Bangladesh National Nutrition Services

A WORLD BANK STUDY Bangladesh National Nutrition Services ASSESSMENT OF IMPLEMENTATION STATUS Kuntal K. Saha, Masum Billah, Purnima Menon, Shams El Arifeen, and Nkosinathi V. N. Mbuya Bangladesh National Nutrition Services A WORLD BANK STUDY Bangladesh National Nutrition Services Assessment of Implementation Status Kuntal K. Saha, Masum Billah, Purnima Menon, Shams El Arifeen, and Nkosinathi V. N. Mbuya © 2015 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 18 17 16 15 World Bank Studies are published to communicate the results of the Bank’s work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. 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All queries on rights and licenses should be addressed to the Publishing and Knowledge Division, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@ worldbank.org. ISBN (paper): 978-1-4648-0640-7 ISBN (electronic): 978-1-4648-0641-4 DOI: 10.1596/978-1-4648-0640-7 Cover design: Debra Naylor, Naylor Design, Inc. Library of Congress Cataloging-in-Publication Data has been requested Bangladesh National Nutrition Services • http://dx.doi.org/10.1596/978-1-4648-0640-7 Contents Acknowledgments xi Executive Summary xiii Abbreviations xxi Chapter 1 Introduction 1 Background 1 Objectives of Operations Research 4 Methods 4 Data Collection 7 Subnational-Level Data Collection 8 Data Quality Assurance and Processing 9 Ethical Approval 10 Note 10 Chapter 2 Results 11 Availability of Operational Guidance for National Nutrition Services Intervention Areas 11 Management and Support Services 12 Findings from Qualitative Research on Institutional Arrangements 13 Summary of Findings on Design and Institutional Arrangements 24 Findings on Training from Review of National Nutrition Services Operational Documents 26 Findings from National Nutrition Services Implementation Roll-Out Data 28 Findings from National-Level Interviews on NNS Training, Capacity, and Roll-Out 31 Summary of Findings on Training and Implementation Roll-Out 34 Delivery of Services 35 Insights on National Nutrition Services Delivery from National-Level Stakeholders 36 Bangladesh National Nutrition Services • http://dx.doi.org/10.1596/978-1-4648-0640-7 v vi Contents Community-Based Mechanisms for Creating Awareness and Demand for Nutrition Services 37 Availability of National Nutrition Services, Equipment, and Job Aides 39 Summary of Findings on Service Delivery 51 Monitoring and Evaluation 54 Summary of Findings and Recommendations Regarding Monitoring 57 Summary of Findings on Exposure to NNS Interventions 59 Development Partner Support to NNS 60 Analysis and Recommendations 62 Chapter 3 Key Lessons and Recommendations 63 Abstract 63 Program Design 63 Institutional Issues and Governance 66 Training and Roll-Out 67 Program Implementation/Service Delivery 68 Monitoring and Evaluation 69 Final Conclusions 71 Note 71 Appendix A Qualitative Research and Service Delivery Data 73 Appendix B Community Clinics Data 79 Appendix C Training Data 81 References 83 Boxes 2.1 What’s Working Well in the Management and Support Domains? 13 2.2 What’s Working Well in Training and Capacity Development? 28 2.3 What’s Working Well in Implementation and Service Delivery? 36 2.4 Family Welfare Volunteers and Health Assistants: What Is Their Potential to Extend Outreach? 50 2.5 What’s Working Well with Monitoring? 55 2.6 Example of Development Partner Support to NNS: UNICEF 61 Bangladesh National Nutrition Services • http://dx.doi.org/10.1596/978-1-4648-0640-7 Contents vii Figures 2.1 Allocation and Usage of Funds for FY2011/12 and First Six Months of 2012/13 18 2.2 Major Components of National Nutrition Services Operational Plan and Their Program Managers and Deputy Program Manager 20 2.3 Number of Upazila Receiving Their First Training, by Year, 2012–14 29 2.4 Upazila Receiving NNS Trainings in Each Division 30 C.2 Number of Upazila Receiving Different Nutrition Trainings for the First Time, 2012–14 82 Tables 1.1 Major Domains, Related Specific Research Questions, and Planned Data Collection 5 1.2 Study Areas Selected for Field-Level Data Collection 7 1.3 Categories of Interviewees and Number of Interviews at the National Level 8 1.4 Number of In-Depth Interviews and Focus Group Discussions Conducted in Different Upazila and Collection Dates 9 1.5 Survey Data Collection at Subnational Level by District and Sources of Data Collection 10 2.1 Management, Support, and Institutional Arrangements for National Nutrition Services 12 2.2 Implementing Authority, Implementation Support, Service Providers, Timing of Service Delivery, and Service Contents for Key Components of National Nutrition Services 14 2.3 Main Issues Raised under Each Research Domain and Relative Emphasis Given to Each Issue in the National-Level Interviews 14 2.4 Frequency of Issues Discussed as Important in Subnational- Level Interviews with Health Officials at District and Upazila Levels 16 2.5 Training and Capacity Development 25 2.6 Types of NNS Training/Inputs and Their Implementation Status, by Year, 2012–14 30 2.7 Number of Health Care Providers Receiving Different Types of Nutrition Training from All Sources 33 2.8 Health Care Providers Who Received Nutrition Training from All Sources, by Year, Pre-2012–14 34 2.9 Number of Health Care Providers Who Received Training from Different Training Institutes 34 2.10 National Nutrition Services implementation and Service Delivery 35 Bangladesh National Nutrition Services • http://dx.doi.org/10.1596/978-1-4648-0640-7 viii Contents 2.11 Selected National Nutrition Services Implemented at Surveyed Health Facilities at Different Levels 40 2.12 Availability of Functioning Equipment, Logistics, and Job Aides at the Surveyed Health Facilities at District, Upazila, and Union Levels 40 2.13 Observation of Illness Management of Children Less Than 5 Years of Age at IMCI+ Nutrition Corners in Upazila Health Facilities 42 2.14 Nutrition Services during Illness Management of Children under Five by Age of Children, Sex, Type of Facility, Type of Health Care Providers, and Training of Health Care Providers 43 2.15 Distance and Time Travelled, Reason for Coming to the Facility, Feedback to Caregivers after Measuring Weight, and Showing Weight by Type of Provider 45 2.16 Tasks Performed by Health Care Providers during Antenatal Care Case Management 45 2.17 Nutrition Services during Antenatal Care by Maternal Age, Gestational Age, Number of Antenatal Care Visits, Place, Type of Health Care Provider, Training of Health Care Provider 46 2.18 Types of Advice

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