THE ROLE OF UNITED NATIONS INTERGOVERNMENTAL

AGENCIES AND NON GOVERNMENTAL AGENCIES IN

SOLVING NUTRITIONAL PROBLEMS AT COMMUNITY
LEVEL
1
Yaradua AI, 2 Alhassan AJ, 1 Nasir A,1 Matazu KI,1 Suleiman ZA,1 Matazu SS,3 Azik MK,1 Mohammad I

1
Department of Biochemistry, Faculty of Natural and Applied Sciences, Umaru Musa Yaradua University,
Katsina Nigeria

2
Department of Biochemistry, Faculty of Biomedical Sciences, College of Health Sciences, Bayero
University, Kano Nigeria

3
National Agency for Food and Drug Administration and Control (NAFDAC), Katsina area office Nigeria

ABSTRACT

Nutrition has a profound effect on health throughout the human life course. Every hour of
every day, 300 die because of malnutrition. Due to the dire consequences of the effect of
under nutrition, over weight and obesity on the overall well being of the community,
nutritional intervention at the community level is used as a tool to address nutritional
problems. Because nutritional interventions programs often have low quality and coverage
if they are implemented by governments. Facilitation of such programs by NGOs and
United Nations inter governmental agencies as some evidences have shown can improve
such programs delivery performance in an equitable way. Especially if the interventions
are delivered at community level as it is more cost effective.

Key words: NGOs, community, malnutrition, nutrition, obesity

1. INTRODUCTION

Nutrition has a profound effect on health throughout the human life course. Every hour of each
day, 300 die because of malnutrition. It is an under laying course of more than one third of
children’s death-26 million every year (de-Onis, 2011). But the dearth of children from
malnutrition is not registered on death certificates and as a result it is not effectively addressed
(Save the children, 2012). Even for those who survive, long term malnutrition causes devastating
and irreversible damage. Lack of nutritious food coupled with infection and illness, means their
bodies and brains do not develop properly (Black et al., 2008). At least 170 million children are
affected by stunting worldwide (Black et al., 2008). Stunted children as a result of malnutrition

1
are predicted to earn an average loss of 20% when they become adult (UNICEF, 2011). If current
trend continue the lives of more than 450 million children globally will be affected by stunting in
the next 15 years (Bryce et al., 2008). Manifestation of stunting is an indication of under
nutrition during pregnancy and early childhood (Black et al., 2013). 28 million or 15% and 5
million or 10% of under- five in south and south-east Asia; 13 million or 9.4% of under-five
children in Africa are suffering from acute malnutrition. In the worst affected countries the
national rate of wasting varies from 10-20% of the under five population (Hobbs and Bush,
2013). Over the past several decades, the issue of childhood obesity has exploded into a global
public health crisis. Worldwide in the past 30 years, rates of obesity in children have more than
doubled while rates in adolescents have more than tripled (Ogden et al., 2012). In 2014 more
than 1.9 billion adults over 18 years and older, were over weight of these 600 million were
obese, 42 million children under the age of 5 were over overweight or obese in 2013 (WHO,
2015). Low and middle income countries are now facing a triple burden of under nutrition,
micronutrient deficiency and overweight and obesity with a high prevalence of under nutrition as
well as a considerable rise in overweight and obesity and the associated risks (Popkin, 2012).
The global nutritional situation has indicated 161 million children are chronically under
nourished 51 million are acutely under nourished, 42 million are overweight
(UNICEF/WHO/WORLD BANK, 2015; Stevens et al., 2013). Intra uterine growth retardation is
a significant contributor to poor child outcomes, highlighting the need to improve the nutritional
and health status of pregnant women and women of child bearing age (Norris et al., 2012).

