Adapting the training and visit system for family planning, health and nutrition programmes
Heaver, R.
World Bank Staff Working Paper, International Bank for Reconstruction and Development 662: 56
1984
Document Number: 408552
The paper is a first attempt to explore whether T & V can be adapted to meet the technical, managerial and behavioural needs of population, health and nutrition (PHN) programmes, while remaining cheap enough to be widely replicable. The paper falls into three parts. The first part on theory looks at the similarities and differences between managerial tasks and practices in agricultural extension and PHN, and taking into account the differences, suggests a "model" T & V system for PHN. The system that is put forward is not a blueprint, but a starting point for further adaptations appropriate to the resources and PHN delivery systems of any given country. The second part of the paper moves from theory to practice; it looks at three PHN outreach systems in India, the Philippines and Indonesia. The Indian programme already has many of the managerial characteristics of T & V, but while it appears to be more effective than the programmes in Indonesia and the Philippines, it is also a more intensive user of human and financial resources. So, while the case studies support the potential usefulness of T & V-type management systems, they also raise the question whether these are necessarily resource-intensive, or whether resources can be diluted without undue loss of effectiveness, a question which can only be settled by experiment with alternative approaches. The third part of the paper therefore proposes some alternative approaches to making outreach programmes more cost effective, and outlines some of their theoretical advantages and disadvantages.