Publications

Disruptions and adaptations of an urban nutrition intervention delivering essential services for women and children during a major health system crisis in Dhaka, Bangladesh

Systematic crises may disrupt well-designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID-19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics).

Clustering for global market access in Bangladesh: Endline survey

The "Clustering for Global Market Access Survey" was conducted to assess the impacts of shrimp farm clustering interventions implemented by the Department of Fisheries (DoF), the Bangladesh Shrimp and Fish Foundation (BSFF), and a private sector actor. The survey was carried out in two rounds: a baseline in 2023 and an endline in 2024, to evaluate the effectiveness of these interventions. The data presented here are from the endline survey conducted between May 7 and May 31, 2024. Data were collected at the household, cluster, and community levels using a two-stage simple random sampling design and analyzed through a difference-in-differences approach. The household datasets include 1,222 shrimp farms across three districts in southern Bangladesh—Bagerhat, Khulna, and Satkhira. Among these, 622 are cluster farmers, and 600 are non-cluster comparison farmers situated in either the same or adjacent villages to cluster farmers. The data encompass cluster participation, pond characteristics, inputs received from cluster operators, stocking and harvesting, feed and non-feed input use, sales revenue, integrated farming, labor use, credit access, dietary diversity, and food security. The cluster datasets cover 68 shrimp farm clusters, providing insights into cluster composition and training delivered to cluster members. The community datasets provide contextual information on the 136 villages where both cluster and non-cluster farmers reside.

Clustering for global market access in Bangladesh: Baseline survey

The "Clustering for Global Market Access Survey" was conducted to assess the impacts of shrimp farm clustering interventions implemented by the Department of Fisheries (DoF), the Bangladesh Shrimp and Fish Foundation (BSFF), and a private sector actor. The survey was carried out in two rounds: a baseline in 2023 and an endline in 2024, to evaluate the effectiveness of these interventions. The data presented here are from the baseline survey conducted between November 14 and December 14, 2023.
Data were collected at the household, cluster, and community levels using a two-stage simple random sampling design and analyzed through a difference-in-differences approach. The household datasets include 1,222 shrimp farms across three districts in southern Bangladesh—Bagerhat, Khulna, and Satkhira. Among these, 622 are cluster farmers, and 600 are non-cluster comparison farmers situated in either the same or adjacent villages to cluster farmers. The data encompass cluster participation, pond characteristics, inputs received from cluster operators, stocking and harvesting, feed and non-feed input use, sales revenue, integrated farming, labor use, credit access, dietary diversity, and food security. The cluster datasets cover 68 shrimp farm clusters, providing insights into cluster composition and training delivered to cluster members. The community datasets provide contextual information on the 136 villages where both cluster and non-cluster farmers reside.

Capacity strengthening as a pathway to drive food systems transformation towards sustainable healthy diets: Reflections from the CGIAR Research Initiative on Sustainable Healthy Diets through Food Systems Transformation (SHiFT)

Food systems are failing to provide sustainable, healthy diets that promote health, environmental sustainability, affordability, and cultural acceptability, leaving over three billion people unable to access such diets. Following calls for transformation after the 2021 UN Food Systems Summit and subsequent international dialogues, there is growing recognition of the need for systemic approaches to accelerate food systems transformation (FST). However, many stakeholders remain uncertain about how to implement effective changes, highlighting the need for sustainable development pathways that integrate health, environmental, and inclusion goals. This paper explores what capacities are needed for driving FST, emphasizing the need to strengthen skills and competencies in individuals, organizations, and societies to achieve transformative goals.

Based on the capacity-strengthening experiences of the CGIAR Research Initiative on Sustainable Healthy Diets through Food Systems Transformation (SHiFT) in Bangladesh, Ethiopia and Vietnam, the paper examines SHiFT’s capacity-strengthening practice used. Key questions addressed include identifying stakeholders who need transformative capacities, the capacities required for different roles, and strategies to inspire meaningful implementation.

The reflections on capacity-strengthening trajectories for food system actors in Bangladesh, Ethiopia, and Vietnam underscore the need for tailored, inclusive, and adaptive approaches that address the unique dynamics of each food system. Seven guiding principles emerged: contextualizing within political and economic landscapes; employing adult-based, experiential learning; timing of capacity strengthening interventions; navigating power dynamics; embracing emergence and flexibility; fostering diversity; and stimulating personal agency and leadership. These principles highlight the importance of co-creation, continuous reflection, and iterative adaptation, ensuring capacity-building efforts are relevant, effective, and transformative. By exploring practice-based and case-based insights, this paper contributes to understanding how targeted capacity strengthening can support meaningfully to FST.

Key stakeholders, platforms, and networks in Bangladesh’s food systems transformation process, 2022–2024

In 2022, the CGIAR Research Initiative on Sustainable Healthy Diets through Food Systems Transformation (SHiFT) conducted a stakeholder identification and analysis activity to develop its strategy for stakeholder engagement. As part of SHiFT’s Work Package 5, Catalyzing Food Systems Transformation, this analysis was used to prepare a stakeholder engagement strategy for Bangladesh, Ethiopia, and Viet Nam, SHiFT’s three countries of work. The stakeholder identification and mapping, as well as a report on the country’s food system transformation process and issues, constitute a database that enables rapid selection of potential stakeholders for engagement, capacity sharing, and collaboration, among other purposes. The stakeholder identification process is repeated, typically on a quarterly basis, to update the database.
This summary report is based on information first collected in 2022 and updated as of December 2024. Building understanding, engagement, and capacity with diverse food system stakeholders will help to foster collaboration and coordination across varied perspectives, and to drive transformative actions across the food system for positive outcomes on the environment, food security and nutrition, and livelihoods and inclusion.
SHiFT’s approach is to engage with and provide technical support to relevant stakeholders, networks, and platforms whose objectives are aligned with the Initiative’s goals. This approach aims to contribute to local and national food systems transformation for sustainable healthy diets, rather than facilitating the formation of new networks or platforms that would require more time to build engagement and capacity, and might not be sustainable. The Initiative’s efforts are also meant to avoid overlapping with those of the country’s government and other development partners. Instead, SHiFT aims to create synergies through coordinated actions to achieve national food systems transformation and sustainable healthy diets, as well as broader national goals on food systems.

