An undernourished nutrition budget

Twenty-five-year-old Rima Rani Paul is currently in her eight month of pregnancy. When she visited the doctor recently, she was recommended a balanced diet, rich in nutrient-dense foods, as the fetus was not growing as expected.

Despite this, on most days Rima's husband Shipon Paul – a street vendor in Kapasia, Gazipur – cannot afford to buy her nutrient-rich fruits and vegetables after providing for their eight-member family.

Last month, when I visited the local union health and family welfare centre for prenatal vitamin supplements, I was only provided with some iron and folic acid supplements due to supply shortage.

— RIMA RANI PAUL KAPASIA, GAZIPUR

The situation was particularly challenging during her first trimester, which coincided with the Covid 19 lockdown. Shipon didn't have a regular earning and it was difficult for Rima to put food on the table, let alone have a balanced diet, she told this correspondent.

"Last month, when I visited the local union health and family welfare centre for prenatal vitamin supplements, I was only provided with some iron and folic acid supplements due to supply shortage," Rima told The Daily Star.

"However, the centres are supposed to provide vitamin B complexes and calcium carbonate supplements for free as well," she said.

Rima also has no idea how she can receive the government maternity allowance, meant for the poor and underprivileged pregnant women to meet their increased nutritional demands.

According to public health and nutrition experts, despite Bangladesh's significant improvements in various nutrition indicators in the past, the direct interventions to improve nutritional status – such as ensuring maternal nutrition to reduce the low birth weight of babies, managing acute malnutrition, providing allowances to poor pregnant and nursingmothers and so on – require more attention, especially during the Covid-19 pandemic.

For instance, a BRAC study found that 73 percent of women and 67 percent of men did not eat nutritious foods in the pandemic, while the pandemic affected the dietary pattern of 28 percent of households.

However, a recent Bangladesh National Nutrition Council (BNNC) publication showed that although the government spent Tk 23,210 crore in nutrition relevant interventions in 2016-2017, which represented around one percent of GDP and around nine percent of the national budget, only two percent of the nutrition expenditure was on direct interventions.

Of the two percent, the Ministry of Health and family Welfare (MoHFW) spent only four percent of its nutrition budget while the Ministry of Women and Children Affairs (MoWCA) spent seven percent of its nutrition budget. These were the two major ministries working on direct interventions through 13 operational plans.

Contrary to that, the vast majority of expenditure (around 98 percent) was in addressing wide- ranging underlying causes of malnutrition, such as water and sanitation, the status of women, social protection, agriculture, education, environment and climate change etc.

Dhaka University nutrition and food science professor Dr Nazma Shaheen said, "In order to achieve our SDG and nutrition targets, it's imperative we scale up the most important and effective interventions and strengthen them by expanding coverage to include a larger number of beneficiaries."

CURRENT INTERVENTIONS INADEQUATE

When The Daily Star visited a number of centres of Sima's upazila recently, it was seen that there is a supply shortage of prenatal vitamins for pregnant mothers.

According to the pharmacist of Rima's centre, they receive only 2,000 pieces of iron and folic acid supplements, 500 pieces of calcium carbonate and 1,000 pieces of vitamin B complexes, which are far less than the actual demand of an average of 250 pregnant women in each union.

"Most of the time, our stock finishes within the first 10 days of the month, and when they come later, they have to return empty-handed, which discourages many from coming again," he said, on conditions of anonymity.

According to experts, increasing the expenditure of micronutrient distribution, ensuring maternal and adolescent nutrition, is crucial as the prevalence of under-5 stunting children is still 28 percent.

The expenditure for the Karmajibi Lactating Mother Sohaita Tohbil project of MoWCA was also found inadequate. According to project director Md Jamal Uddin Bhuiyan, the project has been providing training and a monthly allowance of Tk 800 for three years to only 2,77,000 lactating mothers in every city corporation, municipality and BGMEA and BKMEA factory workers.

Urging for more allocation, the PD said, "We have got an allocation of Tk 276 crore 65 lakh, which is not sufficient because for the past two years, we have been unable to increase the number of our beneficiaries, even though there is a huge demand amid the pandemic," he said.

BNNC director-general Dr Md Khalilur Rahman said that Covid 19 pushed back the nutrition achievement for at least three years.

In terms of human resource shortage for direct interventions, the BNNC DG claimed that there is not a single person at the district level who can talk about nutrition to people or do the required advocacy.

Dr Iqbal Kabir, chief consultant, BNNC, also said that there is a need for more allocation to expand coverage of existing interventions, while tracking where the budget is being spent.

"For this, we need to develop a multi-sectoral budget tracking system so that we know where the money is going," he added.