Institutional and Policy Environments for Promoting Nutrition in Bangladesh

Presented by: Aktari Mamtaz Joint Secretary Ministry of Health and Family Welfare People’s Republic of Bangladesh

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Bangladesh: Country Profile · Country Area : 1.47.570 sq. km.

· Total Population : 151.41 Million (BBS 2010)

· Population Density (per sq. km.) : 993 persons (BBS 2009)

· Life Expectancy at Birth

-- Male : 65.7 years (BBS 2009)

-- Female : 68.3 years (BBS 2009)

· Maternal Mortality Rate ( per 1000 live births) : 1.94 (BMMS 2010)

· Infant Mortality Rate ( per 1000 live births) : 52 (BDHS 2007) (<1 Yr)

· Neonatal Mortality Rate (<1 Month) : 37 percent (BDHS 2007)

· Child Mortality Rate (<5) (per 1000 live births) : 65 (BDHS 2007)

• Per Capita Income : US$ 818

Achievements made so farBangladesh has made considerable progress in high rates of

economic growth and reducing poverty rates by 8 per cent between 2005 and 2010.

In 2010, Bangladesh received the Millennium Development Goal (MDG) award for remarkable achievement in reducing child mortality (MDG 4).

Bangladesh is also currently on track to meet MDG 5 (Maternal Health)

Bangladesh received Digital Health for Digital Development award in 66th UN General Assembly for contributing Maternal and Children Health through ICT.

Common Nutrition Problems in Bangladesh

Protein-energy malnutrition(PEM) Maternal Malnutrition(MM)Iron Deficiency Anemia (IDA)Vitamin A Deficiency(VAD) Iodine Deficiency Disorder(IDD)Low Birth Weight (LBW)Zinc DeficiencyOver nutrition(emerging )

Howarth Bouis, 2006

Share of Energy Intake in Rural Bangladesh

Staples

Non-stapleplants

Fish andanimal

Food Insecurity in Urban SlumsHousehold consumption

Dhaka Chittagong

Khulna

Rajshahi

All

Absolute food insecurity:<2,122 kcal/person/d

42.4 56.0 52.0 61.3 47.8

Extreme food insecurity:<1,805 kcal/person/d

24.2 35.8 38.5 36.0 29.0

Urban food security Atlas, 2008

Present status of Nutrition in Bangladesh

Chronic and acute malnutrition levels are higher than WHO thresholds

Children under weight for age is decreased from 47.5% in 2004 to 37.4% in 2009

Children under weight for height(wasting) increased from 14% in 2004 to 17% in 2007

Children short for age(stunting) increased from 43% in 2007 to 48.6% in 2009

Present status of Nutrition in Bangladesh(cont.)

Iron Deficiency Anemia among women and pre-school children is 51% and 68% respectively

Vitamin A supplementation has consistently increased from 82% in 2004 to 88% in 2007

Night blindness among children of age 18-59 months is 0.04% in 2005, well below the WHO thresholds

Prevalence of night blindness among pregnant women and lactating mother is 2.7% and 2.4% respectively.

Based on evidence formulated policies and plans

1983 - National Nutrition Policy1997 – National Food and Nutrition Policy 1997 – National Plan of Action for Nutrition2006 – National Food Policy2008 – National Food Policy Plan of Action2009 - National Health Policy2010 - National Agriculture Policy2011 – Country Investment Plan2011 - National Food Safety Policy and Action Plan (in

progress)

Interventions taken and Implemented Bangladesh Integrated Nutrition Project (MOHFW) National Nutrition Project (MOHFW) Micronutrient supplementation Initiatives(MOHFW)Fortification of edible oil and salt iodization (Industry supported by

MOHFW) Rice ,cereal, vegetable production and diversification of Crops, (MOA )One House One Farm Project (LGRD)Fish and Poultry Programs for fulfill protein gaps (MOFL) Regular Awareness Program through Media(Information)Developed food policy and Country Investment Plan targeting

sustainable food security and Nutrtion (Food and Disaster Management)

1. Scaled up comprehensive nutrition intervention through NNP in different parts of Bangladesh( around 30-40% coverage).

2. Stunting rate has decreased remarkably from 71% in 1992 to 45% in 2007.

3. Underweight rates showed substantial decline from 61% in 1992 to 42 % in 2007.

4. Proportion of women with low BMI reduced from to, from 53% in 1996/97 to 30 % in 2007.

5. Linking de-worming campaigns with vitamin A supplementation intervention

Evidence of Implemented interventions

Rice production

Rice production tripled since IndependenceBangladesh is close to self-sufficiency in normal years

Source: BBS except own estimates for Boro 2010

0

5000

10000

15000

20000

25000

30000

35000

Thou

sand

MT

Total rice Aus Aman Boro

Average growth rate between 2000 and 2010: 3%

Current GOB Programs and Initiatives to address Under NutritionCountry Investment Plan(2011-2016),MOFDMOne Farm One House(2011-2016)(6000 farm will be

establish), MOLGRDFortification of Edible oil and Salt Iodization(2011-2016),

MOIRice , cereal, vegetable production and diversification of

Crops(2011-2016),MOA Health , Population and Nutrition Sector

Development Program (2011-2016),MOHFW

Country Investment Plan, MOFDM(12 programmes)

COMPONENT PROGRAMME

Food Availability

Sustainable and diversified agriculture through integrated research and extension

Improved Water Management and infrastructure for irrigation purposes

Improved quality of input and soil fertility

Fisheries & Aquaculture Development

Livestock Development, with a focus on poultry and dairy production

Food Access

Improved access to markets, value-addition in agriculture and to non farm incomes

Strengthened capacities for implementation and monitoring of NFP and CIP actions

Enhanced Public Food Management Systems

Institutional Development and Capacity Development for more effective safety nets

