Miscellaneous : books and papers
English Version of Viet Nam PANP Manuals David Marsh 02.01.98
WHO manual and Princess Diana Andre Briend 16.01.98
Offer of papers by C Schuftan from Hanoi Claudio Schuftan 26.02.98
Reflections of an old socialist Claudio Schuftan 26.02.98
Some food for thought Claudio Schuftan 10.03.98
letter from an old socialist Claudio Schuftan 16.03.98
Re: letter from an old socialist Deepti Chirmulay 20.03.98
Free/low cost publications on Food and Nutrition Michael Golden 18.03.98
Low cost newsletters Ann Burgess 05.04.98
Cochrane reviews of helminths and growth/iron in pregnancy Michael Golden 27.04.98
Food for thought Claudio Schuftan 27.06.98
Nutrition and Poverty Claudio Schuftan 15.08.98
Side-dish for thought Claudio Schuftan 01.10.98
Treatment guidelines for severe malnutrition Claire Schofield 15.10.98
Global FFT Claudio Schuftan 21.10.98
FFT for Erica and her peers Claudio Schuftan 01.11.98

Fri, 2 Jan 1998 09:27:10 -0500

From: "Marsh, David (dirsync)" <DMARSHatsavechildren.org>

Subject: English Version of Viet Nam PANP Manuals



I'm pleased to draw your attention to the publication of these important new nutrition training manuals by Save the Children/USA's Vietnam Field Office.

Happy New Year,

David Marsh, SCF/USA




After careful planning and writing, Save the Children/US-Vietnam Field Office (VNFO) is pleased to announce that its set of 10 training manuals for the Poverty Alleviation and Nutrition Program (PANP) is now available. These books carefully describe the Training of Trainers (TOT) course provided by VNFO Living University (LU).

The PANP was developed in direct response to the growing number of malnourished children in Vietnam. Since its establishment, VNFO+s main objective is to sustainably reduce 2nd and 3rd-degree malnutrition among children who would have been severely physically and mentally affected. In trying to achieve this end, it developed a participatory program that was in the context of Vietnam; that is, VNFO heavily considered the available and accessible community and human resources within these impoverished rural areas. The implementation of the PANP has been so successful and sustainable that over 90% of moderate and severely malnourished children who participated in the PANP have been rehabilitated and more importantly, remained so for up to four years after their participation in the program.

More specifically, the PANP comprises of four components including:

1) the Growth Monitoring Promotion Program (GMP) which encourages the weighing of children under three-years-old to determine their nutritional status;

2) the Nutrition Education/Rehabilitation Program (NERP) which enrolls the 2nd and 3rd-degree malnourished children, their mothers and family members in sessions where they learn basic nutrition messages and preparation of a nutritious, calorie-dense meal;

3) the Nutrition Revolving Loan Program (NRLP) which targets children who remain malnourished even after some NERP sessions by accessing them to supplementary food through in-kind loans. And consistent with its philosophy on developing programs that will be able to sustain themselves through the human and community resources, SC developed

4) the Endowment/Income Generating Program which gives grants to communities so they can generate income through projects--such as milling machines and transporting boats--to fund/maintain the PANP.

As of September 1997, VNFO+s provincial partners and other NGO+s in Vietnam have implemented the PANP in 13 provinces to rehabilitate more children suffering from malnutrition. Yet interests to replicate this program extend beyond Vietnam--representatives from various international agencies in Haiti, Bangladesh, Cambodia, and Nepal have participated in the LU and have been consulted by VNFO in their effort to bring this model home to improve the lives of malnourished children in their respective country.

In response to national and international interests, VNFO not only produced Vietnamese manuals describing the content and methodology of the TOT courses provided by the LU but also translated them into English. They were both written for a general audience; that is, VNFO did not focus so much on the technicality of the language and medical procedures as it emphasized upon reaching out to as many people interested in improving the nutrition of children as it could. For some example, the manuals offer many activities for all 4 components of the program, samples of questions, evaluation and monitoring sheets, advice on counseling and much more. These manuals could be read, understood and applied by people on various levels (e.g., trainers on the district levels). Hence, the simplicity and clarity of the explanation and methodology will allow for informational and replicational access to the PANP district, provincial, nation and world-wide.

If interested, the English and Vietnamese PANP training manuals will be available December 22nd of 1997. Whereas the English version suggested cost is 50 USD, the Vietnamese is 300.000 VND. However, because the real cost of the manuals is much higher than the suggested one, any additional payment is appreciated. For orders and/or information regarding these manuals, please contact our receptionist Nguyen Thi Tuyet Mai at If you have any further inquiries about the training courses, please contact our director of the Living University Tran Thi Lang at 84.48.461805. Furthermore, you can also reach us by e-mail: scusvnfoatnetnam.org.vn or by fax at 84.48.46. 1807.

