Making social protection nutrition-sensitive
Bangladesh has made rapid progress in health and nutrition over the past decade. There has been a significant decline in stunting among under-five children, as well as a rise in life expectancy. The country's hunger score improved from 34 in 2000, to 28.6 in 2012, to 19.1 in 2021. The Global Hunger Index also noted its achievement in reducing undernourishment, under-five mortality rate, and wasting of children.
However, Bangladesh is yet to achieve nutrition security for its entire population. As per the Bangladesh Demographic Health Survey (BDHS), 2017-18, stunting and wasting in Bangladeshi children are still above global averages. The Household Income and Expenditure Survey (HIES), 2016 put the percentage of people living below the poverty line at 24.3.
The Covid-19 pandemic and the restrictions imposed in its wake have affected people's livelihoods, food security and health; it has rendered the poor, especially women and children, even more vulnerable. It was estimated that the pandemic would increase the nation's poverty rate to 35 percent. With the loss of income and rise in prices of essential commodities, 23 percent households from urban slums and 15 percent households from rural areas cut down their food consumption during the lockdown period. Disruption in several services such as immunisation and sanitation services, and closure of schools and pre-schools (providing meals to children) portend a malnutrition crisis which, if not checked, will swiftly undo all the gains of the past several years. The pandemic is a pointer to why investing in health and nutrition is critical for the population's well-being, immunity and resilience. The response to the pandemic and the combat against malnutrition must engage the joint forces of all development actors.
Social security programmes (SSP) are the Bangladesh government's primary instruments for supporting vulnerable groups in the country. There are around 120 such programmes being implemented by 23 ministries and divisions, targeting 27.8 percent of the population, though the number of programmes and the extent of coverage vary from year to year. The National Social Security Strategy (NSSS), adopted in 2015, seeks to streamline and strengthen the existing safety net programmes for better results from the money spent. They include schemes such as cash transfers, food transfers, school stipends, employment generation, and other subsidy programmes. As per the NSSS human development strategy, SSPs, among others, must address the root causes of malnutrition.
The Bangladesh National Nutrition Council (BNNC), the nodal agency that provides guidance in formulating nutrition policies and ensuring that nutrition is mainstreamed into all government policymaking, reviewed selected SSPs. The review revealed that there is scope for improving those programmes' gender and nutrition sensitivity in order to improve nutrition outcomes for the most vulnerable and disadvantaged segments of the population.
For social protection to be nutrition-sensitive, programmes need to be combined with interventions that have a direct beneficial impact on nutrition, such as supply of micronutrient fortification of food, referrals to nutrition-specific services, promotion of diversity in agriculture, behaviour change to promote diversity in diet, and recommended care practices as well as designs that help ensure equitable distribution of food and resources to women and children within families.
Though there was an increase in the total number of beneficiaries under SSPs from eight million in 2010 to 11 million in 2016, there were considerable rural urban discrepancies. Around 36 percent of the beneficiaries were from rural areas and only 10.5 percent were from urban areas. Nearly 40 percent of the Bangladeshi population now live in urban areas. Despite better utilisation of nutrition services in urban areas than in rural areas, the nutrition status of the urban slum population is much poorer than that of the non-slum population. This calls for stronger focus in the targeting of nutrition-sensitive SSPs based on the available data for urban slum population.
As part of addressing a wider spectrum of the population, different programmes were designed targeting different beneficiary groups without having a clear transition strategy for the beneficiaries from one programme to another along their lifecycle. Moreover, individual programmes seemed to be designed to resolve a particular vulnerability; a comprehensive approach to address multiple root causes of vulnerability would have been better for avoiding duplication, efficient use of limited resources, and provision of comprehensive support for the beneficiaries.
A recent review by the BNNC and Nutrition International found that many of the largest SSPs did not include a nutrition situation analysis in their initial design, nor nutrition-related outcomes in their monitoring framework. Many programmes are also not evaluated regularly and do not publish annual performance reports. There were gaps in coordination and collaboration between various agencies addressing the same target groups.
Various ministries and departments need to go beyond the "silo" approach and work in collaboration to achieve nutrition outcomes. A data infrastructure is necessary to cut across the implementing ministries so that targeting and reaching beneficiaries is more effective. Better coordination and data-driven evidence for further strengthening the SSPs are needed to make them more visibly nutrition-sensitive. Good nutritional status and growth are foundations not only for vulnerable people's rights and well-being, but also for future equitable growth and prosperity.
Saiqa Siraj is country director of Nutrition International in Bangladesh.
Eadara Srikanth is former Asia programme manager for technical assistance for nutrition programme at Nutrition International in Bangladesh.
Richard Morgan is programme director of social safety net programmes at Nutrition International in Bangladesh.