Some economic aspects of planning health interventions among malnourished populations.

The development of effective health or nutrition interventions can be facilitated by cxamining briefly the process whereby basic research in agriculture is translated into the appropriate technologies that are adapted by farming households. Basic agricultural research creates the production potential for technological development through the use of plant genetics, phytopathology and soil science. The basic scientist works at the frontier within which the applied scientist works, with the possibility of innovation at all levels. Applied scientists or “biological architects”the plant breeders, agronomists, and othersuse this basic research to develop the specific varieties which are adapted to a set of geoclimatic and socioeconomic conditions. Thus, applied wheat research in the United States has developed varieties that fit this specific climate and land-extensive mechanized planting process but cannot be readily transferred to either temperate or tropical zones in low-income nations. The end product ofresearch is a technology appropriate for a given agricultural region defined in geoclimatic, economic, and other terms. One anobogy in health is the adaptation of the oral rehydration technology for acute diarrhea to Haitian socioeconomic conditions. Spoons and glasses, such as those successfully used in Bangladesh for preparation of oral rehydration solutions by the mother, were not found in poor households in Haiti. However, in Haiti salt could be purchased in chunks and a coarse sugar was available. Drs. Gretchen and Warren Berggren developed a rehydration formula for the mother consisting of two pea-sized cubes of salt, five Coca Cola caps of panda (sugar), a rum bottle of boiling water and a little lime Zvi Griliches to provide potassium. The Coca Cola caps and the rum bottles were common in the average household, and because the technology was appropriate, the formula worked. This appropriate technology needs to be adoptable by the ultimate user; in agriculture it is the farmer, in health it is usually the mother. A farmer bases his decision to change techniques of production on the available technology, the type of delivery system including the appropriate social infrastructure, and the profitability of the changes in techniques. This may require credit to provide the farmer with inputs complementary to the new seed varieties (such as fertilizer and insecticides), marketing for his increased output or other factors that minimize risk and maximize returns. Minimization of risk appears to be especially critical for the poorer farmer, who often requires additional knowledge along with the seeds, irrigation, and other changes in the social circumstances to affect his production decisions. Similarly, in nutrition and health, the needs of the household must be carefully considered. This is especially critical for poorer households for whom economic and other constraints clearly affect their ability to change the way they determine their health status. Surveillance of agricultural productivity or health status inputs, outputs and outcomes are useful in understanding the distortions in this delivery system (1). Of course the best surveillance systems are those in which consumers have the power to