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# Case 2: THE TAMIL NADU NUTRITION PROJECT: THE USE OF GROWTH MONITORING FOR TARGETING SERVICES TO THE DISADVANTAGED

Appraised in 1980, the Tamil Nadu Nutrition Project (TINP) had expanded by the end of 1987 to about 9,000 villages, each served by a Community Nutrition Worker (CNW), a newly created paraprofessional. CNWs were women from the village in which they were to work, selected for training as far as possible from those who were poor but had well-nourished children--i.e., women already well placed to teach others about how to make the most of limited income and food resources. Their main responsibilities were to weigh children monthly to see if they were growing adequately; provide short-term food supplements to those who were not; deworm children every four months; distribute vitamin A supplements twice yearly; educate mothers about proper nutrition and about diarrhea management; and provide supplementary feeding to pregnant women who needed it.

Targeting was a central feature of the project design. First, the project services were limited to children in the 6-36 month age group and to pregnant women, since it appeared that these were the most nutritionally at risk (although during implementation it was recognized that 0-6 month children were equally important beneficiaries). Second, each child in the target age group was weighed by the CNW once each month, and only those failing to grow adequately were included in the supplementary feeding program. Third, children who were severely malnourished received special medical examinations and referral care while their families received intensive nutrition education. Two alternative criteria were used to decide whether a child was eligible for supplementary feeding and special attention. If the child's growth chart showed it to be less than 70% of the median weight for its age, it was admitted to the program immediately. But in addition, children who had lost weight since the last month's weighing, or who did not gain enough weight for two consecutive months, were also eligible for feeding. On average 28% of the children weighed were eligible for the program.

A built-in danger of targeted programs is that not all clients receive program benefits, and that those who do not may lose the incentive to participate. At the start of the TINP pzoject, it took considerable education to convince mothers whose children did not meet the criteria for supplementary feeding to nevertheless continue to bring their children for monthly weighing. Project managers believe that this educational effort was successful only because of the high degree of community involvement which the project encouraged. £he first task of the newly trained CNW, before the delivery of any project services, was to recruit and train about 25 women volunteers (known as a Women's Working Group) to assist in the education and involvement of other villagers. Each volunteer was responsible for familiarizing a given group of families with the goals of the project, for giving them nutrition education, and for assisting the CNW in gathering and weighing the children in the three days each month allocated to that task. This community involvement led to the achievement of weighing rates averaging 90% of the children each month, minimizing the risk of excluding deserving clients--the main danger of targeted projects.