Capacity assessment to support food systems transformation towards sustainable healthy diets in Bangladesh: Exploring the capabilities of the SHiFT strategic partners

Strengthening the multidisciplinary capabilities necessary to accelerate food systems transformation has garnered increased interest over the past decade. A capabilities assessment was done with the Strategic Partners of the CGIAR Research Initiative on Sustainable Healthy Diets through Food Systems Transformation in Bangladesh to understand their abilities to facilitate transformative changes towards sustainable healthy diets. Both Strategic Partners, the Food Planning and Monitoring Unit (FPMU) and the Bangladesh National Nutrition Council (BNNC), have long histories and well-established structures for collaboration and coordination with diverse stakeholders to realize the nutrition-focused (BNNC) and the food-related (FPMU) ambitions of the Government of Bangladesh. They are engaged in food and/or nutrition policy development, governance of the sectors, and monitoring progress at both national and sub-national levels. Using a capability assessment tool tailored to capturing food systems transformation capabilities at organizational level, the capabilities to deliver results and adapt and self-renew were the highest scored for FPMU. BNNC scored more on the capabilities to achieve coherence and to relate to support food systems transformation higher.

However, food systems transformation and sustainable healthy diets emerged as relatively new concepts in both organizations. It was acknowledged that whereas the current mandates of BNNC and FPMU may address issues relevant for sustainable healthy diets, to date this still lacks adequate translation into the current policy development and planning operations and has no intentional prioritization. Both teams underscored the urgency to invest in human resources and institutional capacity strengthening as well as earmarking finances to pursue food systems transformation agendas. Becoming more articulated and explicit about what comprises food systems change, what are sustainable healthy diets and what could be monitored is crucial to support the Strategic Partners to have tangible actions to track. Moving from food system narratives to specific actions will facilitate understanding of what is, or needs to be, monitored.

Do empowerment impacts endure? The medium-term impacts of the Agriculture, Nutrition, and Gender Linkages (ANGeL) Project in Bangladesh

Whether impacts of development interventions are sustainable has attracted much recent interest (examples include Bandiera et al., 2017, Banerjee et al., 2021, Blattman et al., 2020, Carneiro et al., 2021, Grisolia, 2024, and Haushofer and Shapiro, 2018). When interventions involve trained facilitators, for example, it is of interest to know whether effects persist once these facilitators are no longer delivering the message (Ahmed et al, forthcoming). The recognition of women’s empowerment and gender equality as intrinsically important has spawned a growing literature on the impacts of development interventions on women’s empowerment (Quisumbing et al. 2023, Quisumbing et al. 2024) and attitudes towards gender roles (Alderman et al. 2025). Yet, with few exceptions (Alderman et al. 2025) there is little overlap between these two areas of work, in large part because many impact evaluations fail to follow up after the initial evaluation is completed. A synthesis of findings from a portfolio of 11 agricultural development projects in South Asia and Africa suggests that, while projects are able to affect aspects of empowerment such as decisionmaking over resources and control over income, changes in gender norms are more difficult to achieve in the two to three year time span over which impact evaluations are typically conducted(Quisumbing et al. 2024). If women’s empowerment interventions aim ultimately to change gender norms, to detect impacts, they should be measured over a sufficiently long period of time to allow for norm change.

Social assistance and adaptation to flooding in Bangladesh

As climate change exacerbates weather shocks, there is growing interest in understanding whether social assistance programs can support coping among poor rural households and whether program effects vary by gender. We assess whether a social assistance program – the Transfer Modality Research Initiative (TMRI) –influenced the effects of prior monsoon flooding on household consumption and adult diets in southern Bangladesh. TMRI provided cash or food transfers, with or without nutrition behavior change communication, from 2012-2014. Within the study sites and years, flooding was substantial but moderate. Our findings suggest that, without TMRI, a one-standard-deviation increase in lagged flooding led to households smoothing consumption by drawing down savings and reducing diet quality among both men and women. In contrast, among TMRI treatment households, lagged flooding did not reduce savings, and both men’s and women’s diet quality improved. Effects on diet quality appeared largely driven by legumes and by fruits and vegetables, and improvements appeared strongest among households receiving both transfers and behavior change communication. Results indicate that social assistance can help households cope with effects of moderate flooding in southern Bangladesh, protecting household savings and improving both men’s and women’s diets.

Bangladesh: Systematic analysis of domestic production and world market shocks

This study explores Bangladesh’s vulnerability to economic shocks and identifies those contributing most to eco-nomic uncertainty. The Bangladesh Computable General Equilibrium (CGE) model was employed to simulate a range of potential economic outcomes under various shock scenarios sampled using historical data to capture domestic agricultural yield volatilities and world market price uncertainty for traded goods. Data mining and machine learning methods were applied to quantify the contribution of each shock to the uncertainty of economic outcomes (gross domestic product [GDP], private consumption, poverty, and undernourishment). Our findings suggest that potential variation in Bangladesh’s GDP ranges from +0.8 to -1.0 percent to baseline, with domestic shocks ac-counting for 53.7 percent of uncertainty, and remaining 41.7 percent are explained by the volatility of world market prices and Foreign Exchange (FX) flows. At the same time, private consumption is more uncertain (from +4.0 to -3.5 percent to base), and external factors are the most important risk contributors (70.1 percent is world prices and 2.9 percent is FX flows). Similarly, external factors contribute roughly two-thirds to the potential variation of national poverty and undernourishment rates that fluctuate from -2.4 to +1.8 and –2.2 to +1.9 relative to the baseline rates percentage points respectively. Understanding how potential shocks might impact various segments of the Bang-ladesh economy and population is a critical first step in facilitating a discussion on risk mitigation strategies that include increasing sectoral productivity or diversifying production to reduce reliance on high-risk sectors.

