Developing the second National Plan of Action for Nutrition in Bangladesh
Dr Md. M. Islam Bulbul is the Deputy Programme Manager with National Nutrition Services and a technical specialist in the Public Health and World Health Wing of the Ministry of Health and Family Welfare in Bangladesh.
Dr Iftekhar Rashid is the leader of the Health Systems Strengthening Team in the Office of Population, Health, Nutrition and Education, U.S. Agency for International Development (USAID) based in Bangladesh.
The views expressed in this article are solely the views of the author and do not reflect the views of the United States Agency for International Development or the United States Government.
Click here to listen to an interview with the authors on the ENN podcast channel |
Introduction
Bangladesh, the most densely populated country in the world with an estimated 162 million people living in a land area of 148,000 square kilometers, has shown remarkable improvement in human development in the past decades, with a significant reduction in poverty. Despite progress, child and maternal malnutrition remains as a major challenge for the country to reach the 2030 Sustainable Development Goals and graduate from its categorisation among the least-developed countries.
The 2014 Bangladesh Demographic and Health Survey shows that overall indicators of economic growth and greater household wealth are strongly related to nutrition. For example, children whose mothers are in the lowest wealth quintile are almost two and a half times more likely to be stunted (50 per cent) than children whose mothers are in the highest wealth quintile (21 per cent). More than one in three (36 per cent) children under five (CU5) are stunted and 14 per cent are wasted. However, even in the highest household wealth quintile, stunting is quite high at 21 per cent; wasting is also high at 12.8 per cent, which clearly highlights that undernutrition is a cross-cutting problem for all Bangladeshis, although it is more pronounced in lower wealth quintiles (NIPORT, 2016). This situation reflects the underlying causes of undernutrition in the country, which include lack of maternal education; child marriage and early first birth; sanitation and handwashing practices; access to food and healthcare; infant and young child feeding practices; and the status of girls and women in the family and in society.
Losses in economic productivity due to undernutrition are reported to amount to an estimated US$1 billion of revenue per year (Howlader et al, 2012). Realising the importance of improving nutrition in the overall development agenda, the Government of Bangladesh (GoB) has been focusing on nutrition policies, strategies and programming and on developing a second National Plan of Action for Nutrition (NPAN2).
Bangladesh was an ‘early-riser’ country, joining the Scaling up Nutrition (SUN) Movement in 2011 and establishing a SUN multi-stakeholder platform (MSP) at the national level in 2012. Led by the GoB, members from the different SUN MSP networks (such as UN, donor and civil society) have actively participated in the NPAN2 formulation process as members of different committees and by providing financial, consultancy and temporary secretariat support for smaller sector committees and mobilising their respective GoB counterparts.
Building a multi-sector narrative
In 2014 the key development partners in nutrition published a common narrative1. While there was a renewed promise to work together, stakeholders identified the need for a multi-sector nutrition policy. The recent National Nutrition Policy 2015 (NNP-2015) clearly articulates multi-sector programming and inter-sector coordination as objectives and places an emphasis on both nutrition-specific and nutrition-sensitive interventions.
National commitment to combat malnutrition is in line with the country’s Vision 2021 and the seventh Five-Year Plan (2016-2020). Other factors such as the revitalisation of the Bangladesh National Nutrition Council (BNNC), with the Prime Minister as chair, have also catalysed the development of an action plan to operationalise the NNP-2015.
A national technical committee was created in January 2016 to guide the overall development of NPAN2 (2016-2025). This was further sub-divided into four different sector committees: Health, Urban Health and WASH; Food, Agriculture, Fisheries and Livestock; Women Empowerment, Education, Social Safety Net, Information; and Institutionalisation of NPAN2: Finance, Planning, Budget. The committees all had high-level representation from relevant government ministries, along with members from UN agencies, NGOs, donors and academia. Each committee developed an action plan for its respective sectors following a common format and highlighted cross-cutting areas, which were harmonised later in the process. Experts from Bangladesh and international consultants were engaged to ensure that each section of the action plan is not only technically sound but also feasible in terms of overall capacity, utilising global learning from different sectors. A costing exercise was involved, which is included in the NPAN2 to help in advocacy for resource mobilisation and financial planning.
A core group was formed during the final step of the exercise to merge the different parts and produce the final document, in which cross-cutting areas were harmonised. The draft NPAN2 went through several rounds of revisions as stakeholder comments were incorporated. The plan addresses the current and emerging nutrition problems of all citizens, especially CU5 (with particular focus on the first 1,000 days), women of child-bearing age (including pregnant and lactating mothers) and adolescent girls. Target indicators for 2025 include reducing CU5 stunting to 25 per cent and wasting to eight per cent, and increasing the rate of exclusive breastfeeding to 70 per cent in infants under six months of age.
