the potential contribution of Suchana programme interventions on household food affordability. This
analysis aimed at assessing the degree to which economic constraints might affect poor and very poor
households in Sylhet division in North-East Bangladesh (i.e. Suchana beneficiary households in Sylhet
and Moulvibazar districts) from accessing a nutritious diet.
The Cost of the Diet (CotD) method and software was developed by Save the Children, and the
analysis can estimate the hypothetical minimum amount of money a typical household would need to
purchase their recommended intakes of energy, protein, fat and micronutrients, using locally available
foods. Specifically, this assessment set out to answer the following questions:
▪ What is the minimum cost of a nutritionally adequate and culturally acceptable diet for typical
households in Sylhet division?
▪ What locally available foods are inexpensive sources of essential macro and micronutrients,
and could be promoted through programme interventions?
▪ What is the potential effect of Suchana's livelihoods and home food production (HFP)
intervention on household's ability to afford a nutritious diet in the assessment area?
▪ How might the access to various social protection interventions improve access to a nutritious
diet by households in the assessment area?
Introduction to the study area and Suchana programme:
Sylhet and Moulvibazar districts of Sylhet division lies in the north-eastern part of Bangladesh. Though
Sylhet Division has the lowest poverty rate in Bangladesh, the malnutrition picture is particularly
severe. According to the Bangladesh Demographic and Health Survey (BDHS, 2014), Sylhet division
has the highest rates of child stunting (49.6 percent) and under-five mortality (67 per 1,000 live births)
in the country. Sylhet also has the lowest female literacy rates, the worst school attendance rates for
adolescent girls, the highest gender inequality scores, the worst performance against women's
empowerment indicators, and overall the lowest proportion of empowered women in the nation.
Save the Children's Suchana programme is operating in Sylhet and Moulvibazar districts aimed at
addressing chronic malnutrition among children under two. Suchana is a multisectoral nutrition
programme jointly funded by the European Union (EU) and the UK Department for International
Development (DFID). The programme aims to reach 220,000 beneficiary households (BHHs),
targeting pregnant and lactating women (PLW), children under 2, and adolescent girls in 20 Upazilas
and 157 Unions across Sylhet and Moulvibazar districts. The project delivers a range of nutritionspecific and nutrition-sensitive interventions that include an overt focus on sustainability and
strengthening necessary systems that impact nutritional outcomes. Collectively these interventions
aim to significantly reduce stunting and to break the inter-generational cycle of poverty and
undernutrition.
The Cost of the Diet Methods:
The CotD assessment was conducted in Sylhet and Moulvibazar districts in North-East Bangladesh
under Sylhet division. These two districts were selected as Save the Children was implementing the
'Suchana' programme in rural communities in 20 Upazilas of these two districts at the time of the
assessment
A total of 16 markets and 12 villages were selected for the final assessment from a complete list of
villages where Suchana was operational at the time of the assessment, and one additional market and
one village were selected for the field practice. Markets were selected from three different
administrative levels. Of the 16 markets, four markets were Upazila markets, four were Union level
markets and the rest eight markets were village level markets. These markets were selected to be
representative of where poor and very poor households living in Sylhet and Moulvibazar districts
purchased their food. All of the 12 villages were within the catchment areas of the markets where
market surveys were conducted.
The primary aim of the market survey was to record the prices and weights of food items found in
the assessment area across various seasons. To obtain the seasonal variation in food price and
availability, retrospective data were collected. The reference year selected for data collection was
from October 2017 to November 2018. During the market survey, the prices and weights of foods
across three seasons were recorded for each food item in each market, traders were asked the price
of the smallest unit of each food item that they sold in each of the three seasons. The price of the
smallest unit sold is generally higher per unit compared to bulk purchase and reflects the typical buying
practice of poor population.
To estimate a realistic and nutritious diet, the analysis needs to take into consideration the typical
food consumption habit, cultural practices and food taboos in the assessment area. These particular
type of information was collected through interviews and focus group discussions (FGDs).
In addition, the analysis has obtained household income and expenditure data from a secondary source
to calculate the affordability, and programme monitoring data were used to assess the effectiveness of
various interventions. During the analysis the cost of four hypothetical diets was estimated using the
Cost of the Diet software for a typical household of six individuals: a lowest cost diet that only meets
recommended average energy requirements; a lowest cost diet that only meets the average energy
requirements, a lowest cost diet that meets the average energy and the recommended protein and fat
requirements, a lowest cost diet that meets specifications for energy, protein, fat and micronutrients
but does not take into account typical dietary habits, and a lowest cost diet that meets specifications
for energy, protein, fat and micronutrients and takes into account typical dietary habits and cultural
acceptability.
