1. FOOD SECURITY Concepts, Basic Facts, and Measurement Issues June 26 to July 7, 2011 Dhaka, Bangladesh

2. Kazal 4d: Issues in Nutrition and Policies for Its Promotion in Bangladesh Learning: The goal is to identify and understand links between food and nutrition, and available and potential policy instruments and institutional arrangements. Focus on policy documents related to nutrition aimed at expanding and strengthening nutritional support.

3. Brief Contents food and nutrition plans and policiesfood and nutrition plans and policies conceptual framework in designing food & nutrition security interventionsconceptual framework in designing food & nutrition security interventions linkages between food security and nutritionlinkages between food security and nutrition National Nutrition ServicesNational Nutrition Services important issues of nutrition and malnutrition situation in Bangladeshimportant issues of nutrition and malnutrition situation in Bangladesh institutional arrangements and nutrition interventions of MH&FWinstitutional arrangements and nutrition interventions of MH&FW

4. Food and nutrition plans and policies What is food and nutrition policy? “The Food and Nutrition Policy encompasses the collective efforts of the government and other stakeholders to influence the decision-making environment of food producers, food consumers and food marketing agents in order to improve the nutritional status of the population.”

5. Food and nutrition plans and policies Key elements for developing the food and nutrition policy  Sustainable food production, processing, distribution and consumption  Ensure optimal food quality and safety  Collective/multi-sectoral efforts for sustainable food and nutrition security  Achieve and maintain nutrition well-being and healthy lifestyle of the population

6. Food and nutrition plans and policies Key stakeholders for developing food and nutrition policy  Government  UN agencies  International organizations  Nongovernmental organizations (national and international)  Industry  Professional bodies  Academia/researchers  Consumers  Mass Media Steps involved in developing the food and nutrition policy  Understanding the need for a policy;  Review the current food and nutrition status of the population;  Review the existing the policies (if any) and identify the lacunae;  Develop appropriate food and nutrition policy using: − Direct policy instruments; and − Indirect policy instruments;  Develop plans of action for implementation;  Evolve an effective and strong monitoring and evaluation mechanism;  and  Establish a nutrition surveillance system to facilitate programme appraisal and follow-up action.

7. The evolution of Food and Nutrition Security concerns

8. Conceptual framework in designing food & nutrition security interventions (Source: adapted from Metz, 2000)

9. A Conceptual Framework – Food and Nutrition security

10. Figure: Conceptual framework of the nutritional status at household level

11. The Food and Nutrition Security Conceptual Framework The household food security conceptual framework adopted by EFSAs considers food availability, food access and food utilization as core determinants of food security, and links these to households’ asset endowments, livelihood strategies, and political, social, institutional and economic environment. Figure : The Food and Nutrition Security Conceptual Framework

12. Linkage between nutrition, poverty alleviation, employment generation and gender

13. Linkages between food security and nutrition  Gender of the head of the household and nutritional status of children and women  Relationship between household food consumption pattern and nutritional status of children and women and young child-feeding practices  Relationship between food consumption score and nutritional status of children and women  Relationship between food consumption score and young child-feeding practices  Relationship between household food consumption groups and nutritional status of children and women  Relationship between Coping Strategy Index and nutritional status of children and women  Relationship between Coping Strategy Index and nutritional status of children and women by area and by division  Relationship between most affected livelihoods and nutritional status of children and women

14. Linkages between food security and nutrition  Relationship between percentage of food expenditures and nutritional status of children and women  Relationship between wealth status and nutritional status of children and women  Relationship between households without enough food in the past 12 months and nutritional status of children and women  Relationship between decrease in health expenditures in the past 12 months and nutritional status of children and women  Relationship between monthly income per household and nutritional status of children  Relationship between “informal borrowing” and nutritional status of children

15. Linkages between food security and nutrition Figure : Food consumption score and nutritional status of children and women

16. Linkages between food security and nutrition Figure: Average CSI at household level amongst acutely malnourished children by division, by area, and nationality in Bangladesh

