Situation Analysis
for
Nutrition at the Center
CARE Bangladesh
October 2013
Compiled by:
Dr Farzana Ishrat
1
CONTENTS
Acronyms
3
Preamble
5
Methodology
5
Bangladesh: brief history on Nutrition
6
Population statistics
7
National Initiatives or Programs Addressing Nutrition
8
UN supported activities
13
USAID supported initiatives on Nutrition:
15
National Initiatives or Programs Addressing WASH
16
National Initiatives /Programs Addressing Food Security &
Agriculture
17
USAID funded projects/ initiatives on Agriculture
18
National level coordination or initiative on integrating nutrition
with food security/agriculture or WASH
Target area: Sunamganj district
19
List of agencies working on Nutrition in Bangladesh:
22
DONORs for Nutrition services in Bangladesh:
22
Persons met/ communicated with
23
References:
24
20
Annex
2
ACRONYMS/ABBREVIATIONS
ARI
Acute respiratory infection
ASPS
Agriculture Sector Program Support
BCC
Behaviuor Change communication
BF
Breastfeeding
BFHI
Baby Friendly Hospital Initiative
BINP
Bangladesh Integrated Nutrition Project
BMS
Breastmilk substitute
BNNC
Bangladesh National Nutrition Council
CBN
Community based Nutrition
CBNC
Community Based Nutrition Componenet
CC
Community Clinics
CDD
Control of Diarrheal Diseases
CED
chronic energy deficiency
CG
Community group
CHCP
Community Health Care Provider
CIP
Country Investment Plan (CIP)
CSA
Civil Society Alliance (CSA)
DAE
Department of Agriculture Extension
DGFP
Directorate general of Family Planning
DGHS
Directorate General of Health Services
DP
Development Partner
DPHE
Department of Public Health Engineering
EPI
Expanded program on Immuniation
FANTA
Food& Nutrition Technical Asssistance
FAO
Food & Agriculture Organisation
FFS
Farmers Field School
FP
Family Planning
FSNSP
Food security & Nutrition Surveillance project
GMP
Growth monitoring & Promotion
GOB
Government of Bangladesh
ICDDRB
International Centre for Diarrheal Diseases, Bangladesh
IMCI
Integrated Management of Childhood Illness
IYCF
Infant & Young Child Feeding
LGRDC
Local Government, Rural Development & Cooperatives
MCWC
Mother & Child Welfare Centre
MDG
Millenium Development Goal
MIS
Management Information System
MO
Medical Officer
3
MOHFW
Ministry of health & Family Welfare
MPTF
Multi-Partner Trust Fund
MYCNSIA Mother & Young Child Nutrition Security in Asia
NCD
Non communicable diseases
NGO
Non Government Organisation
PHC
Primary Health Care
PHN
Public Health Nutrition
PoA
Plan of Action
RCHCIB
Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB)
SAM
Severe Acute Malnutrition
SPRING
SPRING Strengthening partnership, results and Innovation in Nutrition Globally
SUN
Scaling up Nutrition
SWAp
Sector Wide Approach
UHC
Upazila Health Complex
UHFWC
Union Health & Family Welfare Centre (UHFWC)
UNDAF
United Nations Development Assistance Framework (UNDAF)
UNICEF
United nations' Children’s Fund
USAID
VAD
United States Agency for International Development
Vitamin A deficiency
WASH
Water, Sanitation & Hygiene
WHO
World Health Organisation
UNDAF
Bangladesh United Nations Development Assistance Framework
4
Preamble:
With the highest population density in the world, at 1142per sq km1 excluding
a handful of city states of and small countries with populations under less than
10 million) Bangladesh has one of the highest rates of peace-time undernutrition in the world. Again, within the country there are pockets of very high
prevalence of under-nutrition. To improve the situation in remote parts of
Bangladesh, CARE is planning to serve the people in two subdistricts or
upazilas (Derai and Bishwambarpur) in Sunamganj district situated in the north
eastern haor* area of Bangladesh, bordering the Assam province of India.
Prior to designing the project CARE has commissioned this situation analysis
to help in designing the appropriate interventions.
Methodology:
This report has been prepared primarily from information collected from
secondary sources including document reviews and the internet. Face to face
meeting some personnel in the Government of Bangladesh and the
Development Partners have added value to the report. Where face to face
meetings were not possible information were collected over telephone.
