Lessons on sustainability for community health projects
MEDLINE Abstract: In the Gambia a community-based strategy was tested, in which a traditional snack food was promoted as a dietary supplement to improve women's nutrition during pregnancy. The results suggest how community nutrition programmes can be designed so as to favour sustainability. By and large, the lessons learned are also applicable to other types of community health programme.; The Gambian Food and Nutrition Association (a nongovernmental organization) ran a pilot project in 4 villages to test a community-based strategy to promote the consumption of a traditional snack food by pregnant women in order to improve their nutrition. The project involved production and distribution training, nutrition education, community production, supervision, and collaboration with the Ministry of Health. After 6 months (in January 1994), an evaluation was performed using rapid assessment procedures to 1) assess community attitudes and beliefs regarding maternal nutrition, 2) assess views of those involved about the promotion of the snack food, and 3) elicit community concerns and suggestions for future maternal health interventions. While the project was successful in producing and promoting the snack food, and the pregnant women felt that their health had improved and that their babies were bigger, the intervention was deemed to be nonsustainable because of certain strategic decisions and because of shortcomings in the knowledge and attitudes surrounding maternal nutrition.
Evaluation of the project revealed that the following factors contribute to sustainability in community-based maternal nutrition programs: 1) involving the community in the planning, implementation, and evaluation to promote community responsibility and feelings of ownership; 2) creating an intervention compatible with community norms and values; 3) building on existing social units and roles without overburdening community members with new tasks; 4) motivating, training, and supervising community members in the performance of clearly defined roles; 5) identifying strategies that allow communities to contribute a progressively greater amount of the resources required to sustain the program; 6) designing a simple production method that is sparing of time and that depends upon comparatively small production groups; 7) eliciting support from key male and female community leaders; 8) collaborating with community development agents; 9) providing adequate nutrition education to the community...