17. National Nutrition Services Important Nutrition Projects in Bangladesh Bangladesh Integrated Nutrition Project (BINP) National Nutrition Project (NNP) Expanded Program on Immunization (EPI) Nutritional Surveillance Project (NSP) The National Immunization Days (NIDs) National Vitamin A Plus Campaign (NVAC) The Integrated Horticulture and Nutrition Development Project

18. National Nutrition Services Policy and Programmatic Responses to Malnutrition The Government of Bangladesh (GoB) finalized and endorsed the National Plan of Action for Nutrition (NPAN) in 1995. NPAN was a cross Ministerial Action Plan, but could be adequately implemented and monitored Nutrition needs to be firmly highlighted on the national development agenda, articulating the roles of the various Ministries. NFP and the NFP PoA and NNS are recent policy and programmatic actions towards strategic nutrition improvement

19. Important issues of nutrition and malnutrition situation in Bangladesh Key statistics of child and maternal nutrition in Bangladesh Source: UNICEF, April 2009 Nutrition% of the population Malnutrition, in children (birth to 59 months) Wasting (weight-for-height)17.4 Stunting (height-for-age)43.2 Underweight (weight-for-age)41 Low birth-weight36 Exclusive breastfeeding (birth to 6 months)43 Anemia, in children (6-23 months)64 Chronic energy deficiency, in mothers32 Night blindness (Vitamin A deficiency), in children (18-59 months) 0.04 Iodine deficiency, in children (6-12 years)33.8

20. Nutrition and malnutrition situation in Bangladesh Nutrition situation in Bangladesh  Dietary pattern  Childhood Under-nutrition  Maternal malnutrition  Micronutrient Deficiencies

21. Nutrition and malnutrition situation in Bangladesh The underlying causes include (i) household food insecurity resulting from inability to grow or purchase a nutritionally adequate amount and variety of food; (i) household food insecurity resulting from inability to grow or purchase a nutritionally adequate amount and variety of food; (ii) lack of dietary diversity; (ii) lack of dietary diversity; (iii) inadequate maternal and child care due to inappropriate hygiene, health and nutrition; (iv) low rates of exclusive breast feeding; (v) inadequate access to quality health services; (v) inadequate access to quality health services; (vi) poor environmental hygiene and sanitation along with low levels of income and maternal formal education. Malnutrition early in life has long-lasting and negative effects on overall growth, morbidity, cognitive development, educational attainment and adult productivity.

22. Institutional arrangements and nutrition interventions of MH&FW INSTITUTE OF PUBLIC HEALTH NUTRITION (IPHN) IPHN is implementing quite a good number of important work intended for the improvement of the nutritional status of the people particularly for the under 5 children and mothers. IPHN Activities: A. Vitamin A Plus Campaign : Children under 1 year - High potency vitamin A capsule (1 lack I.U) Supplementation during measles vaccination at EPI site.Children under 1 year - High potency vitamin A capsule (1 lack I.U) Supplementation during measles vaccination at EPI site. Children 1 to 5 years-High potency vitamin A capsule (2 lack I.U) supplementation through national events 2 times (4-6 month Intervals) a year.Children 1 to 5 years-High potency vitamin A capsule (2 lack I.U) supplementation through national events 2 times (4-6 month Intervals) a year. Children 2 to 5 years- Supplementation of Albendazole through national events 2 times (4-6 month Intervals) a year.Children 2 to 5 years- Supplementation of Albendazole through national events 2 times (4-6 month Intervals) a year. Mother - High potency vitamin A capsule (2 lakh i.u.) supplementation during postpartum period. (With in 6 wks of delivery).Mother - High potency vitamin A capsule (2 lakh i.u.) supplementation during postpartum period. (With in 6 wks of delivery).

23. IPHN Activities B. Reduction in the incidence of iodine deficiency diseases (IDD) Iodized salt monitoringIodized salt monitoring Awareness creation activitiesAwareness creation activities Training of field workers of health and family planning on control of iodine deficiency disorder (CIDD)Training of field workers of health and family planning on control of iodine deficiency disorder (CIDD) Training for testing Iodized saltTraining for testing Iodized salt Surveillance of salt for iodizationSurveillance of salt for iodization C. Reduction of incidence of Anemia: Awareness creation activities to control anemiaAwareness creation activities to control anemia Parasitic disease controlParasitic disease control Strategy implementation address the major causes of the malnutrition and anemia including iron-foliate supplementation, longtime food fortification & implementation.Strategy implementation address the major causes of the malnutrition and anemia including iron-foliate supplementation, longtime food fortification & implementation.

