Nutrition, health and population in strategies for rural development

The principal thesis of this paper is that a country's strategy for rural development should embrace a "composite package" approach for the delivery of nutrition, health and family planning services in rural areas. The reasons for the increased attention now being given to problems of rural poverty, including malnutrition and ill health as especially serious manifestations of poverty, are reviewed in section I. The interrelationships between socioeconomic development and the reduction of fertility are then examined, making use of an analytical framework developed by Richard Easterlin. In considering priorities for rural development in section III, it is emphasised that an accelerated rate of expansion of food production is a necessary but not a sufficient condition for improving levels of food consumption. There is also a need to increase the effective demand of low-income households, and the advantages of a pattern of agricultural development which enables a large and growing fraction of farm households to participate in gains in productivity and income are streesed. The significance of expanding job opportunities outside of agriculture and of slowing the rate of growth of the population,as factors contributing to an increase in returns to labour,is also stressed. Beyond the need to accelerate growth and to structure it so as to achieve broad participation, it is suggested that priority should be given to programmes which link the delivery of nutrition, health and family planning services and thereby increase the attractiveness and effectiveness of each and also reduce the cost of achieving wide coverage. A final section examines the reasons why it is important to integrate the delivery of these services. It is time-consuming and difficult to achieve administrative integration, but in this instance the potential benefits justify the efforts. Section IV also considers some of the problems which must be faced in implementing an integrated programme capable of fostering widespread improvements in nutrition and health and increased acceptance of family planning.