Food Utilization

Community based nutrition programs and services

Orient food and nutrition programs through data

Food safety and quality improvement

National Nutrition Services(NNS) MOHFWMaternal, Neo-natal and Child Health CareCommunity Based Health CareMaternal, Reproductive and adolescence

HealthMicronutrient supplementation by Institute of

Public Health Nutrition (IPHN)under MOHFW

Health , Population and Nutrition Sector Development Program, MOHFW

Targeted Nutrition Indicators for Current 5 Year’s Plan(2011-2016)1. To reduce the prevalence of Low Birth Weight (<2,500 g)

from 36 % to 20% or less…..2. To reduce the prevalence of underweight (WAZ <-2 Z-scores)

in children <5 years from 48% to 36%....3. To reduce the prevalence of stunting (HAZ <-2 Z-scores) in

children <5 years from 43% to 37% 4. To reduce wasting (WHZ < -2Z) in <5 years from 13 % to 8 % 5. To maintain the prevalence of night blindness among

children aged 12-59 months below 0.5%...

Targeted Nutrition Indicators for Current 5 Year Plan(2011-2016)(Cont.)

6. To Reduce night blindness among pregnant women below .5 %

7. To reduce the prevalence of anaemia in < 5 years children from 49% to 40%, adolescents from 30% to 20%, and in pregnant women from 46% to 30%.

8. To reduce the prevalence of iodine deficiency (UIE <100 g/L) from 43% to 23% of all school aged (6-12years) Children

9. Pregnancy wt gain more than 9 kg or more in 50 % of pregnant women

10. To increase household food consumption (egg, meat, fruits) through homestead food production.

Implementation Progress of Current Interventions of MOHFW Policy Achievement:To Scale Up Nutrition, MOHFW has decided to shift from

vertical program (NNP,1994-2011, implemented in 172 sub district, which ended on June 2011) to an integrated nutrition service named the National Nutrition Service(NNS)

Line Director NNS will provide necessary supervision , guidance and coordination between related Operation Plans to ensure Scaling Up Nutrition.

All facilities under DGHS and DGFP providing Maternal and Neonatal Health services will be made available for integrated nutrition service delivery

Implementation Progress(cont.)

Components NNSIncludes the interventions for the first 1000 daysEvidence-based direct interventions to prevent and treat

under nutritionTreatment of severe acute malnutritionBCC to promote good nutritional practicesCoordination of nutrition activities across different sectors

and strengthen sectoral collaborationMainstreaming gender into nutrition programming

Implementation Progress (cont.)Targeted Modalities:Accelerate the progress in reducing high rates of under

nutrition by mainstreaming the implementation of Evidence -based direct interventions into regular Health and Family Planning Services

Scaling up community-based nutrition services through Community Clinics

Updating the National plan of ActionCapacities of District hospitals and Upazila Health Complexes

will be strengthened to adequately manage severely malnourished cases

Special attention should be paid to

Operationalizing the NNS to ensure coordination in nutrition interventions

Human resources development in terms of capacity building of existing workforce in the health sector

Ensuring multi-sectoral coordination and establishing intra and inter-ministerial linkages on nutrition interventions and

Conducting a stock taking and a costing exercise as soon as possible.

 

Opportunities …..

State’s political commitment.National Plan of Action on Nutrition,1995(will be under

current sector program)National Infant and Young Child Feeding (IYCF) strategy

and action plan.National communication strategy on IYCF and action

plan.National food Policy and Action PlanCountry Investment Plan(CIP),2011( a road map towards

investment in agriculture, food security and nutrition Other Ministries Involvement

Opportunities….Research Started for improved yield of cereals, for

improving the quality of soilAlso for increased yield of pulses, vegetables, poultry

and livestockFood fortification has just started in the country; wheat

flour and perhaps rice should be fortified with micronutrients

Challenges .....

1. Knowledge and awareness among the policy makers, health workers, concerned parents and mass people regarding: • Under nutrition and it’s future impact• Efficient way out from under nutrition

2. Lack of priority focus on critical age (9 months pregnancy to 24 months) in the national program

3. Lack of focus on future mothers (adolescence girls)

4. Lack of capacity of existing frontline nutrition service providers

5. Lack of optimum monitoring mechanism in nutrition program implementation

6. Lack of community mobilization regarding the impact of under nutrition

7. Inadequate human resources8. Lack of Nutrition Sensitive Agriculture9. Decreasing Agricultural Lands due to rapid urbanization by

housing companies

Challenges ....

Key recommendations to face the immediate ChallengesThe need to produce enough food that could

satisfy hungerEqually important – to produce food that

could control under nutritionProduced food has to be nutritious, providing

macro and micronutrientsFood has to be available and accessibleNutrition Sensitive Agricultural Production Eliminate gaps of Coordination and

Collaboration in relevant sector

Support needed to Address Under Nutrition

Financial Technical Capacity building Information and knowledge Sharing Bio-medical research related to nutrition

Support is most essential for Capacity Building

1. To develop efficient HR for field level of relevant sector.2. To develop excellent Nutrition Core Management Group

in country level, who will own the Scaling Up Nutrition (SUN) movement and will able to bring the targeted result

3. To establish a common data base for SUN initiatives through which progress of all interventions could be tracked online

4. To develop efficient IT people for nutrition data management

Development partners could support the process of scaling up Nutrition

To stimulate State authorities regarding nutrition & food security sensitive development approach.

To increase the coverage of tested nutrition interventions according to Lancet series on maternal and child under nutrition

Could mobilize political commitment for Scaling Up Nutrition(SUN).

Provide necessary Resource to support Nutrition Interventions

Thank you all