For the quantitative data several data sources were consulted In addition
support of a statistician experienced in demographic surveys was also obtained.
Limitations:
The planned face-to face interview with some key personnel could not be
conducted for various reasons including. One of them was away on sick leave
following cardiac surgery and another was out of the country. Attempt was
made for meeting before finalizing this report but could not be done due to
unavoidable circumstances.
______________________________________________________
*A haor is a wetland ecosystem in the north eastern part of Bangladesh which physically is a bowl or
saucer shaped shallow depression, also known as a backswamp
5
Bangladesh
Brief History:
The poor nutritional status of the people of Bangladesh first came to notice following
the National Nutrition Survey conducted in 1962-64,2 This was perhaps instrumental
in including the nutrition issue in the constitution of the country soon after
independence in 1972. Article 18(1) of the constitution states: “The State shall
regard the raising of the level of nutrition and the improvement of public health as
among its primary duties, and in particular shall adopt effective measures to prevent
the consumption, except for medical purposes or for such other purposes as may be
prescribed by law, of alcoholic and other intoxicating drinks and of drugs which are
injurious to health”..
Following this the Institute of Public Health Nutrition was established in 1974 and the
Bangladesh National Nutrition Council (BNNC) in 1975, chaired by the head of
Government (Prime Minister)2. Both the bodies are housed in the Ministry of Health
& Family Welfare (MOHFW). However, in the early days the most important and
large scale program was the Vitamin A supplementation project as the incidence of
night blindness due to Vitamin A deficiency (VAD) in children 12-59 months was
much above the World Health Organization (WHO) criteria for Public Health problem
(3.5% in 1983)3. The plan was to immediately address the problem with Vitamin A
supplementation while promoting long term solution through dietary diversity to
increase the intake of vitamin A and best carotene rich food by the household as a
whole. Nevertheless, while the Vitamin A supplementation project continued for
years successfully keeping the night blindness incidence in children under 5-year old
at 0.62%, well below the WHO threshold of 1.0% for clinical VAD, the subclinical
deficiency remained pretty high with 22% pre-school children having low retinol
level (,0.70μmol/L). Furthermore, high incidence of night-blindness in pregnant
women surfaced. This indicated lack of or non-effective promotion of dietary diversity
to reduce VAD as well as deficiency of other nutrients. The fight against iodine
deficiency was later included alongside the fight against VAD. However, these
piecemeal projects left the greater nutrition problems of mass scale under-nutrition
in children and chronic energy deficiency (CED) in adults
unsolved and
unaddressed. In the early 1990s the World Bank,
UNICEF and a few other development partners
supported the Government to design and implement
Under 5year children
the first large scale integrated nutrition project, the
Stunted 41%
Bangladesh Integrated Nutrition Project (BINP)4. It
Wasted 16%
had a core component called Community based
Underweight 36%
nutrition component (CBNC) and subcomponents
involving the food production units – Poultry for Nutrition (PFN) and Household
Food Security through Home Gardening (HFSNG)5. The BINP was implemented
during 1995-2002. Encouraged by the mid-term review findings of BINP, expansion
of nutrition services was designed taking into consideration the lessons learnt from
BINP.The National Nutrition Program (NNP) came into being in 2000 and was
6
implemented till mid 2011 ( in two phases 2000-2006 and 2006-2011). From 2006
NNP was included in the Health SWAp and from mid 2011 being implemented as
National Nutrition Services (NNS) under the Health Population Nutrition Sector
Development Program(HPNSDP). Nutrition has been identified as a priority area in
the HPNSDP3,7. This mainstreaming of nutrition services was done primarily because
of the annual program review (APR) of Health Nutrition & Population Sector Program
(HPNSP) 2009 recommendation as “DPs will not fund for the parallel project outside
the scope of HPNSDP.”3 However, no transition plan was drawn nor any transition
period was allowed for this shift in the implementation policy.. As such field
implementation is suffering as identified by the recent Annual program review (APR)
mission in September 2013 led by the World Bank6.
Population statistics:
Total population
Population of women of
reproductive age [give age range
used in country
(a) 15-49) or (b) 14-49 (c) any
other ________]
And also expressed as a % of
total population
Population of children under 24
mos.
And also expressed as a % of
total population
% of Rural Population
% of population classified as
“marginalized”, if any
% of population below poverty
line -“poor”. Use MGD
definition*.
