Dr Lawrence Haddad, Executive Director, GAIN: I was absolutely delighted to see the progress made in Bangladesh. More than 1% per year stunting reduced, which is above the standard performance indicator. Not complacent, 31% is still very high. At the Chittagong Hill Tracts (CHT) stunting rate is 51%. The underweight and wasting rates, also incredibly, almost halved over a 10-years period. So, lots of work to go but as an outsider I am super impressed. However, diets are not diversifying as quickly as we would like to see, especially for younger children, women and adolescents. So, we are at a crossroads. Globally we have a chance to make some commitments and Bangladesh is at a threshold as well.
Malnutrition reduction accelerates poverty reduction, helps address zero hunger and helps health and wellbeing. ‘Diet’ is related to at least 5 or 6 risk factors from the top 10 risk facts for the global burden of disease. We, in the nutrition world, don’t talk about SDG 12 as much we should, but this is about sustainable use and production not just of food but mostly about food loss and food waste comes in.
Malnutrition has a massive impact on health, survival and productivity and economic growth. An estimate for Bangladesh is that a billion dollars are lost to economic productivity due to malnutrition burden. While a baby’s brain at birth weighs just a pound, it quickly develops at an early age and weighs up to 3 when reaching adult age. So, anything that disrupts that rapid development of the brain, such as poor water, poor sanitation and poor food, is going to have a massive impact on cognitive ability on an individual and that’s a lifelong burden really. Hence, poor diet is the main concern.
While some are not getting enough of right food, others are consuming too much of wrong food. So diets have every connection to economic growth and like most things, though there are few exceptions, it gets better with economic growth. It takes a long time for income growth to translate into improved diets. So, we must address this issue.
Most people in Bangladesh, according to the World Bank survey, 87% of rural Bangladeshis acquire food from markets, which is surprising as people especially in rural Bangladesh would produce their own food. This means they interact with the food system and interact with businesses in the private sector. We know from a study in the Lancet Global Health from a couple of years ago, it would cost half of the income of a typical Bangladeshi family to purchase 5 fruits and vegetables, per person per day - averaging attainment of a healthy diet beyond most people’s income now. This indicates diversification of the diet is really lacking - eggs, milk, fruit and pulses compose 15-30% of recommended daily intake on average in Bangladesh and increased sugar consumption in last 3 years.
So this is the GAIN promotional part - we work within the food system, government, private sector and civil society around improving the consumption of nutritious and safe food for all. And we work in the demand side because it’s not just income which stops people from acquiring diverse diets. We have to work around to build the demand and make sure supply can meet the demand that means working with producers, millers, retailers, wholesalers to make nutritious food safe and affordable. Then we work in enabling environment, which is around policy, civil society and accountability. Businesses are everywhere, not just food but also financial, traders, media, refrigeration equipment etc. We need to understand consumers are very important drivers of change. For example, in Kenya, we talk about nutrition promotion rather than nutrition itself. You must find something that’s interesting to people and add nutrition to it.
Strengthening workforce is an incentive for a country. ILO, giving examples from Bangladesh, said if an employer cares about the diets and food intake of the employees, it means he takes care of them as persons. So, while workforce nutrition is important, most of the workplaces have no such intensive programmes. We have been working in garment sector here and seen an amazing result in anaemia reduction in young women, while increased loyalty, reduced absenteeism along with other positive outcomes. We know that businesses are part of identifying the problem but can also be big part of the solution. How can we get them to change? Can we get investors to say we will only invest in your company if you have a certain percentage of your products that are healthy star rating? From a data set of 20 largest companies in the world, only a 32% of them made a 3.5 out 5 rating for health. So, you can imagine big institutional investors saying we will only invest in your company if 50% of your products meet the health star rating.
And most important is accountability. Civil society is important. They deliver resources, advocate for nutrition. They also hold organisations accountable. But it seems there are too many accountability mechanisms globally. We at GAIN are trying to rationalise and harmonise the accountability mechanism at the global level.
GAIN Bangladesh works a lot in the fortification area, workforce nutrition programmes, improving child diets, along with zinc bio-fortified rice – aiming to enhance the consumption from 1 million families to 20-30 million families in the next 5-10 years. We have a big focus on adolescents taking pledge to consume good food which is very exciting. We have programmes on leadership and governance which is important.
