Government versus NGO efficiency, Bangladesh

Summary of published paper1

It is often assumed that during emergencies, nutrition and food interventions can be more efficiently managed by NGOs than by government. A recent study on an integrated nutrition programme in Bangladesh may challenge this assumption, even though the programme was conducted in a non-emergency setting. The study also found that the supplementary feeding component of the intervention was very costly in terms of providing calories. Given the limited data in the public domain on the costs (and cost-efficiency) of emergency supplementary feeding programmes, the findings may be of interest to emergency programme planners - Ed

The Bangladesh Integrated Nutrition Programme (BINP) was adopted to improve the nutritional status of the population, especially of women and children, through community based nutrition interventions. The community based nutrition component focuses on growth monitoring of children, dissemination of nutrition-related information and supervised supplementary feeding of target women and children in Community Nutrition Centres (CNCs) at village level. The government has adopted the National Nutrition Programme (NNP) based on experiences and lessons learned from the BINP, and intends to provide a similar mix of services to those being delivered under the BINP. Scaling up the activities to the whole country will cost approximately 150 million dollars a year.

The BINP experimented with two models of delivery, one using government management structures and the second using non-governmental organisations (NGOs) working in the local community. A recent study has compared the efficiency of the government of Bangladesh (GOB) and NGO management in the provision of nutrition services and involved a detailed costing to estimate cost of delivering nutrition services from the CNCs. The number of individuals enrolled, the number actually participating in the programme, and person-days of service delivered were used as effectiveness measures.

Thirty-five CNCs were randomly selected from five BINP areas, of which 21 were in GOB-run areas and 14 in NGO-run areas. The cost of providing nutrition services per enrolee was US$24.43 for GOB-run CNCs and US$29.78 for NGO-run CNCs.

The analysis implies that the NGO facilities are not more efficient in the delivery of nutrition services when cost per person/days of service delivered is considered. One potential criticism of this type of comparison is that it assumes enrolment and participation without looking into potential mis-targeting. If the expected enrolment is calculated by using prevalence of malnutrition rates found by the BINP, it is clear that enrolment rates were lower in GOB facilities and higher in NGO facilities than otherwise expected for rural Bangladesh. However, enrolment does not equal participation. Re-estimating the costeffectiveness measures with expected enrolment numbers makes the NGO facilities even less efficient compared to GOB facilities.

On average, the BINP delivered food supplementation of 480 kcals per participant at a cost of about US$0.25 per day. Allowing for administration and management costs, the actual food cost becomes US$0.20 per participant per day. If the project were to use this amount of money to buy rice from the local market, the calorie content of the rice would be more than 2000 kcals. Unless the food supplementation process generates other types of benefit, such a high level of cost cannot be justified. The study authors conclude that even if other benefits such as nutrition education and community involvement are generated, policy makers should compare a programmes' relative efficiency and effectiveness with its separable components, to determine whether concentrating on specific components will generate higher levels of social benefits per dollar spent.

Show footnotes

1Mahmud Khan, M and Ahmed, S (2003). Relative efficiency of government and non-government organisations in implementing a nutrition intervention programme - a case study from Bangladesh. Public Health Nutrition; 6 (1), pp 19-24, 2003

More like this

FEX: Community case management of severe acute malnutrition in southern Bangladesh

Summary of study1 Bangladesh has the fourth-highest number of children (approximately 600,000 at any one time) suffering from severe acute malnutrition (SAM) in the world....

FEX: From the editor

Rabia, seven months, with her mother at an OTP Aim and structure of this special issue This Field Exchange special issue on ‘Lessons for the scale up of Community-based...

FEX: Improving blanket supplementary feeding programme (BSFP) efficiency in Sudan

By Pushpa Acharya and Eric Kenefick Pushpa Acharya is currently working as Head of Nutrition for the World Food Programme in Sudan. She has a PhD in Human Nutrition from the...

FEX: Scaling up CMAM in the wake of 2010 floods in Pakistan

By Dr. M. Suleman Qazi Dr. Qazi was engaged by the ENN to capture the lessons from Pakistan on CMAM scale up. Dr Qazi is a medical graduate with a post graduate degree in...

