‘Weak policies and slow progress’: Why Bangladesh’s nutrition programmes are failing to step up to the plate

08-Mar-2017 - Last updated on 07-Mar-2017 at 22:37 GMT

State responses to nutrition have lagged behind other issues that have been deemed to be more politically pressing. ©iStock

Bangladesh’s considerable nutritional improvements in recent years can be attributed to wider economic and social progress, not specific nutrition-focused policies which have been branded ‘weak’ and ‘sporadic’.

The country has seen a reduction in the number of children under five who are moderately or severely stunted, falling from 55% in 1997 to 41% in 2011, until dipping further to 36% in 2014.

“Mortality rates for children under five years of age have also continued to decline, from 221 deaths per 1000 live births in 1970, to 46 in 2014,” researchers wrote in the journal Global Food Security.

However, they said very little of this success could be attributed to national nutrition policy and community health programmes.

Instead, they were due to broad factors such as rising incomes, smaller family sizes, greater gaps between births, and better education and health access, especially for women.

“Community based nutrition programmes have not yet been operating at scale as in other countries and the current governance arrangements for nutrition delivery are weak,” they stated.

“As Bangladesh faces growing new nutritional problems and still suffers from a relatively high burden of child stunting, such ‘nutrition-specific’ programmes will have to play a greater role than in the past, as the further gains from some of these wider drivers may be limited and are likely to have plateaued.”

They argued that state responses to nutrition have lagged behind other issues that have been deemed to be more politically pressing, such as increasing food production and boosting education.

As a result, high levels of both stunting and underweight prevail, indicators of micronutrient status are poor, and rising obesity is contributing to the double burden of malnutrition.

Political rhetoric

While high-level political rhetoric supporting action on nutrition suggests this may be about to change, the researchers claim only time will tell if leads to successful action.

“It is too early to tell whether the National Nutrition Services (NNS) – as the primary government and donor supported vehicle…will attain the substantial reach at the community level which will be required to bring down the substantial levels of undernutrition which remain.

“Significant challenges exist which look likely to hinder any serious community level delivery in the short term – including some of the political economy incentives which earlier studies noted were responsible for an ineffective and fragmented system.

Overall they said the country’s track record around nutrition-specific plans and policy coherence has been characterised by sporadic jumps and starts, and a “collective slowness in responding to the urgency of nutritional deficiencies.”

Source: Global Food Security

DOI:10.1016/j.gfs.2017.01.005

“Bangladesh’s story of change in nutrition: Strong improvements in basic and underlying determinants with an unfinished agenda for direct community level support”

Authors: Nicholas Nisbett, Peter Davis, et al.