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FPWG Consultation on the draft NFP Plan of Action Monitoring Report

This report provides an overview of progress and needs for further action in selected areas of intervention for achieving adequate nutrition for all individuals, especially mothers and children.

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FPWG Consultation on the draft NFP Plan of Action Monitoring Report

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  1. FPWG Consultation on the draft NFP Plan of Action Monitoring Report Overview of progress and needs for further action in selected areas of intervention (AoIs) NFP Objective 3 Adequate nutrition for all individuals, especially mothers and children Lalita Bhattacharjee, Nutritionist 6 December 2009

  2. Long term planning for balanced food AoI # 3.1

  3. 1.Progress towards policy targets Establishing consistent physical growth targets • Current growth charts developed by NNP, MoHFW adapting new WHO Standards in 2006 Determining per capita calorie requirements & age specific RDA for energy and other nutrients • Normative recommendations proposed by FAO/WHO (2001) and RDA of ICMR (2004) are being used in Bangladesh • Task Force set up by GoB in 6/2005 under chairmanship of DG,FPMU to review issues related to food and energy requirement and provide recommendations on per capita daily food intake requirement; National Food Composition Tables (FCT) • Comprehensive FCT compiled in 1988 (INFS/WFP/HKI) using INFS and NIN data

  4. 2. Recent policy development/actions underway • MoFDM/WFP MoU in 2007 -08 study by BIDS/WFP with NFPCSP technical support estimated energy requirements comparable with FAO/WHO/UNU for males ( 2755 vs 2780 kcal), lower for females( 1888 vs 2235 kcal) • Expert Consultation held in 2007 to develop national food basket for balanced nutrition, initiated by FPMU/MoFDM, BAN-HRDB/MoA and experts from 22 national and international agencies; • Arrived at national average calorie requirement 2350 kcal – needs further validation through research • Institutions working on FCT: INFS, ICDDR,B; • INFS updating/developing FCT database with new and old data; INFS analyzing 50 ethnic and indigenous foods with NFPCSP support

  5. 3.Needs for further action • Defining long term targets for physical growth and nutrition • Determining per capita consumption of cereals and other foods • Determining RDA • Developing/updating FCT • Monitoring impacts of food based nutrition interventions • Strengthening GMP

  6. Balanced and nutritious food for vulnerable groups(AoI # 3.2)

  7. 1. Progress towards policy targets Availability of variety of low cost foods: • Decline in pulse production and consumption (14g/d) and likewise sweet potato => protein and beta carotene gaps in diet; • Price differentials between rice and non rice foods - a source of dietary imbalance; !!! price hike led to rise in the share of rice to total food expenditure (45-50%) Coverage of food based nutrition programmes: National level data NA; • VGD coverage ↑ 450,000 in 2001-02 to 750,000 in 2005-06, remained same 2009; • # children in FFE ↑ from 1.06 M in 2002 to 1.20 M in 2004 but ↓to 0.694 M in 2008 Development of low cost diet chart from local ingredients forbalanced diet: INFS ( 1991, modified in 1998; Charts produced by BAN-HRDB, BNNC, NNP, being used in community nutrition programmes (CNP), GMP integral part of CNP

  8. 2. Recent policy developments underway • Revised National Agriculture Policy ( 2009) calls for enhanced crop diversification to improve availability of non rice food crops • Interventions underway AoI # 1.4 (Agricultural diversification)

  9. 3. Needs for further action Balance in crop diversification strategy to ensure availability of low cost nutritious foods • current emphasis on high value profitable crops; decline in sweet potato production in favour of potato • In the context of food price inflation, promoting potato production& consumption can address cereal deficits Promoting the production and demand for healthy rice varieties (BR 16, BR 25) Promote integrated home gardening – integrated horticulture development, backyard poultry and community fish ponds Promote food based strategies in agriculture sector interventions and nutrition considerations in policies Improve FFE coverage and scaling up food supplementation programmes for children 6 mo – 2 y (150 kcal/d)