Women’s literacy overall
- For lowest poverty quintile
- For rural areas
National Data
Data Source
with Year
Target Area Data
(usually district
level)
Data Source
with Year
142,319,000
Population and
Household
Census, 2011
(Socio-economic
and
Demographic
Report), BBS
DO
2,443,000
(Sunamgonj District)
Population and
Household
Census, 2011,
BBS
554656
DO
36,960,144
a) 53.1% of females
b) 25.96% of total
population
7794603
DO
5.60 of total population
112510154;(80.8%)
(Sunamgonj District)
- 45.50 % of female
- 22.70% of Total
Population
605691
(Sylhet Division)
DO
6.60
87.98
(Sylhet Division)
DO
-
DO
DO
31.5**
-- 53.44
- 50.20
49.8
DO
(Sunamgonj
District)
*The MGD definition is “living on less than $1.25 per day”.
** http://data.worldbank.org/country/bangladesh ( Accessed on 29.10.13)
7
National Initiatives or Programs Addressing Nutrition
National Nutrition Services (NNS)4
The prevalence of under-nutrition is still one of the highest in the world, (highest
peace time). The Government of Bangladesh as well as its development partners
(DPs) have identified nutrition as a priority area for development. The MOHFW has
a separate operational plan (OP) for nutrition -the National Nutrition Services (NNS)
out of the 32 OPs in the HPNSDP. The Directorate General of Health Services
(DGHS) is primarily responsible for the implementation of NNS. Both the DGHS and
DGFP (Directorate General of Family Planning) are given the responsibility of
streamlining and strengthening the nutrition services by using their regular
manpower from their respective directorates, thus doing away with the need of
having nutrition staff/workers in different tiers including the grassroot level. The OP
states that at “the community level, nutrition services will be delivered by Health
Assistant, Family Welfare Assistant and CHCP (Community health care providers) in
addition to their usual duties” . However, how this will be done is not clearly
mentioned in the operational plan.
Already 482 medical officers (MO) in the Upazila Health Complexes (UHC) have
been designated as MO (Public Health Nutrition)7. The MO (PHN) is responsible for
coordinating all activities of NNS at the upazila level and below. The MO (PHN) will
oversee the delivery of health centre-based nutrition services in the UHC as well as
monitor health centre-based nutrition interventions in all unions and Community
Clinics (CC) as a whole.”
The objectives of NNS4:
General Objective:
To reduce the prevalence of malnutrition among the people of Bangladesh with
special emphasis on the children, women, adolescents and underprivileged section
of the society.
Specific Objectives:
1. To implement a mainstreamed, comprehensive package of nutrition services to
reduce maternal and child malnutrition and ensure universal access
2. To develop and strengthen coordination mechanisms with key relevant sectors
(especially Ministry of Food and Disaster Management, Ministry of Agriculture,
Ministry of Women and Children Affairs, Ministry of Information, Ministry of
Education, Ministry of Livestock and Fisheries, Ministry of Local Government,
Rural Development and Cooperative, etc.) to ensure a multi-sectoral response to
malnutrition
3. To strengthen the human resource capacity to manage, supervise and deliver
nutrition services at the different levels of the health &family planning services.
4. To strengthen nutrition management information systems and operations
research to ensure an evidence-based response and establish linkages to MIS
8
Major Components of NNS OP
Major Activity
a) Behaviour Change Communication (BCC)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Control of Vitamin-A deficiency disorder
Control & prevention of Anaemia
Control of Iodine Deficiency Disorder
Other Micronutrient problem of Public Health importance (zinc, vitamin D, calcium etc)
Community & facility based management of severe acute malnutrition(SAM)
Protection, Promotion & Support of Breastfeeding/ Infant and Young Child Feeding
(IYCF) including BFHI & BMS Code
Food fortification (Salt Iodization, fortification of oil/other food with Vitamin A, iron etc.)
School Nutritional Education Program
Food Quality and Food Safety
Monitoring, Evaluation, Operations research, survey
Nutrition Surveillance Program
m) Establishment of nutrition unit (NU) and strengthening of existing NU
n) Community based Nutrition (CBN) in selected area
o) Nutrition in emergency / NCD
p) Establishment of nutrition Service in CC & GMP
HPNSDP has been designed for functional integration and mainstreaming of
nutrition However, it is yet to materialize. “The Health Directorate implements and
supervises their own activities and FP Directorate does the same. The field staff is
yet to learn, internalise and own nutrition services” laments an official of MOHFW 8.
