Coordinated strategies for controlling micronutrient malnutrition: a technical workshop.

Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training.

An examination of the performance and motivation of indonesian village health volunteers.

Indonesian "kader Posyandu" or village health post volunteers are a key link in the provision of primary health care services and health education to this country's 170,000,000 inhabitants. Yet little is known about the quality of service that they actually provide, with most existing data being derived from their own self-reports or from those of the mothers they serve. Moreover, it is widely acknowledged that inadequate kader motivation and subsequent high rates of dropout are a chronic problem for the Indonesian primary health care strategy, creating frequent disruptions in service as well as the necessity for continual recruitment and training efforts. The present study was conducted to shed further light on these issues through observations of kader behavior during village health post clinic days. These observations emphasized the amount and type of health education related to child survival that was performed by the kader. Subsequent interviews with kader, mothers, and village leaders complemented these observational data and provided further information on present and potential motivators for kader. The observations indicated that while kader performed growth monitoring, immunization, and other village health post clinic activities appropriately, they failed to take advantage of opportunities to educate mothers in nutrition, oral rehydration, and other important skill areas. In turn, interviews indicated that while money for services rendered could be a powerful motivator for these volunteers, they felt that even more important, given limited resources, was an expression of appreciation on the part of the community being served. These data have proved critical for the design of a health communication campaign seeking to improve kader performance and lengthen their term of service.