Date: Fri, 16 Jan 1998 11:56:57 +0100 (MET)

From: briendatext.jussieu.fr (Andre' BRIEND)

Subject: WHO manual and Princess Diana


Dear NGO nuts,

Someone rightly said that publication of WHO manual would help. Clearly, it is overdue. Many avoidable deaths result form this delay.

This leads me to the following remark :

Hardly a week after untimely Princess Diana's death in Paris, books giving all the details of her life and death were available on all the shelves in bookshops all over the world. Can anyone tell me why the WHO manual, which in fact takes up the protocol used in Jamaica for +/- 20 years, and used for the last 5 years by emergency NGO's for hundred of 1000 of kids, and has been written up for years is not yet printed ?



Dr. Andre' Briend

From: Claudio Schuftan, avivaatnetnam.org.vn

Date: Thu, 26 Feb 1998 09:25:18 -0700

Subject: Ngonut: Offer of papers by C Schuftan from Hanoi




1. The Causes of Hunger and Malnutrition: Macro and Micro Determinants.

2. Technical, Ethical and Ideological Responsibilities in Nutrition.

3. DeWesternizing Health Planning and Health Care Delivery: A Political Perspective

4. Preparing Food and Nutrition/Primary Health Care Programs: Experiences from

Cameroon and Liberia.

5. Viewpoint: Ethics, Ideology and Nutrition.

6. Ethics and Ideology in the Battle Against Malnutrition.

7. The Challenge of Feeding the People: Chile under Allende and Tanzania under


8. The Role of Health and Nutrition in Development.

9. Multidisciplinarity, Paradigms and Ideology in National Development Work.

10. Survey on Attitudes towards Nutrition Planning.

11. Household PurchasingPower Deficit: A more Operational Indicator to Express


12. Foreign Aid and its Role in Maintaining the Exploitation of the Agricultural Sector:

evidence from a CaseStudy in Africa.

13.Low School Performance: Malnutrition or Cultural Deprivation?

14. Hunger and Malnutrition: Outlook for Changes in the Third World.

15. Nutrition Planning What Relevance to Hunger?

16. Rosalia (a poem by Orlando Leon).

17. The Political Economy of Ill-Health and Malnutrition.

18. The Markets of Hunger:Questioning (nonemergency/long term) Food Aid.

19. Activism to Face World Hunger: Exploring New Needed Commitments.

20. The Child Survival Revolution: a Revolution that isn't?, or Health still only for Some

by the Year 2000.

21. DEVELOPMENT NEMESIS: (1) Development and Today's Reality. (2) The Actors

and the Future of Development: The Era of Empowerment.

22. Looking Beyond the Doable:Resolutions for a New Development Decade.

23. Institution Building: The Achilles Heel of Development Projects. (or Why Projects

Don't Work...)

24. Positive Deviance in Child Nutrition: A Critique.

25. The Project Approach in Development Assistance.

26. Triage Management in Third World Ministries.

27. On Behalf of the African Child: Challenges and Windows of Opportunity for the

Donor Community.

28. The Household Entitlements Revolution, or a Women-Centered Approach to Family

Security .

29. Brave New World: A Political Pendulum in Search of its Balance.

30. Malnutrition and Income: Are We Being Misled? (A Dissenting View).

31. A Path for the 90's?: Government-Donor Partnership to Finance Primary Health

Care in the Third World.

32. Notes on Civil Service Downsizing: The Golden Handshake Option Revisited.

33.The World Declaration on Nutrition and the 1992 International Conference on

Nutrition (ICN) Plan of Action: The Cutting Edge of Conventional Thinking.

34. Income Generation Activities for Women: The 9th Essential Element of PHC?: An

Idea Whose Time has Come.

35. Some Reflections on the ACC/SCN's 'How Nutrition Improves'.

36. Nutritional Goals for the Mid-90s: A Call for Advocacy and Action.

37. The Emerging Sustainable Development Paradigm: A Global Forum on the Cutting

Edge of Progressive Thinking.

38.Giving Conditionalities a Good Name, or Conditionalities: The Launching of a


39. The Community Development Dilemma: What is Really Empowering?

40. Development in the Mid 1990s: Reflections of an Old Socialist.


Copies of any of the above papers can be requested free of charge from:

Dr.Claudio Schuftan, IPO Box 24, Hanoi, Vietnam.

