Bangladesh : Delivering for Success at Scale

Conference on Delivering for Success at Scale 7- 8 February 2017, BRAC Auditorium, Mohakhali, Dhaka, Bangladesh

This conference built on the longstanding partnership between BRAC, ICDDR,B and the Institute of Development Studies (IDS) to explore the role of knowledge in the conceptualisation, design, delivery and management of development programmes and policies. Bangladesh has been a lead player in the use and integration of research into development decision-making, notably in relation to health systems, nutrition, social protection, agriculture and poverty. Evidence will continue to be important in strategic development planning by the Government of Bangladesh among others.

The conference included examples of how high quality research can be embedded within programmes, showcased research findings, discussed the challenges of integrating research with programmes, highlighted successful examples and discussed future needs. The UK Department for International Development funded Transform Nutrition and Future Health Systems presented relevant research.

Read an article about the conference in the Bangladesh Financial Express ‘On health and nutrition’. We also published a blog by Rittika Brahmachari, IIHMR Pathways to scaling up interventions: reflections from delivering for success at scale 

For more information contact Aazia Hossain aazia@icddrb.org

What factors influence community nutrition workers in performing their jobs? Preliminary findings from Bihar, India

by Aparna John, PhD candidate, Institute of Development Studies at University of Sussex

Child undernutrition rates in India are among the highest in the world (Raykar et.al, 2015). Despite the decline in undernutrition indicators such as stunting (low height for age), underweight (low weight for age) and wasting (low weight for height), India is home to 40 million stunted and 17 million wasted children. The Government of India has invested in efforts to reduce childhood undernutrition and improve maternal and child health through one of its flagship programmes — the Integrated Child Development Services (ICDS) Scheme. ICDS, the world’s largest community nutrition programme, is delivered by 1.34 million village based female workers, Anganwadi workers (AWWs). [Read more...]

Should the Maternal Infant and Young Children Nutrition programme in Kenya be scaled up?

This briefing Social Return On Investment Assessment Of A Baby Friendly Community Intervention In Urban Poor Settings, Nairobi, Kenya by Transform Nutrition project partners African Population Health Research Center answers that question. It outlines the impact of the Maternal Infant and Young Children Nutrition project that aimed to improve the health and nutritional status of children and inform implementation of the government’s Baby Friendly Community Initiative. The Study is now also featured in June 2016 issue of Field Exchange.

Public-Private Partnerships and the Reduction of Undernutrition in Developing Countries

This Transform Nutrition discussion paper Public-Private Partnerships and the Reduction of Undernutrition in Developing Countries brings structure to the discussion of private-sector engagement in nutrition. It clarifies different models of engagement, reviews the evidence base on public-private partnerships (PPPs) for the reduction of undernutrition, and outlines some potential ways forward.

Assessing Bangladesh’s National Nutrition Services Program

By Masum Billah and Shams El Arifeen, ICDDR,B

Despite important economic progress and reaching lower middle-income status in 2015, Bangladesh remains one of the high under nutrition burden countries. This is not due to a lack of political will. In 2009, the Annual Program Review of the Health, Nutrition, and Population Sector Program of the World Bank recommended scaling up nutrition interventions in Bangladesh through mainstreaming critical nutrition interventions in health and family planning services. To achieve this goal, the country made nutrition a priority.

The National Nutrition Services (NNS) has since been pursuing a variety of key strategies and actions. In 2011, the operational plan (OP) of NNS under the current Health, Population and Nutrition Sector Development Programme (2011-16) was approved by the Government of Bangladesh which meant mainstreamed nutrition interventions should be implemented through the existing health system from July 2011 onwards.

But how well is this program working? A new report  Bangladesh National Nutrition Services: Assessment of Implementation Status, published by the World Bank presents the findings of a research study done by IFPRI and icddr,b, partly supported by Transform Nutrition, to assess the implementation of the Government of Bangladesh’s National Nutrition Services Program (NNS). Importantly it also identifies the achievements, identifies key bottlenecks that adversely impact these achievements, and highlights potential solutions to ensure smooth delivery of the program in the future.

The study
The overall objective of this study was to assess the effectiveness of the delivery of the different components of NNS. The report was written by a team from IFPRI and ICDDR,B, including Drs. Shams El Arifeen and Purnima Menon, who lead Transform Nutrition’s work on making health systems more nutrition-sensitive.  The study focused on assessing issues related to management and support services; training and capacity development; service delivery; monitoring and evaluation, and; exposure to interventions.  A mix of quantitative and qualitative methods were used to assess the quality of  service provision related to integration of nutrition with antenatal care services and sick child care in health facilities: The research also focused on elements of the enabling environment to support the roll-out of the NNS interventions, examining institutional arrangements and the policy environment at the national level.