CAUSES OF MALNUTRITION

The determinants of malnutrition are multifaceted (USAID, 2014), ranging from individual
health status, to house hold access to safe, nutritious and divers foods; to water, sanitation and
hygiene (WASH); to feeding and caring practices; to family size and birth intervals (Khan et al.,
2006). The most immediate causes of under nutrition in children are insufficient energy and
other nutrient intake combined with infectious diseases especially diarrhea (Black et al., 2008;
Black et al., 2013). Fundamental to these basic determinants are complex array of under laying
determinants, including gender equality and women empowerment, early marriage/child
marriage, education, and environmental, socio-cultural, economic, demographic and political
factors (USAID, 2013)

CONSEQUENCES OF UNDER NUTRITION OVERWEIGHT AND OBESITY

Under nutrition increases the risk of mortality and morbidity (Black et al., 2013). Stunting
increases the risk of poor pregnancy outcomes (including babies who are small for gestational
age), impaired cognition that results in poor performance, reduced economic productivity and
earnings (Hoddinott, 2008) and future risk for overweight and subsequent non communicable
diseases (NCDs) such as hypertension and cardio vascular disease (Baker, 1997; Victoria, 2008;

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Norris, 2012). Stunting, micro nutrient deficiencies overweight and related NCDs can occur in
the same country, district, house and often in the same individual over the course of life
(Tzioumis and Adair, 2014). The most significant and endemic micro nutrient deficiencies
world- wide are; Iodine deficiency disorder-IDD (WHO/UNICEF/ICCIDD, 2007), Iron
deficiency anemia-IDA (WHO/UNICEF/UNU, 2OO1; WHO/CDC, 2004), Vitamin A
deficiency-VAD (WHO/FAO, 2005; FAO/WHO, 2002). Zinc deficiency (UNHCR/WFP, 1999),
iron, iodine and vitamin A deficiency affect at least 2 billion people worldwide (WHO, 2007),
the majority of whom are found in developing countries (USAID, 2014). It is estimated that just
over 2 billion people are anemic and just under 2 billion have inadequate iodine nutrition,
leading to decreased productivity, increased morbidity and in the case of pregnant women
increased risk of death, while 254 pre-school aged children are vitamin A deficient (WHO/FAO,
2005).Nutritional anemia, caused by deficiency of iron and other micro nutrients as well as other
factors (example parasitic infections) is one of the most widespread and dangerous nutrition
related conditions (USAID, 2014). Deficiencies in iodine, iron and zinc in early childhood can
have lasting negative effect ramification on childhood development and impaired school
performance (Brabin et al., 2001; ) Anemia during pregnancy can cause pre-term births, low
birth weight and developmental delays in children, and increase a woman’s risk of hemorrhage
and death (USAID, 2014). About 800000 child deaths per year are attributable to zinc
deficiency. Zinc deficiency is responsible for approximately 16% of lower respiratory tract
infection, 18% of malaria cases and 10% of diarrheal diseases (WHO, 2002). Micro nutrients
deficiency combined with stunting opportunities for health physical and cognitive development
(Black et al., 2013).

NUTRITIONAL INTERVENTION AT COMMUNITY LEVEL

Nutrition intervention can be specific, where intervention is at a critical point in the life cycle to
address the immediate determinant of malnutrition. For example, promotion of breast feeding,
appropriate complementary feeding and supplementation. It can also be nutrition sensitive where
it is used to address the under laying and systemic causes of malnutrition, for example family
planning; healthy living and spacing of pregnancy; water, sanitation and hygiene; nutrition
sensitive agriculture; early childhood care and development; girl and women education (Ruel et
al., 2013). For long obesity interventions were designed by policy makers or academics without
community involvement. These types of interventions tend to have limited benefits are expensive
and unsustainable. Delivering nutritional intervention as a package at the community level is
more cost effective than implementing single interventions (Adams et al., 2005; Darmstadt et al.,
2005). Community based programs and outreach workers have been shown to help reach the
poor more effectively and to achieve equity goals (Berman, 1984; Berman et al., 1987; Haines et
al., 2007; Haws et al., 2007). Government programs often have low coverage and quality, and
there is some evidence that facilitation by an NGO can improve healthcare delivery performance

3
in an equitable way (Busham et al., 2002; Soetas and Griffith, 2003; Schwartz and Bushan,
2004a; Schwartz and Bushan, 2004b; Loevison and Harding, 2005).

