Interactions with the recipient community in targeted food and nutrition programs.

This article explores the relation between targeted nutrition and food assistance programs and the recipient communities. The author begins by suggesting that the renewed current emphasis on targeting has resulted from the high cost of universal entitlements in poor countries and from the need to increase the food security and resilience of the poor in these countries. They stress the fundamental human right of communities to have involvement in all steps of program targeting as elemental to good democratic governance. Next, the article reviews the issues surrounding different levels of community involvement in the components of program targeting, namely needs assessment, definition and implementation of eligibility criteria, delivery of services and benefits, and monitoring and evaluation of results. Four types of targeting eligibility are described: self-targeting, means tested, categorical, and community based. It is noted that the type and the level of engagement of programs with communities depends on whose concept of community welfare is being pursued (the development summit's or the community's), and on how broadly nutrition improvement is defined. Examples are used to illustrate the potentially severe consequences of ignoring community governance and social structures in the targeting of programs. A framework is then presented with important variables to consider when planning a targeted program: state governance contexts, the nature of the local community's institutions of governance, the ratio of the need to the available benefit, and the stability of the context. Finally, the article presents recommendations for filling in the large research gaps on this topic.

Foods provided through U.S. Government Emergency Food Aid Programs: policies and customs governing their formulation, selection and distribution.

This report describes the food commodities that are used in U.S. emergency food aid programs and outlines issues in their distribution, selection and formulation that may limit their ability to meet the nutrition needs of recipients. Issues are being raised at this time because the U.S. Congress plans to renew the authorizing legislation by the end of 2002. The author summarizes quantity and quality problems with food aid contributions and the difficulties experienced with the coordination of food aid with related needs of disaster victims. He identifies the foods supplied for emergency feeding by the U.S. Government and the World Food Program, and describes the limited applications of nutrition science to the formulation of the processed foods provided through U.S. food programs. The core of the report outlines the dominant nonnutritional priorities, stemming from the linkages to U.S. agricultural supply markets, U.S. commercial food interests, food aid pledging customs and difficulties in U.S. Government humanitarian response coordination. The presentation concludes with a review of issues, emphasizing the need for further studies, and some suggestions for shaping future food aid programs and policy with a strengthened capacity for protecting and promoting the nutritional status of disaster victims.

Health and nutrition in self-reliant national development: an evaluation of the Jamaican community health aide programme

This research is an in-depth case study of health and nutrition in Jamaica. It includes an evaluation of the Community Health Aide Programme in the western Parish of St. James with a population of 114,000 in 1975. The program employs village women who, after brief training, provide health and nutrition education and some direct health care to their home districts. The program began in 1973 in St. James with 120 aides. By 1976 over 1000 were employed island-wide. The conclusions drawn are that health aides training material well and performed up to reasonable expectations in their work effort. However, professionally-striving aides, probably rewarded by nurse trainer-supervisors, were definitely poorer in work output while being highest in training-test scores. Unfortunately, the program was not achieving most of its stated nutritional and health care outcome objectives in 1975. For example, efforts to increase breast feeding and improve nutrtitional status were unsuccessful. Although householders were attending family planning clinics significantly more often, no fertility reductions were detected. A major underlying problem was the planners' cultural idealist theories of health and dietary behavior. The data supports a more cultural-materialistic view. Observed nutritional status improvement between 1973 and 1975 is traced to shifts in Jamaican and international political-economic environments and not to the health aides education work. Shortcomings in the program were linked to the wider institutional environment of the country. A highly centralized political system was undermining efforts to decentralize program control. Nursing professions sharply limited the potential duties of health aides. Political patronage distorted the distribution of aides in favor of the governing party. Lastly, the program came under heavy influence from U.S. medical schools and funding sources. The study concludes that highly centralized, fractionated, and dependent political economies, such as many former colonial territories, will have difficulties implementing these programs successfully unless important pre-conditions are recognized. The programs must be an integral part of self-reliant development policies which allow genuine control of the health delivery system at the local level