Inefficiency and poor monitoring of the nutrition specific interventions have been making insignificant impact at the field level worsening the country's already pitiable nutrition scenario although the government has declared it to be a priority area.
Experts note the faulty design of National Nutrition Services (NNS) to address the country's nutrition issues and a section of corrupt and inefficient officials are responsible for exacerbating the whole nutrition project. They said success of the mainstreaming nutrition programme of the government depends on the managers concerned and their operational skills.
They however suggested implementing specific nutrition goals in a timeframe with the existing health workforce to make the nutrition specific interventions successful and also by assigning the field and facility level service providers with nutrition specific jobs with adequate training and logistics.
Nutrition specific interventions are included in the key priority interventions of the government's health population nutrition sector development plan (HPNSDP 2012-2016) of the ministry of health under National Nutrition Services Operational Plan (NNS/OP).
In the overview guide on mainstreaming nutrition published by NNS there is a monitoring table of standard indicators to monitor effective coverage of nutrition specific interventions under which the implementing agency will monitor the percentage of children 0-23 months who were breastfed within the two hours of birth, percentage of children of six months who are exclusively breastfed, percentage of children of 6-23 months who are fed a minimum acceptable diet and so on.
Brac, a key partner of the government's Health, Nutrition and Population Programme, implements the mainstreaming nutrition programme in 222 upazilas under the guideline of Institute of Public Health Nutrition (IPHN) and work on infant and young child feeding (IYCN) in 50 upazilas.
About the impact of the present nutrition specific interventions, Health, Nutrition and Population Programme Coordinator Dr Raisul Haque told the FE that a third party evaluation team of International Food Policy Research Institute (IFPRI) has evaluated their activities of 2014 which will be published in February of next year. The report of 2013 has already been published.
When asked about the same kind of report, an official at IPHN referred to Brac saying the organisation has been doing the surveillance work. But the person concerned of Brac informed the FE that the government's surveillance report on nutrition which was available was of 2012.
During a recent visit to Mitrasinga village of Jessore Sadar upazila it was revealed that a 'swasthya karmi' of Brac Rehana Parvin works for the last one and a half years in an area with 2,400 households and 1,460 people. Seven 'swasthya sebikas' work under her supervision for which she has to maintain seven register books.
She knows there are 67 children aged between 0-2 years. She counsels mothers with nutrition advice and visits houses every month.
Archana Rani Sarker, a 'swasthya sebika' at the same village told the FE that she has to visit 300 HH where there are 67 breastfeeding mothers and nine pregnant women.
An official of Brac said ignorance is the main reason for which mothers do not give proper diet after six months. Rather they give children harmful diets like chips, packet juice and other solid foods.
He also said the height and weight of 90 per cent of the breastfeeding mothers in Jessore are disproportionate as they do not eat regularly and properly.
Eight upazilas of Jessore district have a population of 2.37 million with 70,886 children. Of them, children aged 0-6 months are 16,499, children of 7-12 months 18123 and children of 12-24 months are 36,264.
The upazila health and family planning officer of Jessore (Sadar) Upazila Health Office told the FE that they have been conducting nutrition activities through their field staff. But he could not say much about the impact of their interventions.
According to a Brac surveillance report, percentage of early initiation of breastfeeding is 92 in their project areas, while percentage of exclusive breastfeeding is 82 and percentage of children of 6-23 months who are fed appropriate complementary diet is 68.
Freelance public health consultant Dr MA Sabur said the design of NNS to implement mainstreaming nutrition is faulty. They want to achieve 10 goals at a time with the existing system. But they should properly use the existing workforce, deploy specific personnel with specific nutrition jobs and use the community clinics instead of pressurising the health assistants and family planning welfare officers.
"The problem lies with the management's decision and inefficiency of the policymakers," he added.
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