NON GOVERNMENTAL ORGANISATIONS

A non-governmental organization (NGO) is a legally constituted entity created by private

organization or people with no participation or representation of any government (Lynn, 2009).
The World bank define NGOs as private organizations that pursue activities to relieve suffering,
promote the interest of the poor, protect the environment, provide basic social services or
undertake community development. NGO activities can be local, national or international
(UNDP, 2002).

The term NGO came into use in 1945, with provision in article 71 of chapter 10 of the United
Nations charter on February 27 1950. International NGOs (INGOs) were first defined in
resolution 288 (X) of the Economic and Social Commission (ECOSOC) as any international that
is not founded by an international treaty. In June 1997, the vital role of NGOs in sustainable
development was recognized in chapter 27 of Agenda21, leading to intense arrangement for a
consultative relationship between the United Nations and NGOs. Globalization throughout the
last century heightened the importance of NGOs, which have since developed to emphasize
humanitarian issues, developmental aid, and sustainable development (Lynn, 2009).

COMPARATIVE ADVANTAGES OF UNITED NATIONS INTER GOVERNMENTAL

AGENCIES AND NGOS IN COMMUNITY NUTRITION INTERVENTIONS

a. Innovation in nutrition program design and implementation

b. Flexibility in designing and modifying nutrition programs to suite local conditions and
greater opportunity for rigorous evaluation
c. Serving as repositories of specialized knowledge
d. Providing targeted public goods for communities
e. Common properly resourced management design and assistance with program
implementation
f. Greater trust and credibility of NGOs by participants, and by perhaps developed
countries, donors and firms
g. Representation and advocacy based on affiliation with poor socially excluded people
(Adapted from UNDP, 2002).

ROLE OF UNITED NATIONS INTER GOVERNMENTAL AGENCIES AND NGOS

IN SOLVING NUTRITIONAL PROBLEMS AT COMMUNITY LEVEL IN
EMERGENCY SETTINGS

Emergencies often result in food shortages and impair the nutritional status of affected
communities, in particular infants, children and adolescent, but also adults especially
pregnant and lactating mothers and older persons. Malnutrition can be the most serious

4
 public health problem and may be the leading cause of death whether directly or indirectly
(Lynn, 2008). Access to food and maintenance of adequate nutritional status are critical
determinants of people’s survival in a disaster. Micronutrients deficiencies can easily develop
during an emergency or be made worse if they are already present. This happens because
livelihoods and crops may be lost, food supplies may be interrupted; there is an increased risk
of diarrheal diseases, resulting in mal-absorption and nutrient losses, and of infectious
diseases, which suppresses the appetite whilst increasing the need for micronutrients to help
fight illness (WHO/WPF/UNICEF, 2006).

NGOs work closely with UN and government agencies to procure and move food aid into
emergency regions. World Food Program (WFP) is the UN’s food agency that works closely
with NGOs to effectively manage commodity and food distribution (United Nations High
Commission for Refugees (UNHCR), 2000). There are two mechanisms through which
nutritional and food assistance may be provided to emergency affected communities by NGOs.

