Potential effectiveness of public nutrition education for improving nutrition

A key question is whether any kind of education or training can make a difference in the nutritional situation of low-income countries. Many respondents identified social injustice and lack of empowerment of the poor as the most important issues to address. "Lack of commitment, not lack of training, is the problem," said one respondent. Sustainable, long-term alleviation of nutrition problems depends on addressing what UNICEF publications refer to as the "basic" causes of malnutrition [7]: economic, political, and ideological structures, and patterns of control over available resources.

This observation notwithstanding, considerable effort and resources are devoted to improving nutrition, and the effectiveness of programmes is limited by the fact that appropriate, situation-specific analysis is not taking place before programmes are implemented. It is well documented [e.g., ref. 8] that programmes are rarely evaluated for impact, and of the evaluations that are performed, few feed back into programme redesign or modification (although there are exceptions). The inappropriate training of those designing and implementing them is one reason for programme failures. Those who know the research in the field of nutrition do not necessarily have the skills to translate that knowledge into programmes; different individuals are involved in scientific studies and in policy-making, and the structures do not exist to create those links.

Several key characteristics may contribute to the effectiveness of educational programmes in improving nutritional indicators:

» Reaching a critical mass of people at multiple levels within the system. The most effective training approach for managers may be to target persons already working in relevant jobs and to allow them to remain linked to their jobs while receiving training. More important, training needs to reach a significant proportion of them. At the policy level, one or two well-placed individuals can make a difference in nutrition policy, but it helps to have several such persons working together from different points in the system.

» Obtaining institutional commitment to allow newly trained professionals the resources and responsibility to apply what they have learned after they return to their jobs. One way of achieving this is to involve higher-level supervisors in selecting candidates and in planning for their activities after training. When professionals are sent for training by their institutions, part of their commitment should be to assure returning graduates that they will have increased responsibilities to permit them to apply what they have learned.

» Building in follow-up through networking, information exchange and dissemination, and periodic reunions of participants and faculty. This can contribute to morale and commitment, and can provide a means to update participants on new developments in the field.

These are characteristics of training that can enhance its effectiveness. Still, education of professionals is a long-term investment whose contribution is difficult to measure directly, given the other factors also affecting nutrition. The effect of having a cadre of multidisciplinarily trained nutrition professionals may be in having people placed to prevent mistakes from being made, to ensure that nutritional consequences are considered in policy decisions and that programme designs are realistic and context specific. Where effective advocates for nutrition are present, the "counterfactual," what would have occurred in their absence, may not be known.