class session on part 1, consisting of initial assessment of an hypothetical nutritional emergency, followed by work in small groups on part 2. Part 1 consists of presentation of situation characteristics, e.g. "overworked health assistant reports a big increase in chest infections, diarrhea, and typhus," and "there is a hand-dug well 1/2 mile from the shelter." Part 2 describes the situation 2 months later, after intervention has begun. Situation characteristics appear such as, "Records from clinic attendance indicates that the commonest disease symptoms are diarrhea, cough with or without temperature, general aches and pains, worms, and eye infections." The case study also includes additional information on food stocks, demographic data, and nutritional survey data (the latter not included in this article). Concluding the article are examples of topics for group discussions and presentations.
[Operational sequence for the implementation of a subregional food and nutrition strategy] Secuencia operativa para la implementacion de una estrategia subregional de alimentacion y nutricion.
In: Lineamientos de una estrategia Andina de alimentacion y nutricion [by] Junta del Acuerdo de Cartegena. Grupo de Politica Technologica. Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos. Lima, Peru, Junta del Acuerdo de Cartagena, Grupo de Politica Technologica, Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos, 1983. 143-74.This article outlines and diagrams a recommended operational sequence for implementation of food and nutrition strategy for the Andean region. The multisectorial strategy envisioned by the planners would involve the supply and demand for foods; basic health, environmental sanitation and educational services; and food information and technology. The integrated, multisectorial nature of the strategy requires policies, plans, and programming designed to facilitate harmonious development of all the necessary elements within the 5 Andean countries. The proposed methodology for operationalizing the strategy is based on a systems focus which covers all aspects of production, processing, distribution, final consumption, and technoeconomic policies for food and nutrition. Because the food and nutrition strategy is more than a production program, its design should identify interrelations between the availability and prices of foods, external commerce, industrial trends, food commerce and distribution, and food consumption in adquate quantities by the entire population. A basic service component for health should also be included for the Andean population because of its relationship to nutritional aspects. The suggested instrument for operationalizing the systems focus is the "Methodology for Evaluation andprogramming of Technological and Economic Development of Production and Consumption Systems" developed by the Andean Projects for Technological Development Food Group for the Group for Technological Policy of the Cartagena Accord. The methodology consists of a manual and a "Model of Numerical Experimentation", which permits identification of system components, calculation and evaluation of relevant aspects of each production factor, and design and selection of development alternatives. The Model of Numerical Experimentation" allows simulation of goals for satisfaction of needs, exports of final products, import substitution, different production technologies, commercial margins, subidies, customs duties, taxes and exchange rates and related variables. Various food production systems have already been studied using the methodology in each of the 5 Andean countries. It is recommended that implementation of aspects of the food and nutrition strategy involving food production and consumption proceed in 8 operational sequences: 1) characterization of the current industrial, agroindustrial, and fishing economy 2) identification and selection of basic foods and/or strategies 3) representation and quantification of each of the selected systems 4) evaluation of each system and intersystem relationship 5) identification and selection of systems of production of alternative foodstuffs 6) proposal for a national and regional food system 7) concerted development programming for the regional food system and 8) design of mechanisms of evaluation and follow-up.
[Towards a subregional food and nutrition strategy. How to begin?] Hacia una estrategia subregional en alimentacion y nutricion por donde empezar?
In: Lineamientos de una estrategia Andina de alimentacion y nutricion [by] Junta del Acuerdo de Cartegena. Grupo de Politica Technologica. Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos. Lima, Peru, Junta del Acuerdo de Cartagena, Grupo de Politica Technologica, Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos, 1983. 111-42.This work suggests objectives, rationale, methods, and organizational structure for an Andean regional food and nutrition strategy. Although a food and nutrition policy is a desired goal in the region, the complexities of the problem and the fact that definitive solutions require a broad development strategy hamper development of a food and nutrition strategy. The food strategy initially should address aspects of food supply, food demand and utilization through provision of basic services, and food information and technology. The food supply strategy should involve 4 types of foods and 3 types of nutrients causing specific deficiencies. The food types should include 1) foods competitively produced in the region but not widely utilized by the Andean population, such as rice from Colombia or fish and seafoods from Peru and Ecuador 2) required foods not yet produced competitively in the region but capable of production within 5 years, such as meat from Bolivia or oils from Venezuela, Ecuador, Peru, and Colombia 3) foods competitively produced whose availability should be assured more widely in seasonal and geographic terms, such as sugar cane, bananas, potatoes, and yucca. 4) foods not currently produced competitively in the region and not likely to be produced within 5 years but which are important to the local diet and are in chronically short supply, such as maize, wheat, flours, oils, and fats. The deficiency-causing nutrients would be iodine, vitamin A, and ferrous sulphate or other iron derivatives. Basic services to be added or improved should include primary health care programs and environmental sanitation programs. Information and technology components of the food and nutrition strategy would initially involve the investigation and transferrance of technology for each step affecting food supply and demand for goods and services included in the overall strategy, as well as attempts to develop a basic data base concerning the interventions adopted. The organizational structure for the food and nutrition strategy should be flexible, with a lower level including a technical work group and an upper level composed of representatives of various sectors and organizations which would coordinate policy design and implementation.