Key findings
The study indicated that NNS lacked specificity in choice of interventions and preventive service platforms resulting in attempts to deliver too many interventions with limited coverage and quality.  Frequent changes in leadership, coordination, capacity and workload-related challenges faced by the NNS have hampered the implementation of nutrition interventions.  The study also reported slow roll-out and poor coverage of training, especially among the frontline health workers. Although the quality of nutrition service during antenatal care, one of prioritized health service delivery contacts, was somewhat better; height and weight measurements, provision of appropriate nutrition counselling and screening for severe acute malnutrition during sick child management contacts were sub-optimal.  Critical challenges relating to service delivery at community and outreach level (preventive platforms), lack of systematic supportive supervision, poor recording and reporting of service statistics, and weak monitoring mechanisms have jeopardized the NNS’s ability to achieve adequate delivery of quality nutrition services.

Our recommendations
Our study found that the overall NNS effort is an ambitious, but valuable, approach to support nutrition actions through an existing health system with diverse platforms. The results indicate that although the maintenance of strong and stable leadership of NNS is an essential element to ensure integrated and well-coordinated service delivery, the current arrangement is unable to ensure effective implementation and coordination of NNS. So how can this be improved?

  • Focusing on some of the critical challenges related to leadership and coordination and then embedding a smaller set of priority interventions into well-matched health system delivery platforms is most likely to help achieve scale and impact.
  • Strategic investments in ensuring transparency, engaging available technical partners for monitoring and implementation support, and not shying away from other potential high coverage outreach platforms, such as some NGO platforms, also could prove fruitful.
  • The Government of Bangladesh, and the health system in particular, must lead the effort to deliver nutrition and the NNS is an important start towards this goal. Nonetheless, it is clear that development partners who have expressed a commitment to nutrition must coordinate their own activities both among themselves and with the government and provide the support that can deliver nutrition’s potential for Bangladesh.

Bangladesh is ranked 142 of 187 countries on the 2014 Human Development Index and 57 among 120 developing and transitioning countries on the 2014 Global Hunger Index.  There is still some way to go to to ensure the population of Bangladesh is well nourished and able to make the most of economic progress. icddr,b, IFPRI and Transform Nutrition are working to generate evidence on effectiveness of different  nutrition-specific and nutrition-sensitive interventions in Bangladesh to support strategic policy and intervention choices that can improve nutrition in Bangladesh.

 

 

From global mantra to local results: scaling up impact on nutrition

By Stuart Gillespie, Purnima Menon and Andrew Kennedy

 This blog is based on an article recently published in the ‘Global Nutrition Report 2015’.

Despite relative consensus on actions to improve nutrition globally, less is known on how to operationalize the right mix of actions - nutrition-specific and nutrition-sensitive - equitably, at scale, in different contexts. How to “put it all together” to maximize sustained impact?

In a recent review by the Transform Nutrition consortium of approaches to scaling up impact on nutrition, a number of elements repeatedly emerged as key factors. First, the start point for most successful large-scale programs (e.g. Progresa-Opportunidades in Mexico, Alive and Thrive in Bangladesh) was a discussion and ultimately a shared vision of what large-scale impact actually looks like — and not on any intervention per se. [Read more...]

How to scale up impact on nutrition

We know a lot more about what is driving malnutrition and we know more about the type of interventions that are needed to respond. And yet, we continue to struggle with the “how” questions. A new Transform Nutrition research brief written by Stuart Gillespie is out now Scaling up impact on nutrition: what will it take? which will help guide policymakers and programme managers when designing and planning for scaling up impact on nutrition.

Scaling Up Impact on Nutrition: Four Case Studies

Supplementary material for the paper: Gillespie, S, Menon, P., Kennedy, A (2015) Scaling up impact on nutrition: what will it take? Advances in Nutrition 6:440–51.

Scaling Up Impact Four Case Studies (pdf)

Case Study 1:        Scaling up a high quality IYCF counseling intervention in Bangladesh: Alive & Thrive(1,2)

Case Study 2:        Scaling up iron-folic acid supplementation in Nepal(3)

Case Study 3:        Scaling up social protection in Mexico: Progresa-Oportunidades

Case study 4          Scaling up homestead food production in Bangladesh

An assessment of Bangladesh’s National Nutrition Services Program

A new report Bangladesh National Nutrition Services : Assessment of Implementation Status presents the findings of an operations research study conducted to assess the implementation of the Government of Bangladesh’s National Nutrition Services Program (NNS). It identifies the achievements and determine the bottlenecks that adversely impact these achievements, and highlight potential solutions to ensure smooth delivery of the program.

Scaling Up Impact on Nutrition: What Will It Take?

 

Despite consensus on actions to improve nutrition globally, less is known about how to operationalize the right mix of actions—nutrition-specific and nutrition-sensitive—equitably, at scale, in different contexts. A new review by Transform Nutrition Scaling Up Impact on Nutrition: What Will It Take? of four case studies of large-scale nutrition programs with proven impact at scale highlights a need for greater coherence and consistency with regard to the “ends and the means” of scaling up as key to success, and sets out 9 critical elements to guide actions for scaling up impact on nutrition.