Three smart solutions for nutrition

As is well-known, access to and availability of good nutrition for the people allows for healthy growth of an economy and of a nation. The virtuous circle is not difficult to follow: better nutrition ? increased productivity/earning ?improved nutrition?increased productivity/earning. Nutrition is important from both inclusive and sustainable development perspectives. In June this year, we attended a policy seminar on nutrition which was jointly organised by the Copenhagen Consensus and the Bangladeshi think-tank, Centre for Research and Information (CRI).Minister of  Ministry of Health and Family Welfare Md. Nasim spoke to the audience, as did policymakers and Copenhagen Consensus researchers. Media report said that the 'research was a timely input to the revitalised Bangladesh Nutrition Council, and the National Plan of Action for Nutrition (NPAN).'
In this article, we shall provide our own take of the interventions, prioritising them based on this writer's interpretation of the research findings generated by the Copenhagen Consensus (see Table). We hope that these will be considered by policymakers given their potential to do the most good for Bangladesh, as demonstrated by cost-benefit analysis (all research papers are available online at http://www.copenhagenconsensus.com/bangladesh-priorities/bangladesh-nutrition).
MATERNAL AND EARLY CHILDHOOD NUTRITION: One of the key findings of the research is the strong evidence for prioritising investment targeting pregnant mothers, infants and children in order to improve health and nutrition of pregnant women, providing nutrition supplements during pregnancy can yield high benefits. The research revealed the highest benefit in providing iron-folate supplementation during pregnancy, generating nearly Tk 28 for every Taka spent. Besides, during pregnancy, calcium supplementation and balanced energy protein supplementation can also be considered as smart investments, which provide Tk 12 and nearly Tk 17 of benefits, respectively. It is worthwhile to note that the National Nutrition Service (NNS) strategic plan already includes two of these three nutrition direct interventions: iron and folic acid supplementation and calcium supplementation. The intervention that does not appear in the NNS plan is balanced energy protein supplementation which is also the most expensive and logistically challenging intervention.
Another option examined is the promotion a nutrition package comprising of nine interventions that are to be administered to mothers, babies and small children in the first 1,000 days of life. Chronic malnutrition (stunting) and acute malnutrition (wasting) are responsible for more than 300,000 child deaths a year in Bangladesh. Children in rural Bangladesh are more at risk of stunting than those in urban areas. The research suggests that such a package of nutrition would generate the second highest benefits for every taka invested - nearly Tk 19 for every Taka spent. An improvement in physical and cognitive development would result in better educational achievements for children as they grow up, as well as better health and increased earnings later, upon entering the workforce.
The first intervention during pregnancy is multiple micronutrient supplementations (including iron-folic acid supplementation). During infancy and early childhood, another seven interventions are exclusive breastfeeding education, complementary feeding education, provision of complementary foods (such as balanced energy and protein), vitamin A supplementation (6-59 months old), multiple micronutrients, management of severe acute malnutrition (SAM), and zinc supplementation. The overall package includes salt iodisation.
The final finding in this area relates to changing the behaviour of pregnant women to stop consuming smokeless tobacco. Bangladesh has the highest prevalence of smokeless tobacco among women in the world. The proposed behavioural intervention includes face-to-face counselling by a health care provider, the use of printed materials and it would be run by community health workers responsible for home visits and delivery of change and communication messages. Raising social awareness and assuming a 15 per cent uptake, it is estimated that such behavioural change communication activities can generate Tk 7.0 of social good to the society.
GIRLS' EDUCATION AND NUTRITION: Low participation in secondary schooling among girls is attributable to rise in marriage and subsequent high-dropout rate and the role of girl's education in the labour market. As a result, the poor nutritional status of children is strongly associated with mothers with low levels of education. Research for Copenhagen Consensus looks at two potential solutions to improve education and nutrition among girls.
One approach is to provide stipends to encourage girls to enroll and stay in school, suggesting that additional schooling would potentially lead to increased earnings. Another approach is to focus on extending and improving secondary schooling for girls as a solution to child malnutrition. Research suggests that a high level of education results in both interventions through better awareness of health and nutrition, generating benefits of nearly Tk 13 and Tk 6.0, respectively.
DIETARY DIVERSIFICATION: Two-thirds of the average Bangladeshi family diet consist of cereals like rice and there can be many benefits of prioritising investments in promoting complementary and supplementary feeding among women and children.
Complementary feeding refers to the introduction of family foods which usually occurs in infants from 6-24 months of age. Supplementary feeding refers to those foods high in vitamins, minerals, fiber, fatty acids and amino acids that would otherwise not be consumed in sufficient quantities. Investing Tk 1 here could generate a return of nearly Tk 15 of benefit to the society.
Despite great progress over the last 20 years, poor nutrition still hurts Bangladesh. From the policy perspective, the NPAN is going to set Bangladesh's nutrition investments and governance as it will try to encompass the NNS and the Health, Nutrition and Population Sector Programme (HNPSP), both of which are set to expire this year.
Significant progress on nutrition policy can be made with strong leadership and coordination across government departments. Existing nutrition strategies need to spend the budget allocated, and more needs to be spent across all of government departments. Here, the role of the Bangladesh Nutrition Council will be the most important to bring about coherency and coordination for smarter and more target nutrition investments.  It is clear that there is no one single solution that will address all dimensions of maternal and child health. Making progress in reducing all dimensions of under-nutrition in Bangladesh will require multiple interventions, not just one.  But the benefits - for the economy and the society - will be deep and manifold.
Prioritising nutrition investment in the three discussed areas can boost Bangladesh's vision of becoming a middle-income country and ensure that the economy is able to enjoy a healthy, well-nourished demographic dividend.
The writer is Professor of Economics at Jahangirnagar University. Hasanuzzaman belongs to Copenhagen Consensus Center.
[email protected]
[email protected]