Making social protection nutrition-sensitive | The star of the day

All social protection programs in Bangladesh must be nutrition sensitive for the country to achieve 100% nutrition security. SOURCE: DPE.GOV.BD

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All social protection programs in Bangladesh must be nutrition sensitive for the country to achieve 100% nutrition security. SOURCE: DPE.GOV.BD

Bangladesh has made rapid progress in health and nutrition over the past decade. There has been a significant drop in stunting in children under five, as well as an increase in life expectancy. The country’s hunger score fell from 34 in 2000, to 28.6 in 2012, to 19.1 in 2021. The Global Hunger Index also noted its success in reducing undernourishment, under-five mortality rate and child wasting.

However, Bangladesh has yet to achieve nutrition security for its entire population. According to the Bangladesh Demographic Health Survey (BDHS), 2017-18, stunting and wasting among Bangladeshi children are still higher than global averages. The 2016 Household Income and Expenditure Survey (HIES) put the percentage of people living below the poverty line at 24.3.

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The Covid-19 pandemic and the restrictions imposed in its wake have affected people’s livelihoods, food security and health; it has made the poor, especially women and children, even more vulnerable. It has been estimated that the pandemic will increase the country’s poverty rate to 35%. With the loss of income and rising prices of basic necessities, 23% of households in urban slums and 15% of households in rural areas reduced their food consumption during the lockdown period. The disruption of several services such as immunization and sanitation services, and the closure of schools and preschools (providing meals to children) portends a malnutrition crisis which, if left unchecked, will will quickly undo all the achievements of recent years. The pandemic shows why investing in health and nutrition is essential for population well-being, immunity and resilience. The response to the pandemic and the fight against malnutrition must engage the joint forces of all development actors.

Social Security Programs (SSP) are the main instruments of the Government of Bangladesh to support vulnerable groups in the country. About 120 such programs are implemented by 23 ministries and divisions, targeting 27.8% of the population, although the number of programs and the extent of coverage vary from year to year. The National Social Safety Strategy (NSSS), adopted in 2015, aims to streamline and strengthen existing safety net programs for better results with the money spent. They include programs such as cash transfers, food transfers, school grants, job creation and other subsidy programs. In line with the NSSS Human Development Strategy, PHCs, among others, must address the root causes of malnutrition.

The Bangladesh National Nutrition Council (BNNC), the nodal agency that provides guidance in formulating nutrition policies and ensuring that nutrition is mainstreamed in all government policies, reviewed selected PHCs. The review found that there is room to improve the gender and nutrition sensitivity of these programs to improve nutrition outcomes for the most vulnerable and disadvantaged segments of the population.

For social protection to be nutrition-sensitive, programs need to be combined with interventions that have a direct beneficial impact on nutrition, such as the provision of micronutrient-fortified foods, referrals to nutrition, promoting diversity in agriculture, behavior change promoting diversity in diets and recommended care practices and designs that help ensure equitable distribution of food and resources to women and children within families.

Although there was an increase in the total number of beneficiaries under PHC, from eight million in 2010 to 11 million in 2016, there were considerable gaps between rural and urban areas. About 36% of beneficiaries came from rural areas and only 10.5% from urban areas. Nearly 40% of the Bangladeshi population now lives in urban areas. Despite better utilization of nutrition services in urban areas than in rural areas, the nutritional status of the urban slum population is much poorer than that of the non-slum population. This requires greater focus in targeting nutrition-sensitive PHC based on data available for the urban slum population.

As part of addressing a wider range of the population, different programs have been designed targeting different groups of beneficiaries without having a clear transition strategy for beneficiaries from one program to another throughout their life. life cycle. Additionally, the individual programs appeared to be designed to address a particular vulnerability; a holistic approach to addressing multiple root causes of vulnerability would have been preferable to avoid duplication, efficient use of limited resources and provision of comprehensive support to beneficiaries.

A recent study by BNNC and Nutrition International found that many of the largest PHCs did not include a nutrition situation analysis in their initial design, nor nutrition-related outcomes in their monitoring framework. Many programs are also not evaluated regularly and do not publish annual performance reports. There were gaps in coordination and collaboration between the various agencies addressing the same target groups.

Various ministries and departments need to move beyond the “silo” approach and work together to achieve nutrition results. Data infrastructure is needed to cross line ministries for more effective targeting and reaching of beneficiaries. Better coordination and data-driven evidence to further strengthen PHCs are needed to make them more visibly nutrition-sensitive. Good nutritional status and growth are the foundation not only for the rights and well-being of vulnerable people, but also for equitable future growth and prosperity.

Saika Siraj is Country Director of Nutrition International in Bangladesh.

Eadara Srikanth is Asia Program Manager for Nutrition Program Technical Assistance at Nutrition International in Bangladesh.

Richard Morgan is Director of Social Safety Net Programs at Nutrition International in Bangladesh.