We can. overcome. Undernutrition: Bangladesh. Case Study. International Cooperation and Development

Transcription

1 We can overcome Bangladesh Case Study Undernutrition: International Cooperation and Development

2 2 W E C A N O V E R C O M E U N D E R N U T R I T I O N : B A N G L A D E S H C A S E S T U D Y Dramatic progress achieved yet huge challenges remain The case of Bangladesh shows that dramatic progress on nutrition can be achieved, even in partner countries with a low per capita income. At the same time, it is clear that significant additional support will be required to put an end to undernutrition in the long term. As things stand Bangladesh remains off course in terms of meeting key Global WHA targets for stunting, wasting, overweight and anaemia. As part of the European Commission s global pledge to invest 3.5 billion to reduce the number of stunted children by seven million, there is a firm commitment to increase support for Bangladesh Government led efforts to reduce undernutrition. As clearly laid out in its Nutrition Action Plan, the European Commission will ensure that resources and expertise are channelled into sectors identified as strategic priorities by partner countries. In Bangladesh the focus will be on reinforcing political commitment and policy development, promoting and protecting livelihoods for the most vulnerable and continuing to invest in knowledge, innovation and improved accountability. Undernutrition Context and trends Targeted stunting reduction (million Under 5 s stunted children) Beginning prevalence: 40.1% Target prevalence: 25.5% 6,04 million Reduction needed to achieve WHA target = 3.41% Trend in stunting reduction estimated in 2012 = 2.57% 0,44 million 3,62 million Target Effort needed Effects of Stunting Children who suffer from chronic malnutrition fail to grow to their full genetic potential, both mentally and physically. It significantly increases the likelihood of premature death, and those that survive are prone to ill health and are less able to contribute to an active and productive life. The condition is measured by stunting shortness in height compared to others of the same age group which manifests itself in the early life cycle of children, and the effects of which are irreversible. Cover page: Girls with higher levels of education are less likely to get married and have children at an early age. Photo by: GMB Akash and EU Bangladesh Delegation. 1 Source: Bangladesh Demographic and Health Survey 1997 and Utilization of Essential Service Delivery (UESD) Survey Bangladesh ranks 17 out of 21 countries with very high child stunting prevalence and 6 th out of the 14 countries with the largest numbers of stunted children. Bangladesh has one of the fastest prolonged reductions in child stunting in recorded history. Between 1997 and stunting has fallen from 59% to 36% (latest data from BDHS 2014). Bangladesh therefore continues to have significantly lower rates of both stunting and under five mortality as compared to India, despite having lower average income. However, the nutrition success story in Bangladesh should not divert attention from the fact that Bangladesh still has one of the highest levels of stunting and number of children affected in the world 2. Similarly, it has a very high prevalence of low-birth weight. It is also clear that progress in reducing undernutrition has proved very unequal between rich and poor. Indeed there has been no significant improvement among women and children in the poorest households (rates of stunting are twice as high in the poorest wealth quintile).

3 W E C A N O V E R C O M E U N D E R N U T R I T I O N : B A N G L A D E S H C A S E S T U D Y 3 The EU is supporting the Government of Bangladesh to take a more multi-sectoral approach to undernutrition. Photo by: GMB Akash and EU Bangladesh Delegation Changes in stunting prevalence (%) over time, by wealth quintile 70 % Stunting levels % % % 30 % 40 % 50 % 60 % 70 % 30 % Wealthiest Second wealthiest Middle Second poorest Poorest Source: Global Nutrition Report 2014 Country Profile Bangladesh Bangladesh India Source: UNICEF, WHO, World Bank. Joint Child Malnutrition Dataset, 2014 revision. Female Secondary Education Enrollment (%) Improved Sanitation Coverage (%) Source: UNESCO Institute for Statistics Improved facilities Shared facilities Source: WHO/UNICEF JMP Unimproved facilities Open defecation An estimated 5.7 million children under five years of age (38.7%) are stunted according to the 2013 national survey. Furthermore, levels of acute malnutrition (wasting) regularly exceed emergency thresholds. Micronutrient deficiencies are also a major concern with one third of all children under five, and 4 out of 10 women, anaemic. At the same time, the proportion of women who are overweight or obese has almost doubled, increasing from 9% in 2004 to 17% in DHS 2011.