Finally, I want to mention the world food summit in Japan in December which is a big opportunity for governments to collaborate and seek commitments from organisations such as UN, donors, civil society and the private sector. I hope the governments are involved via the SUN mechanism, in developing commitments. They need to make a commitment that would be specific, meaningful and smart. Moreover, we must be coherent and not immediately go to and say we need more money for nutrition - that’s a massive turnoff for governments, businesses and for donors. We should take a moment and think, are we spending the existing money for nutrition properly and getting greater impact? Are our policies and legislations enabling the spending to be powerful?
We started the SDGs in 2015 and we have 10 years to achieve those goals. I think it is very much possible for Bangladesh to achieve 20% of its stunting target by 2030. But there are other goals such as undernutrition, over-nutrition, climate change and range of others that needs to be met. The only way we can do that is by working together.
Md Ruhul Amin Talukder, Additional Secretary, Ministry of Agriculture: Commitment of the government in improving nutrition status of the country to achieve SDG targets is already made in the Second National Plan of Action for Nutrition (NPAN2). Still we have challenges in food systems, input market, food safety and climate change impact. Understanding the challenges is very important in running the strategies and priorities of the country with limited resources, which the government is actively doing.
An important target is doubling labour productivity, which link advancing nutrition for producers and processors of food. Another aspect is the agriculture orientation index, which is the share of investment on agriculture compare to overall expenditure in the GDP. We look forward to investment from private sector and others to reduce the post-harvest loss which is around 25-30% for fresh vegetables and fruits. The government is trying to encourage the youth in agro entrepreneurship, in the value addition process in agro sector at the rural level.
Dr. SM Mustafizur Rahman, Line Director, National Nutrition Services: We need the NGOs, international organisations, civil societies and the academia to work together to achieve our target of eliminating poverty. Speaking of SDG 2, we are sufficient in terms of cereal production, but we are deficient in terms of proteins and other nutrients. We should take good care of nutrition and psycho-social behaviour of pregnant women as that will allow proper brain cell development of their children. We have a window of opportunity having 36 million adolescents. Iron deficiency or anaemia is a big concern in our country. So, we must take care of nutrition for people of all age groups.
Though exclusive breastfeeding rate is 65%, we are not being able to meet 35%. This is because negative mindsets prevail, suggesting that breastfeeding is insufficient. We must clear such doubts. Besides, we need to be wary of the increasing presence of unhealthy fast food items in the market what requires policy attention.
Md Badrul Arefin, Director General, (Additional Secretary), FPMU, Ministry of Food: The Ministry of Food has drafted a new food and nutrition security (FNS) policy with a focus on SDG 2030. We also have an FNS program in the field covering 12 districts. The targeted under-nourished population, under the project are given food support like production support for diversity of food like home gardens and small ponds for fish production.Research-based evidence shows that children can retain information for a long time if it is introduced to them in a suitable manner.
We propose to consider textbooks to disperse information on nutrition too. Bangladesh has about 42.7 million school children; they are given new books each year. If we can get even 10 percent of the inside back covers to contain messages about nutrition, in the form of colourful photographs and cartoons, it would have sustainable impact.
Md Abdus Sattar, Additional Secretary, Ministry of Chittagong Hill Tracts Affairs: CHTs is one tenth of the landbut only 1% of the population resides there. The father of the nation established the CHT Development Board to undertake development activities. They established some residential schools where students are supplied with food and education. The agriculture department established mixed fruit cultivation which is more income generating options. Sometimes, the fruits are cultivated in surplus, and often cannot be exported as it cannot be preserved. Nutritious fruits such as mangoes, jackfruit and bananas are not being marketed.
People living here are not getting milk as per their requirement as there are no farms for milk production; they are not getting enough eggs and therefore, being deprived of necessary nutrition. So, I request everybody who works in these areas to come forward to assist. Our ministry will extend full cooperation.
Fernholz Manfred, Team Leader, EU Delegation, Dhaka: We believe that Bangladesh is doing well in reducing undernutrition and to advance faster, we have to push for the multisector approach. EU has been working hard with Food Planning Monitoring Unit (FPMU) and Bangladesh National Nutrition Council (BNNC) lately to have a multisector approach making sure we are working more and more on nutrition sensitive approach not only in a nutrition specific manner.
