NUTRITION - Small investments can make a huge impact

Bangladesh has made great strides in many areas, including poverty eradication and life expectancy. There are still many opportunities for investments that improve the nation's future and transform lives.

Recently, a high-level team of prominent Bangladeshi development and economics leaders and a Nobel Laureate in Economics identified a prioritised list of such opportunities. They were tasked with answering the question: "What policies and investments would give Bangladesh the most impact for every taka spent?" 

My think-tank, the Copenhagen Consensus Center, commissioned teams of dozens of specialist economists from Bangladesh, South Asia, and around the world to study 76 concrete solutions to improve the future of the country. 

This eminent panel met in Dhaka to examine and test all of this research, and found the top two investments were TB treatment and implementation of an e-procurement system for government. The third best investment (as well as the seventh) was on nutrition, which just underlines how vital it is for Bangladesh. 

And for nutrition, too, Bangladesh has seen great progress. The UN Food and Agricultural Organization estimates that in 1993, the average Bangladeshi had access to 2,000 calories per day, whereas today that number has increased to 2,450 calories. The prevalence of underweight children under five years of age declined from 66 percent in 1990 to 33 percent in 2014, meeting the Millennium Development Goal target one year early.

But poor nutrition continues to impede Bangladesh's progress. The effects include maternal mortality, infant mortality, and stillbirths. Also, poor growth among small children results in stunting, which in turn has life-long consequences. Affecting about six million Bangladeshi children under the age of five, the condition decreases cognitive development, leads to worse health outcomes and school performance, and lowers productivity throughout adult life. The rate of stunting in Bangladesh is significantly higher than the global average. 

The Seventh Five Year Plan states, "A particular challenge faced by the nutrition sub-sector is that it is perceived as a low priority relative to other development issues." The Plan identifies institutional limitations, persistent micronutrient deficiencies, lack of public awareness, maternal under-nutrition, acute malnutrition and lack of dietary diversity as the key problems that need tackling.

My think-tank, the Copenhagen Consensus Center, has partnered with the Bangladesh think-tank Centre for Research and Information to look at nutrition. 

This partnership saw us hold a high-level nutrition policy seminar in Dhaka this month. 

Publishing new research on nutrition investments and their costs and benefits in Bangladesh, and bringing together key decision-makers and academics to discuss the policy framework, the Policy Seminar provided an opportunity for a proactive and focused discussion on nutrition priorities and policy options. 

The seminar was addressed by the Honourable Minister of the Ministry of Health and Family Welfare, Mr. Mohammed Nasim. The discussion was moderated by Professor Abdul Bayes, Director, BRAC-RED who also leads the BRAC-LANSA (Leveraging Agriculture for Nutrition in South Asia) Team in Bangladesh.

Attended by stakeholders and experts of nutrition from the government, NGOs and international agencies, the policy seminar discussed different ways of responding to malnutrition. 

One such intervention is to try to stop pregnant women from consuming smokeless tobacco. Bangladesh has the highest prevalence of smokeless tobacco use among women in the world. This behavioural intervention would include face-to-face counselling by a health care provider, the use of printed materials and it would be run by community health workers responsible for home visits and delivering change and communication messages. Examining the costs and benefits, researchers for Copenhagen Consensus have worked out that for every taka we spend trying to change the behaviour of pregnant women, the benefits – from things like reduced healthcare costs and better health – would be worth 7 taka to society. 

Another intervention is to focus on providing nutritional supplements during pregnancy. Different supplements do different things; for example, calcium given to pregnant women can reduce the chances of a complication called pre-eclampsia during childbirth. Here, every taka spent just on this specific supplement would generate 12 taka of benefits to society. Iron-folate supplements would have benefits 28-times the costs, and balanced energy protein intake would be 17-times. 

Encouraging girls to enrol and stay in school via stipends would increase the age of starting a family, which can lift the potential earnings of mothers. This, in turn, will lead to improved nutrition and reduced stunting of children, with greater earning potential passed onto their children in the long term. Each taka spent on the stipend programme will generate around 8 taka of social and economic benefit. 

Supplementary foods are important not just for pregnant mothers. We can provide nutrients that would otherwise not be consumed in sufficient quantities (such as vitamins, minerals, fibres, fatty acids and amino acids). Promoting dietary diversification through nutrient dense foods, both in quality and quantity, will lead to better nutritional status of women and children. Each taka spent on designing complementary and supplementary feeding programmes will generate a benefit of around 15 taka for society. 

Besides complementary and supplementary feeding, direct nutritional interventions aimed at mothers, babies and small children in the first 1,000 days would yield improvements in physical and cognitive development. This can lead to better educational achievements for children as they embark upon a healthier lifestyle, and increased earnings later, upon entering the labour market. Every taka spent in delivering a bundled nutritional package of maternal and child interventions would generate a return to society of around 19 taka. 

These are among the ideas examined in seven new nutrition research papers released by Copenhagen Consensus.

Direct nutritional interventions are simple and relatively cheap. As the Bangladesh Priorities eminent panel found, these investments compete very favourably with other policy options.

We know that if we can get certain micronutrients to infants, we can rescue them from stunting. Achieving wider coverage should be a top goal.

To fund such investments, firstly, existing nutrition strategies need to spend the budget allocated, and more needs to be spent across all of government on proven nutrition interventions. There is a compelling economic case to do so. Poor nutrition has an impact on economic outcomes, on health, on education; improving nutrition can bring about positive change in the short and long term and is essential to Bangladesh's Vision 21. 

Fortunately, there are smart nutrition interventions, packages and policies like those analysed by researchers for the Copenhagen Consensus Center. By pursuing cost-effective responses to malnutrition, Bangladesh can own the problem and its solutions. Bangladesh can exercise control over its own budgets and policy priorities, and draw on international agendas. 

Substantive progress on nutrition policy can be made with strong leadership and coordination across government departments. Prioritising nutrition in the government budget would provide huge benefits to Bangladesh.

The writer is president of the Copenhagen Consensus Center, ranking the smartest solutions to the world's biggest problems by cost-benefit. He was named one of the world's 100 most influential people by Time Magazine.