24. IPHN Activities D. Reduction of Protein Energy Malnutrition (PEM) by training program Awareness program for PEM control.Awareness program for PEM control. Growth monitoring of 1-3 years old childrenGrowth monitoring of 1-3 years old children Communication on weaningCommunication on weaning E. Infant and Young Child Feeding (IYCF) Strategy implementation.Strategy implementation. Promotion and protection of Breast feeding through proper implementation of BMS code and proper child weaning PracticePromotion and protection of Breast feeding through proper implementation of BMS code and proper child weaning Practice F. To strengthen laboratory activities: To develop the effective laboratory facilities of food and biochemical aspects of nutrition.To develop the effective laboratory facilities of food and biochemical aspects of nutrition. Serological tests for Nutrition related diseasesSerological tests for Nutrition related diseases G. Guideline for the “Management of Severe Malnutrition of Children in Bangladesh”

25. IPHN Activities H.Nutritional survey. To evaluate nutrition related situation at present in selected districtsTo evaluate nutrition related situation at present in selected districts To assess rapidly the impact of price hike on household food security, food quality and nutritional status among poor women and children in BangladeshTo assess rapidly the impact of price hike on household food security, food quality and nutritional status among poor women and children in Bangladesh Recently a survey prepared from 164 family in Bangalypoor union, Sayidpur Upazila, Nilphamary districtRecently a survey prepared from 164 family in Bangalypoor union, Sayidpur Upazila, Nilphamary district I. Strengthening Nutrition & Food Safety Education WHO supported Program Training for nutrition Sector.Training for nutrition Sector. Training for nutrition vulnerable population.Training for nutrition vulnerable population. Development of Radio & Television spot on Nutrition awareness creation.Development of Radio & Television spot on Nutrition awareness creation. Research on nutrition.Research on nutrition. J. Strengthening of Child Nutrition Unit: Identification of malnourished children under 1-3 years of age through growth monitoringIdentification of malnourished children under 1-3 years of age through growth monitoring Orientation and education program for motherOrientation and education program for mother

26. Institutional arrangements and nutrition interventions of MH&FW Currently few nutrition services are delivered as part of core health service delivery. These are  Iron Folic Acid (IFA) supplementation is a part of antenatal care for pregnancy, but only about 50% of women make one visit to a health facility  Zinc Supplementation: Zinc supplementation during treatment of childhood diarrhea has recently gained importance under the leadership of ICDDR,B and MOHFW.  De-worming and distribution of Vitamin A capsules.  IPHN also manages the program to combat iodine deficiency disorder  The National Nutrition Program has prime responsibility for implementing the area based community nutrition (ABCN) program. The core components of ABCN include: Behavior change and communication (BCC) activities; Growth Monitoring and Promotion (GMP); Food supplementation to children under 2 years of age and pregnant women from ultra poor households; Micronutrient supplementation (vitamin A and iron-foliate); deworming. Additionally it is responsible for promoting infant and young child feeding, particularly breast feeding.

27. A Multi-sectoral Approach of National Food and Nutrition Policy in Bangladesh A draft national food and nutrition policy (FNP) was prepared and approved by the Bangladesh National Nutrition Council (BNNC) and the Council of Ministers (Cabinet). The strategy for effective implementation of the FNP is divided into four major sectors: (a)Food, agriculture, fisheries, livestock, and forestry for increased production, proper distribution, and food security; (b) Health, family welfare, and environment for primary health care, caring practices, disease control, sanitation, and hygiene; (c) Nutrition education and communication for the creation of awareness at different levels with formal and non-formal education; and (c) Nutrition education and communication for the creation of awareness at different levels with formal and non-formal education; and (d) Community development and social welfare for poverty alleviation, income generation, and economic growth. (d) Community development and social welfare for poverty alleviation, income generation, and economic growth. To implement the various provisions of the FNP, a national plan of action for nutrition has been approved. To implement the various provisions of the FNP, a national plan of action for nutrition has been approved.