Participatory approaches in community nutrition
(see also :
Community participatory planning process for nutrition improvement)
Conoscenze su le tecniche partecipative Florence Egal 17.03.99
Participatory approaches in community nutrition Maarten Immink 17.03.99
Participatory approaches in community nutrition Marcia Griffiths 17.03.99
Participatory approaches and refugees Alison Tweeddale 29.03.99
Re: Participatory approaches and refugees Aliou Ayaba 29.03.99
Re: Participatory approaches and refugees Paul D Sommers 02.04.99
Participatory approaches and refugees Aliou Ayaba 02.04.99
Re: Participatory approaches and refugees Alison Tweeddale 05.04.99
Participatory approaches and refugees Alison Tweeddale 07.04.99

Date: Wed, 17 Mar 1999 15:31:51 +0100

From: "Egal, Florence (ESNP)"

Subject: Ngonut: Participatory approaches and refugees


-----Original Message-----

From: Lindemann, Tomas (SDAR)

Thursday, March 11, 1999 4:06 PM

Subject: Conoscenze su le tecniche partecipative


The Consiglio Italiano per i Rifuggiati (CIR) is initiating a programme on refugees based on participatory approaches. They are searching for examples where such approaches have been pursued in Europe.


Grazia Curalli e Germana Monaldi may be contacted on:


telefono: (06) 69200114


Please copy

Thank you!

Wed, 17 Mar 1999 15:39:47 +0100

From: "Egal, Florence (ESNP)"

Subject: Participatory approaches in community nutrition


A bit late, but it will be useful anyhow... I will be happy to send back the collated info to people interested.


Florence Egal, Nutrition Programmes Service, FAO


-----Original Message-----

From: Maarten Immink [] Sent: Wednesday, March 17, 1999 1:07 PM


Tomorrow I'll participate in a meeting, in which will be discussed the organisation of a workshop related to community-level rehabilitation and prevention of child malnutrition. The workshop relates to a proposal of setting up a network of community-level nutritional rehabilitation and prevention centres. So far the approach is fairly top-down and technical in the sense of pure nutritional approaches. I am trying to get a much more participatory approach introduced, and have also proposed that perhaps a few people of other, probably Latin American, countries could be invited, to share their experiences with participatory, community-level nutrition programmes. The idea seems generally accepted, and tomorrow I should present a short list of organisations/projects that have applied participatory approaches. We have a few here in Brazil, including ones that UNICEF supports. But I am wondering if you could make some quick suggestions for some Latin American countries. I don't need much information right now, maybe just: country, organisation, name of programme/project, and a one line description.

This would be great. Very sorry about the short notice, but I only now found out that I am expected to have this information before I leave for Sao Paulo this evening. Anything at all would greatly be appreciated. Thank you so much.



Date: Wed, 17 Mar 1999 16:37:00 -0500

From: The Manoff Group

Subject: Ngonut: Participatory approaches in community nutrition



Greetings. I will be brief and can supply more information if you are interested.

There is a fabulous integrated community health and nutrition programme (AIN: Atención Integral a la Niñez) in Honduras. It is out of MSP with primarily USAID support at this moment but other donors are joining. It is a preventive, promotive nutrition work with an overlay of curative, IMCI activities. If you want to know more, let me know or if you want a contact in Honduras.



Marcia Griffiths

The Manoff Group

Date: Mon, 29 Mar 1999 14:59:23 -0500

From: Alison Tweeddale Alison_TweeddaleatWorldvision.CA

Subject: Re: Participatory approaches and refugees


Hello all -

At World Vision Canada we recently held a workshop with partners from Latin America. A major learning focus of the week was the Hearth Model, which is a programme for rehabilitating malnourished children within their communities. To summarize the programme briefly, Hearth uses weight for age measurements on all children in a community to identify those who are well-nourished (known as "positive deviants"), then interviews the mothers of these children. From the interview data a menu of locally available foods is developed to provide an extra meal and snack daily to the malnourished children. The children eat together for 2 weeks in one home (the "hearth") then their own mothers prepare the supplemental food at home for a further 2 weeks. This positive deviant approach to communities addressing their own malnutrition issues has been very successful. If anyone is interested in more details, please let me know.


Alison Tweeddale, Nutrition Officer

World Vision Canada, 6630 Turner Valley Road

Mississauga, ON L5N 2S4

(905) 821-3033 ext3402,

Date: Mon, 29 Mar 1999 15:53:07 -0800 (PST)

From: aliou ayaba <>

Subject: Re: Participatory approaches and refugees


Dear Alison,this sound great!I would like to have more details,but still I have couple of questions.

1-The approach seems to solve the problem of lack of nutrition education but this is only a small part of malnutrition issue, what is done about economic problems of the families ,who pays for the meals and how long will the approach be implemented?

2-Why did they use only weight for age since we all are aware of the pitfalls in using a single anthropometric indicator.

I will be glad to continue the discussion.


Dr AYABA A MD, MPH University of Washington.

Date: Fri, 02 Apr 1999 12:10:58 +0100

From: Paul D Sommers <>

Subject: Re: Participatory approaches and refugees


Is home food growing a component in your rehab. activities? If so, please explain the process by which you modify behavior with household decision makers in relation to specific dietary gaps through food growing


Paul Sommers

Date: Fri, 2 Apr 1999 11:03:22 -0800 (PST)

From: aliou ayaba <>

Subject: Re: Ngonut: Participatory approaches and refugees


Hi all! I would like to have some details of this approach I really appreciate.How long should such intervention last to be effective in the population?Was there any refusals for participation? Please Alison,how can I have access to more details about the intervention?