a. General food distribution:- Food rations are distributed to households affected by an

emergency. It is implemented when there is an acute and severe food shortage resulting
in high mortality and malnutrition rates. WFP collaborates with UNHCR and NGOs in
providing food assistance to asylum seekers, returnees and, in some certain circumstances
internally displaced populations of concern (UNHCR, 2000).When the total number of
such beneficiaries in a country is more than 5000 the assistance is taken care of by WFP.
Below that figure, UNHCR takes full responsibility for food needs of persons of its
concern.
b. Selective feeding program:- UNHCR through its implementing partners, is responsible
for monitoring the nutritional status of the refugees through regular survey and effective
surveillance system, and for the implementation of any selective feeding program that
may be necessary. WFP participates in the planning and execution of nutritional surveys
and in the analysis and determination of the result. Decisions to implement selective
feeding programs are taken jointly by UNHCR and WFP on the basis of the joint
WFP/UNHCR selective feeding guide lines (WFP, 2000). There are two forms of
selective feeding programs
 i. Supplementary feeding program that involve provision of extra food to children
or families beyond the normal ration of their home diet (Beaton, 1982). It is used
to rehabilitate moderately malnourished persons or to prevent a deterioration of
nutritional status of those most at risk by meeting their additional needs. Focusing
particularly on young children and lactating mothers. Depending on the
prevalence of malnutrition and availability of partner NGOs, supplementary
feeding program can be provided through, blanket supplementary feeding which
provide a food supplement to all members of an at risk group in a specified
geographical area irrespective of nutritional status or through targeted distribution

5
 that provide a food supplement to moderately malnourished individuals to prevent
them from becoming severely malnourished and to rehabilitate them.
ii. Therapeutic feeding programs (TFP) :-This program is used in rehabilitating severely
malnourished persons and to provide immediate relief to those in an emergency affected
population in danger of dying because of lack of food.

RESOURCE MOBILIZATION FOR SELECTIVE FEEDING PROGRAM

It is the responsibility of the WFP during UN selective feeding program to mobilize the
following

 Edible oil and fats

 Fortified blended foods
 Iodized salt
 Sugar
 Fortified biscuits

UNHCR is responsible for mobilizing, transporting and storing sufficient quantities of food
outside WFP’s food basket. It includes therapeutic milk, and ready to eat therapeutic food
(RUTF) and non food commodities including essential drugs for treatment (UNHCR, 2006).

WFP and UNICEF cooperate in emergency and rehabilitation assistance for people affected by
natural or man-made disasters and who remain in their country of origin. As in refugee and
internally displaced persons (IDP), WFP is responsible for mobilizing food commodities needed
for supplementary feeding programs, while UNICEF has the mandate to mobilize therapeutic
foods.

NUTRITIONAL INTERVENTION AT COMMUNITY LEVEL IN NON EMERGENCY

SETTING

Since 2010, the global nutrition community has united around the scaling up nutrition (SUN)
movement (SUN, 2016). This movement brings together national governments, donor countries,
United Nations Organizations, Civil Society and the private sector to support nationally driven
process to help scale up nutrition (UNICEF, 2015).

Working with national governments and in partnership with NGOs, sister United Nations
Organizations and others, UNICEF has set out to improve nutrition for all children and women
through the creation of enabling environment which has resulted in an-evidence based,
sustainable, multi sectored nutrition action that is delivered at scale (UNICEF, 2015). This up
dated approach to multi sectored nutrition programming is intended to enable a more effective
contribution to national efforts to accelerate progress in nutrition. UNICEF supports and
advocates for evidence based nutrition specific interventions and nutritional sensitive approaches
towards solving nutritional problems at community level. UNICEF works with integration of

6
nutrition action with those from other sectors, including health, early childhood development,
social protection, water, sanitation and hygiene (WASH) and education (UNICEF, 2015).
Although UNICEF those not work in agriculture it advocates for nutrition sensitive agriculture
interventions and implementation of global standards and guide lines relating to the food
industry. The primary focus of UNICEF’s work in nutrition is on children under the age of 2 as
well as children aged 2-5 years and pregnant and lactating women. The secondary targets are
adolescent girls and women of reproductive age (UNICEF, 2015).

NUTRITIONAL GUIDE LINES

Guide lines for the identification and management of malnutrition has been published by various
international and non-governmental organizations, these include Medicins Sans Frontieres
(1991), the World Health Organization (WHO, 1999; WHO, 2000) and UNHRC/UNICEF/WHO
(2003). In addition food security and food aid are included in the minimum standards set by the
Sphere project (2004).

