Compilation of presentation slides presented in an academic seminar on nutrition security held at PKSF.

2.  This presentation is mainly about extreme poverty and nutrition in
Bangladesh and identifying a few challenges.
 However before that I would present a few general information about
poverty reduction, different poverty reduction programs in
Bangladesh.

3. Poverty types 2009 2010 2016 2017 2018
Poverty 40.0 31.5 24.3 23.1 21.8
Extreme - 27.6 12.9 12.1 11.13

4.  Previous slide shows that Bangladesh is successful in reducing both moderate
and extreme poverty.
 There are a number programs and approaches that helped to reduce poverty
malnutrition .
 In the next slide we would show what are the government and non-government
programs and approaches to reduce poverty and malnutrition

5. Bangladesh Government has taken different programme, plan and policy to
address malnutrition these includes National Food Policy (NFP-2006), NFP Plan
of Action (2008-2015), The Country Investment Plan (CIP, 2010-2015), Health
Population and Nutrition Sector Development Program (HPNSDP), 2011-16, Tribal
HNP Plan (THNPP), National Nutrition Service (NNS) and 7th Five Year (2016-
2020) Plan of Nutrition. Poverty has been declined substantially in Bangladesh,
but nutrition improvements have not kept pace.

6. Poverty, among others, is the direct cause of malnutrition and that’s why no
nutritional improvement can be expected unless and until poverty is reduced. It
creates a vicious cycle of poverty and malnutrition. It has been observed that
there is a disproportion between the reduction of poverty and improvement of
the malnutrition. Different indicators for malnutrition which are as follows :
1. Stunting : In Bangladesh 36% (Male-37% & Female-35%) under 5 years old
children are stunted,
2.Underweight : 33% (Male-32% & Female-33%) under 5 years children are
underweight
3.wasted: 14% (Male-15% & Female-14%) under 5 years children are wasted.
4. LBW: The percentage of most recent live births weighing bellow 2,500 grams at
birth (LBW) is 26% (Source: BDHS, 2014 & Multiple Indicator Cluster Survey
(MICS), 2012-2013; UNICEF).

7. 5. Chronic energy deficieny (CED): About 19% (Rural-21% & Urban-12%) women have low BMI
(<18.5)/
6. About 55% of less than 6 months old children are exclusively breastfed
7. 87% of children continued breastfeeding at 2 years.
8.. Early initiation of breast feeding: 51% of mother put their last newborn to breast within one
hour of birth (early initiation of breastfeeding)
and 89% are breastfed within one day (Source: BDHS, 2014).
9. Complementary feeding practice. About 65% of children start to eat solid, semi-solid or soft
food at their age of 6-8 months (Introduction of complementary feeding), whereas only 28%
receive minimum dietary diversified diet and 23% fulfill their minimum amount of acceptable
diet according to their age (Source: BDHS, 2014).

8. 10. Vitamin A deficiency: The prevalence of subclinical vitamin A
deficiency, as measured by serum level of retinol (serum retinol< 0.7
mmol/l) was
a. 20.5% in the preschool age children.
b. It was 20.9% and 5.4% respectively in the school age children and
the Non Pregnant Non Lactating (NPNL) women. (National Micronutrient
Status Survey 2011-12, ICDDR,B).
11. Iron Deficiency: The national prevalence of iron deficiency, as
measured by low ferritin
a. 10.7% in the preschool age children
b. It was 3.9% and 9.5 % in the school age children aged 6-11 year and
12-14 year respectively (National Micronutrients Status Survey 2011-12,
ICDDR,B).
c. In the NPNL women it is 7.1%.

9. 12. Zinc deficiency: The national prevalence of zinc deficiency was
a.44.6% in the preschool age children
b.57.3% in NPNL women (National Micronutrients Status Survey 2011-12,
ICDDR,B).
13. Iodine deficiency: The prevalence of iodine deficiency as measured by the
proportion of the school age children whose mean urinary iodine concentration was
below the cut-off mark of 100 µg/l was
a. 40% School age children.
b. 42.1% In the NPNL women (National Micronutrients Status Survey 2011-12,
ICDDR,B).
14. Anemia:
a. The prevalence of anemia among non pregnant women is 40%
b. It was 50% in pregnant women. (BDHS, 2011 & 2014).

