Background
Even though more than one-third of children under five in the country still suffer impaired linear growth, Bangladesh has observed a decline in the rates of stunting - with an annual rate of reduction of around 1.2% that is not uniform throughout the country (BDHS 1997-2014). The country has also made remarkable progress in reducing the incidence of poverty during the last decade, though the changes are not inclusive, and poverty (based on the lower poverty line) has remained almost unchanged in the Sylhet division. Bangladesh also faces regional income inequalities, which are more pronounced in rural Bangladesh; the Sylhet region is no exception. This spatial disparity demands customized interventions. From a public health perspective, it is essential to improve the growth of children to prevent the related negative consequences. Priority action areas for improving linear growth and accelerating the decline in the rate of stunting in Bangladesh include multi-sectoral coordination of nutrition interventions. This policy brief presents significant findings and recommendations from the impact evaluation of the Suchana programme conducted in the Sylhet and Moulvibazar districts of the Sylhet division. To support and inform policy planners in developing the crucial next course of nutrition actions in Bangladesh, the paper outlines priority actions that can improve linear growth and accelerate the decline in stunting.
About Suchana
Suchana is a multi-sector nutrition programme working with 235,500 poor and very poor households, targeting women and adolescents in 157 unions with a total coverage of 1.4 million populations under twenty Upazilas (sub-districts) from Sylhet and Moulvibazar districts of Sylhet division, Bangladesh. The programme aims to reduce the incidence of stunting among children under two years of age by breaking the intergenerational cycle of malnutrition, and
1 Capacity building among service providers, household food production, interventions targeting adolescents etc.
catalyse support across government and other stakeholders for a coordinated, multi-sectoral approach to prevent undernutrition nationally. A consortium of national and international NGOs led by Save the Children is implementing the programme. The other technical partners are Helen Keller International, International Development Enterprises and World Fish; the implementing partners are the Centre for Natural Resource Studies, Friends in Village Development Bangladesh and Rangpur Dinajpur Rural Services; icddr,b is the research partner and program evaluator. To demonstrate a cost-effective, replicable, scalable model, the Suchana consortium has developed and implemented a nutrition graduation model sequencing interventions at various administrative levels (national, sub-national and local) over 36 months in four phases following a stepped-wedge approach, with periodic evaluations of the effectiveness of this model. The programme includes nutrition-sensitive1 and nutrition-specific2 interventions to improve poor people’s access to essential health and nutrition services, increase their income and productive assets, enhance their resilience to climatic and health shocks, and empower women and adolescents to make better choices about food and nutrition at home.
Methodology
For the evaluation purpose, the baseline and end-line surveys were carried out among Suchana beneficiaries from 1st phase of 40 unions who were treated as the intervention group; and 4th phase of 40 unions who were to be the control group. From the intervention and control unions in Sylhet and Moulvibazar districts, 5,440 households with the youngest child aged below two years of age and 2400 adolescent girls and boys were included in the baseline survey. In order to observe the differences between poor and very poor households and enable a comparison with the baseline values, the online survey included 10,722 children under two years of age and the same adolescent sample size as the baseline survey. Baseline data were collected between the end of November 2016 and February 2017 and the ending data between November 2019 and February 2020. Moreover, a qualitative study was conducted during endline among the service seekers and service providers from the community clinics, government extension services and private vendors.
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