Figur
e 1 Sample of NGO food operation.

GROWTH MONITORING AND PROMOTION

Effective approaches to preventing malnutrition especially mild and moderate malnutrition are
essential to achieving the millennium development goals (MDGs). Addressing malnutrition plays

7
a role in the attainment of six of the eight MDGs, from the first goal of eradicating extreme
poverty and hunger to the six goals of combating HIV/AIDS, malaria and other diseases (World
Bank, 2006)

Community based growth monitoring and promotion is a strategic approach that involved
preventive activities comprised of following the growth rate of a child in comparison to a
standard by periodic, frequent anthropometric measurements in order to assess growth
adequacy and identify faltering early. The periodic weighing of the child and classification of the
child’s progress is not only used to make decisions regarding the child’s care at home or the
need for medical attention, but also to stimulate activities in the community. It seeks to address
the multiple casual factors impacting on a child’s growth and development (Griffith and Del-
Rosso, 2007).

The concept of growth monitoring and promotion emerged in the mid-80s which linked growth
monitoring to an action to be taken for the child (Pearson, 1995). UNICEF has long been active
in supporting growth monitoring as a tool in community nutrition program primarily through
provisioning programs with scales, growth charts and training (UNICEF, 1999). It has been
identified as an important component of child survival and development revolution- an
initiative advocated by UNICEF and supported by several other development agencies (Nabarro
and Chinnock, 1988).

INNOVATIONS

Another development that has stemmed from NGO private cooperation is the food and
commodity tracking system (FACTS)created by Microsoft in 2001 in collaboration with the NGOs
Mercy Corps International and Save the Children. It is an on line-based commodity
management system that allow NGOs to monitor and tract shipments from the port of entry to
the point of distribution (Garin, 2006).

The NGO Concern worldwide has been engaged in community management of acute
malnutrition (CMAM) since inception and initial piloting of the program in 2000. The NGO has
developed a CMAM capacity model which was piloted in Northern Kenya in 2013 and 2014. The
model was designed to strengthen the capacity of government health systems to effectively
manage increased case loads of malnutrition during predictable emergencies without under
mining the health system, the provision of other health services and un-going systems
strengthening efforts (Concern worldwide, 2015).

The child length mat is an innovative tool by Save the Children Foundation that support
community health workers detect chronic malnutrition and rapidly identifying who need special
attention. Another creative low cost solution to address a common problem of inadequate
amount of food fed for each meal is the child feeding bowl, which is specially marked, featuring

8
measurements that denotes the maximum appropriate amount of food for each age under 2
years (Save the Children Foundation, 2015).

INFANT AND YOUNG CHILD FEEDING (IYCF)

The control of chronic malnutrition in children focuses on maternal nutrition during pregnancy
and lactation and in protecting the health and nutrition of the young child and mother during
the first 2 years of life the 1000-days window of opportunity to preventing malnutrition
(Clinton, 2001). Community based approaches such as AIN-C ( Marini et al, 2009) and PM2A
(Deconnite et al., 2008) have been developed using the well established UNICEF model
(UNICEF, 1990) for children with key action points covering health, diet and care.

Growing evidence points to the impact of early initiation of breast feeding on neonatal
mortality. Early initiation of breastfeeding within the first hours of birth could prevent 22% of
neonatal deaths, and initiation within the first day 16% of deaths as shown in a study in rural
Ghana (Edmund et al., 2006). While

In developing countries optimal breastfeeding starting from one hour of birth, exclusive breast
feeding for six months, and continued breast feeding until age 2 or longer, has the potential to
prevent 12 percent of all deaths in children under age 5 (Black et al., 2013). Exclusively breast
fed children are less susceptible to diarrhea and pneumonia and are 14 times more likely to
survive than non breast fed children (Black et al., 2008)

UNICEF and WHO are leading a global partnership to galvanize political commitments to
increase breast feeding rates. UNICEF works with communities to establish counseling
opportunities for mothers to adopt appropriate feeding practices. UNICEF has produced a
community based infant and young child feeding counseling package to train community
workers. Counseling is tailored to the context in which families live, providing concrete actions
to change behaviors, improve feeding practices and strengthened support networks (UNICEF,
2015).

