The Financial Express

Nutrition status in Bangladesh: Part I

Negligence overshadows prospect of SDGs

Prevalence of adolescent girl, maternal, child malnutrition attributed to inept delivery admin

| Updated: October 02, 2022 11:12:27

Photo: Courtesy Photo: Courtesy

Bangladesh is still seen in a miasma high prevalence of adolescent girl, maternal and child malnutrition due mainly to inept governance through the delivery mechanism, casting shadows on SDGs prospect.

Survey findings show the malnutrition prevalence is caused largely by mal-governance in all tiers of coordination committees -- from central to community-support groups.

A good percentage of government officials at district level have yet to mainstream nutrition as one of their top-most priorities and a constitutional mandate owing to their neglect of duty and somewhat undeveloped sense of it, stakeholders say.

A greater dimension of such collective failure is that the country may face setbacks in its drive to achieve the UN-mandated Sustainable Development Goals (SDGs) by 2030 as its nutrition situation remains shabby, according to the stakeholders.

Low nutrition capacity/awareness, low staffing level, absenteeism, weak accountability, perceived technical difficulties and limited accessibility are disrupting the governance all through the delivery chain -- from community to national level, they say.

This correspondent also gained a firsthand experience visiting northern Rangpur and Nilphamari districts, facilitated by Plan International Bangladesh under a Joint-Action for Nutrition Outcome (JANO) project to investigate the overall status of nutrition governance.

During the spot survey, it was observed that the project, which is facilitating the government system in 64 unions in seven sub-districts in two districts to strengthen nutrition governance, is mostly getting better outcomes than the beyond-project areas.

The project is supported by the European Union and Austrian Development Cooperation while consortium partners are CARE, Plan International and Eco Social Development Organization (ESDO).

Union Parishad chairman and ward member change through election every five years which is among some major obstacles to ensuring and continuing the legacy of this present structural works which are underway under the project, they pointed out.

A lack of coordination and cooperation among government's inter-departmental offices central to community groups is harming enormously the delivery mandated public services which ensure improving nutrition, people familiar with the developments said.

Budget deficit and negative mindset are also blamed for lacking in improving the nutrition state at community stage, they opined.

However, if they are pushed up or propelled through development partners like the JANO project, which started in 2018 in Rangpur and Nilphamari districts, the scenario of nutrition gets paradigm shift, they told the FE correspondent.

Md Johurul Huq Shah, secretary at Ramnagar Union Parishad in Nilphamari district, said his union, which is under the project, was trying their level best to ensure structural works in line with the NPAN-2 to improve nutrition status.

Some 25-30 per cent of their works, including organising regular meetings once every two months, to end malnutrition were done before the project started at his union, Shah said.

However, he is implementing and organising their almost 100 per cent of tasks right now as they are still supported by the project, he argued.

"I may face setbacks to arrange regular meetings for lack of meeting expenditure, especially food bills, if the project ends in 2023," Johurul says.

He expressed his utter doubt about being able to go on with the regular activities mostly if the project ends in 2023.

Md. Shafiqul Islam, District Education Officer, Nilphamari, said there existed only 50 per cent of school committees for nutrition in the district so far.

After the project started in 2018, some 70 per cent of high schools are implementing the regular meeting for nutrition, he stated.

"The government is working to change the school curriculum, which will be effective in 2023, to help address malnutrition problems among school students (class six to nine)," he says on a note of optimism.

However, non-government school committees are largely inactive to ensure the monthly meeting due to their involvement in politics, he laments.

"Due to legal loopholes, I cannot ensure the meetings at non-government schools," Islam argues.

Shafiqul also indicates the problem of manpower shortage at his office.

The Food and Agriculture Organization (FAO), the International Fund for Agricultural Development (IFAD), UNICEF, World Food Program (WFP), and World Health Organisation (WHO) jointly in a 2022 report revealed that some 73 per cent of the total population in the country cannot afford a healthy diet.

A healthy diet means one needs to spend Tk 276 daily for the diet here.

Bangladesh is facing growing challenges in ending hunger, ensuring food security and eradicating all forms of malnutrition, stated the report styled the State of Food Security and Nutrition in the World, an annual flagship publication.

Almost 28 per cent of early adolescent (age 10 to14 years) Bangladeshi girls are severely or moderately thin, and nutrition outcomes vary strikingly between rural and urban areas, according to a 2019 World Bank study.

It also indicated substantial deficits relative to healthy norms in the younger adolescent period. The study findings emphasise the importance of leveraging critical developmental entry points through high-impact adolescent nutrition interventions.

An analysis of the three main government policy documents related to nutrition-the Bangladesh National Strategy for Maternal Health 2019-2030, the National Nutrition Policy 2015, and the Second National Plan of Action for Nutrition 2016-2025 (NPAN-2)--also show that the current policies concerning maternal health and nutrition are fragmentary and mostly address the issue of underweight.

The District Nutrition Coordination Committee (DNCC) and Upazila Nutrition Coordination Committee (UNCC) were formed by government order on August 12, 2018.

The DNCC, Upazila and Union coordination committees are asked to hold their meeting once in two months, as per the NPAN-2.

Bangladesh National Nutrition Council (BNNC) also facilitated many meetings at sub-national level in different areas of Bangladesh. These committees are supposed to report to BNNC by sending the meeting minutes by email.

However, monitoring these large numbers of committees is a big challenge, according to the BNNC.

Around 98 per cent of spending on nutrition is on nutrition-sensitive interventions -- the coverage is not at the par as expected by policymakers.

However, a 2021 publication published by the BNNC, managed by the Health Care Department of the Ministry of Health and Family Welfare, shows that indirect activities are gaining more prominence in eliminating the country's malnutrition.

In the financial year 2014-15, 2015-16 and 2016-17, only 2.0 per cent of the total expenditure of the government was spent on direct nutrition activities.

The rest of the budget was spent on indirect programmes like meetings, seminars, training and advertisement. Of this, the government spent a total of Tk 232.10 billion on nutrition-related activities in the FY 2016-17 alone, which is 1.0 per cent of the country's total GDP.

The share of this expenditure in the national budget of that financial year is about 9.0 per cent.

Citing National Micronutrient Survey 2021, Dr Md. Khalilur Rahman , former Director-General, Bangladesh National Nutrition Council (BNNC), in its recent publication said a reference level dating back to a past pre-pandemic time (National Micronutrient Survey 2011-2012) was identified and established through the review where the probable decline in the micronutrient status is projected.

"For instance, iodine, zinc and vitamin B12 forecast a high risk of the regress towards the reference period," he says.

Overall, vitamin A poses a moderate risk of sliding back, whereas the risk in urban-slum areas would be high, according to him.

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