The cluster panacea? An evaluation of three interventions in shrimp value chains in Bangladesh

Clustering farming has often been proposed as an effective way to overcome the significant transactions costs faced by downstream buyers in interacting and negotiating with many small farmers, while making it easier for extension workers and governments to dispense advice, provide upstream services and inputs. In this study, we evaluate the impact of a set of three initiatives in Bangladesh, implemented by a government department, a private sector processing firm and a not-for-profit industrial advocacy body, all involving clustering contiguous shrimp farm ponds to enable group certification necessary for global market access. We implement a canonical difference-in-differences model using two rounds of surveys of a sample of over 1,222 farmers in 2023 and 2024 to assess the impacts on pond management practices, net profits and any unintended impacts on food security and dietary diversity. Our results suggest that the cluster interventions had impressive impacts on adoption of better farm management practices. However, these do not appear to translate into significant gains in net profits, perhaps because these interventions are still relatively new. Further, it appears that cluster farmers pay a penalty on account of a shift to more intensive cultivation, represented by a loss in species diversity and lower incomes from fish and vegetables. We find that there are no significant spillover effects as yet on shrimp farmers in the same village as the clusters. This study reflects critically on the efficacy of clustering that is presumed to enhance access to global markets.

Transforming food systems towards sustainable healthy diets in Bangladesh, Ethiopia, and Viet Nam: A cross-country stakeholder analysis

The CGIAR Research Initiative on Sustainable Healthy Diets through Food Systems Transformation (SHiFT) recognizes the urgency of early stakeholder engagement to facilitate systemic changes towards sustainable healthy diets. This qualitative exploratory study aimed to provide insights about where stakeholders are active in food systems in Bangladesh, Ethiopia and Viet Nam and their characteristics. The conceptual framework of food systems for diets and nutrition proposed by the High Level Panel of Experts on food security and nutrition was used to map all stakeholders using a network analysis approach, in particular applying the degree centrality measure. This measure shows the food system domains with the largest number of stakeholder connections. The analysis reveals that centralization is spread across various food system domains. In Bangladesh, the areas with the most stakeholder connections are observed in the policy and governance and food environment domains. In Ethiopia, more connections were observed under the food environment, and production system domains and the outcomes related to diets, nutrition and health. In Viet Nam, it is the production system, storage and trade, packaging and processing, and food environment domains with the most stakeholder connections. Overall, platforms are active in policy and governance in all countries, suggesting that engaging with multi-stakeholder platforms is beneficial for SHiFT to advance the national agendas aimed at realizing sustainable healthy diets. Considering connectivity with food system domains, SHiFT can collaborate with all sectors. Moreover, focusing on stakeholders in the food environment, particularly on overseeing foodscapes for people, is essential. However, implementing food systems transformation requires identifying and engaging with other actors as well. However, there is limited representation of stakeholders in processing, transport, and retail, especially in Ethiopia and Bangladesh. International stakeholders emerge prominently from our analysis, suggesting that the food system narrative may still be primarily driven from an international/global perspective, resonating with the United Nations Food Systems Summit dialogues. To realize the ambitions of transitioning towards sustainable healthy diets for all, efforts must extend beyond projects/programs and engage national-level stakeholders.

How programme design and local context shape the lasting effects of cash and food transfers

A transfer programme in Bangladesh led to sustained consumption increases and reduced poverty four years post-programme, but design and context mattered. Cash and food transfer programmes in low- and middle-income countries have been shown to be highly effective in increasing household consumption and reducing household poverty in the short term ​(Bastagli et al. 2016, Hidrobo et al. 2018, ​Borga and D’Ambrosio 2021, Ravallion 2016​​). But evidence on whether they sustain longer-term impacts after programmes end is more mixed. Some studies of transfer programmes show significant sustained medium- to long-term impacts on consumption and poverty (​e.g. Carneiro et al. 2021, Stoeffler et al. 2020, ​Macours et al. 2022​)​, but others show effects fading out (e.g. Handa et al. 2019, Cahyadi et al. 2020, Haushofer and Shapiro 2018 ​)​. Some interventions combining transfers with additional components such as cash “plus” programmes or multi-faceted graduation models sustain impacts on consumption four to ten years post-intervention (Bandiera et al. 2017, Banerjee et al. 2022), while others do not (Brune et al. 2022).

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Market Survey

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at advancing equitable access to sustainable healthy diets, enhancing farmers' livelihoods and resilience, and conserving natural resources such as land, air, and water across South Asia. The TAFSSA district agrifood systems assessment seeks to establish a robust, accessible, and integrated evidence base that connects farm production, market access, dietary patterns, climate risk responses, and natural resource management, with gender considerations integrated throughout. The assessment focuses on rural areas in Bangladesh, India, and Nepal, utilizing a district-level, multi-year approach. Data collection took place between February and June 2023 in the Rangpur and Rajshahi districts of Bangladesh. The survey covered 50 villages in each district, focusing on formal and informal multi-vendor markets offering a variety of food products within a 10-kilometer radius of the village centroid. The types of multi-vendor markets included in the survey were village markets, weekly village markets, roadside/street markets, and wholesale markets (mandis).
The survey employed pretested, structured questionnaires organized into four distinct modules:
1. Market Manager Module: Captures general information about the market as a whole.
2. Interview-Based Module: Gathers vendor-specific data, including details on the assortment of goods, availability, resilience, food sourcing, wastage, access, and protection dimensions.
3. Observation + Photo Module: Focuses on market infrastructure, food quality, safety, and hygiene, supplemented with photographic documentation.
4. Food List Module: Documents the availability and prices of an extensive range of food items at each location.

