Suchana: Ending the Cycle of Undernutrition in Bangladesh

 

Suchana: Ending the Cycle of Undernutrition in Bangladesh

 

     I. INTRODUCTION

SUCHANA: Ending the cycle of undernutrition in Bangladesh” is a multi-sectoral nutrition programme aims to achieve a significant reduction in stunting amongst children under two years of age in Bangladesh by catalysing support across government and other stakeholders. The programme adopts an integrated approach to nutrition specific and nutrition sensitive intervention to prevent chronic malnutrition within the critical 1,000 days from conception until a child reaches its second birthday.

Suchana Context & Rationale

Within Bangladesh, although the prevalence of stunting (shortness in stature compared to child’s age) has declined from 51% in 2004 to 36% of children under five in 20141, levels of stunting remain well above WHO and government thresholds. Some six million children are estimated to be chronically malnourished, and uptake of key infant and young child feeding (IYCF) practices remains poor. Chronic malnutrition has long-lasting, irreversible effects on the child’s development, including mental development, health, school performance and later on, work productivity.

The human and economic cost of malnutrition is huge. Left unchecked, it can result in a 2-3% loss in national income due to its long-term impact on productivity; chronic malnutrition during childhood may lead to late enrolment in school, and the missed education means that such children may earn 20% less than children with complete education2. Malnutrition in Bangladesh is estimated to cost approximately US$1 billion a year in lost economic productivity3.

Although we now know why we need to tackle undernutrition and when we need to intervene, strong evidence is still lacking on exactly what can be done to sustainably reduce undernutrition, particularly stunting, and how the necessary interventions can be delivered. A recent analysis indicated that nutrition specific interventions might prevent 15% of deaths and about 20% of the current burden of stunting and 60% of wasting (Bhutta et al. 2013). However, this leaves a substantial burden of deaths and chronic undernutrition that is not preventable by nutrition-specific interventions, highlighting the substantial role of other nutrition sensitive interventions.

II. SUCHANA PROGRAMME DESCRIPTION

With a purpose to accelerate a reduction in the incidence of stunting among children under two years of age in two districts of Sylhet division in Bangladesh, Save the Children International (SCiBD) has mobilized a catalytic coalition of 8 organizations to design and implement the unique and ambitious Suchana programme. The programme is trying to capitalize the expertise and experience of the coalition to catalyse efforts by government and other Bangladeshi stakeholders (such as the private sector, civil society, and diaspora) to identify and scale up sustainable, context specific programmes that can break the intergenerational cycle of malnutrition, by applying a life cycle approach that intensifies during the critical 1000 days from conception. Recognizing the nutritional needs of women even before pregnancy, and the connection between adolescents’ nutrition, early marriage, early pregnancy and child undernutrition, the programme gives specific emphasis to the empowerment of adolescents and young unmarried women.

Significant focus has also been given to improving nutrition governance that translates political commitments into practice. This is crucial for wide-scale impact and sustainability, as changes in increased access to and utilization of health and nutrition-related services, the economic empowerment of women and adolescent girls and improved knowledge, skills, and power to adopt appropriate nutrition behaviour and practices will only be temporary, unless supported by the

realization of a strong vision of improved nutrition governance at all levels and sectors. Similarly, the programme has a heavy focus on the generation of evidence to directly attribute the reduction in stunting to the programme. This will contribute to global debates on undernutrition and influence the design and implementation of policies and practices, lead to scale up, adaption and replication of the Suchana model by government and others. To maximise the impact of the gathered evidence, the coalition has developed a dynamic advocacy strategy. This draws upon the support of key national and international advocacy partners and mobilises the urban elite and growing middle class of Bangladesh, diaspora, and child advocacy groups to boost accountability which in turn will strengthen the provision of services, and their sustainability, at the community, district, and national levels.

GOAL:

Significant reduction in the incidence of stunting amongst children under two years of age in two districts of Sylhet. The coalition aims for at least 2 percentage point additional reduction per year (total 6 percentage points additional reduction in 3 years of interventions) against a current annual decline of 1.4percentgae points /year in the rate of stunting among children under two.

PURPOSE:

Catalyze support across government and other stakeholders for a coordinated, multi-sectoral approach to undernutrition at the national level.

OBJECTIVES:

1. Improved nutrition governance at sub-national and national level demonstrated by enhanced coordination within and between ministries and sectors at national and local level, increased resource allocation to nutrition and effective implementation of nutrition related policies and programmes on the ground

2. Enhanced capacity of government frontline service providers to deliver nutrition related (both specific and sensitive) services in an effective and inclusive manner and increased uptake of services by nutritionally vulnerable groups (PLW, children under two years of age, adolescent girls, and newlywed couples from extreme poor and moderate poor households)

3. Extreme poor and moderate poor households with pregnant women, lactating mothers with children under 2 and adolescent girls are empowered to overcome economic barriers to nutrition and become more resilient to social, economic, and climatic shock

4. Increased knowledge, skills, and power of extreme poor and moderate poor households, particularly women and adolescent girls, to practice and support appropriate IYCF and MCHN behaviour and challenge harmful gender norms (early marriage, early pregnancy and GBV)

5. Deliver a solid and rigorous knowledge and evidence base to galvanize momentum for change to support scalable interventions that address chronic malnutrition throughout Bangladesh.

DURATION:

2015-2022

PARTNERS:

SCI, HKI, iDE, WorldFish, icddr,b, CNRS, RDRS, and FIVDB

FUNDED BY:

FCDO and EU

Funds:

GBP 48 Million