Date: Mon, 05 Apr 1999 14:49:26 -0400

From: Alison Tweeddale <>

Subject: Re: Participatory approaches and refugees


Thanks to everyone for the enthusiastic show of interest for the HEARTH Model! At World Vision Canada we have not yet implemented HEARTH in our programmes but Save the Children has extensive experience with HEARTH and has produced a field guide. The Guide was written by Monique Sternin, Jerry Sternin and David Marsh, and is entitled Designing a Community-Based Nutrition Program Using the Hearth Model and the Positive Deviant Approach - A Field Guide. This would be the best resource for all those interested in finding out more and can be ordered from:

Aurea Cruz
Save the Children
54 Wilton Road
Westport, Conneticut
USA 06880
tel: (203) 221-4085
fax: (203) 221-3799

Another resource is a book entitled Hearth Nutrition Model: Applications in Haiti, Vietnam, and Bangladesh, edited by Olga Wollinka et al and published in 1997 by BASICS. This is a compilation of articles on the theoretical background and experiences in application of HEARTH and is available from:

1600 Wilson Blvd., Suite 300
Arlington, VA
USA 22209
tel: (703) 312-6800
fax: (703) 312-6900

I hope this is helpful. It would be interesting to hear from anyone who has already worked with HEARTH in the field.



Alison Tweeddale

World Vision Canada, 6630 Turner Valley Road

Mississauga, ON, L5N 2S4 Canada

tel: (905) 821-3033 ext3402, fax: (905) 821-1825

Date: Wed, 07 Apr 1999 08:19:07 -0400

From: Alison Tweeddale <Alison_TweeddaleatWorldvision.CA>

Subject: Re: Participatory approaches and refugees


Dear PauI, I believe Drs Warren and Gretchen Berggren copied you on their response to your questions. But for all others who may be interested, here are comments from a couple of the "founders" of the HEARTH Model regarding home food growing and behaviour modification strategies:

Home food growing has not yet been included in the HEARTH approach, but the implications for agriculture are obvious to agricultural workers with concomitant projects. Resources could not be found to add this component formally so far. In Vietnam, severe malnutrition dropped to less than 1% and moderate malnutrition decreased significantly in a community wide basis; however, no formal inquirey documented the specific food-frequency or agricultural changes. Vietnam's National Institute of Nutrition did confirm that, compared to non-intervened villages, the community wide-decrese in malnutrition was sustained over two years (ref: Chapt 4 in HEARTH Nutrition Model:-- Applications in Haiti, Vietnam, and Bangladesh; Wollinka, ed., published by BASICS, 1600 Wilson Blvd., suite 300; Arlington Va 22209; FAX 703 312 6900.) Save the Children/USA also has a manual.

On accomplishing behavioral change, we have the following comments: Dr Muriel Elmer, the expert on participatory adult education who helped with the HEARTH model tells us that "it takes, on average, 21 trials for an adult to change a habit". (Ibid Chapt 2). Thus, the 28 days of HEARTH training may cover the obligatory period as far as child-feeding behaviors are concerned. Other adult education elements in HEARTH that help lead to behavioral change include, according to Dr. Elmer and to educator Monique Sternin who helped pilot the project in Vietnam, the importance of discovery, of observation, of trial of something new over and over again in a "safe " environment, the positive re-inforcement of peers, and last but not least what the mothers of malnourished children in a HEARTH program state as the "change in the child" over the 28 days:--"more active, playful and mischievous!" say the mothers; "this [after-HEARTH] child is a different child!". Contrast THIS DISCOVERY WITH one where somebody simply demonstrated (once or twice) a new recipe. Peer acceptance is part of the picture:--an informal "women's group" ofen grows up around the HEARTH and women observe each other's children, helping out from time to time with a child who is temporarily anorexic due to an infection.. Could these principles be applied in agriculture??

It should be recalled that the HEARTH is, for any given neighborhood, an "itinerant training workshop" for mothers of malnourished children lasting 4 weeks, using local foods available in the marketplace. These key foods are discovered through an exercise that allows volunteer mothers to visit the homes of well-nourished children (the "positive deviants", and there are some in every village!). This exercise is a key one; it ,must be repeated in village after village. Food frequency charts are then derived from extremely simple 24 hour diet recalls, in such a way that villagers can "discover" the appropriate foods, how often they are fed, and how they are prepared. If one drops this exercise, one loses the adult participatory learning mode that is crucial: adults are more apt to change behavior through discovery that something seems to work than through through parroted messages! Then the "skill building approaches" using participatory adult education techniques are applied in HEARTH. Mothers are not easily convinced that children need more local food more often, and that the more energy-dense foods are safe and well tolerated. However, with two weeks practice in a volunteer neighbor's home, and with two weeks on their own (under supervision of that same neighbor), the "change in the child" is usually obvious. (note that treatment for illness, if necessary, occurs before the HEARTH workshop). One supposes that farmer s might have planted more vegetables, for example, but we don't yet have that kind of data.

In Vietnam, the "positive deviant" families were harvesting and eating wild greens and shrimp (free for the taking from family rice paddy canals) whereas families with malnourished children tended to neglect these items in their regular dietary fare. Little agricultural change was implied.

In Haiti, there are seasonally available wild greens, often neglected. But agronomists in the Save the Children project area, at the same time, were emphasizing to local farmers the need for soil conservation methods and importance of planting vegetables.

My guess is that Save the Children, World relief and others would wecome the opportunity to further develop this model with agriculture implied. I have forwarded the questions to our Haitian "confreres" and our friends who worked in Vietnam and Mozambique. Warren and Gretchen Berggren

Alison Tweeddale