Fax: 84 4 8236401. Email: avivaatnetnam.org.vn

by just quoting the respective number(s).


The papers are not available through email. They are sent by surface mail, so please send your postal address.

From: Claudio Schuftan avivaatnetnam.org.vn

Date: Tue, 3 Mar 1998 12:32:54 -0700

Subject: Ngonut: Reflections of an old socialist





I have been in the business of Third World Development --with a capital D-- for the last 25 years; mostly in the areas of health and nutrition and in over 40 countries. I think I am ready to downgrade the upper case D to a lower case d in development. After one repeatedly hits one's head against the wall of hard realities, it behoves anybody honest with him/herself to change his/her views. The trick for me has been to do so without betraying my deep ideological convictions.

First of all, has it all been worthwhile? An overall balance would prompt me to say yes. But it is a garded yes. In this business, we really operate on the 'two steps forwards - one step backwards' mode.

The measuring stick for 'worthwhileness' has to be what is left behind after ODA. And of that that is left behind that really counts, it is the intangibles that count the most; not the half-achieved objectives of projects. Key among these intangibles is changed attitudes of some of the people who worked with you.

Over the years, I have mostly worked inside and through government (and international) bureaucracies. I have thus realized that rigidities in the minds and behavior of senior national cadres is inherent to bureaucracies --trascending the North/South and the ideological barriers. My latest experience took me from working in Kenya to working in Vietnam where I had hoped things would be different. But there is something intriguingly common to bureaucracies in that they abhor change with rewards rather coming from staying the course.

In the midst of all this, you find yourself as a long term adviser. You are under pressure to move the project along, it takes you six months to assert yourself in your new position (while your coworkers are measuring you up), you experience your first frustrations of things not moving, of deadlines passing with no glory, of you increasingly taking the role of the doer rather than of the promoter and coordinator, of the project not spending funds according to plans to keep up a credible absorptive capacity, of the project bringing in short term consultants that have never been in the country and are expected in three weeks to speak words of wisdom that have never been spoken before, and so on...

And through all this, you try to keep your mental sanity and not to hate yourself every morning when you look at yourself in the mirror. The truth is that you get so caught up in the whirl of things that you do not take time out to look at things overall, in perspective: Is all this really helping? Helping who? Further, I cannot emphasize enough the advice I have for you to take every opportunity to escape the claws of the central bureaucracy to do some work in the field. It has always proven to be rewarding, a source of some satisfaction for a sense of accomplishment on small undertakings. It is the string of such small victories that keeps you in reasonable mental health, because development with a small case d does not have big victories in the realm of ODA.

In essence, what you have really become is another (more efficient and well paid) bureaucrat. You have learned not to take a first 'no' as a definite answer and know your way around to revert such a decision --you have nothing to lose, you are not putting your neck on the line.

Besides that, you have developed some relationships with one or two more progressive senior officers in the organization whom you consult and carefully use as needed. Again, in the search of some long term achievements on the fringes of the project you work in, I have found it very rewarding to establish professional contacts and long term working relationships with young faculty (in my case) in schools of public health and/or departments of community medicine in the local university.

This is always an important source of new inspiration.

In your immediate working environment, things are tougher. You find that your coworkers have their own parallel agendas --as opposed to you who devote better than 90% of your time to project objectives. The project does not cater to those parallel agendas and, therefore, (no wonder) you 'lose' your colleagues to different degrees and get only very partial cooperation. The sad truth is that often these parallel agendas are related to sheer everyday economic survival.

I think we have to learn to cater to some of those other needs of our coworkers if we want them to be more committed strategic allies.

English language coaching and travel/training opportunities are often high in the list for such perks.

It has been my own personal rewarding experience that you can always find at least one (young) cadre in your unit with whom you can work more closely and who is eager to learn and do with you; someone who has not yet been caught by the negative influences of the prevailing 'system'.

Seize such opportunities and develop them as intensely as you can. You will gain a strategic ally for life.

All projects have training components, and working in the bureaucracy, you see an array of workshops being organized for staff by many donors or by the government itself. An unwarranted faith has been placed on this entity: the workshop; workshops are our prescription to inform and upgrade people's skills. But although it may achieve the former, it certainly does not achieve the latter: Staff returns from workshops and goes on with their routines as if nothing had been learned. Moreover, training is atomized into different components by different single-track donors with each one doing his thing in an uncoordinated way; the result is multiple workshops for the same staff every year, with the hope that the (poorly qualified) staff will do the integration and coordination in their own heads... Failing to recognize this is costing billions of dollars around the world. People have called this epidemic "workshopitis". As it stands, workshops are more a source of sporadic extra income for staff than of changed behaviors. No funding is thrown in to follow up on workshops' medium or long term impact. Donors like workshops, because money is spent and quickly written off against the budget.