10. 15. Energy intake: According to FPMU, Nutrition Fact Sheet, August 2014
a) Cereals contribute 70% of total dietary energy intake in Bangladesh,
comparable to the recommended 60%.
b) Only 5.6% of dietary energy supply comes from animal products
compared with an average 17% in all developing countries.
c) The average per capita animal food consumption is 109g/capita/day
compared to the desirable intake of 180g/capita/day which are the
richest source of high quality protein, iron and zinc.
d) Average per capita fruit and vegetable consumption is 211g/capita/day
compared to the desirable intake of 400g/capita/day which are the
richest source of vitamins and minerals.)

11. Ujjibito is specially focused here because it focuses on extreme poor and carried
out by PKSF .
Food Security 2012 Bangladesh – Ujjibito” project is being implemented since
November 2013.
Ujjibito project was designed in line with the Ultra Poor Programme of PKSF
which promotes the access of financial services to the extreme poor
households.
This project targeting to reach 325000 extreme poor families living in the poverty
and vulnerability pockets in 28 districts located in the south and western part of
the country.

12. The project works for the extreme poor characterized by
 insufficient income,
 poor health,
 acute malnutrition,
 illiteracy and a high concentration of wage laborers in the households with limited
assets,
 female-headed households (widows, divorcees), destitute women and large family
size.
 The vulnerability of these ultra-poor households exacerbate by their inability to
reduce the risk of natural disasters.
And so why the project is being implemented to help them to ensure sustainable
poverty reduction as envisaged by the Millennium Development Goals (MDGs).

13. The homestead gardening is an intervention UJJIBITO project to support food
security through training and distribution of garden inputs like seeds to the
women members of the project.
The objectives of the homestead gardening are as follows:
 To increase knowledge and skills of vulnerable women, adolescents and
communities to cope with the emerging challenges compounded by food
shortage;
 To increase knowledge of project participants on food security and nutrition &
To promote self sufficiency and to alleviate the burden of food purchase .
The following steps were followed in promoting homestead farming:
Training, interactive courtyard session, providing input support for gardening and
monitoring.

14. Result and impact of home gardening on nutrition security:
1. Almost 90% participating families produced nutritious food for daily
consumption and also earned an extra money from sale of surplus products.
2. Several areas where homestead gardening is practiced also have seen
reduction in night blindness and anemia.
3. Homestead gardening helped many women in the program break the gender
barriers by becoming entrepreneurs, leaders and role models in their
communities.

15.  Number of training for effective homestead gardening should be increased;
 More households should be included especially in climate vulnerable areas for
homesteads gardening;
 Input support especially seasonal seed support should be increased ;
 Market development and business model can be effective for sustainability for
the homestead gardening .

16. Year Poverty Stunting Underweigh
t
Wasting
2000 48.9% 50.8% 42.3% 15%
2014 31.5%
(2010)
36% 33% 14%
Change/yea
r
-4.30% -2.08% -1.53% 0.47%

17. Nutrition improvements not keeping with poverty reduction (BDHS, 2011)
 Enhanced income may not be spent in food expenditure because of socio-cultural habits
and other necessities such as dowry payment or festival expenditure
 There may be high morbidity level affecting nutritional utilization
 Enhanced income from poverty reduction may be spent as treatment cost
 Lack of balanced food leading to lack of nutritional improvement and low food
consumption scoring
 Those who are extreme poor still cannot spend sufficient money for food and suffering
from malnutrition

18. Food item Food groups Food weight
1. Cereals
(bread,rice,maize) and
tubers (potatoes sweet
potatoes)
Staple 2
2. Pulse and nuts (beans,
lentils, peas, peanuts, etc )
Pulse 3
3.egetables Vegetables 1
4. Fruits Fruits 1
5. Beef , mutton , poultry,
pork, eggs and dairy
Meat & fish 4
6. Milk, yogurt and other
dairy
Dairy 4
7. Sugar and other products Sugar 0.5
8. Oil , fat and Butter 0il 0.5
9.Condiments, spices Condiments 0

19. If we calculate Food consumption score for each of the household
the can be categorized as follows.
1. 0-28: Poor consumption
2. 29-42: Borderline consumption
3. 43-52 :Acceptable low food consumption
4. >52:Acceptable high food consumption.
This categorization was done for Bangladesh, which considered
the importance of oil and fish in the diet of Bangladeshi
population (McKinney, 2009)

20.  There is a need for study to find out why enhanced income from poverty reduction is not
translated into improved nutritional condition in proportionate manner?
 To find out is food expenditure proportionately rising?
 To find out whether social and cultural pressures lead to expenditures that reduce food
expenditure
 Finding out the scale of morbidity that might damage nutritional gain from enhanced
income from poverty reduction
 Whether health expenditures affecting food expenditure
 We should not be concerned the poverty reduction only rather the quality of life which
include literacy , nutrition, recreation and others. However nutrition has got special
implication because reduction of malnutrition will improve the health situation to lead a
disease free life.