Making key nutrition actions operational
The NPAN2 specifies priority key action areas and major activities under three thematic areas:
- Comprehensive and integrated social behaviour change communication agenda;
- Research to generate evidence to inform policy and programming; and
- Capacity-building, which targets all relevant sectors at different administrative levels.
The plan identifies the ministries and collaborating partners responsible for tracking progress and achievements of indicators, timeframes and costs involved in implementing the agreed priority interventions. It builds on existing platforms and delivery mechanisms that have proven to be effective, such as the agriculture extension network and frontline community workers. The plan includes a common results matrix for different sectors to work together and seeks coordinated financing of key sectors as well as tracking of investments.
A total of 17 ministries will be involved along with other stakeholders and partners. The costing exercise has estimated that a total of approximately US$1.6 billion is required for the NPAN2 (2016-2025) to carry out the priority activities, institutional development and capacity-building, as well as monitoring and evaluation (M&E) over the next ten years. This M&E will not only track progress made in the implementation of NPAN2 and investments in nutrition, but will also serve as the basis for the annual reports to be submitted to the Prime Minister through the BNNC office, which will be responsible for monitoring NPAN2’s progress. The plan provides a breakdown of nutrition-specific and nutrition-sensitive interventions, with the highest budget allocation (and priority) on women’s empowerment, education and social safety net (US$820,577,795); followed by health and urban health (US$675,721,493). Strategic budgeting and funding will take place within each sector or ministry in alignment with NPAN2. Sub-national dissemination of the plan is underway through division/district-level events (although GoB is a centralised government system, so each ministry takes the lead for programme design, in consultation with sub-national-level personnel).
Lessons learned and next steps
Developing NPAN2 has been a great journey that brought highly motivated people on board to improve nutrition. However, bringing key actors under one plan is quite challenging due to the large number of different types of nutrition programming in various sectors, many of which are applying a nutrition lens to programme design. For example, nutrition messaging is now part of the work of agriculture extension workers; safety-net programmes now target pregnant and lactating women; and education has updated the school curriculum with basic nutrition information at the primary level, with plans to update it further.
Leadership and political commitment were key to success: the Ministry of Health and Family Welfare has played a strong leadership role in convening different sectors/stakeholders and development partners have worked with their respective GoB counterparts to ensure their involvement. Dividing into four sector committees and giving leadership of each committee to its respective GoB sector and development partners was another effective strategy.
Next steps are to ensure that the BNNC is fully functional and working with all relevant sectors to make certain that implementation is on track and ensure wider dissemination of the action plan, advocacy and resource mobilisation.
References
National Institute of Population Research and Training (NIPORT), Mitra and Associates and ICF International. 2016. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International.
Howlader, Sushil Ranjan; Sethuraman, Kavita; Begum, Ferdousi; Paul, Dipika; Sommerfelt, A. Elisabeth; Kovach, Tara. 2012. Investing in Nutrition Now: A Smart Start for Our Children, Our Future. Estimates of Benefits and Costs of a Comprehensive Program for Nutrition in Bangladesh, 2011–2021. PROFILES and Nutrition Costing Technical Report. Washington, DC: Food and Nutrition Technical Assistance III Project (FANTA), FHI 360.
1Undernutrition in Bangladesh – A Common Narrative (http://docs.scalingupnutrition.org/wp-content/uploads/2014/06/Common-Narrative_BANGLADESH-Final.pdf)
More like this
NEX: Développement du second plan national de l’action pour la nutrition au Bangladesh
M. Islam Bulbul, médecin, est gestionnaire adjoint des programmes des Services nationaux de la nutrition et spécialiste technique au sein de la division de la...
FEX: A multi-sector approach to improve nutrition: Experiences of the Nutrition at the Center project, Bangladesh
View this article as a pdf Lisez cet article en français ici Click here to listen to an interview with the authors on the ENN podcast channel By Jahangir Hossain,...
NEX: Mapping multi-sector actions in Burundi and Myanmar: Towards more effective coordination
Ernest Niyokindi is Deputy Chief of Cabinet in the Second Vice President's Office for the Republic Burundi and the SUN Movement Government Focal Point. Dr Célestin...
FEX: Delivery of maternal nutrition interventions at scale and mainstreaming into the health system in Bangladesh
View this article as a pdf Lisez cet article en français ici By Deborah Ash, Zeba Mahmud, Kristen Kappos, Santhia Ireen and Thomas Forissier Deborah Ash is Project...