  10. Nutrition education on dietary diversification (AoI # 3.3)

  11. 1. Progress towards policy targets No national level data on education and awareness of women in nutrition and PHC activities • ↑ in adult literacy rate ( 18 % in 1981; 25.8% in 1991 and 40.8% in 2001); Home gardening : • National data ( 47.2% HG ) • HKI - HG promotion since 1988, progress in 1998 -2002, 65% completed HG • Diversification of HG produce ( average 9.9 vegetable crops in 3 mo period; • 65% sale among active HG households, provides extra household income

  12. 2. Recent policy developments underway • Dietary diversification being promoted through NE • Training programmes implemented for DAE at various levels • NNP providing training to mothers of under 2s (modules on nutrition, health & hygiene, home gardening, poultry raising and income generation)

  13. 3. Needs for further action • Integrating FBDGs into NFP as a tool to inform agriculture, trade, health and nutrition policies • Strengthen NE interventions • Improve coverage of ABCN under NNP areas and piloting ABCN in urban areas • Scaling up HG and dietary diversification using women centered CB approaches in at least 2/3 HH at union levels, promoting SG

  14. Food supplementation and fortification (AoI # 3.4)

  15. 1. Progress towards policy targets • VAC supplementation ↑ among children 6 -72 mo • V & M supplementation through NNP covering only 109 upazilas with plans for scaling up to 1/3 by 2009 • Scanty data on IFA coverage; 15% of pregnant women covered due to low compliance rates and low coverage of ANC (CMNS 2005) • Efforts for IFA- Zn supplementation underway • Fortification of salt with iodine (mid 90s) and edible oil (2005) limited scale; 51% HH salt is adequately iodized; support amendments to Salt Law • GoB launched ‘atta’ fortification in 2002; 29 mills commissioned to supply fortified ‘atta’; ensure fortification of 80% of planned food • Supplementary feeding for malnourished children 52 % 6-9 mo infants given appropriate CF with continuation of BF; 42% 6-23 mo infants fed according to IYCF practices

  16. Night blindness almost non existent, prevalence below 0.1% in 2006; Attributed to blend of actions VAC distribution with EPI and food based strategies VAD is still high, 30% among women and children

  17. 2. Policy developments/actions underway • National Fortification Alliance (NFA) formed in 2003 under aegis of MoI to plan, execute and evaluate FF in the country • Bangladesh Vegetable Oil Refiners Association and private refineries initiated VA fortification of edible oil • VA supplementation (200,000 IU) for mothers within 6 weeks of delivery since 2008 • Scaling up FF efforts and activate NFA • Collaboration with GAIN and other partners for setting up FF units

  18. 3. Needs for further action • Filling up monitoring data gaps regarding SFP coverage as well as IFA-Zn supplementation • IDD assessment to be included in MICS • Improving coverage of SFP, IFA and VA prophylaxis • Research on effects on growth of childern following Zn combined with other MN supplementation • Strengthening of CIDD Project implemented by BSCIC under MoI

  19. Safe drinking water and improved sanitation (AoI # 3.5)

  20. Progress in sanitation coverage (2003 -08)

  21. 1. Progress towards policy targets • Coverage of safe water supply ↑ • Achievement in tube wells feared with arsenic contamination • Use of sanitary latrines ↑ by almost 1/3 in last 5 years • Significant progress in people’s access and use of improved sanitation (estimates of 39% rural and 58% urban noted )

  22. 2. Recent policy developments/actions underway • WSSD supported by multi sectors –DPHE, LGED, WASA, international, multi lateral (UNICEF, IDA,ADB, WB and WHO; bilateral agencies DFID,DANIDA, JICA and Dutch Govt, INGOs WaterAid, Plan Bangladesh • NGO initiatives to integrate community participation with hygiene education, water supply and sanitation • Implementation of National Sanitation Strategy, monitoring and updating progress • ESHWRA Project implementation in 68 upazilas and scaling up planned

  23. 3. Needs for further action • Scale up interventions/funding to improve use of sanitary latrines • Ensure proper maintenance of existing latrines • Strengthening of arsenic mitigation programmes