On the other hand, institutionalized support supervision of field activities of programs and projects is virtually non-existent.

The time has come to make a bold move.

Continuing education and support supervision activities have to be merged. The budget available for workshops should be used instead to fund multidisciplinarily trained support supervision teams (one by province?) to go around at least two times a year to visit peripheral units. They will stay 4-5 days in each place before moving on to the next unit; they will work with the staff in their every day chores and routines, correct mistakes, introduce new procedures, educate on the job on technical and managerial matters, on reliable information systems, etc. Workshops are to be kept to a bare minimum.

I have by now seen too many well intentioned, well planned, well executed, culturally sensitive, balanced top-down/bottom-up interventions in primary health care that have still failed to bring about and sustain desired changes. There are deeply ingrained flaws in the public sector staff's system of motivation and dedication that no amount of outside intervention can affect. My change of view relates to the greater openness I now have for exploring options that include the privatization of certain functions, at least in health, in even the poor rural areas. The truth is that privatization has already occured, but is 'under the table'. Staff is charging fees, is doing private home visits and/or is selling drugs on the side for profit. Given this fait accompli, one might as well stop the farce and stop this unhealthy mix which, in a way, is costing the country double: by keeping up the bottom heavy public sector payroll and by the beneficiaries using the private services of the same staff, because it perceives it gets more personalized attention (let alone all the over-prescribing we see as private practitioners try to make more money).

I remain firm on calling for close controls once selected privatization is given the green light; I think controls will be cheaper than keeping a highly inefficient operation in an environment of ever falling public resources.

With all this (...and so much more), is development work still exciting to me? I think yes. But again, a qualified yes.

I think the Western model of development has, so far, miserably failed to endorse a realistic conceptual framework of the causes of under or maldevelopment that has the courage to put the political and economic causes of worldwide poverty, ill-health, high morbidity/mortality and malnutrition in the proper perspective so as to give those causes the needed priority for more determined actions. In that sense, I continue to feel guilty of being part of this system. I feel I'm being instrumental in changing things just to leave them the same way. But I want to think that, over the years, I have contributed my small grain of salt to expose, demystify and correct some of the flaws of a technocratic (D)evelopment model oversold (not always in good faith) for its potential impact (see attached list of essays).

On the other hand, having now been working in a genuine socialist country, I cannot but see that some of the problems and obstacles in the path of development are the same, and much work is still needed.

I now settle for (d)evelopment work with less grandiose expectations, not missing any opportunity to raise awareness about its contradictions, always trying to stay faithful to my ideological convictions. In this way --despite alternating between depression and (small) euphoria-- every day continues to be a challenge to me .


Claudio Schuftan

Hanoi, March 1998.

From:Claudio Schuftan avivaatnetnam.org.vn

Date: Tue, 10 Mar 1998 20:27:22 -0700

Subject: Ngonut: Some food for thought






It is not easy to say what is really empowering in community developmen work. Any attempted operational definition will (always) carry a certain bias depending on the conceptual glasses one is wearing. What is clear is that --in a mostly zero-sum game-- the empowerment of some, most of the time, entails the disempowerment of others --usually the current holders of power.

Moreover, different local contexts may make the same action(s) sometime empowering, other times not. Also, empowering people in community develpoment work may sometimes be dangerous; it can well trigger repressive actions by the authorities.

Empowerment is not an outcome of a single event; it is a continuous process that enables people to understand, upgrade and use their capacity to better control and gain power over their own lives. It provides people with choices and the ability to choose, as well as to gain more control over resources they need to improve their condition.

It expands the 'political space' within which Assessment-Analysis-Actio processes operate in any community.

What follows is a rough taxonomy of what to look for in the well established community development approaches of Service Delivery, Capacity Building, Advocay and Social Mobilisation when assessing the degree to which they (can) really empower people --as seen through the glasses of the author.

The tables below are, therefore, not checklists, they are primers; the are illustrative rather than definitive; they will have to be adapted to each individual situation being appraised and can be amended and use as needed. They apply mostly to a Third World type of setting.

Within each of the four development approaches covered, actions are listed in no particular order. As can also be seen, several actions ar relevant as a means of empowerment in more than one of the four approaches.