Even the MIS from many peripheral health care centres did not report any nutrition
services. The staff could not describe the nutrition services at MCWC; very little
attention is given to nutrition and few staff trained6.
MYCNSIA (DGFP)8
The DGFP is implementing MYCNSIA project ( Mother and Young child
nutrition security initiative in Asia) with support from UNICEF and Technical
assistance from ICDDR,B in 17 upazilas (subdistrict) in 8 districts. The project
started in Nov 2011 and expected to be completed in 2014.
District
1
2
3
4
5
6
7
8
Bhola
Cox’s Bazar
Rangpur
Comilla
Jamalpur
Sunamganj
Narail
Satkhira
Upazila
Lalmohon and Sadar upz
Moheshkhali and Sadar
Badraganj and Pirgachha
Burichang
Islampur and Sharishabari
Derai and Duarabazar
Kalia and Lohagara
Kaliganj, Asasuni, Shyamnagar & Debhata
9
The 1,000 day nutrition services for the mothers and children under MYCNSIA 8
(translated from a leaflet collected from the project personnel)
A. Pregnant Mothers:
a. At least 4 ante-natal check-up in the health care centre
b. Nutritional counseling for consuming more vegetables, meat, fish
during pregnancy
c. At least one Iron-Folate tab every day during pregnancy and 3 mo
following child-birth
B. Under 2yr Children:
a. Early initiation of BF ( within 1 hr)
b. Exclusive breastfeeding for the first 6 months (180 days)
c. Introduction of home-made complementary food after completing 6
months (180 days)
d. Feeding MNP ( multiple micronutrient powder) from 6 mo to 24
months
e. After completing 6 months (180 days) children should be fed at least
4 types of food ( carbohydrates + pulses +protein (fish / meat / offal
+vegetables and fruits)
f. The child must be administered Vitamin A capsules as recommended
g. Both hands must be washed well with soap and water before
preparing food, before feeding the child and after cleaning the baby
10
Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB)9
The GOB has taken initiatives for revitalization of Community Clinics (CC) as
the top-most priority project in the Health sector. The CC is basically meant for
health education (on health, nutrition and family planning), health promotion and
treatment of minor ailments, first aid and identification of emergency & complicated
cases to establish a referral linkage with higher facilities like Union Health & Family
Welfare Centre (UHFWC) and Upazila Health Center (UHC).
The services to be provided at the CC are9:
1.
2.
3.
4.
5.
Maternal and neonatal health care services
Integrated Management of childhood Illness (IMCI)
Reproductive Health & Family Planning Services
EPI, ARI, CDD
Registration of newly married couple, pregnant women, birth, death,
prediction of EDD
6. Nutritional education and micronutrient supplements
7. Health & Family Planning Education & Counseling
8. Identification of other illnesses like TB, Malaria, Pneumonia, Life
threatening influenza, Obstetric emergencies and refer to higher
facilities
9. Identification of emerging and reemerging diseases & refer to higher
facilities
10. Other services as identified by GOB to be provided
11. Treatment of minor ailments
12. Establishing effective referral linkage with higher facilities
The CCs are the first point of contact for the rural people in the remotest areas of
Bangladesh. It is a one-stop centre for PHC ( primary health care) services. There
are 12,217 out of the planned 13,500 CC in operation currently (as of Jan 2013)
These are open 6 days a week. It is staffed by one Community Health Care
Provider (CHCP), who should be available all 6 days. So far approximately equal
number of male and female CHCP have been recruited (as of Jan 20013) In
addition, one Health Assistant (HA) (mostly men) from the DGHS and one Family
Welfare Assistant (FWA) (all women) from DGFP is present on alternate days to
serve the clients coming to the CC as per the above list of services. The CHCP is
supposed to receive a three month foundation training. But all the CHCPs are yet to
be trained. Community based nutrition services, growth monitoring & promotion and
promotion of IYCF are not clearly mentioned in the list of services to be provided
from the CCs.
RCHCIB project has partnered with several NGOs including CARE Bangladesh (40
upzs from Brahmanbaria, Cox’s Bazar, Jhalokathi & Moulvibazar) for capacity
development of the community group (CG), operational research .
