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Evaluating the Bangladesh Integrated Nutrition Project: Findings and Recommendations

This independent review by Save the Children UK critically assesses the Bangladesh Integrated Nutrition Project (BINP), funded by the World Bank, which aimed to improve child growth and nutrition between 1995 and 2002. Despite significant investment, evidence shows inconclusive results regarding malnutrition reduction among children and women. Key findings indicate low dietary impact and questions surrounding the project's overall effectiveness. The review calls for a halt on further investment until robust evidence of success is demonstrated, and stresses the need for improved monitoring and evaluation practices moving forward.

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Evaluating the Bangladesh Integrated Nutrition Project: Findings and Recommendations

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  1. Thin on the Ground Bangladesh Integrated Nutrition Project (BINP): An independent review by SC-UK Questioning the evidence behind World Bank - funded community nutrition project

  2. Acknowledgements • Prof. Michael Latham Cornell University Prof.WimVan Lerberghe, ITM Antwerpen • Prof. Patrick Kolsteren, ITM • Prof. John Mason, Tulane University • Prof. Saul Morris, LSH&TM • Dr Helen Young, Tufts • Hon’ble Secretary,Ministry of Health and Family Welfare • Abbas Bhuiya, PhD (ICDDR,B) • Prof. Quazi Salamatullah, PhD (INFS) • Prof. Mamunar Rashid PhD (IPHN) • Prof. Ataharul Islam, PhD, (DU)

  3. Why are we concerned about the BINP? • Save the Children UK’s history • Literature reviews • Programmes raised questions • Antwerp conference 2001

  4. Bangladesh Integrated Nutrition Project (BINP)1995-2002 (US $67 million) • Project aim: improve child growth • Decrease severe underweight by 40% • Decrease moderate underweight by 25% • Main project components: • Community-based Growth Monitoring and Promotion • Targeted supplementary feeding

  5. Project M&E data • 1995 baseline: 6 project thanas, 2 control thanas • 1998 Mid term evaluation: same thanas

  6. BINP mid-term evaluation results • Rate of severe malnutrition decreased in project and control areas • Apparent greater decrease in project areas

  7. Prevalence of severe underweight (<-3 z-scores weight-for-age) in 6-23 months, 1990-2000

  8. MTE Results:Low BMI finding and (mis) interpretation • “The prevalence of low BMI <18.5) reduced from a 4.7% point higher rate to a 2.4 percentage point higher rate than in the project thanas compared to the control thanas indicating a net reduction in the prevalence by 2.3 percentage points in 3 years time”. • “BINP has made substantial improvement in the prevalence of low BMI among women of child bearing age” ----- MTE pg 61 (table 131)

  9. Data from project registers (n=998) Severe malnutrition defined as <60% weight-for-age; moderate malnutrition defined as 6075% weight-for-age; not malnourished defined as >=75% weight-for-age

  10. Save the Children’s survey • Cross sectional design 6 years after implementation began • Same project thanas (3 randomly chosen). Three new control areas selected through matching. • No comparison with baseline was possible

  11. Project (n=4,554) Non-project (N=2,261) P-value Male HH 94% 95% 0.06 Formal education of HH 42% 43% 0.74 Own land 42% 46% 0.20 Big bedroom 80% 82% 0.06 Lowest SES 15% 14% 0.35 SC UK’s cross-sectional study: HH characteristics

  12. BINP (n=1,598) Non-BINP (n=790) P-value Severe underweight (<-3 z-scores weight for age) 11.4% 12.2% 0.63 Moderate underweight (<-2 z-scores weight for age) 35.2% 36.3% 0.62 Anthropometric results (6-23 months)

  13. Outcomes of GMP and SFP • GMP understanding: 7% • SFP coverage: 22% • Use of supplementary food : 67% replacement

  14. Can GMP and supplementary feeding reduce malnutrition? • Save the Children study showed small improvements in caring practices but no differences in levels of malnutrition • Supplementary feeding is only successful if linked to health care and providing a supplementary rather than replacement diet (i.e. household food access is adequate) • 98% mothers reported receiving feeding 6 times per week but 67% reported that they did not feed the child other food at home

  15. Conclusions • Insufficient evidence to claim the project has achieved its objectives • Evidence is badly needed before further investment • Feasibility issues related to design and implementation • Questions over sustainability and cost effectiveness

  16. Recommendations • Halt further scale-up of investment in this projects until reviews / pilots demonstrate effectiveness • Independent review of cost effectiveness of current approaches including meta-analysis of data from large scale nutrition projects

  17. Recommendation (cont’d) • BINP end term evaluation in conjunction with baseline and MTE must be used to inform future investment in NNP • Immediate action to improve monitoring and evaluation

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