"Service delivery can be characterised as the approach to community development that addresses actions directly related to immediate causes of maldevelopment; it provides a usually structured set of services to defined beneficiaries. Service delivery is most often sectoral, e.g. health, education, agriculture, other --and per-se tends not to be very sustainable."


-Providing services in a gender sensitive + culture sensitive way.

-Using existing local human resources whenever possible.

-Most people in the community understand the rationale behind the services being offered.

-Community representatives participate in making decisions about the services being delivered.

-Training of staff is mostly competence-based, in-service, aimed at behavioural change and followed by regular support supervision.

-People cease to be passive receipients of services delivered by government and others; they demand a role of responsibility for themselves, especially in determining the type, quality, quantity, place and focus of such services; they take part in both the decision-making process and in the delivery mechanisms.

-Assuring a continuous flow of information between the providers and the end users of services enabling the latter to be equal partners in the planning, delivery, management and evaluation of those services.



"Capacity building can be characterised as the approach to community development that raises people's knowledge, awareness and skills to use their own capacity and that from available support systems to resolve the more underlying causes of maldevelopment; capacity building helps them better understand the decision-making process; to communicate more effectively at different levels; and to take decisions, eventually instilling in them a sense of confidence to manage their own destinies.

Capacity building strengthens the Assessment-Analysis-Action process in the community and, therefore, leads to more sustainability".


-Enabling individuals/families/communities/organisations (through information, training and organisation) to continuously upgrade their ability to know, analyse and understand their situation and their problems.

-Coming up with a shared Conceptual Framework of the causes of the problem(s) at hand.

-Exposing people to relevant information, especially about the real underlying and basic causes behind their problems, so as to change their perceptions. (Includes warning people about 'misinformation' they are exposed to and replacing it).

-Raising people's consciousness to legitimise their claims. (i.e. aimin training at behavioural change).

-Changing people's perception of their potentials to forge a new reality.

-Investing in human resources development.

-Increasing people's awareness of what is permissible and fair to do.

-Building growing constituencies for people's rights-based strategies.

-Using explicit Assessment-Analysis-Action processes and capacitating people in their use and practice (i.e., people themselves collecting, interpreting and using information for action).

-Emphasizing the provision of skills that lead to community ownership of the interventions undertaken.

-Giving high priority to literacy, especially for girls and women.

-Boosting women's negotiation capabilities, as well as their skills and confidence. Capacity building is culture sensitive and cognisant of women's needs.

-Raising consciousness about the natural environment.

-Emphasizing the training of local leaders, teaching them to carry out social and political mappings that point to the current structure of control of resources, as well as to carry out decision audits of who currently makes what decisions about what.

-Training community animators/validators as local strategic allies to introduce new ideas.

-Preparing people to act on the determinants of their surrounding reality so they can press-on with needed advocacy and effective lobbying.

-Effecting changes in personal habits and practices and giving people a better income capacity and access to available support systems.

-Building the mental infrastructure for social mobilisation.



"Advocacy can be characterised as the community development approach that sets in motion the dynamic process of developing concensus and a mandate for action. It brings together like-minded allies with a common goal."


-Convincing and persuading people.

-Increasing people's demand for, access to and utilisation of services (e.g.,health, education) and their access to the means of production.

-Emphasizing work towards the erradication of poverty. (Empowerment implies a reduction of, at least, extreme poverty).

-Increasing household disposable income including actions that create new employment opportunities, democratise access to credit and set up income generation activities for women.

-Fostering actions that decrease the workload of women and give them options for birth spacing.

-Promoting the shifting of the explicit control of resources more to women.

-Promoting a more local control of resources. Striving for more equity, economic justice and fairness and aiming at decreasing the skewedness in the distribution of income and wealth.

-Addressing social and tribal or caste issues.

-Promoting all elements and means of sustainable development.

-Influencing community development-related actions by assuring active people's participation in informed decision-making and by focusing more on what is possible and doable, and particularly on how it can be done.

-Raising people's consciousness about what their rights are and translating them into specific claims.

-Improving the access of end-users and facilitators to reliable community development-related information.



"Social mobilisation can be characterised as the community development approach that gets people actively involved in development Assessment-Analysis-Action processes that address the more basic causes of maldevelopment in an effort to increase their power base; it engages them in actions to fight for their rights and to gain more control over the resources they need. Social mobilisation aims at mobilising resources, placing concrete demands, networking, building coalitions an consolidating sustainable social movements."


-Articulating people's felt needs into concrete demands and these into claims sothey can ultimately better fight for their rights.(i.e., mobilisation of their social power).

-Mobilising people's own and other identified needed resources including those not previously used.