This comprehensive approach ensures a detailed understanding of agrifood systems at the district level, contributing to evidence-based decision-making for sustainable development.

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Local Market and Retail Census

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at advancing equitable access to sustainable healthy diets, enhancing farmers' livelihoods and resilience, and conserving natural resources such as land, air, and water across South Asia. The TAFSSA district agrifood systems assessment seeks to establish a robust, accessible, and integrated evidence base that connects farm production, market access, dietary patterns, climate risk responses, and natural resource management, with gender considerations integrated throughout. The assessment focuses on rural areas in Bangladesh, India, and Nepal, utilizing a district-level, multi-year approach. Data collection was conducted between December 2022 and January 2023 in the Rangpur and Rajshahi districts of Bangladesh. The study employed a census across 50 villages per district, selected based on the probability proportional to the number of households in each village. The census included all formal and informal multi-vendor markets offering diverse food products, as well as retail food shops within the selected villages. Multi-vendor markets considered in the census included village markets, weekly village markets, roadside/street markets, and wholesale markets (mandis). Retail food shops included local grocery stores, vegetable/fruit shops (green grocers), and specialized shops selling meat, eggs, fish, or dairy products. A pretested, structured questionnaire was used for the census. Data collected included details on vendor density, vendor characteristics, operating hours and days, types of products sold, infrastructure and facilities in shops, waste disposal methods, and GPS coordinates of retail shops and markets.

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Retail Survey

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at advancing equitable access to sustainable healthy diets, enhancing farmers' livelihoods and resilience, and conserving natural resources such as land, air, and water across South Asia. The TAFSSA district agrifood systems assessment seeks to establish a robust, accessible, and integrated evidence base that connects farm production, market access, dietary patterns, climate risk responses, and natural resource management, with gender considerations integrated throughout. The assessment focuses on rural areas in Bangladesh, India, and Nepal, utilizing a district-level, multi-year approach. Data collection took place between February and June 2023 in the Rangpur and Rajshahi districts of Bangladesh. The survey covered 50 villages in each district, focusing on formal and informal multi-vendor markets offering a variety of food products within a 10-kilometer radius of the village centroid. The types of multi-vendor markets included in the survey were village markets, weekly village markets, roadside/street markets, and wholesale markets (mandis).
The survey employed pretested, structured questionnaires organized into four distinct modules:
1. Market Manager Module: Captures general information about the market as a whole.
2. Interview-Based Module: Gathers vendor-specific data, including details on the assortment of goods, availability, resilience, food sourcing, wastage, access, and protection dimensions.
3. Observation + Photo Module: Focuses on market infrastructure, food quality, safety, and hygiene, supplemented with photographic documentation.
4. Food List Module: Documents the availability and prices of an extensive range of food items at each location.

This comprehensive approach ensures a detailed understanding of agrifood systems at the district level, contributing to evidence-based decision-making for sustainable development.

Gender and age employment gaps within agrifood value chains in Bangladesh and Uganda

Using data collected with a novel sampling approach for agrifood value chains in Bangladesh (rice and potato) and Uganda (arabica coffee and soybean), this study documented meaningful gender and age employment gaps within intermediary sections of the value chains, which include trading , processing, and wholesaling activities. While agrifood value chains have potential to generate new jobs and close gaps for both women’s and youth employment in low- and middle-income countries, the study identifies large gender gaps in both operators of intermediary firms and those employed by these firms, as well as an age gap, with few youth operating intermediary firms. The brief offers recommendations for addressing systemic barriers that contribute to gender and age gaps in this “hidden middle” of agrifood value chains.

Analyzing hypertension and diabetes mellitus status among Bangladeshi adults: Evidence from Bangladesh Demographic Health Survey (BDHS) 2017–18 data

Market diversification to increase the demand for and value of Bangladeshi shrimp

In a rapidly growing global shrimp industry, Bangladesh’s shrimp sector faces fierce competition from much larger producers such as Ecuador, India, and Vietnam. One of Bangladesh’s challenges is that it is overdependent on Europe's fragmented hotel, restaurant, and catering (HoReCa) segment and ethnic retail markets, where it exports 88 percent of its output. This market is highly price-driven and limited in size. However, Bangladesh’s exporters have no or only limited access to retail markets in the European Union (EU), the United States (US), or other markets that source black tiger shrimp due to a lack of high-quality products, a lack of Aquaculture Stewardship Council (ASC) and Best Aquaculture Practices (BAP) certification, negative market perception of the country’s shrimp, and a lack of promotional activities. As a result of the increased competition and restricted market access, Bangladesh’s exporters and farmers are experiencing spiraling prices, and their future activities are at risk. Diversifying its markets should help the industry increase demand and get better prices for the products it exports. This brief explores the current market position of Bangladeshi shrimp and what the country can do to diversify its markets. Promotion is key, but not to consumers. Business-to-business (B2B) shrimp buyers worldwide must view Bangladesh as a reliable source of competitive, high-quality, sustainable shrimp.

Monitoring biofortification program performance and potential for impact: Indicators, methods, and learnings from the commercialization of biofortified crops program in six countries across Africa and Asia

Background
Biofortification of staple crops is a food-based strategy to reduce the high global burden of micronutrient deficiencies. Monitoring program performance is essential to ensure biofortification programs have high potential for impact; however, few indicators and methods for doing so are publicly available.