We need to understand that it will not come from donor or government money. We need to move faster from this piloting, project approach to bring real investment in areas of nutrition and have a more effective and efficient social protection system in Bangladesh and multisector approach will play a key role in that. We have been advocating for healthy diet - working towards making them more affordable as well. We need to work on value chains and even think about subsidies for nutrition dense foods. We need support from the media at local, national, grassroots levels because they are going to help us disseminate the correct message and sensitize the people, alongside working with the parliament since they are uniquely placed to ensure that nutrition becomes and remains a key political priority. Ensuring that adequate budget is allocated and disbursed besides the enactment and enforcement of the right laws and regulations is important.
Moreover, we work towards food safety, admitting and battling with the malnutrition complexity by prioritising certain areas under a multisector. While we have been able to make very good progress in term of reducing stunting rate, still now, we shouldn’t forget we are talking about 5 million children who are going to be in a protracted poverty status. Hence, to prevent the repetition of the cycle of families carrying the health cost burden, this needs more focus along with further investment in education and children to spread awareness on proper nutrition.Robert Simpson
Robert Simpson, Country Representative, FAO: We need to keep agriculture, although it’s dropping currently at 14% as more people move to urban areas - it’s still very important in the front line and solid nutrition requires how food is grown and comes to the consumer. The message we want to pass on to the 8th 5-year plan is that it is the ‘integrative food system approach’ in achieving the SDGs. So, we should not disconnect food systems from the environment we live in.
Blue economy is extremely important. The ocean serves as the biggest carbon sink leading to an extreme temperature change. In case of nutrition, steps such as financing, integrative food security systems, these are extremely important including how to target resources to those potentially can be left behind. Hence, to prevent overly consumer foods, we need to have a stronger integration of climate smart and sensitive agriculture with diversified food options.
There is a shift in demand amongst the youth and different groups of people in terms of higher demand for convenience or processed food. We should address these issues in nutrition policies. We also have to look at what helps the smallholder private sector, particularly farmers.
Dr. Zeba Mahmud, Country Director, Alive& Thrive: Bangladesh is among the few countries which has a nutrition policy and a nutrition plan of action. It is time that we see nutrition as an input to growth and development. There is a need for an augmented and effective collaboration between different stakeholders: government, parliamentarians, ministries, civil society, and development partners. The private sector has great potential but generally remains ignored. Civil society members like us work in and within communities. We definitely provide a forum for creating strategic linkages among different stakeholders.
We can continue encouraging information dissemination based on evidence and experiences that we have gathered so far and show the evidence of the best practices which will help the food system and the planning and implementation by the government of Bangladesh.
Richard Ragan, Country Representative, WFP: Maybe it’s a wrong thing to say being a public sector person, but I really don’t think the public sector is only the solution. This is really going to be driven by the private sector. As the country moves towards middle income status the role of organizations like WFP who are doing direct nutritional intervention really changes a lot. We are targeting around 30 million people in the pilot phase. It might have the same game changing impact like salt iodization initiative.
The government has just passed a national school feeding initiative, which I think is fantastic - our role is just to provide expertise on the nutrition side of it. A regular, non-healthy diet costs 60 BDT whereas it takes about BDT 170 for a healthy diet. That includes proteins and dairy products which drives household expenditure levels. You know food choices are shaped by environment and change every day. We have to think about the bigger picture of sustaining ourselves in light of the climate change issues besides issues like nutrition intakes, or else children will not have a planet to live on.
Dr. Md Shah Nawaz, Director General, BNNC: BNNC coordinates with 22 ministries that are involved in nutritional activities. Recently, we had a public expenditure review on nutrition. That gave a very astonishing result: 98% of the expenditure went for nutrition sensitive areas and only 2% for nutrition specific areas.
Now, we need to see whether money was spent on the right people. We are starting a finance tracking system. The finance and health ministries are helping us with that. The NPAN2 has some 230 activities with 64 indicators, out of which we prioritised 25 indicators to get achieved by 2025 which is very much within our reach.