4 4 W E C A N O V E R C O M E U N D E R N U T R I T I O N : B A N G L A D E S H C A S E S T U D Y The EU funded NIPN project is helping the Government of Bangladesh to make informed choices on which investments have the greatest nutrition impact. Photo by: GMB Akash and EU Bangladesh Delegation. How to explain both progress and challenges? Education - especially for girls The linkage between maternal education, gender empowerment, and nutrition outcomes, appears to be confirmed by the rapid expansion of education from the early 1990s with an emphasis on female secondary school enrollment through a national secondary school stipend for girls. There is strong evidence from around the world to suggest that girls with higher levels of education are less likely to get married and have children at an early age. Likewise there is a clear correlation between a mother s education and the nutritional status of her children, as well as higher levels of income. Other factors that explain the reduction in stunting 4 include: Off-farm incomes: The significance of labour intensive manufacturing and overseas remittances in economic growth. Bangladesh s Commitment to Overcome Undernutrition Championing Nutrition at the Highest Level The Prime Minister of Bangladesh Sheikh Hasina is a member of the SUN Movement Lead Group. With other world leaders she has pledged to work together to improve the nutrition of the world s poorest and most vulnerable children. The Prime Minister s commitment to SUN illustrates the urgency and priority that she places on alleviating malnutrition, and her recognition of the incredible impact that improved nutrition can have on the future of both individuals and nations. Sir Fazle Hasan Abed, founder and chair of BRAC, is also a member of the SUN Lead Group. Sanitation: The proportion of villages with open defecation declined from 24.7% in 1997 to just 4.2% in 2011 reducing children s exposure to diseases. Agriculture: There are indications that support services for farmers have played a role in partially reducing seasonal food insecurity. Family Planning: Education programmes have led to dramatic falls in fertility rates - making it easier to ensure adequate diet and childcare. Bangladesh faces tremendous challenges to sustain this progress. These include extremely high rates of poverty (e.g. amongst landless households in rural areas), and chronic economic and food insecurity (especially for women) exacerbated by climate change. The adoption and effective implementation of appropriate, mutually reinforcing, national social protection and nutrition policies will be crucial to end undernutrition. 4 See IFPRI / LANSA Discussion Paper (July 2014) The Other Asian Enigma. 5 Nutrition background paper to inform the preparation of the 7th Five Year Plan, Dr AM Zakir Hussain, Pr MQK Talukder, Dr Tahmeed Ahmed, 10/01/2015. Future priorities explicitly highlighted by the Prime Minister as priorities for the Seventh Five Year Plan 5 include increasing government s support for smallholder farmers, improved food production, and national food security; social protection and its link to education and health; building resilience against recurring shocks like floods and cyclones; and women s empowerment. The unlocking of the power of women s active role in the society and economy, has been an extremely productive move for Bangladesh, despite having half the per capita income of India. Amartya Sen, originally from Bangladesh, is an economist who was awarded with the Nobel Prize in 1998, (Guardian Newspaper, 2013)

5 W E C A N O V E R C O M E U N D E R N U T R I T I O N : B A N G L A D E S H C A S E S T U D Y 5 The National Nutrition Policy of Bangladesh was approved by Cabinet in Existing national legislation also includes laws on Food Safety, the Breast Milk Substitute Act 2013, food fortification and maternal leave up to six months. In addition the recently developed Health, Population and Nutrition Sector Development Program , includes an operational plan for mainstreaming and scaling up nutrition services nationally through the National Nutrition Services (NNS). The Government increasingly recognises the importance of strengthening policies to empower the most vulnerable through social protection policies and initiatives. It has introduced digital technology and free education for girls secondary schools and launched the One House, One Farm scheme which seeks to target assistance to the most vulnerable rural families. How does the Political Commitment of Bangladesh measure Up? While overall ranked in 16 th place, Bangladesh scored first in the Global Hunger and Nutrition Commitment Index (HANCI) for several achievements including: 3 Having both a national nutrition plan (including time bound nutrition targets) and a separate budget for nutrition. 3 National efforts to enhance multi-sectoral and multi-stakeholder coordination. 3 Government drive to promote complementary feeding. 3 Commitment to ensure regular national nutrition surveys demonstrating accountability. European Union Support to Scaling Up Nutrition in Bangladesh In recent decades the European Union has progressively scaled up its support to nutrition in Bangladesh. The EU has invested precisely in those areas that have contributed to sustained reductions in undernutrition, including education, health, governance and human rights, disaster management (demonstrating strong partnership with the EU Humanitarian Aid and Civil Protection Department - ECHO), poverty reduction and food and nutrition security. For instance, following the 2007/8 food price crisis, the EU substantially increased investments to address widespread vulnerability. The EU has played a key role in strengthening and institutionalizing both the nutritional surveillance system and national food policy capacities. Regional initiatives (such as MYCNSIA) are also contributing to enhancing political will and institutions at various levels. Although in the context of South Asia, Bangladesh has made dramatic progress in reducing stunting, the levels are still extremely high, the rate of reduction has been slower among the poorest families and levels of wasting and micro-nutrient deficiency remain alarming. The justification for continued EC investment in nutrition is clear. The Multi-annual Indicative Programme has, for the first time, explicitly identified Food and Nutrition Security as a focal sector ( 300 million approximately). In addition, a nutrition sensitive approach will be enhanced through the two other focal sectors: Democratic Governance ( 100 million approximately) and Education / Skills Development ( 300 million approximately). EC investments in nutrition The ambitious National Nutrition Services package million million 85 million The National Nutrition Services (NNS) package, supported by a regional EC funded UNICEF project MYCNSIA, aims to deliver a comprehensive nutrition package to communities. The regional commitment for MYCNSIA is 22.5 million. This focuses on the first 1000 days (the period from pregnancy to a child s second birthday), and provides support for Infant and Young Child Feeding (IYCF), dietary diversification, food supplementation and fortification, and management of acute malnutrition both at facility and community level While in 2010 and 2012 the EC investment in nutrition for Bangladesh was 4.6 and 7.5 million respectively, in 2015, reflecting the recognition of Food and Nutrition Security as a strategic focal sector, the level of planned investment has increased significantly to 85 million. Photo by: José Bascón.