11
Food Security & Nutrition Surveillance project (FSNSP)10
The Food Security & Nutrition Surveillance Project (FSNSP) is the only surveillance
project in Bangladesh that provides nationally representative estimates of food
security and nutrition The system provides up-to-date evidence on the food security,
nutrition and health status of women and children to support the design,
implementation and evaluation of national strategies and assess progress towards
internationally agreed development targets such as those of the MDGs.
Pockets of low dietary diversity is found to exist in the Haor basin (including
Sunamganj) where women’s calorie intake is approximately 60-70% of the
requirement resulting in 40% of women being are underweight. It is important to
note that in the last 10 years the proportion of women with CED ( chronic
energy deficiency) has halved while proportion of overweight women has
more than doubled3 in the country. An important point for future planners.
12
UN supported activities
The Bangladesh United Nations Development Assistance Framework (UNDAF)
2012-2016: 11
The UNDAF is the UN System’s coherent and collective response for addressing
inequalities in Bangladesh. It elaborates what and how results will be achieved over
the next five years for the people of Bangladesh, particularly for the most vulnerable,
deprived and marginalized citizens.
The seven UNDAF Pillars and the respective UN Lead Agencies are as follows:
1.
Democratic Governance and Human Rights (UNDP)
2.
Pro-poor Growth with Equity (UNDP)
3.
Social Services for Human Development (UNICEF)
4.
Food Security and Nutrition (WFP)
5.
6.
Climate Change, Environment, Disaster Risk Reduction and
Response (UNDP)
Pro-poor Urban Development (UNDP)
7.
Gender Equality and Women's Advancement (UNFPA)
Some FAO projects in Bangladesh 18 :
1. National Food Policy Strengthening Program (NFPSP)
2. Food Safety project
3. Integrated Agriculture Productivity Project (IAPP)
4. Emergency center for Transboundary Animal diseases support
5. Prevent, Prepare, Respond to Food and agriculture threats and emergencies
6. Improving Surface Water Irrigation in Coastal Areas and Sylhet Division in
Bangladesh
7. Food Security through enhanced agricultural production diversified sources of
income, value addition and marketing in Bangladesh
13
The Country Investment Plan (CIP)12
The CIP is a roadmap towards investment in agriculture, food security and nutrition It
has been jointly prepared by 13 ministries of the Government of Bangladesh
coordinated by the Food Planning and Monitoring Unit (FPMU) of the ministry of
Food. The CIP is a planning, fund mobilization and alignment tool. It is a 5yr
comprehensive plan that aims at ensuring sustainable food security. It is the
investment arm of the national Food Policy (NFP, 2006) and its plan of action (PoA
2008-2015) and reflects the food security content of the 6th 5yr plan (SFP) 20112015. It is an advocacy and financial tool for increased resource allocation from the
budget (both GOB and DPs)12.
The CIP provides a coherent set of 12 priority investment programmes to improve
food security and nutrition in an integrated way.
Component
Program
1
Sustainable
and
diversified
agriculture
thru integrated research & extension
Food
availability 2 Improved water resource management and infrastructure for irrigation purposes
Food
access
Food
Utilisation
3 Improved quality of inputs and soil fertility
4 Fisheries & aquaculture development
5 Livestock development with a focus on poultry & dairy production
6 Improved access to market, value addition in agriculture & non-farm incomes
7 Strengthened capacities for implementation & monitoring of NFP & CIP actions
8 Enhanced public food management system
9 Institutional Development & capacity Development for more effective safety nets
10 Community based nutrition programs & services
11 Orient Food & Nutrition actions through data
12 Food safety & quality improvement
The M/o Finance and several DPs have committed to use the CIP to allocate
budget contributions, grants and loans..
14
USAID supported initiatives on Nutrition:
i)
SUN (Scaling up Nutrition) 13
It is primarily a movement launched in 2010 to help countries reach MDG on
nutrition targeting the first 1000days of life ( -9months to 24months after birth.)
