1. 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

2. 2 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

3. Achievements made so far Bangladesh 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 66 th UN General Assembly for contributing Maternal and Children Health through ICT.

4. 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 Deficiency Over nutrition(emerging )

5. Howarth Bouis, 2006 Share of Energy Intake in Rural Bangladesh Staples Non-staple plants Fish and animal

6. Food Insecurity in Urban Slums Household consumption DhakaChittagon g Khuln a Rajshah i All Absolute food insecurity: <2,122 kcal/person/d 42.456.052.061.347.8 Extreme food insecurity: <1,805 kcal/person/d 24.235.838.536.029.0 Urban food security Atlas, 2008

7. 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

8. 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.

9. Based on evidence formulated policies and plans 1983 - National Nutrition Policy 1997 – National Food and Nutrition Policy 1997 – National Plan of Action for Nutrition 2006 – National Food Policy 2008 – National Food Policy Plan of Action 2009 - National Health Policy 2010 - National Agriculture Policy 2011 – Country Investment Plan 2011 - National Food Safety Policy and Action Plan (in progress)

10. 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)

11. 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

12. Rice production  Rice production tripled since Independence  Bangladesh is close to self-sufficiency in normal years Source: BBS except own estimates for Boro 2010 Average growth rate between 2000 and 2010: 3%

13. Current GOB Programs and Initiatives to address Under Nutrition Country Investment Plan(2011-2016),MOFDM One Farm One House(2011-2016)(6000 farm will be establish), MOLGRD Fortification of Edible oil and Salt Iodization(2011-2016), MOI Rice, cereal, vegetable production and diversification of Crops(2011-2016),MOA Health, Population and Nutrition Sector Development Program (2011-2016),MOHFW

14. Country Investment Plan, MOFDM(12 programmes) COMPONENTPROGRAMME 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

15. National Nutrition Services(NNS) MOHFW Maternal, Neo-natal and Child Health Care Community Based Health Care Maternal, Reproductive and adolescence Health Micronutrient supplementation by Institute of Public Health Nutrition (IPHN)under MOHFW Health, Population and Nutrition Sector Development Program, MOHFW

16. 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%...

17. 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.

18. 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

19. Implementation Progress(cont.)  Components NNS Includes the interventions for the first 1000 days Evidence-based direct interventions to prevent and treat under nutrition Treatment of severe acute malnutrition BCC to promote good nutritional practices Coordination of nutrition activities across different sectors and strengthen sectoral collaboration Mainstreaming gender into nutrition programming

20. 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 Action Capacities of District hospitals and Upazila Health Complexes will be strengthened to adequately manage severely malnourished cases

21. 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.

22. 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 Plan Country Investment Plan(CIP),2011( a road map towards investment in agriculture, food security and nutrition Other Ministries Involvement

23. Opportunities…. Research Started for improved yield of cereals, for improving the quality of soil Also for increased yield of pulses, vegetables, poultry and livestock Food fortification has just started in the country; wheat flour and perhaps rice should be fortified with micronutrients

24. 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)

25. 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 resources 8. Lack of Nutrition Sensitive Agriculture 9. Decreasing Agricultural Lands due to rapid urbanization by housing companies Challenges....

26. Key recommendations to face the immediate Challenges The need to produce enough food that could satisfy hunger Equally important – to produce food that could control under nutrition Produced food has to be nutritious, providing macro and micronutrients Food has to be available and accessible Nutrition Sensitive Agricultural Production Eliminate gaps of Coordination and Collaboration in relevant sector

27. Support needed to Address Under Nutrition Financial Technical Capacity building Information and knowledge Sharing Bio-medical research related to nutrition

28. 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

29. 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

30. Thank you all