  24. Safe, quality food supply (AoI 3.6)

  25. 1.Progress towards policy targets • No reliable NATIONAL food safety monitoring (FSM) data • ↑ in # of BSTI certified foods • ↑ demand for fast foods, processed foods facilitated commercial production of these foods; • Adulteration in 50% food samples (IPH 2004), 100 % fat samples, Shrimp produce rejected on few occasions (MoFL, 2004), • Some rice and wheat samples (DGF data, 2004) not within quality specifications

  26. 2. Recent policy developments/actions underway • Consumers’ Right Protection Act, 2009 passed • 1967 Bangladesh Pure Food Rules amended to Bangladesh Pure Food (Amendment) Act, 2005 • Formation of Food Safety Advisory Council • BSTI Ordinance 1985 enacted as BSTI Act 2003 giving BSTI some regulatory responsibilities • Institutionalize Street Food Vending System (pilot model in 3 wards in Dhaka tested) • National Food Safety Policy and Plan of Action underway • National anti adulteration drives in progress • MoHFW supported by FAO/WHO for 3 yr project on ‘Food Safety’ being implemented with EC funding

  27. 3. Needs for further action • Amending Consumers Protection Act 2009 to suit consumer's rights and interests along with effective enforcement mechanisms • Activate National Food Safety Advisory Council • Strengthen Food Safety Education Programmes • Establish food borne disease surveillance system • Prepare/update guidelines for safety of fisheries

  28. Women and children health AoI # 3.7

  29. 1. Progress towards policy targets • ↓ in IMR (43% in 2007) attributed to UIP, improved health services and social awareness; NMR ↓ from 41% 1999 -2003 to 37% in 2002 -2006; ↓ in MMR from 574 in 1990 to 391 in 2002 and 351 in 2007; MMR not declining at the desired level • Attendance of skilled birth attendants , steadily improving though at a low pace • ANC and EPI coverage : NIP underway, EPI coverage ↑ markedly from 54% to 82% in last decade

  30. 2.Policy developments/actions underway • Formulation of new National Health Policy (NHP) 2009 replacing NHP of 1999; draft in preparation • Since January 2009 MoHFW in collaboration with FAO/WHO is implementing a 3 yr EC funded project on “Improving Food safety, quality and improving food control in Bangladesh” • Modular project – Preventive food chain approach, legislation and regulatory standards & enhancing analytical capacity

  31. 3. Needs for further action • Strengthen EPI : ARI, Cholera, diarrhoeal diseases, PHC coverage and low cost health facilities for the poor • Improve measures to facilitate access to health care facilities, particularly women and children in remote and hard –to-reach locations • Strengthen training to doctors, nurses and paramedics & provision of appropriate reproductive services to female adolescents and young women

  32. Protection and promotion of breast feeding and complementary feeding (AoI 3.8)

  33. 1. Progress towards policy targets • Slight improvement in BF practice being initiated within 1 hr of birth (43% in 2007); prelacteal feeding widely practised despite global recommendations of feeding colostrum and continue BF • No notable improvement in exclusive BF

  34. 2. Recent policy developments/actions underway • National IYCF Strategy formulated by MoHFW in 2006 • Building upon /strengthening Innocenti Declaration (1990) and BFHI • Strengthening IYCF activities by NNP, BBF, NGOs, UNICEF and development partners • MDG –F Project on ‘Protecting and Promoting Food Security and Nutrition for Families and Children in Bangladesh’ to be implemented by GoB with Inter Agency (WFP/FAO/UNICEF) collaboration and Spanish Government funding support

  35. 3. Needs for further action • Awareness raising on benefits of exclusive BF for 1st 6 mo of life and promote exclusive BF for 1st 6 mo; initiate appropriate CF at 6 mo along with continuation of BF upto 2 yrs • Strengthen BNNC and BFF • Activate international regulations on BMS • Establishing day care centres/creches for working mothers as well as extended maternity leave for at least 5 mo PP • Strengthen BFHI

  36. THANK YOU FOR YOUR KIND ATTENTION

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