Infant and young child feeding (IYCF) actions are often implemented as part of the priority child
survival and development programs of UNICEF and WHO, as well as the plans of many nations.
The scientific rationale for this decision is clear, with several decades of scientific
documentation on this topic including several Lancet series on child hood survival 2003 (3),
nutrition 2008, new born health 2005, child hood 2007 (UNICEF, 2011). Important new
information is now available on what works to improve IYCF. Results from efficacy and
effectiveness trials have demonstrated the effect of community based approaches to improve
breast feeding and complementary feeding practices. Policy and strategy documents produced
by UNICEF and WHO over the last 25 years provide a sound basis for action (UNICEF, 2011).

9
MICRO NUTRIENT FORTIFICATION AND SUPPLEMENTATION

UNICEF is addressing nutritional deficiencies at community level through supplementation,

fortification and improved complementary food products (including micro nutrient powders and
lipid based nutrient supplements) to improve dietary quality (UNICEF, 2015). Food fortification
is a strategy to correct or prevent micro nutrient deficiencies in a population. The aim of
fortification is to increase intake of one or more nutrients in the food supply. Foods fortified with
micro nutrients may not meet fully the needs of certain nutritionally vulnerable sub-groups such
as pregnant and lactating women or young children. Toward this end UNICEF and WHO have
developed the daily multiple micro nutrient formula (WHO/WFP/UNICEF, 2006) other
formulations developed by other inter governmental agencies are also available (Inter-Agency
Standing Committee (IASC), 2007).

Table 1: Composition of Multiple Micro-Nutrient Supplements for Pregnant/ Lactating Women

and Children from 6-59 Months.

MICRO NUTRIENTS PREGNANT WOMEN CHILDREN (6-59 MONTHS)

Vitamin A ug 800.00 400.00
Vitamin D ug 5.00 5.00
Vitamin E mg 15.00 5.00
Vitamin C mg 55.00 30.00
Vitamin B1 mg 1.40 0.50
Vitamin B2 mg 1.40 0.50
Vitamin B3 mg 18.00 6.00
Vitamin B6 mg 1.90 0.50
Vitamin B12 mg 2.60 0.90
Folic Acid ug 1.15 0.56
Selenium ug 27.00 5.80
Iron mg 30.00 17.00
Zinc mg 10.00 4.10
Iodine ug 250.00 90.00
Copper mg 600.00 150.00
WHO/WFP/UNICEF, 2006

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PREVENTION OF OVERWEIGHT AND OBESITY

This includes consolidation and dissemination of data on overweight and obesity trends.
Advocating of stunting reduction strategies that promote linear growth in early life and prevent
excessive weight gain in young children through optimal breast feeding and complementary
feeding. UNICEF partner with governments, Civil society and other partners towards identifying
evidence based policies, guidelines and regulatory frameworks that can address overweight and
obesity (UNICEF, 2015).EPODE (Ensemble Previnons l Obesite Des Enfants) which translate
into together lets prevent childhood obesity is a large scale, coordinated, capacity-building
approach for communities to implement effective and sustainable strategies to prevent
childhood obesity (Borys et al., 2011. It is the largest global childhood obesity prevention
program aimed at promoting healthy behaviors in children (Levi et al., 2009; Boyer, 2008;
Falling walls, 2009). It was first launched in 2004 in 10 French pilot communities which has since
expanded to more than 500 communities worldwide. EPODE methodology promotes the
involvement of multiple stake holders at two levels. A central level that involve ministries,
health groups, NGOs and private partners, and a local level that involve political leaders, health
professionals, teachers, local NGOs and local business community (Commission of the
European Communities, 2007). The program was launched in 2006 in Spain and Belgium (THAO
and VIASANO programs), 2008 in Greece (PAIDGATROFI program) south-Australia (OPAL) and
Mexico (EPODI-5 PASOS program).Innovations in other countries such as the JOGG program in
Netherlands (30 ) or the healthy weight communities in Scotland (37) have been inspired and
influenced by EPODE methodology.