Objective
We documented the set of standardized indicators and methods used to monitor the Commercialization of Biofortified Crops (CBC) program and reviewed their strengths and limitations.

Methods
Following the CBC program impact pathway, we identified and defined a set of indicators and corresponding methods. Country-level implementation teams contextualized and operationalized them to monitor 9 country-crop programs (i.e., high iron beans in Kenya and Tanzania, iron pearl millet in India, vitamin A maize in Nigeria and Tanzania, vitamin A cassava in Nigeria, zinc wheat in Pakistan and India, and zinc rice in Bangladesh) from 2020 to 2022.

Results
Twenty indicators were defined across domains of seed supply, production, availability, awareness, capacity development, advocacy, and consumption of biofortified foods. Data collection methods included external and internal document review, farmer household surveys, rapid market assessments, and modeling. The strengths of these methods were that they were rapid to conduct, low cost, and simple to use. For some methods, the limitations were the potentially reduced accuracy of some results due to the use of external data sources or secondary data inputs and unavailability of data.

Conclusions
The indicators and methods used in the CBC program are practical and cost effective for monitoring the implementation of biofortification programs because they generate the range of information necessary to understand how effectively a program is delivered and bolster plausibility arguments for attributing observed impacts to program activities. Further testing is needed to confirm their generalizability when applied to different contexts and paired with impact evaluations with the aim of producing publicly available global guidance documents.

Between tradition and modernity: Exploring the differences in factors driving happiness in indigenous and the general population in Bangladesh

Resilient Cities urban nutrition profile: Bangladesh

Urban-rural disparities in undernutrition in children under five have dissipated. Stunting declined from 2014 to 2022 in both urban and rural areas, but more so in rural areas, leading to comparable rates of stunting in urban and rural areas (22 percent, 24 percent).
Wasting remains “high” (according to the World Health Organization) in both urban and rural areas (11 percent).
The prevalence of child overweight is low but increasing, especially in Dhaka.
Vitamin A deficiency affects half of children under five. Vitamin D and iron deficiencies are higher in urban areas, with zinc and iodine deficiencies more prevalent in rural areas.
Urban and rural diets lack fruits and vegetables. A third of urban households have inadequate caloric intake.
The cost of a healthy diet increased from $3.03 to $3.64 per person per day from 2017– 2022 and the percentage of the population unable to afford a healthy diet fell from 65 to 48 percent. Currently, 82 million people are unable to afford a healthy diet in the country.
The diet diversity of young children has improved since 2011, but gains were seen mostly in rural areas. The percentage of all children fed the minimum meal frequency dropped by 20 percentage points from 2017 to 2022.
Urban informal settlements are a concern – children have higher rates of stunting, lower dietary diversity, and higher prevalence of micronutrient deficiencies compared to other urban children.
Overweight and obesity in urban adults is a critical problem. More urban women (48 percent) are overweight compared to rural women (35 percent); the same is true for urban men (29 percent) compared to 17 percent for rural men.
Some urban nutrition interventions to tackle child undernutrition are being implemented, but few have been rigorously evaluated.
Data on urban food environments (FEs) is becoming more available, but there are gaps in knowledge, particularly on the design and evaluation of interventions to counter the influence of the country’s increasingly obesogenic urban FE.
National policies include targeted actions to improve urban diets and nutrition. More could be done, however, to improve the healthiness and safety of FEs, leverage social protection programs for the urban poor to make healthy diets more affordable, and to implement double-duty actions to address all forms of malnutrition.

Adapting to climate change: The case of saline tolerant seed varieties in coastal Bangladesh

Salt water intrusion and rising soil salnity are threatening food and livelihood security of paddy farmers in coastal Bangladesh. Visible manifestations of these challenges are degraded soils and chronic decline in tradtional farming, as it is becoming an increasingly infeasible means of livelihood. Promoting saline-tolerant paddy varieties (STRV) has been one of the major focuses of the Bangladesh Rice Research Institute (BRRI) and the attention to the problem has been intensified in recent years through a partnerhsip with a consortium of CGIAR centers. Howewer, robust empirical analysis has hitherto been limited. Using farm level data, this paper analyzes the determinants and impacts of the adopting these new varieties. We use a multi-variate logit model to identify the constraints to adoption, and Propensity Score Matching (PSM) and Endogeneous Switching Regression methods to assess the impacts on yeilds, and net income of the paddy farmers. Results show that adopting saline-tolerant rice varieties raises crop yield by an average of 1 to 2 tons per hectare, equivalent to a net income increase of about US$100 per hectare of cultivated land. Yet, adoption rates remain low due to several institutional constraints and perhaps a lack of nudging farmers in the scaling up strategies. Robustness of the results are tested, and the implications are discussed.

Medium-scale livestock farms in Asia’s rapidly transforming food systems

Academic and policy debates on agriculture emphasize a bimodal typology of ‘small-scale’ and ‘large-scale’ farms. In this article, we draw attention to the role and distinct characteristics of medium-scale monogastric livestock farms in the Global South, drawing on an empirically grounded typology of scale that incorporates three linked components: (1) Social and economic organization of production; (2) Technological choice and environmental impacts, and; (3) Food system linkages and spillovers. We review national livestock sector policy documents from three Asian countries - Bangladesh, Myanmar, and Vietnam - with reference to the typology, and compare assumptions embedded in the policies with the characteristics of farm scale revealed by the typology. Our analysis indicates that current policy goals are not well aligned with the characteristics of medium-scale livestock farming in the region. This disconnect presents a missed opportunity to enhance the livestock sector’s contributions to rural economies, nutrition security, food safety, and environmental performance. We conclude with examples of how policies could maintain and enhance medium-scale monogastriclivestock farms’ contributions to sustainable intensification, public health, and livelihoods.