-Exerting an effective demand for resources other than those readily available.

-Organising people's actions to effectively use and progressively control external resources.(leading to a consolidation of a new and growing power base).

-Networking with others, striving for achieving a critical mass of concerned people (locally and externally), and building coalitions.(i.e., expanding the power base through solidarity).

-Operating in complete Assessment-Analysis-Action cycles, thus collectively identifying problems, searching for solutions and implementing them to, then, assess their impact...and so on.

-Giving people power over decisions thus increasing their self-esteem and self-confidence.

-Increasing local democracy with people (especially women) participating more actively in local government.

-Decentralising decision-making, including shifting control of finances to the local sphere. (i.e., devolution of power).

-Working proactively and concertedly with all strategic allies.


Claudio Schuftan MD

Box 24, Intl.Post Office, Hanoi, Vietnam. Email: avivaatnetnam.org.vn

From: Claudio Schuftan avivaatnetnam.org.vn

Date: Mon, 16 Mar 1998 23:01:26 -0700

Subject: Ngonut: letter from an old socialist






A Household Entitlements Revolution ('HER') very logically complements the existing Child Survival Revolution (CSR) as a development strategy.

Beyond sloganeering, this women-centered approach to family security departs from the principle that there is an array of household (HH) securities that are indispensible for the wellbeing of HH members in general and for the women in it in paricular. What remains a crucial and mostly unresolved challenge in development, though, is resolving th poor HH members', especially women's, actual access to (and utilization of) the resources and services that lead to the fulfillment of all thei basic entitlements.

The main entitlements to which HHs in general and women in particular need to have access to are the ones required to provide them with security in:

- Food [macronutrients (cals.) and micro-nutrients].

- The care of children and the support of women to do so and to take care of their own gender-related needs.

- Health and sanitation.

- Water supply.

- Housing (shelter).

- Income (in kind/in cash, including employment opportunities and access to credit/subsidies, especially for women).

- Education (pre-primary/primary with a focus on girls, female literacy/numeracy).

- Fuel (energy).

- Legal protection (mainly, but not only of children and women's rights).

- Physical environmental safety.

- Physical personal safety, including women's personal safety from domestic violence.

The minimum standards (or threshholds) and the best indicators for each of these entitlements need to be worked out by community representative themselves, together with experts, in each different local context.

There is nothing terribly new in this HH and women-centered approach to entitlements. It rather represents a variation or a shift within the current (Western) ruling development paradigm.

It just (re) packages well known basic HH, children's and women's right in a way that more explicitly emphasizes the need for a new set of priorities that trascends current development orthodoxy.

But the most important aspect of this approach is, perhaps, that it can bring WIPHN closer to (and to focus its work more on) the underlying an basic causes of abuse, neglect, ill-health, malnutrition and unnecessar mortality of women and children.

Under this approach, the major focus of attention in the search for solutions for the above causes, therefore, shifts: it now starts with a major and explicit effort to identify insecure HHs and women living insecure lives. Only then, does attention turn to devising a more comprehensive set of interventions that, as much as possible, simultaneously addresses several of the insecurities identified. (It is important to notice that a few of these insecurrities are always 'limiting', in the same sense that a limiting aminoacid restricts the biological value of a protein -- regardless of the ample supply of all other aminoacids needed to synthesize the protein, the absence of even one limiting aminoacid stops the synthesis of the protein altogether).

This metaphor illustrates well what the orthodox (Western) approach to development has consistently neglected.

Locality by locality, the identification of vulnerable, insecure HHs an women should be simultaneously accompanied by the identification of the (proven, successful) coping mechanisms utilized both by HHs and women t get access to the different resources and services that lead to the fulfillment of their entitlements under given difficult local condition and circumstances; (these coping mechanisms will be very different in urban as opposed to rural settings and will have to be surveyed differently).

What becomes the challenge, then, is to find interventions that support the adoption of those proven, successful coping mechanisms by a larger proportion of at-risk women and HHs in that particular environment.

Ultimately, this becomes the basis for targeting interventions more cost-effectively. The widespread communication of these coping mechanisms to local communities could also become a key challenge for WIPHN using novel Education Information and Communication (EIC) approaches.

All this, of course, requires a much heavier emphasis on national and/o local social mobilization programs and a better coordination amongst them. Coordination amongst UN and bilateral agencies in the field --as well as particularly with NGOs and grassroot organizations at country level-- would need to get more prominence and urgency to maximize mobilization capabilities, especially if and when the new approach here proposed starts to be accepted by others.

