International funders need to develop better relationships with government ministries and implementing organizations to help sustain progress in areas such as stunting, says Dr. Jahangir Hossain, the program director of health for CARE Bangladesh.
Bangladesh has recorded a significant drop in stunting rates for children under five years old in recent years – from 41 percent in 2011 to 36 percent four years later. This comes as international donors have guided Bangladesh’s increase in programs addressing malnutrition over this decade, according to experts, underscoring the role funders can play in getting nutrition on national agendas.
But donors can’t do everything, said Hossain. To sustain these programs, funders have had to develop relationships with government officials and agencies like his.
A critical initial step in Bangladesh, he says, has been turning away from individual initiatives that address specific aspects of malnutrition and, instead, positioning nutrition as part of multi-sectoral responses to broad health needs, like reducing maternal and child mortality. Hossain says this has encouraged a greater degree of collaboration across different ministries and NGOs.
Ahead of the upcoming annual meeting of the World Bank and the International Monetary Fund, where nutrition funding is set to feature prominently, Hossain spoke to Malnutrition Deeply about how international donors helped get malnutrition on Bangladesh’s agenda and outlined the steps he thinks will be critical to keeping it there.
Malnutrition Deeply: After over more than two decades working in health and nutrition, how have you seen the approach international donors take to malnutrition change?
Dr. Jahangir Hossain: Essentially the nutrition project was a more vertical project initially. There is a project where food security, rather than nutrition, is the focus. But there are some [nutrition] components there, like CARE used to manage big food security programs for a long time in Bangladesh with USAID funding. And with time, the nutrition, like the health, hygiene and nutrition component, was [integrated] within this big food security [project]. And over time, we see that that has been expanded.
There is a push for realizing from the donor, since the final outcome is reducing the stunting … that made us bring the nutrition component within the whole food security program and expand that funding within this program. So that if you review the USAID [requests for proposals] for food security for last 20 years or 25 years, you can see how that focus has been increased with time.
But one of the big challenges was that there was not good coordination, and there is duplication.
Malnutrition Deeply: How is that changing, and who is driving that change?
Hossain: For example, the [Food and Agriculture Organization] is working mostly on the nutrition-sensitive area like with the minister of agriculture or minister of livestock, which is a very important stakeholder to reduce malnutrition. They can push the ministry they are working very closely with. That’s a big shift.
Now we are in different meetings. We are having meetings with FAO, with [the United Nations Children’s Fund], together with other kinds of organizations. More than 13 ministries are identified as key ministries that need to participate in this multi-sectoral nutritional platform for nutrition.
Malnutrition Deeply: And how does that change the way you, as the program director of health for CARE Bangladesh, do your work?
Hossain: Previously, the food security program did not interact with us. That’s because the food security program is managed by some other sector, and we are health and nutrition. Now we are participating in the design. We are contributing [to see] how they can work with the existing health system – what the nutrition-sensitive services are – so that it’s kind of more informed by some evidence, experiences and also integrated with the health and other sectors.
Malnutrition Deeply: What do you think helped encourage donors to take more interest in malnutrition?
Since nutrition was considered a kind of silent disaster, it is very difficult to make a policymaker understand why they [should] invest in it. With all this global initiative [around nutrition], the dialogue and this information from The Lancet, there is a huge awareness among the government, public policymakers, and there is also a more proactive investment from the donor side. I think that there is a big shift, which is very good.
I see that there is increasing commitment on nutrition.
Malnutrition Deeply: What comes after increased funding?
Hossain: The intervention has been discovered, but it’s how to coordinate. CARE needs to play that kind of role more in future.
We can bring that implementation of [scientific] knowledge and then we can inform government policymakers how we can efficiently and effectively deliver to the underserved and poor or extremely poor population in their remote communities using the existing government platform.
And the second objective is to build the capacity of government policymakers and programmers to take up and utilize this knowledge and information to implement their future program.