Key findings, discussion and recommendations:
Food availability and diversity in Sylhet and Moulvibazar: The cost of the diet data collection
team found 282 different food items on the market in the livelihood zone. The number of various food
items found in the rural village level markets was comparatively lower than the Union and Upazila level
markets, but still highly diversified (203 food items were found in village level markets), and the food
items selected for the FHAB diet selected by the software was available in more than two third of the
markets. A previous CotD assessment conducted in the same region in 20131, found 180 different
food items in the markets indicates that food availability and diversity have improved in the area over
time. Considering the evidence, the study concludes that the availability of nutrient-rich foods is not
the main barrier to typical poor households obtaining a nutritious diet.
Limiting nutrients: Overall, the markets in Sylhet and Moulvibazar have a diverse range of food
items and can fulfil all major macro and micronutrient requirements. The analysis did not identify any
limiting nutrients in the assessment zone; however, calcium was found to be most difficult to obtain,
i.e. the most significant cost driver, followed by folic acid and vitamin B12. The programme should
consider promoting the consumption of milk and milk products, and small fish by all
family members, especially by pregnant and breastfeeding women, children below two years old
A total of 16 markets and 12 villages were selected for the final assessment from a complete list of
villages where Suchana was operational at the time of the assessment, and one additional market and
one village were selected for the field practice. Markets were selected from three different
administrative levels. Of the 16 markets, four markets were Upazila markets, four were Union level
markets and the rest eight markets were village level markets. These markets were selected to be
representative of where poor and very poor households living in Sylhet and Moulvibazar districts
purchased their food. All of the 12 villages were within the catchment areas of the markets where
market surveys were conducted.
The primary aim of the market survey was to record the prices and weights of food items found in
the assessment area across various seasons. To obtain the seasonal variation in food price and
availability, retrospective data were collected. The reference year selected for data collection was
from October 2017 to November 2018. During the market survey, the prices and weights of foods
across three seasons were recorded for each food item in each market, traders were asked the price
of the smallest unit of each food item that they sold in each of the three seasons. The price of the
smallest unit sold is generally higher per unit compared to bulk purchase and reflects the typical buying
practice of poor population.
To estimate a realistic and nutritious diet, the analysis needs to take into consideration the typical
food consumption habit, cultural practices and food taboos in the assessment area. These particular
type of information was collected through interviews and focus group discussions (FGDs).
In addition, the analysis has obtained household income and expenditure data from a secondary source
to calculate the affordability, and programme monitoring data were used to assess the effectiveness of
various interventions. During the analysis the cost of four hypothetical diets was estimated using the
Cost of the Diet software for a typical household of six individuals: a lowest cost diet that only meets
recommended average energy requirements; a lowest cost diet that only meets the average energy
requirements, a lowest cost diet that meets the average energy and the recommended protein and fat
requirements, a lowest cost diet that meets specifications for energy, protein, fat and micronutrients
but does not take into account typical dietary habits, and a lowest cost diet that meets specifications
for energy, protein, fat and micronutrients and takes into account typical dietary habits and cultural
acceptability.
Key findings, discussion and recommendations:
Food availability and diversity in Sylhet and Moulvibazar: The cost of the diet data collection
team found 282 different food items on the market in the livelihood zone. The number of various food
items found in the rural village level markets was comparatively lower than the Union and Upazila level
markets, but still highly diversified (203 food items were found in village level markets), and the food
items selected for the FHAB diet selected by the software was available in more than two third of the
markets. A previous CotD assessment conducted in the same region in 20131, found 180 different
food items in the markets indicates that food availability and diversity have improved in the area over
time. Considering the evidence, the study concludes that the availability of nutrient-rich foods is not
the main barrier to typical poor households obtaining a nutritious diet.
Limiting nutrients: Overall, the markets in Sylhet and Moulvibazar have a diverse range of food
items and can fulfil all major macro and micronutrient requirements. The analysis did not identify any
limiting nutrients in the assessment zone; however, calcium was found to be most difficult to obtain,
i.e. the most significant cost driver, followed by folic acid and vitamin B12. The programme should
consider promoting the consumption of milk and milk products, and small fish by all
family members, especially by pregnant and breastfeeding women, children below two years old
and adolescent girls. Consumption of iron folic acid (IFA) tablets in the recommended
quantity by pregnant and breastfeeding women should help fulfil the folic acid requirement, and
potentially reduce diet cost.
Local dietary habit and cost of the nutritious diet: The results from the cost of various diets show that
the minimum cost nutritious (NUT) diet was 1.6 times more expensive than the energy only diet,
meaning that it requires at least 1.6 times more money to meet all (used in the analysis) nutrient
requirements. However, given that NUT diet is the theoretical minimum cost nutritious diet, and
doesn't take into consideration the local dietary practices, it is important to focus on the food habit
nutritious (FHAB) diet. The FHAB diet was 1.7 times more expensive than the NUT diet, which means
the constraints applied during the CotD analysis to reflect the typical dietary pattern in Sylhet and
Moulvibazar have made the software to include a comparatively higher priced alternative.
