EVALUATION REPORT Joint UNICEF Bangladesh – Government of Bangladesh Nutrition Programme Mid- Term Evaluation 2017-2020 Final Report Volume I January 2020 UNICEF Bangladesh January 2020 EVALUATION REPORT Joint UNICEF Bangladesh – Government of Bangladesh Nutrition Programme Mid- Term Evaluation 2017-2020 Final Report Volume I January 2020 Authors Rahul Agrawal, Malay Das, Farzana Ishrat, Toufique Ahemd, Ankita Singh, Mrinalini Mazumdar On behalf of NRMC UNICEF Bangladesh January 2020 Joint UNICEF Bangladesh – Government of Bangladesh Nutrition Programme Mid-Term Evaluation 2017-2020 Final Report © UNICEF Bangladesh Country Office, 2020 1 Minto Road P.O. Box 58 Dhaka, Bangladesh January 2020 The purpose of publishing evaluation reports produced by the UNICEF Evaluation Office is to fulfil a corporate commitment to transparency through the publication of all completed evaluations. 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For further information, please contact: Mekonnen Ashenafi Woldegorgis Chief, Social Policy, Evaluation, Analytics & Research (SPEAR) Section UNICEF Bangladesh BSL Office Complex, 1 Minto Road, Dhaka 1000, Bangladesh Telephone: (880-2) 55668088 Email: [email protected] www.unicef.org.bd 1 Joint UNICEF Bangladesh – Government of Bangladesh Nutrition Programme Mid-Term Evaluation 2017-2020 Title Joint UNICEF Bangladesh – Government of Bangladesh Nutrition Programme Mid-Term Evaluation 2017-2020 Geographic Region of the Programme Nationwide Timeline of the Evaluation April 2019 – January 2020 Date of the Report January 2020 Country Bangladesh Evaluators Rahul Agrawal, Malay Das, Farzana Ishrat, Toufique Ahemd, Ankita Singh, Mrinalini Mazumdar Name of the Organization Commissioning the UNICEF Bangladesh, Government of Bangladesh Evaluation 2 CONTENTS LIST OF TABLES AND FIGURES ................................................................................................................ 4 ABBREVIATIONS ......................................................................................................................................... 5 EXECUTIVE SUMMARY .............................................................................................................................. 8 CONTEXT ................................................................................................................................................... 16 OBJECT AND SCOPE OF EVALUATION .................................................................................................. 29 APPROACH AND METHODOLOGY .......................................................................................................... 31 EVALUATION FINDINGS ........................................................................................................................... 48 LESSONS LEARNED, CONCLUSIONS AND RECOMMENDATIONS ..................................................... 97 3 LIST OF TABLES AND FIGURES Figure 1: Trends in prevalence of stunting in Bangladesh .................................................................. 18 Figure 2: The central and sub-themes of the ToC that will be examined in the evaluation .............. 32 Figure 3: Conceptual framework for the evaluation .............................................................................. 33 Figure 5: Comparison of facilities providing IFA, IYCF and SAM screening (%) ............................... 68 Figure 6: Average IYCF counselling in DNSO+CBT districts ............................................................... 68 Figure 7: Planned Budget for Nutrition Program 2017-2020 ................................................................ 72 Figure 8: Snapshot of Connectedness ................................................................................................... 80 Figure 9: Stunting prevalence trend ....................................................................................................... 88 Figure 10: Division wise stunting prevalence ........................................................................................ 88 Figure 11: Wasting prevalence trend ...................................................................................................... 89 Figure 12: District wise wasting prevalence .......................................................................................... 89 Figure 13: Underweight prevalence trend .............................................................................................. 90 Figure 14: Division wise underweight prevalence ................................................................................. 90 Figure 15: Percentage of women aged 20-24 years reporting marriage before 18 years .................. 91 Figure 16: BMI trend among ever-married women aged 15-19 years .................................................. 92 Table 1: Summary of the evaluation design ........................................................................................... 35 Table 2: Relevant data sources for the desk review ............................................................................. 40 Table 3: Phases of the evaluation ........................................................................................................... 42 Table 4: Comparison of maternal and new born care indicators (2007 to 2018) ................................ 67 Table 5: Budget and expense for nutrition program ............................................................................. 72 Table 6: Activity wise planned and availability of fund ......................................................................... 74 Table 7: Impact of the nutrition program activities ............................................................................... 86 4 ABBREVIATIONS A&T Alive and Thrive AFHC Adolescent Friendly Health Corners ANC Antenatal Care ARI Acute Respiratory Infection BDHS Bangladesh Demographic and Health Survey BFC Breastfeeding Corner BINP Bangladesh Integrated National Plan BIRTAN Bangladesh Institute of Research and Training on Applied Nutrition BMI Body Mass Index BMS Act Breast Milk Substitutes Act BNNC Bangladesh National Nutrition Council C4D Communication for Development CBT Competency Based Training CC Community Clinic CIP Country Investment Plan CHW Community Health Workers CHCP Community Health Care Provider CP Country Programme CNUs Child Nutrition Units CS Civil Surgeon CSG Community Support Groups DALYs Disability Adjusted Life Years DFID Department for International Development DGFP Directorate General Family Planning DGHS Directorate General of Health Services DHIS2 District Health Information Software 2 DNCC District Nutrition Coordination Committee DNI Direct Nutrition Interventions DNSO District Nutrition Support Officers DLI Disbursement Linked Indicator DSCC Dhaka South City Corporation ECD Early Childhood Development EPI Expanded Programme on Immunization FAO Food and Agriculture Organization of the United Nations FGD Focus Group Discussions FIVDB Friends In Village Development Bangladesh FLWs Frontline Workers FSNSP Food Security and Nutrition Surveillance Project FWA Family Welfare Assistant FWV Family Welfare Volunteer GAIN Global Alliance for Improved Nutrition GDP Gross Domestic Product 5 GMP Growth Monitoring and Promotion GNC Global Nutrition Cluster GoB Government of Bangladesh HA Health Assistant HDI Human Development Index HQ Head Quarters HMIS Health Management Information System HNAP Health-National Adaptation Plan HNPSP Health, Nutrition and Population Sector Programme HNP Health Nutrition Population HPNSDP Health Population Nutrition Sector Development Programme ICN2 Second International Conference on Nutrition IDD Iodine Deficiency Disorder IEC Information, Education, Communication IFA Iron Folic Acid ILO International Labour Organisation IMCI Integrated Management of Childhood Illness IPHN Institute of Public Health and Nutrition IYCF Infant and Young Child Feeding KII Key Informant Interviews LCBCE Local Capacity Building and Community Empowerment LMIC Low-and-Middle-Income Countries MAM Moderate Acute Malnutrition MDGs Millennium Development Goals MIC Middle Income Country MIYCN Maternal, Infant, And Young Child Nutrition MoHFW Ministry of Health and Family Welfare MoLE Ministry of Labour and Employment MoLGRD&C Ministry of Local Government, Rural