SUN supports both direct nutrition specific interventions and multi-sectoral nutrition
sensitive approach. Bangladesh is one of the “early rising” SUN countries alongwith
Nepal, Ethiopia, Ghana, Malawi, Mozambique, Peru, Senegal, Tanzania, Uganda
and Zambia (12 countries). The Government has nominated Mr. Shafiqul Islam,
Additional Secretary, MOHFW as the Country Focal person of SUN. However SUN
is yet to be visible in the Government programs. The SUN Civil Society Alliance
(CSA) , led by BRAC is more active. The CSA has received funds from the MultiPartner Trust Fund (MPTF)13
The major sponsors for SUN are the World Bank and USAID. CIDA, DfID /UKAid
and the EU have also joined in.
Other USAID supported initiatives on Nutrition and Food Security are a) SPRING b)
FEED-the FUTURE, c)FANTA II
15
National Initiatives / Programs Addressing WASH
Bangladesh is a country where annual flooding is a natural phenomena. In the
densely populated low-lying areas rural sanitation is in very poor condition and the
water sources are contaminated during the flood. About 45% of the population don’t
have access to improved sanitation and over 25 million people lack access to safe
water resulting in the death of 7,000 under 5yrs children annually. This vicious cycle
is difficult to control but not impossible.14
The National WATSAN Policy (1998 ) was adopted with the goal of ensuring the
installation of at least one sanitary latrine in each household in the rural areas of
Bangladesh and improving public health standard through inculcating the habit of
proper use of sanitary latrines.
The National Sanitation strategy15 was formulated in 2005 in the backdrop of the
MDGs set in 2005. The scope of the strategy is to address issues related to
unhygienic defecation only. The goal was set to achieve 100% sanitation by the year
2010.
The Department of Public Health Engineering (DPHE) and the Local Government
Division of m/o Local Government, Rural Development & Cooperatives (LGRDC)
are the lead agencies addressing WASH in the country.
Efforts are underway for collaborative action to promote WASH services to enhance
the achievements in the nutrition programs/ initiatives. The NNS OP emphasise the
need for safe water, proper sanitation and hygiene4. However, the practical situation
regarding service and awareness creation by NNS, DPHE, LGRD, in the community
and household level needs to be assessed.
UNICEF, WHO, World Bank , IDB, ADB, CIDA are important development partners
in promoting WASH activities in the country. NGO Forum, WaterAid, BRAC, Plan
Bangladesh, CARE Bangladesh are some of the lead agencies working in WASH.
The WASH Alliance Bangladesh currently consists of 14 members16
Projects currently being implemented by DPHE in collaboration with different
agencies:
1
Bangladesh Rural Water supply & sanitation project
2
Water supply, sanitation & Drainage project in Sylhet and Barisal city
3
Water supply & environmental sanitation project at thana sadar and
growth centre pourashava
16
National Initiatives /Programs Addressing Food Security &
Agriculture
Agriculture Extension Service (DAE)17
Department of Agriculture Extension (DAE) is under the m/o Agriculture. The lowest
level of staff members are the Sub Assistant Agriculture Officer (SAAO). They hold
a diploma in Agriculture - a 4yr course taken after completing 10yrs of schooling
(SSC). Regular Farmers Field School (FFS) are held with both men and women
farmers. Usually one man and one woman from the same household attend these
FFS. Topics related to human nutrition, homestead vegetable gardening, growing
fruit trees, use of farmyard manure and making energy saving stove are specifically
addressed to women farmers They also
receive information to bring about changes
in consumption pattern to improve the
 population below poverty
nutritional status of the household members.
line dropped from above
They are also taught how to cook vegetables
58% to 29%
preserving their nutritional values5. This is
done under the Agriculture Sector Program
Support (ASPS). The ASPS works in the
 percentage of ultra-poor
Haor areas of Sylhet division which includes
dropped to 16 from 37
Sunamganj
Bangladesh has been awarded a diploma by
the FAO in June this year (2013) for its progress in fighting hunger and reaching
MDG 1. This is in recognition of halving the people below the poverty line.
NATP National Agriculture Technology Project
Livestock extension support component19
The role of Fisheries and Livestock sectors in the development of agro-based
economy of Bangladesh is very important and promising. They contribute around 8%
to national income, which also is 32% of the total agricultural income. About 90% of
animal protein in our diet comes from fish and livestock. Hence, the Bangladesh
Government has identified livestock as one of the key player of poverty reduction
strategy and achieving the MDGs. It has set strategic targets for meeting protein
demand, employment generation thru livestock sub-sector20
The main functions of the Ministry of Fisheries and Livestock are to preserve
fisheries resources, fulfill the requirement of animal protein through proper
management and planned development, increase socio-economic conditions of
fishermen, create employment opportunities for rural unemployed and landless
people19 The DLS is currently implementing about a dozen projects to this effect.