Having said that, the food items selected for the FHAB diet was still one of the cheapest options
available in the markets, and have identified culturally acceptable cheap sources of nutrients. The
programme through its SBCC activities can promote the consumption of cheap nutrientrich foods these are: dried fish and lentils as a cheap source protein; amaranth leaf, jute leaf and sweet
potato leaf as major sources of vitamin A.
Household income, expenditure and affordability of nutritious diet: One of the most
powerful uses of the cost of the diet analysis is to assess the likely impact of income generating
activities (IGAs) on household affordability of the nutritious diet and ultimately nutritional status.
While standalone livelihoods or IGA intervention can significantly improve household income and
purchasing power, the improvement can still be inadequate to afford a nutritious diet. The analysis of
the affordability gap/surplus in the cost of the diet analysis can shed light in this aspect of a programme,
and looking at the reduction in the affordability gaps over time might be more important for a
programme with nutrition goal, than just observing an increase in income.
The results from the affordability analysis show that most beneficiary groups (HFP and IGA from both
Phase 1 & 2) still cannot potentially afford both the nutritious food as well as the non-food expenditure.
When the affordability gap is expressed as a percentage of average household income, it ranged
between 1.5 per cent and 14.4 per cent, that means these households would still require between
BDT 1,000 and BDT 18,000 per year to meet food and non-food expenditure. The results also show
that the affordability gap of IGA beneficiaries is lower than the HFP beneficiaries.
A previous CotD analysis in 2013 found the affordability gap to be 17 to 57 percent of the income for
poor and very poor household respectively. Given that Suchana programme have also targeted poor
and very poor households; when the results of the current CotD analysis is compared with the 2013
CotD analysis, it is evident that the current affordability of poor and very poor population under
Suchana intervention is noticeably better than six years ago. Even if a significant portion of the
improvement in affordability is attributed to Suchana interventions, the programme should still
recognise the existing affordability gap, and intensify its effort to eliminate the gap. Moving forward
the programme should consider the following actions to maximise the impact on nutrition:
▪ Suchana should consider revisiting its current livelihoods strategy and actions to identify
potential ways to improve the return on investment and household income. For instance,
encouraging beneficiaries to adopt IGA options with a higher rate of return where applicable,
identify ways to improve the return from on-farm IGAs and/or reduce loss etc.
▪ In addition, it should also consider reviewing it's market system and value chain centred
activities to identify potential scope to improve income further and subsequently reduce
affordability gaps
hile focusing on improved income, the programme should equally put importance on better
production rate at kitchen gardening and HFP; and reduce food cost by promoting lower-cost
nutritious food items available in the region.
▪ Consider strengthening activities that links the most vulnerable BHHs with the government's
social protection scheme. The additional income from the social protection schemes can
significantly reduce the affordability gap.
▪ Use the FHAB diet cost as a benchmark to track the progress of beneficiary groups in
upcoming socio-economic surveys or assessments and observe changes in affordability gap to
assess whether new initiatives have worked.
▪ Suchana should also consider intensifying its effort to engage more in the SBCC activities. The
FGDs during the CotD data collection and also previously conducted formative research
highlighted the dominant role of husbands or male family members in household expenditure,
food purchase decision, access to market and ultimately income generation. Without
significantly engaging the male members in the process (and changing norms) the SBCC
activities are unlikely to have a significant and lasting impact on changing behaviours and
practices.
Infant and young child feeding practices: The CotD software calculated that a 12- 23-month-old
child’s diet should include 532g of breastmilk. However, during the CotD data collection, around 40
to 50 percent of the mothers have admitted feeding the child with various infant formula or baby food
at varying frequencies. It was beyond the scope of the CotD analysis to find the breadth and spread
of the practice; nevertheless, this is very concerning. As shown in the modelling section of this report,
the introduction of infant formula or processed baby food not only can increase the diet cost of
children by 2.5 times but also poses a risk to overall health and wellbeing by replacing the vastly better
nutritious mother's milk. Suchana investigate further to understand the severity of this problem and
should address this issue through all SBCC channels.
Home Food Production (HFP): Suchana's HFP intervention is part of its key strategies improve
the availability of food at the household level. The CotD modelling shows that the kitchen gardening
or vegetable production alone can potentially reduce the annual cost of a nutritious diet by
approximately one percent, and the HFP interventions are potentially reducing the food cost by 2.3
to 3.2 percent. While this is a significant contribution, but far below the proportion of 8-12 percent
reduction of the cost of the nutritious diet recommended by 2013 CotD analysis to have a significant
impact on food security and nutrition. Furthermore, it was beyond the scope of the CotD analysis to
assess whether the overall return from HFP intervention is cost-effective and as per the programme
design. The programme should conduct a cost-effectiveness analysis of the kitchen garden and HFP
interventions to understand whether the current production, consumption and rate of return is cost
effective and also investigate further opportunities to improve productivity and consumption
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