First of all, it must be stated that we are quite found of planning.We believe it is both necessary and useful. Thailand has already had five Nationl Economic and Social Development Plants.As a planner I first joined the National Economic and Social Development Board in 1960- just in time for the preparation if the First National Plan.
From my personal experiences, I can confirm that all our five plans invariably contain a nutrition component. The first three plans,going from 1961 to 1976, followed the health approach to the problem of malnutrition with emphasis on curative action. During the Fourth Plan we realized that there were many socioeconomic factors which contribute to the malnutrition problem.We therefore turned to a more delvelopmental approach with more intersectoral linkages.Afood and Nutrition Plan was formulated and incorparated in the National Plan for the first time.However. by the end of the Fourth Plan,the Nutrition Program was not fully implemented and several observationa indicate that many of yhe policies have not been very successful in attaining the set objectives.
The Fifth National Economic and Social Development Plan
The formulation and the launching if the Fifth Five-Year Plan,starting in October 1981, represents a major turning point in our approach to planning. While the nutrition program continues to be included in the Fifth Plan, we have adopted a different planning concept.
Our past Plans employed nutrition programs to eradicate malnutrition. But the Fifth Plan recognizes that malnutrition is a symptom of poverty and ignorance. We now use nutritional programs as stopgap measures to relieve the most severe froms of malnutrition until systematic solutions bring about longterm sustained improvement.
The main thrust of the Fifth Plan’s nutrition policy does not lie in its nutritional program but in its program of poverty alleviation and development of backward areas. This is a major change in development appoach from previous Plans which concentrated almost solely on overall growth while expecting benefits from such growth to trickle down to rural areas.
The Poverty Alleviation Plan is a rural inveatment program targeted at high povery concentration areas which inculde 216 districts and 30 subdistrict in 37 provinces of the North-east,the North and the South. The objective of the Poverty Alleviation Plan is to improve the quality of life for 7.5million rural poor by assisting them to overcome their povertyrelated problems of hunger, sickness,ignorance and general deprivation. To achieve this objective the Plan employs four policy instruments. 1) Rural job creation for three million people during the dry season in 24 poor,high-unemployment districts and subdistricts.2)Village development projects such as village fish-ponds. Village water resources, small-animal disease control project,cattle and buffalo bank and other rural-poor focused development projects to improve the socioeconomic conditions of over a million people in 5,000 villages.3) Provision of basic services such as health facilities, nutrition and clean water supplies, and educational material to the target areas. And 4) help to increase agricultrual productivity and the production of nutritive foods through a food production for nutrition peoject to benefit 160,000 children and 80,000 pregnant women,an upland rice improvement project covering 65 districts in 16 provinces and soil improvement profects.
All these projects have cost several billion bath of Government budget.
At the same time, the Fifth Plan recognizes that the poverty alleviation projects will take time to raise the incomes and the aweareness of rural poor sufficiently to eliminate malmutrition altogether.Until this is accomplished, stopgap measures are necessary to relieve the worst cases of malnutrition,especially those among vulnerable groups such as children and pregnant and lactating women.
Again,the Fifth Plan has Introduced targeted interventions with specific objectives: 1) to eliminate third-degree PEM among infants and preschool children,pregnant and lactating women,2) to reduce second and first-degree PEM among preschool children by 50% and 25% respectively, and 3) to reduced PEM among school-sge children by 50%
To achieve these objectives, the following instruments are employed: 1)nutrition surveillance across the country to identifly malnourished children and pregnant and lactating women through anthropometric measurements: 2)provision of supplementary food to 230,000 preschool children with third degree malnutrition;3) subsidized school lunches for 5,000 school;4) promotion of high-nutrition food production and distribution in 246 high-poverty districts;5) improvement of sanitation and environmental health and provision of immunization for children to increase the effectiveness of nutrition programs;6) nutrition education, including nutritional value of foods and importance of breasifeeding and so on to pregnant and lactating women and the general public through house-to-house visit. The people covered under this program are around 5 million.In addition there are demonstrations which will cover 2.5 million people;7) nutrition related reseach, training and extension.
It can,therefore, be concluded that. Unlike earlier Plans, the current Plan’s nutrition policy follows the economist’s view on nutrition in pursuing policies which attack the root cause which are poverty and ignorance rather than the symptom or malnutrition while at the same time nutritional programs are used as stopgap measures to relieve the worst froms of malnutrition.
Unfortunately, however, the relative emphasis on these various nutrition programs and hence the budget allocation to each have not been based, as they should, on their relative cost-effectiveness in solving malnutrition problem. Unlike poverty alleviation projects which have been introduce only recently and cannot be evaluated yet, the nutrition intervention programs have been in effect for a long-enough period to have their impact assessed and relative cost-effectiveness evaluated. Such an assessment may revel that certain programs are indeed very effective and should be expanded while others are costly and ineffective and should be deemphasized or discontinued altogether. Assessment of the cost effectiveness of nutrition planning if the maximun reduction of malnutrition is to be accomplished in the shortest possible time with a limited budget.
In fact the evaluation of the 1982 nutrition program reveals that the problem of PEM has been somewhat reduced.Out of 1.5 million children weighed in 1982, the number with malnutrition problem has been reduced from 53 percent in pre-Fifth Plan period to 48 percent in 1982.