17
Ekti Bari ekti khamar (one house , one farm) EBEK21
A project implemented in selected unions of all the upazilas in the country. Every
house in the village has unutilized land, home yard, pond/ditch, canal, etc. It also
has unskilled manpower, unemployed youths and women. EBEK project aims at
tapping these unutilised resources to increase the family income by offering training
on agriculture, home gardening, fish culture, poultry and livestock, seed money and
encouragement.. EBEK is being implemented by the Rural Development &
Cooperative Division, Ministry of Local Government, Rural Development and
Cooperatives.
USAID funded projects/ initiatives on Agriculture
SPRING (Strengthening partnership, results and Innovation in Nutrition
Globally)22
:
SPRING is a nutrition sensitive intervention in agriculture and works with NNS,
RCHCIB and other partners across health and agriculture sectors to improve
nutritional status of pregnant women and children in order to decrease the
prevalence of stunting among children. SPRING’s work in Bangladesh centers
around the use of 1000 days approach across different sectors, including health
and agriculture to facilitate social and behavior change with the goal of preventing
stunting in young children. SPRING is currently working in15 upz in the Barisal and
Khulna divisions Bangladesh. It plans to expand to another 25 upazilas in the
south.
18
National level coordination or initiative on integrating nutrition
with food security/agriculture or WASH.
WaterAid is engaging with BRAC & ICDDRB on collaboration to reduce infection
and worm infestation to improve child nutritional status In the recent years the
mortality from diarrhoea is greatly reduced because of ORS and Zn supplementation
following bouts of diarrhea in children, However, morbidity incidence is still high
because of poor hygiene and lack of proper sanitation holding back the
improvements in indicators like stunting and wasting. The incidence of diarrhea
including Cholera has increased disproportionately this year Experts attribute lack of
hygiene practices, lack of safe water and proper sanitation as some of the major
reasons for this23.
The SUN movement could be a perfect platform for collaboration and coordination
between WASH and Nutrition services. Sir Abed (BRAC) and the Prime Mister of the
Government of Bangladesh had breakfast meeting in New York in September 2013
of with Chief Executive of WaterAid Barbara Frost to discuss collaboration to
effectively address the link between stunting & wasting and WASH24.
RCHCIB, NNS and SPRING have recently set up collaboration to increase capacity
for over 5,300 key MOHFW personnel on nutrition and hygiene counseling25
19
Target area:
Sunamganj district
Situated in the north eastern haor area of Bangladesh Consists of 11 upazila i)
Bishwamberpur,ii) Chhatak, iii) Dakhin Sunamganj ,iv) Derai v), Dharmapasha,
vi) Dowarabazar vii) Jagannathpur viii) Jamalganj ix) Sunamganj Sadar x)
Sulla xi) Tahirpur
Literacy rate of 35% in the district is much lower against national 51.8%
There are many wetlands (haors and beels) in Sunamganj. For reaching remote
areas mostly boats are used. There are several ethnic groups (Khasia,Manipuri,
Garo etc) living in this border district..
The district is known for the stone and sand business, River Sand. It has been
supplying river sand, natural sand, crushed stone, gravel and shingle. Several
thousand workers are directly dependent on these for their livelihood.
