Bangladesh MSP at the Sub-National Level: Implementation of the National Plan of Action for Nutrition 2 – a Case Study in Sunamgunj and Rangpur, Bangladesh
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Multi-sector programmes at the sub-national level: Implementation of the National Plan of Action for Nutrition 2 – A case study in Sunamgunj and Rangpur, Bangladesh MSP at the sub-national level: Implementation of the National Plan of Action for Nutrition 2 – A case study in Sunamgunj and Rangpur, Bangladesh Authors Acronyms Dr Charulatha Banerjee (Regional Knowledge ANC Antenatal care Management Specialist – ENN), Natalie Sessions (Global BBS Bangladesh Bureau of Statistics Knowledge Management Coordinator – ENN), Jeremy BCC Behaviour change communication Shoham and Carmel Dolan (ENN Technical Directors) BNNC Bangladesh National Nutrition Council CAB Consumers Association Bangladesh Acknowledgments CHCP Community Health Care Provider CHW Community health worker ENN carried out a case study on multisector programming CIG Common interest group at sub-national level as part of our work under the CS Civil surgeon Technical Assistance for Nutrition (TAN) programme CSG Community support group funded by the UK Government through UK Aid. From CSO Civil society organisation the Government of Bangladesh, ENN would like to Deputy Commissioner (Head of administration DC thank Dr Shahnawaz (Director General, Bangladesh in the district) National Nutrition Council); Mr Md. Habibur Rahman DDFP Deputy Director, Family Planning Khan (Additional Secretary, Ministry of Health and Family DG Director General Welfare, currently working as the SUN Country Focal DHS Demographic Health Survey Point) and Md Ruhul Amin Talukder (Joint Secretary, DLSO District Livestock Support Officer Public Health 2 Ministry of Health & Family Welfare). We DNC District Nutrition Coordinator are extremely thankful to Dr Nazmus Salehin (Assistant DNO District Nutrition Officer Director, Bangladesh National Nutrition Council), who DNSO District Nutrition Support Officer facilitated permissions and interactions in the study DRR Disaster risk reduction districts. A special note of gratitude to Dr Md Islam Bulbul, ECD Early childhood development Deputy Programme Manager (DPM), National Nutrition FAO Food & Agriculture Organisation Services and Technical Specialist (Public Health & WH), FPMU Food Policy Monitoring Unit who helped us to understand the details of working FSNIS Food Security & Nutrition Information System in the districts and facilitated many interactions at the FSNSP Food Security & Nutrition Surveillance Project national level and also was one of the reviewers of the HMIS Health Management Information System document. This exercise would not have been possible International Organisation for Development ICCO without the field-level support provided by the team of Cooperation, Netherlands CARE Bangladesh led by Late Dr Jahangir Hossain whose IPHN Institute of Public Health Nutrition untimely demise we are extremely saddened by. Special MEAL Monitoring, evaluation and learning thanks to Ms Nazneen Rahman, Team Leader Health, CARE MoA Ministry of Agriculture Bangladesh, who ensured all arrangements were in place MoE Ministry of Education in both districts and whose assistance was invaluable. MoF Ministry of Finance The support and organisation of her colleagues, Mr Md. MoH&FW Ministry of Health & Family Welfare Hasanuzzaman, Technical Manager in Sunamgunj, and Md MoI Ministry of Industries Golam Rabbani, Manager Rangpur, was critical to the field MoWCA Ministry of Women & Children’s Affairs work and we offer them generous thanks. Special thanks MSP Multi-sector programmes/programming to Jillian Waid, Technical Director, National Information & MUCH Meeting the Undernutrition Challenge Planning for Nutrition, whose support at various points NATP National Agricultural Technology Programme in the exercise was invaluable, and for taking the time NGO Non-governmental organisation to review the document in detail. Dr Rudaba Khondker, NIPN National Information & Planning for Nutrition Country Director, GAIN, deserves a special mention for NPAN National Plan of Action for Nutrition sharing her valuable insights at the outset, which helped RKMS Regional Knowledge Management Specialist us frame the exercise. We also acknowledge the range of SAAO Sub-assistant Agriculture Officer government officials at district level who gave their time SUN Scaling Up Nutrition to participate in interviews (the full list is shown in Annex SUN CSA SUN Civil Society Alliance 1) and the stakeholders at district level, including elected SUN FP SUN Focal Point leaders and NGO representatives, who shared information TAN Technical Assistance for Nutrition and experiences freely; for this we are thankful. UHFPO Union Health & Family Planning Officer UNCC Upazila Nutrition Coordination