10 May 2017

Making Bangladesh’s rapid economic growth also drive rapid nutrition improvement

I was in Dhaka this week visiting with the great GAIN office team in Bangladesh, well led by Rudaba Khondker.  During the course of several group meetings I heard from GAIN’s current and potential partners about GAIN’s strategic positioning and our value add as a partner.  I learned a lot about our partners and about GAIN.  Thank you to everyone who gave me their time during my stay. 

Rudaba and I wrote the blog below. 

Bangladesh is growing rapidly.  GDP per capita was $1212 in 2015.  The height of under 5’s is growing much more slowly.  While the stunting rate is going down at a pace to meet the 2025 target, the annual GDP growth rate is much more rapid—at 7-8% per year. 

It is pretty clear that the rapid income growth is not translating through to rapid declines in stunting, wasting and women’s anaemia, the latter two being are stuck at high levels.  On the other hand, this income growth, interacting with rapid urbanisation, is pushing up rates of overweight, obesity and non-communicable diseases such as diabetes.  A study cited in the Global Panel’s Foresight report on Food Systems estimates that by 2030 Bangladesh will have more people with diabetes than the much higher income Mexico and Indonesia. These facts should worry Bangladeshi leaders and policymakers at the highest level.  I’m sure they are seriously thinking about it and looking for partners to support them to address the situation.

These leaders and policymakers should be worried: treatments for NCDs are expensive and take health resources away from the prevention of malnutrition in all its forms.  This will act as a heavy brake on Bangladesh’s aspirations to move to a developed country status by 2041.

So we need to make income generation more powerful in reducing undernutrition and less powerful in driving up other forms of malnutrition.  This is not easy.  Here are some ideas:
    With the nutrition peer educators in the garment factory. 
  •   Make one of the most powerful engines of Bangladeshi economic growth--the ready made garment industry—better able to improve nutrition outcomes.  The industry has over a thousand factories with 2,000-5,000 workers in each, mostly women.  GAIN with its partner Business for Social Responsibility (BSR) and Change Associates Ltd. works with 24 of these factories to provide nutrition training to 90 women per factory and each of them then  trains 20 workers.  The aim is to improve business outcomes (piece rate productivity, turnover, absenteeism) and nutrition outcomes (evaluation findings will be out by June this year).  If the evaluations are positive, the potential for scale is large and the goal is to use these results to make the case to the factory buyers and the relevant authorities to undertake workplace nutrition actions by including nutrition as part of the Code of Conduct for the factories 
  •   Strengthen the efforts to improve women’s empowerment.  While in Dhaka I learned about IFPRI’s analyses using their women’s agricultural empowerment index. Women's empowerment is proving to be a powerful lever of a wide range of development outcomes—all at a given level of income. Nothing we did not know, but it is great to have hard quantitative results.
  •  Make food systems more nutrition effective.  Food systems contain large resources flows (along value chains, between consumers and retailers, investments in agricultural inputs): what might be achieved if we put a nutrition lens on these flows? If we did I suspect the food system in Bangladesh would generate more nutrition per unit of income growth. The importance of engagement with business is seen with sceptism by some (and some scepticism makes sense—not all businesses do good things for nutrition) but to attain the SDGs, business resources need to be mobilised. It is noteworthy that Bangladesh has included private sector engagement in the 7th Five Year Plan and in its National Nutrition Policies, Strategies and Plans.

Other observations
  • The unfinished agenda in Bangladesh for fortification is huge, not just large scale, but fortification in small scale mills, biofortification and home fortification.  There is not enough strategic coordination between these different approaches to make sure that between them they cover all segments of the population who suffer from micronutrient malnutrition.  We are working with the government and partners to explore the value added and feasibility of establishing and supporting a government Food Fortification Facility to do just this. 
  • Urban malnutrition is a rapidly growing problem, along with food safety. Slums constitute a large percentage of the country’s urban population and are growing rapidly.  Urban areas heterogeneous and some locations have rates of malnutrition that are frequently worse than those in the rural areas.  Urban areas present challenges for nutrition programming for a variety of complex reasons relating to pollution, land tenure, security and access, infrastructure and mobility.  These challenges need to be addressed.
  •           More than half of the Bangladeshi population is under age 25. Adolescents make up one fifth (27.7 million) of the population. We must be impatient for new solutions for adolescent girls and boys.  Soon they will be the next entrepreneurs, carers, innovators and voters.  They can't afford to wait for solutions.  It is time for new initiatives here.

As usual Bangladesh is inspiring to those who care about progress in development.  It is a country that has been written off from a development perspective many times in the past.  Not so anymore.  The eyebrow raising economic growth rates have investors on alert for economic opportunities.  It is our job to help turn that economic growth into a series of great opportunities to also invest in nutrition—and to drive subsequent economic growth. Remember, nutrition status is a maker and a marker of development.

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