Demography: (census 2011);
Sunamganj dist
Bishwamberpur
Derai
Total popn
24,67,968
1,56,381
2,43,690
Household
4,40,332
29,336
45,040
Density
659/sq km
HH size
5.58
Housing & electricity
Sunamganj dist
Bishwamberpur
Derai
Pucca
6.6
0.8
4.3
Semi pucca
11.7
5.4
11.4
Kutcha
77.5
77.9
81.7
Jhupri
4.2
14.9
2.5
Electricity
34.0
21.0
34.0
Drinking Water supply
Sunamganj dist
Bishwamberpur
Derai
Tap %
1.0
0.1
0.2
Tubewell %
88
85
93.4
Other %
11
15
6.5
Toilet facilties:
Sunamganj dist
Bishwamberpur
Derai
Sanitary (water
sealed) %
7.4
3.1
6.4
Sanitary (non
water sealed) %
25.3
19.3
30.0
Non sanitary
%
55.2
62.6
51.9
None
%
12.1
15.0
11.7
20
Map of Bangladesh
Map of Sunamganj
21
List of agencies working on Nutrition in Bangladesh:
1. National
a. BRAC
b. DSK (Dustho Shastho Kendra)
c. Bangladesh Breastfeeding Foundation
d. TAHN (Training & Assistance for Health & Nutrition)
e. Eminence Bangladesh
f. VARD
g. VOSD
2. International
a. CARE Bangladesh
b. Save the children
c. Plan International
d. HKI
e. Micronutrient Initiative
f. CONCERN
g. World Vision
h. Alive & Thrive
i. MSF
j. TDH
k. ACF
3. UN agencies:
a. UNICEF
b. WHO (World Health Organisation)
c. World Food Programme
d. FAO
e. IFAD
4. Academic /Research agencies
a. ICDDR,B
b. INFS ( Institute of Nutrition & Food Science)
c. College of Home Economics
5. Others:
a. USAID funded
i. World Fish
ii. Global Health Initiative
iii. Feed the Future
iv. FANTA
v. SPRING
b. GAIN
DONORs for Nutrition services in Bangladesh:
1.
2.
3.
4.
5.
World Bank
JICA
USAID
DFID
CIDA
22
Persons met/ communicated with:
1. Prof Fatima Parveen Chowdhury
Secretary BNNC and Director, CME
(former Director IPHN and Line Director NNS)
Ministry of Health & Family Welfare (MOHFW)
Government of Bangladesh
2. Prof Soofia Khatoon
Professor of Pediatrics Shaheed Suhrawardy Medical College and
Secretary, Bangladesh breastfeeding Foundation,& Chairperson, BFHI
Committee, BBF
3. Dr Mary Manandhar
International REACH Facilitator, UN REACH
4. Dr Iftekhar Rashid
National REACH Facilitator , UNREACH
5. Dr Lalita Bhattacharjee
Nutritionist, NFPCSP-FAO
National Food Policy Capacity Strengthening Program,
FPMU, Ministry of Food & Disaster Management, Govt. of Bangladesh
,
6. Dr Tahmina Hossain Talukder
Assistant Director & Deputy Program Manager,
DGFP
7. Dr Shamsul Karim
Assistant Director, MCH Services & Program Manager
Directorate of Family Planning,
Government of Bangladesh
8. Dr Alamgir T Azad
Member, Annual Program Review (APR) team
HPNSDP-World Bank
9. Mr Shamim Ahmed
Program Manager, WaterAid Bangladesh
23
References:
1. http://www.tradingeconomics.com/bangladesh/population-density-people-per-sq-km-wbdata.html
2. IPHN website: http://iphn.gov.bd/english/
3. Program Implementation Plan, HPNSDP, MOHFW, July 2011
4. Operational Plan(OP) for National Nutrition Services, DGHS, MOHFW July 2011
5. Implementation completion report. Report no 25183, World Bank, Dec 2002
6. Personal communication with Review Mission member
7. Health Bulletin, DGHS, June 2012
8. Personal communication with PM, DGFP
9. http://www.communityclinic.gov.bd/about.php
10. State of Food Security & Nutrition in Bangladesh, FSNSP 2010
11. Bangladesh United Nations Development Assistance Framework 2012-2016
12. Bangladesh Country Investment Plan, Government of Bangladesh, June 2011
13. http://scalingupnutrition.org/news/funding-approved-to-support-civil-society-coordinationon-sun-in-bangladesh
14. http://www.wateraid.org/where-we-work/page/bangladesh
15. National Sanitation strategy 2005 m/o Local Government, Rural Development &
Cooperatives, 2005
16. http://www.washbd.org/
17. http://www.dae.gov.bd
18. http://www.fao.org/asiapacific/bangladesh/fao-projects/en/
19. http://www.mofl.gov.bd/
20. http://natpdls.org.
21. http://www.ebek-rdcd.gov.bd/
22. http://www.spring-nutrition.org/news/spring-expands-partnership-governmentbangladesh-improve-nutrition
23. http://www.wateraid.org/where-we-work/page/bangladesh
24. Project Manager, WaterAid, personal communication
25. http://www.spring-nutrition.org/news/spring-expands-partnership-governmentbangladesh-improve-nutrition
24