6 6 W E C A N O V E R C O M E U N D E R N U T R I T I O N : B A N G L A D E S H C A S E S T U D Y With EU funding of 35 million, the Suchana project will demonstrate results at the household level. Photo by: GMB Akash and EU Bangladesh Delegation. In line with the Global EC Action Plan on Nutrition, the current focus of the EU is on three strategic priorities, which can also be harnessed as opportunities for joint programming with other member states. Strategic Priority 1: Enhancing mobilisation and political commitment for nutrition The EU will strengthen nutrition governance and policy for food and nutrition security with emphasis on promoting a multi-sectoral approach. Launched in May 2014, a document called the common narrative was agreed as a joint statement by development agencies, including the EU. It reflected a broad consensus on shared priorities for support to Government efforts to scale up nutrition. MUCH Project The MUCH project (EC contribution 8 million) builds on the common narrative initiative and collaboration between the EU and USAID to build consensus across key stakeholders. The project will be implemented by FAO to provide support at national level to strengthen the Food and Nutrition Security Policy framework and develop capacities for a more multi-sectoral approach, within government, as well as for private sector and civil society. The project represents an important opportunity to enable the Government of Bangladesh to draw on global expertise and ensure that initiatives being supported by different agencies are in line with national priorities. It will also lead to the development of training packages for different ministries that strengthen the nutrition sensitivity of sectors such as agriculture, education, water and social protection. Strategic Priority 2: Scaling up actions at country level Investments will prioritise initiatives to build resilient livelihoods for the extreme poor, especially women; supporting the National Nutrition Service to deliver nutrition specific interventions; and working with government to develop understanding and engagement for improved nutrition among urban populations. SUCHANA Project and Scaling Up Interventions In the recent Common Narrative on Undernutrition in Bangladesh, Development Partners agreed on a shared understanding of the situation. In this framework, DFID and EU worked together to design the SUCHANA project (EC contribution 35 million planed), which will accelerate the reduction of maternal and child malnutrition in two especially vulnerable districts. SUCHANA will do this by working with local government and civil society to better understand the nutrition situation. There will be a special emphasis on empowering young people to play a key role in promoting awareness in their communities. The multi-sectoral package will include raising poor people s incomes, especially women, with a market-smart and resilient livelihoods approach. The training of government workers and small businesses will also play an important role in achieving the project goals. A well-designed monitoring and evaluation system will ensure a shared learning process for all those involved. In addition to SUCHANA, an additional EU investment ( 40 million) has been committed to promote multi-sectoral action at the local level to identify practical solutions to scale up, together with community empowerment to ensure that undernutrition is also being tackled from the bottom up.

7 W E C A N O V E R C O M E U N D E R N U T R I T I O N : B A N G L A D E S H C A S E S T U D Y 7 Strategic Priority 3: Strengthening the expertise and the knowledge-base Building on the experience with the Surveillance project, the EU plans to continue its strategic role through the development of a National Information Platform for Nutrition. National Information Platform on Nutrition (NIPN) The increased political attention and financial commitments to nutrition in recent years have created a strong demand from countries, development partners and other nutrition stakeholders for better information on nutrition. The primary objective of NIPN (EC contribution 3.5 million) will be to support Bangladesh to strengthen national information and analysis about undernutrition, in order to inform the prioritization of decisions. This will be done using information about levels of undernutrition, levels of investment in nutrition and information about the effectiveness of programmes. Leveraging Agriculture Through Biofortification for Improved Nutrition and Health for the Poor and Undernourished in Bangladesh The EU funded HarvestPlus Biofortification project (EC contribution to biofortification program was 5 million) aims to reduce the prevalence of micronutrient deficiency through nutrition sensitive and evidence based agricultural interventions. Zinc shortage is a significant public health nutrition problem for Bangladesh s children under five years old and it is estimated that seven out of 10 women in Bangladesh do not get enough zinc in their diets. Scientists are using selective plant breeding known as bio-fortification to mass produce a high-zinc rice in Bangladesh which as a result, has become the first country in the world to develop rice varieties biofortified with zinc. The development and distribution of zinc-biofortified rice varieties (by HarvestPlus together with the International Rice Research Institute and other partners) began in 2013, and is estimated to reach 500,000 households by Bangladesh has made dramatic progress in reducing stunting but a key challenge is to make sure that no one is left behind. Photo: GMB Akash and EU Bangladesh Delegation.

8 MN EN-N European Union 2015 Published by Directorate-General International Cooperation and Development, Directorate Sustainable Growth and Development, August The contents of this publication do not necessarily represent the official position or opinion of the European Commission. Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use which might be made of information in this publication. Directorate General International Cooperation and Development, Rue de la Loi 41, B-1049 Brussels. For further information: ISBN DOI /885167