Rural-urban diet convergence in Bangladesh

This paper seeks to bring concepts from economic geography and human geography into closer dialogue and apply them to the analysis of food systems. We analyze temporal and spatial patterns of diet trans formation in Bangladesh using data from nationally representative household surveys. We conceptualize diet transformation as a ‘triangle’ comprised of three elements (food purchases, diet diversification, and processed food consumption), influenced by four conditioners (time, income, non-farm employment, and space). We find that: (1) Diets are converging over time and space. food purchases, non-staples, and processed foods occupy high shares of food consumption value, irrespective of urban or rural location. Controlling for income, rural landless households and households in urban areas have very similar diets. Households in ‘peripheral’ and ‘non-peripheral’ rural areas experience similar levels of diet transformation. (2) Food purchases and processed food consumption are conditioned mainly by non-farm employment (NFE). (3) Diet diversification is positively associated with income, but not with NFE or land ownership. We characterize the spatial convergence of diets as an outcome of ‘time-space compression’ (the accelerating volume and velocity of economic and social transactions resulting from advances in transport and communications technology), and the distinct form of peri-urbanization under conditions of extremely high population density found in Bangladesh.

2022 Social Accounting Matrix for Bangladesh

The 2022 Bangladesh Social Accounting Matrix (SAM) follows IFPRI's Standard Nexus SAM approach, by focusing on consistency, comparability, and transparency of data. The Nexus SAMs available on IFPRI's website separates domestic production into 42 activities. Factors are disaggregated into labor, agricultural land, and capital, with labor further disaggregated across three education-based categories. The household account is divided into 10 representative household groups: Rural and urban households across per capita consumption quintiles. Nexus SAMs support the improvement of model-based research and policy analysis in developing countries and allow for more robust cross-country comparisons of national economic structures, especially agriculture-food systems.

Mobile phones, income diversification, and poverty reduction in rural Bangladesh

The widespread adoption of mobile phones (MPs) presents the possibility of creating employment and self‐employment opportunities. Although several studies have documented the impact of MPs on income, the link between MP ownership and poverty reduction channeled by income diversification has not been fully explored. This paper aims to examine this relationship using nationally representative panel data and fixed effect models to account for confounding factors and unobserved heterogeneity. Results indicate that MP ownership is associated with increased income diversification, particularly through on‐farm and off‐farm self‐employment, as well as non‐earned income. This relationship is more pronounced in households with lower levels of education and deprived areas. In addition, owning a MP is also found to decrease poverty via income diversification. Therefore, policies aimed at enhancing access to mobile technologies could create a resilient income portfolio by decreasing transaction costs and improving market efficiency, ultimately mitigating poverty in rural regions.

Can transfers and complementary nutrition programming reduce intimate partner violence four years post-program? Experimental evidence from Bangladesh

Little is known about whether reductions in intimate partner violence (IPV) from transfer programs persist. Using a randomized controlled trial, we find that women in rural Bangladesh who received cash transfers with complementary nutrition programming (including group-based training, home visits, and community meetings) experienced sustained reductions in IPV four years after the program ended. Neither cash transfers alone, nor food transfers with or without complementary nutrition programming, showed sustained impacts on IPV. Evidence suggests that cash with complementary nutrition programming sustained IPV reductions through persistent increases in women’s bargaining power, costs to men of perpetrating violence, and men’s emotional well-being.

Survey of Micro, Small, and Medium Enterprises in Agri-Food Value Chains: Network-Based Recruitment Approach in Bangladesh

The datasets and questionnaires in this package come from the second phase of IFPRI's "Digital Financial Services Adoption among SMEs in the Midstream of Agricultural Value Chains" project. This phase focused on midstream actors in the rice and potato value chains in Bangladesh, using tailored surveys to explore their financial capabilities and constraints. The surveys were conducted between June and August 2023 in the Bogra and Rangpur districts. The data collection was iterative, designed to capture insights from intermediary actors across different segments of the agri-food value chain. In randomly selected villages within our primary study areas, a brief farmer survey was used to identify intermediary actors they had sold commodities to in the last 30 days. These identified intermediaries were then contacted and interviewed using a more comprehensive survey. In Bangladesh, 280 rice farmers and 254 potato farmers participated in the farmer surveys. For the midstream actors, the sample includes 1,066 traders, 456 processors, and 220 wholesalers in the rice value chain, and 1,117 traders, 1 processor, 235 wholesalers, and 1 aggregator in the potato value chain.

Farming for the future: Prioritization of climate-smart agriculture technologies in SAARC countries

Climate-smart agriculture (CSA) is pivotal in combating the impacts of climate change on global agriculture and food security. It has increasingly gained prominence as an adaptation strategy against the adverse impacts of climate change on agriculture, particularly in South Asia. However, scaling up the adoption of CSA interventions becomes critical, due to predominantly small and marginal nature of landholdings in the region, various institutional and policy constraints, and trade regulations and barriers. Another significant challenge lies in categorizing and prioritizing the multitude of technologies considered to be climate smart. Therefore, this study attempts to explore the different CSA technologies within the socio-economic context of six South Asian countries: Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka, with the main objective of proioritization and scaling-up of these methods. The study begins by compiling an inventory of existing technologies and subsequently prioritizing them by using the World Bank (WB) CSA Technology Index. Secondly, the study tries to address the key challenges and propose policy measures to upscale the adoption of CSA technologies in these countries using participatory research conducted with the key stakeholders in these countries. The participatory research provided valuable insights, revealing critical policy and institutional barriers, and providing a basis for framing strategies and policy solutions to facilitate wider adoption of CSA technologies in the region.

