The policy implications of field experiments in primary health and nutrition care

Abstract

Is the experience to date with health and nutrition interventions encouraging enough to justify augmented efforts to make primary nutrition and care available to all? If so, what can be learned from that experience about how best to make primary care widely available?

A review of ten pilot projects which provide simple health and nutrition services and which kept data adequate to permit an assessment of their effectiveness suggests that mortality declines were notably more rapid in a clear majority of the project sites than would have been expected in the projects' absence. Although the data cannot be considered fully reliable or completely unambiguous, when taken as a whole they present a persuasive case that, in the hands of able administrators and in populations of up to 70,000, infant and child mortality can be reduced by $\text{1}\text{3}$–$\text{1}\text{2}$ or more within 1–5 years, at a cost of under the equivalent of 2% of per capita incomes.

Among the particularly promising program components were maternal food supplements, maternal immunization against tetanus, nutrition monitoring, and greater reliance on paramedical personnel. At least equally important was the effectiveness and sensitivity with which the particular components selected, whatever they may have been, were implemented and administered.

The experience of the projects reviewed indicates that primary health and nutrition care is potentially capable of helping make a substantial difference in infant and child mortality levels, The need now is to deal effectively with the challenges involved in developing large-scale programs capable of translating that potential into reality.