On health and nutrition

Abdul Bayes | Published: February 13, 2017 20:21:09 | Updated: October 23, 2017 14:34:16

A conference titled 'Delivering for Success at Scale' was recently held in Dhaka. Jointly organised by the Institute of Development Studies (IDS), International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr.b), and the Bangladesh Rural Advancement Committee (BRAC). The meeting was a product of the longstanding partnership between icddr.b, IDS and BRAC. In fact, the trio travelled together in the past to explore the role of knowledge that is required in conceptualisation, design, delivery and management of development programmes and policies. 
Bangladesh has been a lead player in the use and integration of research into development decision-making, notably in relation to health systems, nutrition, social protection, agriculture and poverty. 
The conference aimed to project how high quality research could  be embedded within progarmmes, showcase research findings, discuss the challenges of integrating research with programmes, highlight successful examples and discuss future needs etc.
A country brief on the stories of change in nutrition in Bangladesh throws important insights on Bangladesh's progress:  "There have been remarkable improvements in welfare and human development in Bangladesh in recent years. These have been supported by rapid economic growth and many successful social and health programmes undertaken by the government and non-governmental organisations, shrinking family sizes and growing access of women to education. Overall improvements in child nutrition measured in terms of reduced child stunting can be seen as part of this success story though there are still many areas of nutrition in significant need of attention". 
The brief also notes that the association between improved health services and improved nutrition in Bangladesh is very strong. "It does, however, rest on a relatively weak health system, in which general morbidity remains high….Antenatal coverage for births increased from 58 per cent in 2004 to 79 per cent in 2014, and 64 per cent of women in 2014 benefited from services by a trained antenatal care provider. Birth attendance by a trained skilled provider nearly tripled over a decade from about 16 per cent in 2004 to 42 per cent in 2014. As maternal and infant mortality has declined, so have stunting rates". 
The picture on sanitation is positive as Bangladesh is one of the 16 countries that reduced open defecation by over 25 percentage points in the Millennium Development Goal (MDG) period; the access to pure drinking water tremendously increased. Reduction in open defecation led to reduction in stunting although absolute child stunting levels are still high at 36 per cent. By and large, nutritional indicators seem to lag behind health indicators in the country.
Much of improvement in nutrition in recent years is likely to be associated within broad improvements in human development and poverty reduction 'within a wider enabling environment of pro-poor economic growth, rather than through programmes, specifically aimed at improving nutrition. As Bangladesh moves into the future, having already made many nutrition-sensitive gains, a more concerted effort on nutrition-specific community programmes is needed if substantial remaining gaps and future challenges (including obesity) are to be addressed.
By and large, much of improvements in nutrition in Bangladesh in recent years is likely to be explained by what can be seen as 'nutrition-sensitive drivers' within the wider enabling environment of pro-poor economic growth that is linked to improved agricultural production and diversification, a vibrant NGO (non-governmental organisation) sector supporting income generation, expansion of non-farm business and manufacturing sectors creating employment opportunities, remittance from labour migration, and improving infrastructure and electrification. These contributed (a) improved access to education, health and family planning services use and availability, (b) demographic change, such as smaller family size, increased birth intervals and lower age at pregnancy, and (c) more widespread use of safe water and better sanitation. 
"These drivers are also largely the result of economic and social development, not of programmes and interventions specifically intended to improve nutrition." A succinct summary was presented to show how research helped design and implement programmes by way of monitoring the design and process of the intervention. Special reference was made to oral rehydration therapy (ORT) of the late 1970s. The campaign initially faced tremendous challenges from processor and users but through gainful engagement in research in later period, it helped intervention reach the shore of success. 
Both direct and indirect drivers - as a result of economic and social development - played pivotal role in improving health situation in Bangladesh. In fact, it is a paradox that Bangladesh performed well with a weak health system. "Yet many millions of children in Bangladesh still grow up stunted because of poor nutrition and acute nutrition deficiencies. The challenge is to make further improvements. Taken together, a major recommendation is that nutrition-specific interventions will need to take on greater role in Bangladesh than they have done to date."
In the concluding plenary session of the conference, panelists focused on three main issues of contemporary concerns. First, why is it that unlike smaller ones, large interventions are difficult to scale up? The panelists identified a few constraints to this effect. These are lack of political commitment, resources and transparency, structural problems, stakeholders' political decision. Second, who sets research agenda of what relevance? In some cases, the agenda is dictated by donors but most of the programmes could set their own research agenda given sufficient capacity building. Sometimes dictated agenda could outperform indigenous agenda in terms of relevance and reality on the ground.   
Panelists also suggested a drift away from traditional research reasoning and argued for more relevant research. Presiding over the concluding session,  Dr Mohammad Musa, Executive Director of BRAC, called for more integrated approach among various stakeholders ranging from conceptualisation to planning and implementation to measurement of outcomes. In a regime of dwindling aid and grants, he rightly observed, both practitioners and researchers should eye on home-grown sources of funding. 
The writer, a former Professor of Economics at Jahangirnagar University, is Chair, Department of Economics and Social Science (ESS) BRAC University.

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