In practical terms, what this means is that sectoral approaches --health (EPI, ORT, FP), nutrition, water, basic education, women's affairs, etc.-- need more integration. WIPHN could again play an important advocacy role in this. But such a drive for integration also has to come from the HH and local women's organizations level up. This in turn, means that sectors and programs first have to jointly embark i the identification of insecure HHs with women living insecure lives.

If all sectors jointly start by identifying these insecure HHs, by identifying working-coping-mechanisms used by some of them and then contribute their findings to a community participatory forum, a great contribution would be made to a more appropriate search for more workeable and sustainable solutions. (Ideally, local organized groups should actually actively participate from the planning of the HH survey on). If such community fora do not yet exist, preliminary efforts will have to be made to organize them, probably working with local NGOs.

If we are to solve entitlements shortcomings of women at the HH and other levels, we have to subsequently tackle (at least) a few of the more crucial of them at the same time; if not, the question arises: How effective is it to continue trying to tackle one entitlement at a time..? Health or nutrition alone cannot be significantly improved without resolving the access questions related to other entitlements!

Interventions chosen do not need to (and probably will not) be new, but will be combined and focused in a way that different relevant causal levels are tackled, using some tried and perhaps some new approaches to solve old problems expressed as felt needs by community representatives especially women. Some interventions will be manageable with the exclusive inputs (resources) and organization (mobilization) of community members and existing women's organizations, others will require some form of public pressure and lobbying thus translating felt needs into effective demands. Both of these, the internal and the external dynamization processes together, ultimately lead to the indispensible empowerment of the organized community.

The approach here proposed does not lend itself for a grandiose national-scale scheme. Its focus has to be intensive rather than extensive. It calls for a gradually growing set of mostly local interventions that can best start in the geographically most vulnerable region(s) or district(s) of the country.

The pilot implementation of this HH and women-centered approach could best be achieved through operations research activities. The surveying of HHs and women for risk and coping mechanisms can be the subject of a 'rapid assessment' methodology. The communication of the results of these surveys to the organized local groups would then be followed by some local collective decision-making. All of us could help finding funds for some of these community-based interventions and could help lobbying for some of the others that are more nationwide in scope.

This open letter is published to encourage discussion and to seek enrichment of the ideas here presented. It is open to constructive criticism and will need to be expanded before the concepts herein can b applied in the field.


Claudio Schuftan MD

Email: avivaatnetnam.org.vn

Date: Fri, 20 Mar 1998 12:41:00 +0530

From: Deepti Chirmulay

Subject: Re: Ngonut: letter from an old socialist


All the discussions on development, be it of children, women, tribal, other

disadvantaged groups, end in the identification of need for a flexible &

'integrated approach'. However, despite this, all developmental aid and

programmes end up being limited, structured and sectoral! Why is this so?

This needs stakeholder analysis and identification of necessary remedies!

As for the woman-centered approach, the mechanism for operationalizing this

has to be through development of 'local' - functionaries/ women /

counsellers, and development of institutional support structures. As was

discussed in the earlier 'food for thought' note, empowerment of

disadvantaged group automatically means reduction in power or interests of

now powerful groups. Any local person thus working with this approach would

face intense opposition locally. This needs to be countered by development

of organizational structures and mechanisms locally to support this functionary.

We at BAIF, Pune, India are trying to take up multicentric pilot project for

operationalizing a simillar approach, involving local NGOs.


Deepti Chirmulay MD

BAIF Development Research Foundation,

314 /1, Warje, Pune 411029 INDIA

Email : baifatwmi.co.in

Date: Wed, 18 Mar 1998 10:38:57 +0000

From: Michael Golden <m.goldenatabdn.ac.uk>

Subject: Ngonut: Free/low cost publications on Food and Nutrition


Ann Burgess, of the Nutrition Society (UK) has compiled a list of Free or low-cost publications that members, particularly those in the more isolated places and all those who have major constraints with getting literature may wish to receive. Please send requests straight to the publishers and not to Ngonut, Ann Burgess or the Nutrition society.



compiled by The Nutrition Society, 10 Cambridge Court, 210 Shepherds Bush, London W6 7NJ, UK

These English-language publications give up-to-date information on human nutrition. Most are free to people working in low income countries - but check before you order.

