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 thank Deputy Commissioner (Head of administration DC Dr Shahnawaz (Director General, Bangladesh National in the district) Nutrition Council); Mr Md. Habibur Rahman Khan (Joint DDFP Deputy Director, Family Planning Secretary, Ministry of Health & Family Welfare and SUN DG Director General Focal Point) and Md Ruhul Amin Talukder (Joint Secretary, DHS Demographic Health Survey Public Health 2 Ministry of Health & Family Welfare). We DLSO District Livestock Support Officer are extremely thankful to Dr Nazmus Salehin (Assistant DNC District Nutrition Coordinator Director, Bangladesh National Nutrition Council), who DNO District Nutrition Officer facilitated permissions and interactions in the study DNSO District Nutrition Support Officer districts. A special note of gratitude to Dr Md Islam Bulbul, DRR Disaster risk reduction Deputy Programme Manager (DPM), National Nutrition ECD Early childhood development Services and Technical Specialist (Public Health & WH), FAO Food & Agriculture Organisation who helped us to understand the details of working FPMU Food Policy Monitoring Unit in the districts and facilitated many interactions at the FSNIS Food Security & Nutrition Information System national level and also was one of the reviewers of the FSNSP Food Security & Nutrition Surveillance Project document. This exercise would not have been possible HMIS Health Management Information System without the field-level support provided by the team of International Organisation for Development ICCO CARE Bangladesh led by Late Dr Jahangir Hossain whose Cooperation, Netherlands untimely demise we are extremely saddened by. Special IPHN Institute of Public Health Nutrition thanks to Ms Nazneen Rahman, Team Leader Health, CARE MEAL Monitoring, evaluation and learning Bangladesh, who ensured all arrangements were in place MoA Ministry of Agriculture in both districts and whose assistance was invaluable. MoE Ministry of Education The support and organisation of her colleagues, Mr Md. MoF Ministry of Finance Hasanuzzaman, Technical Manager in Sunamgunj, and Md MoH&FW Ministry of Health & Family Welfare Golam Rabbani, Manager Rangpur, was critical to the field MoI Ministry of Industries work and we offer them generous thanks. Special thanks MoWCA Ministry of Women & Children’s Affairs to Jillian Waid, Technical Director, National Information & MSP Multi-sector programmes/programming Planning for Nutrition, whose support at various points MUCH Meeting the Undernutrition Challenge in the exercise was invaluable, and for taking the time NATP National Agricultural Technology Programme to review the document in detail. Dr Rudaba Khondker, NGO Non-governmental organisation Country Director, GAIN, deserves a special mention for NIPN National Information & Planning for Nutrition sharing her valuable insights at the outset, which helped NPAN National Plan of Action for Nutrition us frame the exercise. We also acknowledge the range of RKMS Regional Knowledge Management Specialist government officials at district level who gave their time SAAO Sub-assistant Agriculture Officer to participate in interviews (the full list is shown in Annex SUN Scaling Up Nutrition 1) and the stakeholders at district level, including elected SUN CSA SUN Civil Society Alliance leaders and NGO representatives, who shared information SUN FP SUN Focal Point and experiences freely; for this we are thankful. TAN Technical Assistance for Nutrition 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 a clear understanding of convergence.