FEX: Comparing cash and food transfers: findings from a pilot project in Sri Lanka

By Lili Mohiddin (Oxfam GB), Manohar Sharma (IFPRI), Anette Haller (WFP Rome) Lili Mohiddin, Manohar Sharma & Anette Haller Lili Mohiddin has been an Emergency Food Security...

FEX: Quantity through quality: Scaling up CMAM by improving programmes Access

By Saul Guerrero & Maureen Gallagher Saul Guerrero is the Senior Evaluations, Learning and Accountability (ELA) Advisor at ACF UK based in London. Prior to joining ACF, he...

FEX: Experiences of the Nutrition in Emergencies Regional Training Initiative

By Abigail Perry, Jessica Meeker, and Andrew Seal, UCL Centre for International Health and Development (UCL-CIHD) Abigail Perry is a nutritionist with extensive experience in...

FEX: Cost effectiveness of CMAM in Malawi

Government of Malawi guidelines Summary of published research1 A recent study assessed the cost-effectiveness of community-based management of acute malnutrition (CMAM) to...

FEX: From the editor

This issue of Field Exchange gives extended coverage to a briefing paper just released by Oxfam and SC UK on the 2011 response to the Horn of Africa crisis. This paper argues...

Resource: Cost Effectiveness of Community-Based Management of Acute Malnutrition (CMAM) in Malawi

Reference: Health and Policy Planning, 2011: 1-11. Published March 4th 2011. This study assessed the cost-effectiveness of community-based management of acute malnutrition...

en-net: Concern seeking consultant to evaluate South Sudan nutrition programme

Draft Terms of Reference for post project Evaluation of ECHO supported ‘Provision of Effective and Integrated Nutrition Care for Children Under Five Years’ project in Aweil...

FEX: Evaluation of CMAM Pakistan: UNICEF country case study

Summary of evaluation1 A flood affected community in Khyber Pakhtunkhwa province CMAM has been implemented in Khyber Pakhtunkhwa province of Pakistan, with scale up in 2010...

FEX: Food aid targeting in Ethiopia

Summary of published paper Food Distribution, Ethiopia '95 Based on data from a nationally representative survey of 4166 farm households by the Grain Market Research project...

FEX: WFP HIV/AIDS Programming in Malawi

By Jeremy Shoham, ENN Households headed by the elderly may be vulnerable This article was written based on a WFP consultation to Malawi in February 2005. The WFP Malawi...

FEX: Delivery of Social Protection Programmes in Kenya

By Clemensia Mwiti and Nupur Kukrety Clemensia Mwiti is a Humanitarian Support Professional (HSP) in Emergency Food Security and Livelihoods. Nupur Kukrety is the Social...

FEX: Integration of CMAM into routine health services in Nepal

By Regine Kopplow Regine is a former CMAM Advisor with Concern Nepal. She is a nutritionist with a background in rural development. She has worked in the field of nutrition...

FEX: Technical and Management issues within CTC (Special Supplement 2)

4.1 CTC from Scratch - Tear Fund in South Sudan By Ed Walker (Tearfund) Beneficiaries collecting their general ration in South Sudan. Tearfund has been working in Northern...

FEX: CMAM rollout in Ethiopia: the ‘way in’ to scale up nutrition

By Dr Ferew Lemma, Dr Tewoldeberhan Daniel, Dr Habtamu Fekadu and Emily Mates Dr Ferew Lemma is Senior Nutrition Advisor to the State Minister (Programs), Federal Ministry of...

en-net: Senior Nutritionist MYAP - Uganda - Concern Worldwide

Reference: ES/SN/UG Country: Uganda Job Title: Senior Nutritionist MYAP Contract Grade: B Contract Length: 2 years Date Needed By: September 2012 New Post or Replacement:...

FEX: Emergency food-based programming in urban settings

Summary of published research1 Children attending Stara School, Nairobi, that receives WFP food support. The Food and Nutrition Technical Assistance 11 (FANTA-2) Project has...

Close

Reference this page

Government versus NGO efficiency, Bangladesh. Field Exchange 20, November 2003. p9. www.ennonline.net/fex/20/government