Does nutrition-sensitive social protection build longer-term resilience? Experimental evidence from Bangladesh

Evidence shows that cash and in-kind transfer programs increase food security while interventions are ongoing, including during or immediately after shocks. But less is known about whether receipt of these programs can have protective effects for household food security against shocks that occur several years after interventions end. We study the effects of a transfer program implemented as a cluster-randomized control trial in rural Bangladesh from 2012-2014 – the Transfer Modality Research Initiative (TMRI) – on food security in the context of the COVID-19 pandemic. We assess TMRI’s impacts at three post-program time points: before the shock (2018), amidst the shock (2021), and after the immediate effects of the shock (2022). We find that TMRI showed protective effects on household food security during and after the pandemic, but program design features “mattered”; positive impacts were only seen in the treatment arm that combined cash transfers with nutrition behavior change communication (Cash+BCC). Other treatment arms – cash only, and food only – showed no significant sustained effects on our household food security measures after the intervention ended, nor did they show protective effects during the pandemic. A plausible mechanism is that investments made by Cash+BCC households in productive assets – specifically livestock – increased their pre-shock resilience capacity.

Food security and nutrition in Bangladesh: Evidence-based strategies for advancement

The International Food Policy Research Institute (IFPRI) prepared this report to provide a comprehensive assessment of food security in Bangladesh, with a focus on the core dimensions of availability, access, and utilization.

With support from Md. Al-Hasan, Sadat Anowar, Julie Ghostlaw, Mir Raihanul Islam, Razin Kabir, Md. Aminul Karim, Md. Aminul Islam Khandaker, Nabila Shaima, Raisa Shamma, and Sonjida Mesket Simi

Task or time? Comparing methods for measuring the gender distribution of work

There is growing evidence that gender disparities in the distribution of paid and unpaid work impose constraints on women’s well-being and livelihoods, reducing access to paid employment, and time for education, leisure, and social activities. Yet, gender disparities in unpaid work often go undiagnosed by traditional household surveys. While time-use surveys are well-suited for measuring unpaid work, they are often expensive to administer and take substantial amounts of survey time, leading to respondent fatigue, particularly in multi-topic surveys where other outcomes are also being collected.

In this paper, we compare data collected using the task allocation module in the Transforming Agrifood Systems in South Asia (TAFSSA) integrated household survey and the time-use module in the Women’s Empowerment in Agriculture Index (WEAI) survey. We begin by describing the methods used to collect the data in each of the surveys. We present an overview of the characteristics of the study sites in the TAFSSA integrated survey and sites in the same countries where the WEAI data were collected. We then present comparable data from each of the two methods. The findings confirm the gendered patterns in involvement in different activities as measured by both survey modules. While women’s participation in agricultural activities is high across Bangladesh, India, and Nepal, the amount of time they spend on agricultural activities is less than that spent by men. Both survey tools confirm that women undertake most of the food preparation-related activities, and men contribute through shopping/purchasing food.

2022 Social Accounting Matrix for Bangladesh: A Nexus Project SAM

The 2022 Bangladesh Social Accounting Matrix (SAM) follows IFPRI's Standard Nexus SAM approach, by focusing on consistency, comparability, and transparency of data. The Nexus SAMs available on IFPRI's website separates domestic production into 42 activities. Factors are disaggregated into labor, agricultural land, and capital, with labor further disaggregated across three education-based categories. The household account is divided into 10 representative household groups: Rural and urban households across per capita consumption quintiles. Nexus SAMs support the improvement of model-based research and policy analysis in developing countries and allow for more robust cross-country comparisons of national economic structures, especially agriculture-food systems.

Climate action through reducing food loss and waste: Lessons from Bangladesh, Malawi and Nepal

Reducing food loss and waste (FLW) is crucial to improving food security, reducing malnutrition, providing livelihoods for food system workers, and is key to combating climate change. Overall, food systems contribute an estimated 33 percent to anthropogenic greenhouse gas (GHG) emissions; food waste alone is responsible for eight to 10 percent. Yet, most countries that have submitted their Nationally Determined Contributions (NDCs) for reducing carbon emissions under the Paris Agreement have not included any commitments for reducing FLW. Many national FLW policies are not aligned with climate change goals and the NDCs. To make this bridge, countries must build supportive regulatory frameworks to reduce agrifood system emissions and include FLW as a mitigation measure.

From April to June 2024, the USAID-funded Comprehensive Action for Climate Change Initiative (CACCI), through its Asia program led by the International Food Policy and Research Institute, held national level consultations in Bangladesh, Malawi, and Nepal on FLW management.

Diet quality and associations with motivation and ability to consume a healthy diet among adolescents from urban low-income households in Bangladesh

In low- and middle-income countries, particularly in urban areas, adolescent diets consist mainly of energy-dense and nutrient-poor foods, putting them at risk of malnutrition and non-communicable diseases (NCD). In Bangladesh, little is known about the diet quality of adolescents, their food choices and the drivers of such choices. This study assessed motivations and ability to consume a healthy diet among adolescent girls and boys from low-income urban families and how these drivers were associated with dietary diversity and diet quality. A cross-sectional survey was conducted among 299 adolescents (15–19 years) from low-income households in Dhaka city during September–October 2020. The Diet Quality Questionnaire was used to collect non-quantitative food intake in the previous day or night to calculate diet quality indicators of food group diversity score, % of adolescents achieving minimum dietary diversity, NCD-Protect and NCD-Risk and the Global Dietary Recommendations score. Motivation was measured by 11 food choice motives. Ability was measured by belief in own ability to engage in healthy eating behaviors (self-efficacy). Adolescent diets showed a mean food group diversity of 4.9 out of 10, with 60% of adolescents achieving minimum dietary diversity, but lacked health-promoting foods (average of 2.7 out of 9 food groups) yet included few foods to avoid and limit (1.6 out of 9). Adolescents valued food choice motive ‘safety' the most, followed by ‘health', ‘taste', ‘price', ‘convenience' and ‘local or seasonal'. A higher motivation to consume ‘local or seasonal' and a lower motivation driven by ‘price', and a higher perceived self-efficacy were associated with better diet quality. Future interventions should address self-efficacy, concerns about food price and increase local and seasonal foods availability in the urban poor food environment of Dhaka to improve overall diet quality.