The WHO global strategy on diet, physical activity and health (DPA) describes the actions
needed to support healthy diets and regular physical activity. WHO has also developed the
global action plan for the prevention and control of non communicable diseases 2013-2025.
The plan will contribute to progress on 9 global NCD targets to be attained in 2025, including a
25% reduction in premature mortality from NCDs by 2025 and a halting of the global obesity
rates to those of 2010 (WHO, 2015). WHO also provide leadership; evidence based
recommendations and advocacy for international action to improve dietary practices and
increased physical activity. WHO also promote and support research to facilitate
implementation and evaluation of programs aimed at reducing overweight and obesity in close
collaboration with organizations of the United Nations system and other inter governmental
bodies (FAO, UNESCO, UNICEF) research institutes and other partners.

IMPROVED FOOD SECURITY

Through changes in income, and increased availability of diverse nutrient-dense foods coming
from production or markets; agriculture can play a role in improving mother and young children

11
diet (Herforth et al., 2012; Webb and Block, 2012). UNICEF plays an advocacy role where
needed and support those agencies focusing on agricultural and value chain interventions

HEALTH RELATED SERVICES

Health related functions at community level involve the establishment by UN agencies and
NGOs of nutritional care and support for children and adults living with HIV/AIDS and other
infectious diseases. The service include, testing for those infections and targeted nutritional
support.HIV infection increase requirement for energy and micro nutrients with increased
susceptibility to malnutrition which leads to an increased risk of opportunistic infections and
death. UN agencies and NGOs have on the whole being quick to embrace HIV as a key priority
issue. Toward this various guiding principles and guidelines have been developed
(USAID/AED/WFP, 2OO7; IASC, 2OO6; IASC, 2004).

NUTRITIONAL EDUCATION FOR BEHAVIOR CHANGE

Nutritional education is any set of learning experiences designed to facilitate the voluntary
adoption of eating and other nutrition related behaviors conducive to health and well being
(Contento et al., 1998). From 2003-07, World Vision in collaboration with the Indian Ministry of
Health and other NGOs provide pregnant women with specific health messages about maternal
and child health. The program focused on Home based education. Dispatching community health
workers to identify and visit pregnant women in their community. Elements of the program
directly relevant to maternal motility include messages about antenatal care (ANC), maternal
nutrition and family planning; these were integrated with messages about infant nutrition and
care (Berkley center for religion, peace and world affairs, 2011). Adventist Development Relief
Agency (ADRA) addresses health disparities at community and facility level. In one southern
African nation they worked in, ADRA discovered people were not eating orange, fruits and
vegetables for fear it will make them sick and were not eating spinach on the basis that its
prominent growth signified it was inedible. As a result food was plentiful in the community but
malnutrition was endemic. To ease the dissonance between local beliefs and practical health
priorities, ADRA identified local attributes regarding health and medicine and shaped an
education and action program to address those views effectively. In that particular community,
ADRA compiled recipes and held cooking demonstrations giving the community practical and
culturally relevant ways to improve nutrition (Berkley center for religion, peace and world
affairs, 2011).

CONCLUSSION

Because nutritional interventions programs often have low quality and coverage if they are
implemented by governments. Facilitation of such programs by NGOs and United Nations inter
governmental agencies as some evidences have shown can improve such programs delivery
performance in an equitable way. Especially if the interventions are delivered at community level
as it is more cost effective.

12
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