Dr. Piyali Mustaphi, Chief, Nutrition Section, UNICEF: Thanks to the government that stunting rate is reduced - there are issues in CHT and tea gardens: 45% stunting in tea gardens. Urban slums have also shown a very high rate of malnutrition. It’s really important that we handle these. We are talking so much about food and nutrition, but the minimal acceptable diet is only 27%. It is also very concerning to see about 51% children getting married below age of 18, which leads to high-risk pregnancies with higher maternal mortality and low birth weight of infants. These children are born disadvantaged and the cycle of malnutrition continues throughout their lives. So, we need to stop child marriage at all costs.
Yes, we are doing well we will reach SDG targets for stunting, but we need to accelerate our actions as development partners. Besides, if we focus on maternal nutrition, under-three nutrition, under-five nutrition and adolescent nutrition, and also strengthen our prevention activities for the 1000-days period, it will surely make a massive difference.
Dr. Iftekhar Rashid, Health Specialist, The World Bank: I think we have given less importance to the urban areas. The government programmes for the past two and a half decades were focused basically on the rural areas. This is because the Ministry of Health does not cover the urban areas, which in fact fall under the jurisdiction of the Ministry of local government.
Also, the coverage is not as good as in the rural areas when it comes to primary healthcare services. In urban areas, there are many big hospitals, many private sector initiatives but the typical rural primary healthcare network has brought a lot of success in the nutrition programs in rural areas. Stunting rate at urban slums has been the highest in the country, especially during the last seven years. It is even higher than in the hard-to-reach rural areas. The living conditions, water, sanitation, pollution, sharing of cooking facilities are the reasons behind this. So, we need to focus on the urban areas and take a multi-sectoral approach to reduce stunting.
Md Khaleduzzaman Talukder, Manager (Technology Development), SME Foundation: SME Foundation is the apex body on SMEs providing technical and financial supports specially to uplift their status, from micro to small and from small to medium. The government make a very fantastic SME policy in 2019. Government is also committed to increase the contribution to GDP from SMEs by 50% by 2030.
There are a lot of targets in SDG, but SME foundation focuses on food and nutrition specially. SME Foundation is trying to upgrade their technical expertise and is nursing investments especially in food safety management system and good manufacturing practices in bakeries. In agriculture sector, SME foundation found 177 clusters in Bangladesh. Among these, 26 are agro-processing clusters.
The main challenges are technological upgradation and finance from commercial bank due to their interest rate is high. SME foundation provides single digit loan from 2008. Now, we are very much connected to SUN network hoping to maximize the capacity of SMEs using the SUN network.
Dr. Jaynul Abedin, Assistant Director, IPHN: If we want to enhance our nutrition status, we need to grow more food. For that purpose, we need to improve river flow. Or else, there is a chance of water shortage for harvesting purposes. For that we need to engage in proper digging of rivers, throughout the year. Second, people in Bangladesh need to involve in food diversification to get protein and vitamins from different sources.
If food diversification is improved, we can correct our nutritional status to a certain extent. And to increase output of fishes we need to utilise our rivers more properly. Regarding meat and milk, we need to focus more closely on cattle breeding to enhance our output and fulfil our demand for protein. And finally, we need more inter-departmental coordination.
Harry Verweij, Ambassador, Embassy of the Kingdom of the Netherlands: I just want to highlight a few more general remarks especially on the private sector. I think BGMEA, BKMEA and all other big employer confederations, representatives of industries need to start playing a strong role in this country on SDGs. We need to understand that it is no longer a donor-donation recipient relationship between Bangladesh and the world, e.g. UN, EU, etc. It’s a more equal relationship, but as equal partners meaning equal inputs at a more commercial and trade relationship level.
We have been here for more than 50 years, as a friend. But now want to be a friend who is doing business with Bangladesh. Also, the agriculture sector should change its approach - there’s a huge number of firms in agriculture and livestock sectors - I think we should be aware of that. Another point is the issue of water in agriculture. We are a strong partner for Bangladesh in the implementation of the delta plan. This is huge water centric development plan in which we develop our perspective of climate change into a new vision of how to do agriculture in Bangladesh.
From an embassy perspective, we are just brokers trying to connect. We facilitate transfer of technology and other areas of expertise. We should include other partners from private sector, employer federations and big entrepreneurs and have them invest and make them proud of investing in development of Bangladesh also from an agriculture, water perspective as it’s a huge market.