Committee Upazila Nirbahi Officer (sub-district UNO administrative head) UNOPS United Nations Office for Project Services MSP at the sub-national level: Implementation of the National Plan of Action for Nutrition 2 – A case study in Sylhet and Rangpur, Bangladesh Contents Executive Summary 1 Introduction and methods 3 Background 3 Section 1: National Plans and Institutional Architecture 5 National Plan of Action for Nutrition (NPAN1 and NPAN2) 5 BNNC 6 Coordination within NPAN2 7 Nutrition activities within sectors 8 Focus districts 11 Section 2: Findings 13 What is working well? 13 Persisting challenges 15 Section 3: Lessons learnt and Recommendations 19 Conclusions 20 Annexes 21 Annex 1: Sector wise ongoing activities related to Nutrition 22 Annex 2: Summary of cost of NPAN2 23 Annex 3: Details of costed interventions 24 Annex 4: Technical Assistance delivered to BNNC by Nutrition International as part of TAN project 25 Annex 5: Interviewees at the national level, Rangpur and Sunamgunj 26 Executive summary his case study is one of a series ENN has as Chairperson, and given the enormous task of been undertaking since 2017 to understand leading the roll-out of NPAN2. the experiences of countries in rolling out Tmulti-sector programmes (MSP) for nutrition NPAN2 aims to improve the nutritional status of with a focus on the sub-national level. Bangladesh mothers and children in the 1,000-days period, as is the second country in Asia to be studied (the well as that of adolescents, the elderly, disabled and first being Nepal) and is one of six studies so far pre-school and primary schoolchildren. To do this, the conducted. plan aims to scale up nutrition-specific and nutrition- sensitive interventions and improve the coverage of Rates of malnutrition in Bangladesh are among the programmes to ensure that the most vulnerable are highest in the world, with a stunting prevalence of targeted. Nutrition-specific activities in the health 36%1 and a wasting prevalence of 14%.1.6% of sector will be complemented by activities from other children under five years old are overweight which is sectors such as agriculture, fisheries and livestock, lower than one would expect in a healthy population. education and social protection. NPAN2 emphasises Bangladesh recorded a 51% to 43% decrease in the importance of social behaviour change stunting prevalence between 2004 and 2007 with the communication, which includes messages from all trend being maintained post-2007 also with an annual nutrition-sensitive sectors. rate of reduction of 1% per year. As a member of the Scaling Up Nutrition (SUN) Movement, Bangladesh Between February and March 2019 ENN’s Asia recently launched its National Plan of Action for Regional Knowledge Management Specialist (RKMS) Nutrition 2 (NPAN2) (2016-2025), which outlines visited Bangladesh to understand the planned roll- the implementation framework for its 2015 National out of NPAN2, particularly at the sub-national level. Nutrition Policy. The visit was planned with the full knowledge that sub-national level roll-out was in very preliminary NPAN2, which is multi-sector in nature, involves 17 stages, so the focus was on capturing the readiness ministries2 and is costed over 10 years at US$1.6 of the enabling environment for programme roll- billion. This ambitious plan, developed over nearly two years, involved a multitude of stakeholders, including line ministries, development partners, 1 National Institute of Population Research and Training (NIPORT) and ICF International, 2016. Bangladesh Demographic and Health Survey 2014: national and international non-governmental Policy Briefs. Dhaka, Bangladesh and Rockville, Maryland, USA: NIPORT organisations (NGOs) and technical advisors from and ICF International. 2 Ministry of Health and Family Welfare, Ministry of Agriculture, Ministry national research institutions. As part of the plan, of Food, Ministry of Fisheries and Livestock, Ministry of Women and the institutional architecture of the Ministry of Health Children’s Affairs, Ministry of Local Government, Rural Development and Cooperatives, Ministry of Primary and Mass Education, Ministry of Social & Family Welfare (MoHFW) was revamped and the Welfare, Ministry of Disaster Management & Relief, Ministry of Education, Ministry of Environment and Forest, Ministry of Finance, Ministry of dormant Bangladesh National Nutrition Council Industries, Ministry of Information, Ministry of Planning, Ministry of (BNNC) was also revamped, with the Prime Minister Commerce, Ministry of Religious Affairs. 1 MSP at the sub-national level: Implementation of the National Plan of Action for Nutrition 2 – A case study in Sunamgunj and Rangpur, Bangladesh out and on identifying the opportunities across at local government level (the most local arm of sectors for intersector collaboration and programme administration), which has