"Breastfeeding Briefs" from International Baby Food Action Network / Geneva Infant Feeding Association, CP 157, 1211 Geneva 19, Switzerland (breastfeeding)

"Child Health Dialogue" from AHRTAG, 29-35 Farringdon Rd, London EC1M 3JB, UK. <harrison.katahrtag.org> (control of child diseases particularly malnutrition, diarrhoea, malaria, measles and respiratory infections)

"Community Eye Health" from International Centre for Eye Health, Institute of Ophthalmology, 27-29 Cayton St., London EC1V 9EJ, UK (eye health, vitamin A deficiency)

"Field Exchange" from Emergency Nutrition Network, Dept Community Health & General Practice, 199 Pearse St, Trinity College, Dublin 2, Ireland. <foreillyattcd.ie> (nutrition in emergencies)

"Food, Nutrition and Agriculture" from Food Policy and Nutrition Division, Food and Agricultural Organization, 00100 Rome, Italy. (food, nutrition, food policy, food regulations)

"Footsteps" from TearFund, 100 Church Rd, Teddington TW11 8QE, UK. <imcattearfund.dircon.co.uk> (churches, health, agriculture, development)

"Health Action" from AHRTAG, 29-35 Farringdon Rd, London EC1M 3JB, UK. <stearman.katahrtag.org> (primary health care)

"IAPB News" from International Agency for Prevention of Blindness, National Eye Institute, National Institutes Building 31, Room 6A03, Bethseda, MD 20892, USA. (eye health)

"IDD Newsletter" from Dr J.T. Dunn, International Council for Control of Iodine Deficiency Disorders, Box 511, University of Virginia Medical Centre, Charlottesville, VA 22908, USA. <jtdatvirginia.edu> (iodine deficiency research, policies, country reports)

"I/D/E/C/G/ Annual Report" from Executive Secretary International Dietary Energy Consultancy Group, c/o Nestle Foundation, Box 581, 1001 Lausanne, Switzerland. (activities, publications and research on dietary energy)

"IFPRI Report" from International Food Policy Research Institute, 1776 Massachusetts Ave NW, Washington DC 20036, USA. <ifpriatcgnet.com>(food security, food policy, research)

"Learning for Health" from Education Resource Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. (health promotion)

"Mothercare Matters" from Mothercare Matters, John Snow Inc., 1616 N. Fort Myer Drive, 11th floor, Arlington, VA 22209, USA (maternal and neonatal health/nutrition)

"Nestlé Foundation Annual Report" from Nestlé Foundation, 4 Place de la Gare, CH-1003 Lausanne, Switzerland (research)

"NFI Bulletin" from Nutrition Foundation of India, 13-37 Gulmohar Park, New Delhi 110049, India. (nutrition research, programmes, India)

"NU News on Health Care in Developing Countries" from International Child Health Unit, University Hospital, S-751 85 Uppsala, Sweden. (health care, nutrition)

"Nutrient News" from National Institute of Nutrition, Tamaka, Hyderabad 500 007, India (nutrition, India)

"Nutriview" from Dr M Blum, Hoffmann-La Roche AG, Dep. VME, CH-4070 Basel, Switzerland. <max.blumatroche.com> (micronutrients, nutrition)

"OMNI Update" from OMNI Project, John Snow Inc., 1616 North Fort Myer Drive, Arlington, VA 22209, USA . <omni_projectatjsi.com> (micronutrients, USAID projects)

"PAMM Newsletter" from Program against Micronutrient Malnutrition, Dept.

International Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, Georgia 30322, USA. <vanderhaatsph.emory.edu> (micronutrients, training)

"Safe Motherhood" from Division of Family Health, World Health Organization, 1211 Geneva 27, Switzerland. <abouzahatwho.ch> (maternal health)

"SCN News" from ACC/Sub-Committee on Nutrition, c/o WHO, 1211 Geneva 27, Switzerland. <accscnatwho.ch> (nutrition, UN & other agencies)

"Sight & Life Newsletter" from Task Force SIGHT & LIFE, PO Box 2116, 4002 Basel, Switzerland. <martin.friggatroche.com> - funded by Hoffman-La Roche Ltd (xerophthalmia)

"World Food Programme Journal" from WFP, Via Cristoforo Colombo, 00145 Rome, Italy. (feeding programmes, food aid)

"Xerophthalmia Bulletin" from Dr D.S. McLaren, International Centre for Eye Health, 27 Cayton St, London EC1V 9EJ, UK. (vitamin A, vitamin A deficiency)

The Nutrition Society thanks everyone who supplied information. Please let us know of other useful publications by sending an email to <annburgessatsol.co.uk>

Information of other useful publications will be distributed on ngonut


Ann Burgess, Nutrition Consultant

Craiglea Cottage, Glenisla, Blairgowrie PH11 8PS, Scotland, UK

Ph: +44 1575 582218


Best wishes,

Prof. Michael H.N.Golden