Chile's national nutritional supplementation program for older people: lessons learned.

Demographic changes in developing countries have resulted in rapid increases in the size of the older population. As a result, health-care budgets face increasing costs associated with the declining health and function of older people. Some governments have responded to this situation by designing innovative programs aimed at older people. One such program, implemented by the government of Chile, distributes an instant food mix fortified with vitamins and minerals to all persons over 70 years old who are registered by the national health service. The national health service covers approximately 90% of the older population. The program specifically targets nutritional vulnerability and micronutrient deficiency, which are common among poor older people in Chile. We present here the findings of a one-year investigation into all aspects of Chile's program for the elderly. The research included in-depth interviews with policy makers and program implementers, focus group discussions with user groups, analysis of the micronutrient content of the nutritional supplement, and telephone interviews of a random sample of older people. The results demonstrate that there can be a considerable degree of self-targeting within national programs; programs need to be sufficiently flexible to permit periodic protocol change; user groups must be consulted both before and during program implementation; and the design of an effective program evaluation must be in place before program implementation. It is hoped that these results will be useful to policy makers and implementers planning programs aimed at improving the health and function of older people.