Focus on Asia
In India, Project Nashta
In Thailand, the Basics of Need
By K. Tontisirin, G. Nantel and L. Bhattacharjee

Project Nashta 1981. Samadhan is just an idea. In Delhi’s low-income resettlement colonies, residents are a heterogeneous mix of different cultures, religions, languages and even cuisine. With no resources for information, awareness or available services, families are apathetic at best to the disabled amongst them. Some blame Karma, the evil eye, bad blood brought in by the daughter-in-law (never the son), the full moon and a variety of other events as the cause for the disability. This was the scenario into which Samadhan stepped. Our entry point into the target community was a child with intellectual disability, his mother and family. Twenty years down the line, we are happy with the progress achieved, not only with the disabled but with the women of the community.

Initially, our focus was on intellectual disability, but it gradually developed into a facility for all disabilities. With the support of the nodal centre, an early intervention unit for infants and pre-schoolers soon became available for home visits. These visits made us realize that the uneducated mothers had instinctively developed extremely innovative coping mechanisms. From making colourful mobiles out of broken pieces of glass bangles, to stringing colourful pieces of cloth the local tailor had thrown out, these mothers had demonstrated commendable resourcefulness and creativity. They were providing their children with training for cognitive skills we would usually associate only with the well-educated. This experience triggered the concept of “Mothers Group”. We saw this as an opportunity to get the mothers together for sharing with and learning from one another. It would be a venue for a safe catharsis away from family and potential criticisms, and hopefully it would lead to solidarity among the women.

In an effort to get mothers of children with disability involved in the activities of the centre, we asked them to help the vocational training unit in the production of papier mache handicraft items. These were brightly coloured peacocks, parrots, caparisoned elephants and wall hangings - all very ethnic and beautifully made. Hitherto, the process had been laborious and slow, as the students were at different stages of development with varied intellectual capacities. With the help of the mothers, the quality, rate and completion of the production improved. We could now market the handicraft products. A central government outlet was our first buyer and soon we were selling them at Diwali and Christmas. It has now become possible to give small stipends to both the women and students. Although modest, the financial success of this venture was instrumental in inducing a willingness to look at other income-generating options. At one of the regular meetings, women voiced their concern about the malnutrition of their children, which initiated Project Nashta.

Nashta is an easily made, low-cost nutrition supplement. Its Hindi translation is “breakfast”. A short-term nutritionist helped make it into a high-protein nutrition supplement, which was suitable not only for malnourished infants from our target community but also for any children in need of such supplement. The ingredients are moong (peanuts), channa dal (lentils), wheat germ and shakkar (molasses-like sugar), which is used as binder. The women also suggested changing the loose-powder form of the Nashta, which was messy, into ‘ladoos’ (spherical sweets). Not surprisingly, this led to the well-being of families as a whole and gradually evolved into an organized process for generating income.

The mothers now meet every morning (many had to get “permission” from husbands and mothers-in-law), a paradigm shift from traditional home chores to involvement outside the home and family, rearranging commitments, such as filling containers with water, available only at fixed times from the Municipal Corporation. They discuss the packaging and pricing of Nashta based on what they spend on materials, learning the intricacies of demand and supply. Right from the beginning, they understood that they had complete responsibility for the project. It was they who undertook the purchase of the raw ingredients, the roasting, grinding and finally making the ladoos, which must be done when the sugar syrup is still hot and be manually formed into balls. In doing so, the women also learned the importance of cleanliness and hygiene. A positive outcome has been realizing the need to work together as a team with discipline and punctuality. Most of the women have learned to write their names. Presently, not entirely convinced of microcredit schemes, the women are looking seriously into other options. The Mothers Self-Help Group has improved their self-respect and self-confidence. They now see themselves as contributing members of their families, and the community looks at them with new respect. As one woman puts it, “even my mother-in-law respects me now”.


The Basics of Need Thailand, with a population of 61 million, has been highly successful in rapidly reducing the prevalence of malnutrition, a relatively rare occurrence in the developing world. One key to the very significant and rapid progress came with the fifth development plan (1982-1986), which focused firmly on the people’s participation, instead of leaving the Government to shoulder the entire burden. The primary health care approach was seen as a practical community-based and participatory mechanism to address persistent health problems, including malnutrition. This led to the training of village health communicators and health volunteers or mobilizers who, at the ratio of one mobilizer per ten households, can be found in virtually every rural village with a countrywide force of over 500,000.

At the time, it had become known that malnutrition had profound effects on child growth, cognitive development, work performance and productivity. It also became increasingly apparent that malnutrition had multiple causes and its prevention would require collaboration between the sectors of health, agriculture, education and community development. The challenge was to orchestrate programmes in all of those sectors.

A first National Food and Nutritional Plan (1977-1981) was developed. It was “multi-sectoral” by virtue of the fact that it involved the Ministries of Public Health, Agriculture and Cooperatives, Education and Interior, which shared responsibility for implementing the programmes. Although it did not show any impact in reduction of malnutrition, the Plan raised nationwide awareness and contributed to building up and expanding a number of sector-specific targeted programmes to address problems of malnutrition at community level. The participation of each ministry in this Plan was vertical, however, without horizontal communication, and this resulted in an inadequate multi-sectoral collaboration. An evaluation of the Plan’s impact had resulted in the following conclusions:

• Efforts to alleviate malnutrition depended solely on government-provided services, so that relatively few were able to benefit;
• Communities were inadequately prepared and did not participate significantly. Government and community personnel had conflicts of interest;
• There was insufficient manpower to cope with needs at the household level;
• There was low community awareness and understanding of the significance of malnutrition.

As a result of this very frank evaluation of the situation, planners recognized that malnutrition was a symptom of poverty and that policies should therefore be directed to alleviating poverty. The Poverty Alleviation Policy and Plan were developed, with the goal of eradicating poverty, and the need to improve nutrition conditions as a criterion was introduced. The Plan’s implementation was initiated in 1982 in areas where poverty was most concentrated. The community-based approach used was successful, and two years later the implementation was expanded to the remainder of the country.

In individual villages and communities, with tools such as a simple scale and the use of growth charts, mothers and caretakers were made to “see” and understand the magnitude of malnutrition based on weight or age. As a means of addressing the urgent cases of under-nutrition, recipes for complementary food mixtures, rich in nutrients and based on local ingredients, were developed, produced, distributed and fed to severely and moderately malnourished children. With this approach, a significant improvement in the nutrition and vitality of children was observed within three to four months.

In the Alleviation Plan, it had been clearly spelled out that good nutrition was not a goal in itself, but rather a means of promoting development. At that time, the concept of “Basic Minimum Needs” (BMN) indicators of quality of life had been introduced. These were a list of indicators used for assessment purposes to identify situations that needed improvement, set goals and monitor progress. It was the first time that nutritional status was being recognized as a key social indicator; as a result, it was included in the list of BMN indicators. The adoption of the BMN approach helped strengthen the bottom-up planning and the integration of efforts from the various sectors at the community level. The system of using BMN as the backbone for common dialogue between sectors and community mobilization appears to be the key ingredients for Thailand’s success.

This article was co-authored by K. Tontisirin, G. Nantel and L. Bhattacharjee of the Food and Nutrition Division of FAO, headed by Dr. Tontisirin, former Director of the Institute of Nutrition at Thailand’s Mahidol University.