FEX: Coordination of the Nutrition Sector response for forcibly displaced Myanmar nationals in Cox’s Bazar, Bangladesh
View this article as a pdf Lisez cet article en français ici By Abigael Naliaka Nyukuri Abigael Naliaka Nyukuri worked for United Nations Children's Fund (UNICEF)...
FEX: Bangladesh Nutrition Cluster: A case in preparedness
By Andrew Musyoki and Anuradha Narayan Andrew Musyoki is a Nutrition Specialist with UNICEF Bangladesh Anuradha Narayan is the Chief of the Nutrition Section, UNICEF...
FEX: Improving minimum dietary diversity for children aged 6-23 months when household affordability is a major constraint in northeast Bangladesh.
View this article as a pdf Lisez cet article en français ici By Md Masud Rana, Sheikh Shahed Rahman, Md Al-Amin Shovan, Bazlul Kabir Joarder and Mohammad Raisul...
Improving social protection programmes to support mothers and young children’s diets in Bangladesh: Combining cash transfers with behaviour change
View this article as a pdf The Ministry of Women and Children Affairs, Government of Bangladesh, provided information and editorial support for this article. Dr Md Shah...
NEX: Decentralising nutrition management and coordination in Chad
Mohamed Cheik Levrak is the international REACH facilitator in Chad, building on his REACH experience as the national facilitator in Mauritania. Before that he worked for 17...
NEX: A catalyst for scale-up in SUN countries: Experiences of technical assistance for Tajikistan and the Philippines
ENN's SUN Knowledge Management team with contributions from Nutrition International (NI) and Maximising the Quality of Scaling Up Nutrition Plus (MQSUN+) Click here and...
FEX: Development and added value of the Nutrition Cluster in Turkey
By Wigdan Babikir Makki Madani View this article as a pdf Lisez cet article en français ici Dr Wigdan Madani is the Nutrition Cluster Coordinator for Turkey, based in...
Addressing inequities in nutrition outcomes in Nepal: Integrating an unconditional child cash grant and infant and young child feeding programme
View this article as a pdf Kedar Raj Parajuli is the Chief of the Nutrition Section in the Family Welfare Division of the Department of Health Services, Ministry of Health and...
en-net: Nutrition Adviser - Bangladesh, Concern Worldwide
Nutrition Advisor - Emergency Response: Bangladesh About the role: This is a 6-month, new role with unaccompanied terms based in Cox's Bazar, Bangladesh at Grade 4 with a...
FEX: Post-Rome integrated action: Experiences from North-eastern Nigeria
By Kirathi Reuel Mungai and Adeola Goriola Makanjuola View this article as a pdf Lisez cet article en français ici Kirathi Reuel Mungai is a nutrition specialist...
Resource: Multi-sector programmes at the sub-national level: Implementation of the National Plan of Action for Nutrition 2 – A case study in Sunamgunj and Rangpur, Bangladesh
This case study features as one of three in a series of case studies documenting multi-sector programming at the sub-national level. The case study describes the enabling...
NEX: Regional nutrition strategies to address the double burden in the Eastern Mediterranean
Dr Ayoub Al Jawaldeh has been the Regional Adviser for Nutrition in the WHO Regional Office for Eastern Mediterranean Region since 2009, leading the Regional Nutrition...
en-net: Opportunities with Nutrition International-TAN in Bangladesh
BGD-03-Operationalization of National Plan of Action for Nutrition-2 (NPAN2) BGD-04- Support strengthening of multi-sectoral nutrition monitoring, evaluation and reporting in...
NEX: Community engagement through local leadership: Increasing access to nutrition services in a conflict setting in Yemen
Dr Fatima AK Sallam is a Project Manager with Soul for Development, a local Yemeni NGO. She is a qualified medical doctor. Khaled Albably is a Senior Project Officer with Soul...
FEX: Municipal budget allocation and utilisation for nutrition in Nepal
View this article as a pdf Lisez cet article en français ici By Shraddha Manandhar, Pramila Shrestha, Bishow Raman Neupane, Satya Narayan Acharya, Harendra Bahadur...
FEX: Editorial
View this article as a pdf In this issue of Field Exchange we are delighted to feature, for the second year running, a special section that shares key outputs of Action...
Reference this page
Dr Md. M. Islam Bulbul and Dr Iftekhar Rashid (). Developing the second National Plan of Action for Nutrition in Bangladesh. Nutrition Exchange 10, July 2018. p14. www.ennonline.net/nex/10/nationalplannutritionbangladesh
(ENN_6025)