Finally to be mentioned is how it’s extremely difficult for foreigners to do business in Bangladesh. There should be attempted to attract more FDI. As soon as you brand the country, there will certainly be more FDI and I can say that being a fan of Bangladesh.
Md Zakir Hossain Akanda, Member (Secretary), Planning Commission: The government is attaching highest priority in the cause of poverty reduction – a reduction of half of the level to what it was about 1 year back. The government knows very well that poverty and malnutrition, these two things mostly move together - mostly, not always, as the reduction means an increase in time, labour and money on health, education and hygiene.
Our government is pledge-bound to improve the nutritional status because the government knows well, that to attain the status of developing, we need to have some pragmatic and sustainable development projects to contribute to the vulnerable and poor quantile of the society. Still the government is considering seriously about nutritional improvement and based on that, the first and foremost step it has taken is to enhance budget allocation by 3 times compared the past for the national social security strategy programs and adopted a national social security policy last year. That contributes to malnutrition and related issues.
In addition, the government has taken some programmes which have considered unique geographical locations, e.g. newly raised island which are growing in number. We are developing plans being a disaster-prone country. One disaster can reduce the status of a family to a poverty level or below a poverty line. Bangladesh is affected by variety of disasters including flash floods, storms, and landslides quite frequently. So, considering all the facts, to increase availability of protein the government has taken some measures, which is very relevant to today’s production. Production of animal source of protein includes egg, meat and milk. The government has substantially developed meat production. While we almost in stage of meat sufficiency, we are lacking behind with the production of eggs. The government has been developing multiple projects in those areas.
Simultaneously, for agriculture, the government has undertaken projects in rural areas not for rice production but for high value crop, which are mostly lentils, oil seeds and condiments. So, we do believe the way the government is reducing the level of poverty; we will be able to reduce the malnutrition and come up with quality and nutritious food. I would like to make an appeal to development partners, civil society and private organizations to come forward for the reduction of malnutrition in Bangladesh since the government can’t do it alone and needs concerted effort.
And also, we thank GAIN, particularly GAIN Bangladesh for arranging such a roundtable and developing national school nutrition program along with WFP and being the key player in the mandatory oil fortification law and salt iodisation policy.
Md Mujibul Haque, MP, Chairman, Standing Committee on Ministry of Labour and Employment: I would like to express my utmost gratitude to the language martyrs. Distinguished guests, thank you for your insights on the food and nutrition sector on Bangladesh. Thank you to GAIN and Prothom Alo for organising the event. Nutrition issues are very important, as highlighted in the constitution of Bangladesh. The government of Bangladesh is very keen to implement the laws and policies in the food and nutrition sector. Our Honourable PM Sheikh Hasina, our visionary leader has been working tirelessly to realise the dreams of the Nation’s Father.
Here commitment to the food and nutrition sector is highlighted by the laws and policies of the government and are linked to the SDGs.We need to improve the nutrition status and food safety in the upcoming 8th 5-years plan. I am very happy to know that GAIN has been working in Bangladesh for a very long time to reduce micronutrient deficiency and improve the wellbeing of women and children and workforce in the RMG sector. I am very much confident that we will be able to change in the food system and nutrition which will have a positive impact on the nation.
About 20 to 30 years ago, we didn’t even have a situation whereby we could talk about what nutrition is. In 1975 at MIT, 10 Professors who conducted a survey on third world country and commented that Bangladesh is a cancer infected patient that cannot be treated. They urged development partners to prioritise their activities elsewhere. After 40 years in 2015, The Editor of Christian Science Monitor of USA wrote, Bangladesh is a role model among third world countries achieving self-sufficiency in food. Our government is on track to achieve our nutrition target in 2030. A country like England took 70 years to double the per-capita income. It took us 40 years to increase our per capita income by more than 3 times. We are advancing at a rapid pace. Our government with its policies, administration, political ideology will be guided towards achieving our target with regards to malnutrition deficiency in the country.
Firoz Choudhury, Assistant Editor, Prothom Alo:
On behalf of Prothom Alo, we would like to convey our thanks and appreciation for joining in today’s important discussion.