21. Thank You

22. UPP-Ujjibito
Nutrition Part
Ujjibito working for both
. Nutrition Specific
. Nutrition Sensitive

23. Nutrition Activities & Achievement
Sl
No
Activities Achievement
1 1000 days intensive health care
services for pregnant women ,
lactating mothers and 0-23
Months children.
(No. of Pregnant & lactating)
153586
No. of 0-23 Month Children 131848
2 Growth Monitoring and
Promotion (GMP)of 24-59
months children
111064
3 Provide referral services of
SAM children 0-49 months
children
4051

24. Nutrition Activities & Achievement (Contd.)
Sl
No
Activities Achievement
4 Conduct court yard session on
health, hygiene and nutrition
322367
5
Conduct session on health,
hygiene and nutrition I School
Forum and adolescent club
52944
6 Establish linkages with
government health facilities
including Community Clinics
292
7 Promote health, hygiene
practice- ensured TIPI Tapa
112955
8 Distribute vegetable seeds for
homestead vegetable
gardening (production price)
BDT 8 crore
about
9 Distribute different fruit tree 201606

25. Nutrition Activities & Achievement (Contd.)
Sl
No
Activities Achievemen
t
10 Established Ujjibito Secondary
School Forum & Nutrition Corner
667
11 Established Ujjibito Primary School
Forum & Nutrition Corner
780
12 Formed Ujjibito Kishori Club
(Adolescent) at community level
986
13 Establish Ujjibito Pusti Gram
(Nutrition village) 709
14 Organized Blood Grouping Camp
(No. of adolescent & reproductive
age women)
238700
15 Organized Health Camp (No. of
Camp)
403
16 Demonstrate Healthy Cooking -

26. Ujjibito Nutrition Corner- Materials

27. Challenges to address Nutrition Security :
Ujjibito & ENRICH

28. Challenges
• To ensure no. of 5 ANC during pregnancy and additional food
• To ensure safe delivery by SBA / institutional delivery
• To ensure no. of 3 PNC after delivery and additional food
• To ensure growth monitoring of all <5 children of targeted area/
household
• To ensure exclusive breast feeding properly
• To consume IFA during pregnancy
• To implement Infant and Young Child Feeding (IYCF) as
national guideline

29. Challenges (Contd.)
• To admission of SAM Children at hospital / SAM center
• To aware healthy cooking practice
• To ensure diversified food intake at family level
• To practice hand washing properly
• To ensure micronutrient consumption
• Lack of nutrition education
• Trained service providers at hard to reach area

30. Pathways to Prosperity for
Extremely Poor People (PPEPP)
Implementation Challenges – Nutritional
security of the Extreme Poor

31. Pathways to Prosperity for Extremely Poor People (PPEPP)
PPEPP Duration
Inception Phase April, 2019 to March 2020
Implementation
phase
April, 2020 to March 2025
PPEPP Working Area
Region Possible Districts Possible Number
of Upazilas
North West Lalmonirhat and
Kurigarm
10
South
Western
Coastal area
Shatkhira, Khulna,
Bagherhat,
Potuakhali, Bhola
9
North Eastern
Haor Area
Kishorganj, Hobiganj,
Shunamganj and
Netrokona
9
Total Districts = 12 28
• PPEPP expected to reach appx. 250,000
households covering one million
extreme poor
• 357,000 mother, children, women of
childbearing age and adolescent girls

32. PPEPP’s Objectives
32
1. To enable two million people to exit from extreme
poverty for good in two phases
2. To support the development of stronger national
institutions and systems to deliver the public and private
services required by extremely poor people to become
resilient and prosper

33. PPEPP evolves the poverty graduation model, building on what works
while addressing its limitations -
 better integration of nutrition interventions
 better identification and development of local markets
 more disaster management and climate resilience built in
 more emphasis on community mobilization
 recognition of labour constrained households
 built-in exit strategy
PPEPP’s fresh features:
- address barriers that stop the poorest people pulling themselves out of
poverty;
- make it more cost effective; and,
- ensure that it is sustained here after the end of project intervention
What new in PPEPP than that of earlier EP programmes

34. Components of PPEPP
PKSF’sComponents
Resilient Livelihood
Nutrition
Community
Mobilization
Cross cutting issues
Disaster & Climate
resilience
Disability
Gender equality
PMUComponents
Market Development
Policy Advocacy
Life-cycle grant

