Govt to shut nutrition centres on WB prescription, merge the scheme into main health programme
At least 46,000 nutrition workers are to lose jobs following a merger of the National Nutrition Programme with the mainstream health and family planning scheme in June.
Sources said the plan taken up under World Bank prescription will be finalised within this month.
Nutritionists and NGOs working on health issues say after the merger the focus on free delivery of nutrition packages to women and children will be drifted away and the nation would lose some 46,000 trained workers.
The health and family planning programme has remained ineffective due to lack of manpower and the nutrition programme is going to meet the same fate, they added.
With the new programme all the 42,000 nutrition centres at around 150 upazilas will be closed from June and nutrition packages be delivered through community clinics.
In a meeting on February 6, the health ministry decided to merge the nutrition scheme with five-year (2011-2016) Health Population and Nutrition Sector Development Programme. A draft operational plan has also been prepared.
The government and donors say the nation must have a sustainable nutrition programme, instead of a standalone one. Nutrition is a multi-sector issue and therefore, they argue, it should be part of the government’s mainstream activity.
Under the 12-year-old National Nutrition Programme (NNP) the government spent Tk 1,500 crore to deliver nutrition packages at around 150 upazilas while its target was to cover at least 174 upazilas.
In the new plan, nutrition measures will receive eight percent of total Tk 23,500 crore allocated for the five-year development programme and be directed by a National Nutrition Services cell under the Institute of Public Health and Nutrition (IPHN).
Through bringing it in the mainstream, the nutrition service would be available at all of the 488 upazilas of the country, officials say.
Experts are doubtful about this plan. “The IPHN will work under the Directorate General of Health Services, which is already suffering from manpower shortage,” said Prof MQK Talukder, life member of Bangladesh Nutrition Society.
Prof Tahmeed Ahmed, head of nutrition, ICDDR,B, said the design and the purpose of NNP was quite good.
NNP is important for a country like Bangladesh where 45 percent children under age five and one third of mothers suffer from malnutrition, and 80 percent young infants from anaemia, Tahmeed added.
Experts also argue the NNP never got due attention from the government and the monitoring was also defective.
“The government employed NGOs to implement the programme. Monitoring and evaluation were poor,” said Prof Tahmeed.
“It’s not clear how the community clinics would provide nutrition services and who will monitor it. The Area Based Nutrition Component under which the community nutrition promoters visit every mother and child will also be abolished. Even the eight percent allocation is not enough,” said Prof SK Roy, a senior scientist of ICDDR,B.
On the other hand, Health Secretary Mohammad Humayun Kabir is critical of the NNP’s achievements as “it could not reach targeted 174 upazilas.”
He said the way the NNP was working, the government would have to employ 1.25 lakh workers to bring the rest of the country under the programme net.
Instead, its merger with the mainstream health programme will resolve the manpower issue as the services will be delivered through community clinics, Kabir added.
SK Roy citing latest NNP report said for the upazilas under the programme infant mortality rate was 22 per thousand live births a year while elsewhere it was 54. And maternal mortality rate for the NNP areas was 1.8 per thousand live births a year and for other upazilas it was 3.2.
