Develop ‘multi-sectoral budget tracking system’

Bangladesh should immediately build a nutrition governance structure, develop a multi-sectoral budget tracking system and increase budgetary allocation to address chronic malnutrition.

All gains made in the reduction of all forms of malnutrition like stunting, underweight and micronutrient deficiencies in the last decade will be battered by Covid-19 and Russia-Ukraine war impacts.

Against this backdrop, stakeholders and experts have expressed doubt about meeting 62 per cent of the nutrition goals by 2030.

Bangladesh has to achieve 13 nutrition goals in line with SDGs (sustainable development goals) by the time.

Alarmingly, child malnutrition level is most likely to slide back to its previous situation.

The present situation has worsened dramatically mainly due to the impacts of Covid-19 and the ongoing war.

Besides, weak state monitoring, evaluation and surveillance system, and poor budgetary allocation for health, education and social safety net may worsen the situation if it is not addressed instantly.

These grim pictures have come to fore in recent times when analysing recent data by a group of experts.

According to the Bangladesh Demogra-phic and Health Survey, stunting among under-5 children reduced from 45 per cent to 36 per cent between 2000 and 2014.

However, 36-per cent stunting prevalence is still classified as high as per WHO standards.

In 2016-17, Bangladesh spent Tk 232.10 billion ($2.7 billion) on nutrition-relevant interventions, representing an estimated 1.0 per cent of GDP and 9.0 per cent of the national budget.

Nutrition budget allocation and actual expenditure have remained moderately stable in relative terms during the period under review.

Expenditure is spread across 15 ministries/divisions and almost 300 projects or operational lines.

Four ministries-food, health, primary and mass education, and women and children affairs-account for almost 80 per cent of nutrition expenditure.

Twenty largest projects cover 81 per cent of the total expenditure.

A vast majority is spent on nutrition-sensitive interventions (98 per cent) and a significant amount on non-development operational lines.

IEDCR adviser Dr M Mushtuq Hussain said, "Our country has yet to develop any public health structure like public health division or public health directorate to address nutrition governance."

Terming the Bangladesh National Nutrition Council (BNNC) non-functional, he argued that it was playing a role like a toothless tiger or a spineless institution.

Dr Hussain suggested developing a public health division, headed by a secretary, or a public health directorate to remove governance weaknesses.

Terming nutrition budget inadequate, he urged the government to escalate direct and indirect budget.

Public-health expert MH Chowdhury Lenin said malnutrition-be it infant, adolescent and maternal-is rising as poverty has recently increased from 20 per cent to 40 per cent for sky-rocketing commodity prices.

Speaking of stunting, Dr Lenin, also head of medicine department at Health and Hope Hospital, cited the country's governance to cut malnutrition as poor.

Urging the BNNC to strictly monitor DNCC (district nutrition coordination committee) and UNCC (upazila nutrition coordination committee) and boost efforts, he said it was not working satisfactorily as the core and legally-mandated institution.

"The BNNC is talking about shortages of resources or manpower like other government entities to ignore its lawful and major responsibility."

The government must focus on it and swell budgetary allocation for health, education and food to curb malnutrition, Dr Lenin suggested.

"Our country, which is now utilising its demographic dividend, will run out of steam due to the deteriorating nutrition governance, he observed.

BNNC director Dr Md Taherul Islam Khan said, "We lag behind somewhat for Covid-19 in finishing routine work like organising meeting and monitoring them…"

He sees some shortcomings at upazila-level activities, but efforts at DNCC level are sound.

The BNNC is regularly evaluating and monitoring all activities related to nutrition amid its limited resources crisis, according to Dr Khan.

Talking to the FE, Gaibandha district education officer Md Enayet Hossain said the DNCC sits usually every three to four months.

There are 420 high schools in his district and he could not articulate exactly how many schools have formed nutrition coordination committees and are doing their regular meetings.

However, Mr Hossain, who is a member of the DNCC, said they are trying to visit those schools and instructing committees to hold meetings.

Talking to the FE, Bogura district education officer Md Hazrat Ali said they hold a meeting at DNCC level after an interval of two to three months.

Mr Ali too could not instantly confirm the number of committees and meetings at schools in his district.

He said the number of high schools, excluding primary schools, colleges and madrasas, stands at 459.

School meetings could not be monitored adequately all the time for resource constraints, Mr Ali explained.

Kazi Zebunnessa Begum, additional secretary of Health Services Division (World Health Wing), at an event recently said the government is working to create the post of nutritionist at district level.

Their recruitment is underway, she added.

Faiz Kawser, Project Manager of the Joint Action Nutrition Outcome (JANO) project, Plan International Bangladesh, said the project is on addressing several of the core challenges faced by Nilphamari and Rangpur districts.

This project, jointly implemented by Care Bangladesh, Plan International Bangladesh and ESDO, is implementing good practices in Rangpur in terms of nutrition and adolescent health which is being intervened from the union level to the district Level.

“The way we are supporting the government’s action plan through our project interventions is an example which can be replicated in other districts of the country as well to get a better and sustainable outcome nationwide,” Kawser said.

To make the result sustainable, Plan International has to continue working on these issues with more collaborative effort through continued multi-sectoral approaches and strengthened nutritional governance.

The development organisation is working closely with the local government, Kawser said, adding that based on the results it has experienced so far, its approach can be regarded as an innovative and best practice.

An estimated $1.6 billion is required to finance the NPAN2 over a 10-year period to do priority activities of this demand-driven plan, according to stakeholders.

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