35. Community Level Nutrition Service Delivery in PPEPP
Domain Direct Nutrition Interventions (DNIs)
Infant and
Young Child
Feeding (IYCF)
1. Early initiation of breastfeeding
within first hour after birth
2. Exclusive breast feeding from birth up
to 6 months
3. Age appropriate complementary
feeding of children from 6-23 months
Hygiene 4. Hand washing with soap at critical
times – before eating/preparing food,
before feeding a child and after
defecation
Micronutrient
supplementation
5. Vitamin A supplementation for
children 6-59 months once every six
months
6. Iron Folic Acid (IFA) supplementation
for pregnant and lactating women
(PLWs) and adolescent girls
7. Multiple Micronutrient Powder
(MNP) for children 6-23 months
8. ORS with Zinc in the management of
acute diarrhea
Deworming 9. Deworming for children 24-59 months
once every six months
Consumption of
nutrient-rich
fortified foods
10. Consumption of foods rich in Iron and
Vitamin A by PLWs, adolescent girls
11. Household consumption of iodized
salt, fortified oil with Vitamin A
Management of
acute
malnutrition
12. Screening and referral of acute
malnutrition in children 0-59 months
13. In-patient and out-patient
management of children 0-59 months
with acute malnutrition according to
national protocol
Maternal
Nutrition
14. Adequate food intake and rest during
pregnancy and lactation
15. Micronutrient supplementation
(including iron, folic acid and calcium)
16. Consumption of nutrient-rich foods
Nutrition Counsellor
(NC)
Community Clinic
(CC)
Community Nutrition
Promoter (CNP)
Group Nutrition
Volunteer (GNV)
Adolescent Girls Nutrition
Volunteer (AGNV)
Community Nutrition
Volunteer (CNV)
Nutrition Sensitive
Community services
Nutrition Sensitive
Livelihood activities
Peoples’ Forum,
Adolescent Girls Club
Community events
IGA establishment,
Capacity building,
Vocational training
Direct Nutrition Interventions (DNIs)
Nutrition Specific
Intervention
- for mother, children, women of
childbearing age and adolescent
girls
Nutrition Sensitive
Intervention
- for mother, children, women of
childbearing age and adolescent
girls and community

36. PPEPP - PKSF component
DFID EP Unit
FID under
MoF (PSC)
Programme Execution
PKSF
PCC
PMU
Programme Implementation
Partner Organizations (POs)
Local Govt. Inst. in the
locality in concern
Upazila Parishad
Union Parishad
GoB service providing
agencies at local level
Local level extension
services of crop,
livestock and fisheries
departments of GoB
Local level health,
education and social
services of GoB
Private sector service
providing agencies at
local level
Private sector input
service provider for
crop, livestock and
fisheries at local level
Non-government
service providers on
health, education and
social services of GoB
Directlyinvolvedwith
projectimplementation
Indirectlycontributeto
projectactivities
}

37. Challenges of Nutrition Specific Intervention
Challenges and questions to be asked on issues such as –
• Targeting of 357,000 mother, children, women of childbearing age and adolescent girls
• Accessibility and Utilization of Nutrition across targeted women, children & their
community
• Nexus between mother & child malnutrition
• Access and affordability of EP HHs to adequate nutrient to meet individual and
household requirements
• WASH influencing the nutrition status
• Early child bearing and intergenerational cycle of under-nutrition
• Appropriate child feeding
• Social exclusion & disaster susceptibility

38. Challenges of Nutrition Sensitive Intervention
Challenges and questions to be asked on issues such as –
• Agriculture: making nutritious food accessible across targeted women, children & their
community
• Education of children so as to learn and earn sufficient income as adults
• Healthcare: improving access to services to ensure that women and children stay
healthy
• Resilience: establishing a stronger, healthier population and sustained prosperity to
better endure emergencies and conflicts
• Empowerment: women are empowered to be leaders in Nutrition-Sensitive
Approaches

39. Challenges …
• Critical awareness – missing
• Maltreatment
• Wrong perception on nutrition
• Vitamin is everything,
supplements are great
• Food adulteration
• Changing media landscape
• Coordination

40. Everything surrounds vitamin…

42. Bideshi
Khabar
Ar Dami
Khabarer
Pusti Beshi

43. People are interested in
paying for medicines,
supplements…
BUT
Not on fresh food

44. Issue of
deep
concern

45. Changing media
landscape
We need to consider
maximize the utilization of
cell phones…
in nutrition specific and
nutrition sensitive
programming

46. Food intake
vs utilization
Food intake
Maltreatment
Poor hygiene and
sanitation
Nutrition
output
Food
Adulte-
ration