The unmet financial needs of intermediary firms within agri-food value chains in Uganda and Bangladesh

Intermediary firms within agri-food value chains operating between the farmgate and retailers typically account for at least as much, if not more, value added as the primary agricultural production sector of the economy, but little is known about how these small and largely informal firms conduct their business. Drawing on a set of innovative surveys implemented amid the arabica coffee and soybean value chains in Uganda and the rice and potato value chains in Bangladesh, we describe the financial activities of the firms that transform agricultural produce into food. We document four sets of results. First, across all intermediary actors in our data the overwhelming majority of transactions are cash-based. Second, although many intermediary actors are un-banked, access to financial accounts varies considerably by value chain segment, commodity, and country. Third, while most intermediary actors report using mobile money for personal purposes, especially in Uganda, very few use mobile money to facilitate business transactions. Fourth, although intermediary actors frequently report exposure to risk, very few effectively manage this risk. We conclude by discussing how intermediary agri-food value chain actors represent an underappreciated population for the promotion of new technologies both to improve the stability of the agricultural sector and to improve outcomes among smallholder farmers.

South Asia Nutrition Knowledge Initiative: Abstract digest August 2024

In this third edition of the South Asia Nutrition Knowledge Initiative’s Abstract Digest, we present studies on global, regional, and country-specific evidence on various topics of nutrition. These include the impact of short birth intervals on child malnutrition in the Asia-Pacific region, a summary of lessons from program evaluations of food systems interventions for nutrition in South Asia, the effect of zinc supplementation in pregnant and lactating mothers in a three-country study, and a review of evidence on school meals, impact on nutrition, and their other evolving dimensions.

The peer-reviewed country-specific studies are on anemia among women in Bangladesh, the double burden of malnutrition among women of reproductive age in India, and reproductive and child health transitions in India. Other country-specific studies pertain to community-based and nutrition program and multi-sectoral community development interventions in Nepal, and utilization of an integrated child development services program in India.

This issue also includes studies focusing on methods, such as measures for coverage of nutrition-sensitive social protection programs, a systematic scoping review examining aspects of quantitative nutrition research engaging with the intersectionality of inequities, a protocol to develop a data repository to support interdisciplinary research into childhood stunting, and a concept exploratory study on empowerment among adolescent girls.

We also highlight the availability of an open-access dataset for an integrated food systems assessment, which includes a wealth of data collected from Bangladesh, India, and Nepal spanning climate adaptation, agricultural production, food purchasing and shopping practices, gender disparities in unhealthy eating, adolescent diets and aspirations, and much more!

Below is the list of articles. Please scroll down to explore the abstracts in the pages that follow. If this Abstract Digest was forwarded to you, we invite you to subscribe.

Happy reading!

Climate shocks and fertilizer responses: Field-level evidence for rice production in Bangladesh

The fertilizer response of yield has been one of the major indicators of agricultural productivity in both developed and developing countries. Filling the evidence gap remains vital regarding fertilizer response in Asia, particularly in South Asia, given the evolution and emergence of new challenges, including intensifying climate shocks. We aim to partly fill this knowledge gap by investigating the associations between climate shocks and fertilizer response in Bangladeshi rice production. Using three rounds of nationally representative farm household panel data with plot- level information, we assess fertilizer response functions regarding rice yield and how the shapes of these response functions are heterogeneous in relation to anomalies in temperatures, droughts, and rainfall. We find robust evidence that climate anomalies have adverse effects on fertilizer responses, including higher temperatures for the Boro and the Aman irrigated systems and higher temperatures and droughts for the Aman rainfed systems. These findings hold robustly under various fertilizer response function forms, i.e., polynomial function and stochastic Linear Response Plateau. Furthermore, results for stochastic Linear Response Plateau are also consistent for both switching regression type models and Bayesian regression models.

JEL Codes: Q01, Q12, Q01, Q19

An ex-ante analysis of the impact of biofortified zinc rice on dietary zinc inadequacy: Evidence from Bangladesh, Indonesia, and the Philippines

Background: South, East, and Southeast Asia are among the regions of the world with the highest estimated prevalence of inadequate zinc intake. Because populations in those regions eat rice as their main staple, zinc biofortification of rice can potentially improve zinc intake, especially among the most vulnerable.
Objectives: We modeled the impact of the consumption of zinc-biofortified rice on zinc intake and inadequacy among women of childbearing age and young children nationally in Indonesia, the Philippines, and at a subnational level in Bangladesh.
Methods: We conducted an ex-ante analysis by applying increments of zinc content in rice, from a baseline level of 16 parts per million (ppm) to 100 ppm, and based on rice consumption data to substitute levels of conventional rice with zinc-biofortified rice varying between 10% and 70%.
Results: Among all datasets evaluated from these 3 countries, the prevalence of dietary zinc inadequacy at baseline was 94%–99% among women of childbearing age, 77%–100% among children 4–5 y old, and 27%–78% among children 1–3 y old. At the current breeding target of 28 ppm, zinc-biofortified rice has the potential to decrease zinc inadequacy by ≤50% among women and children in rural Bangladesh and among children in the Philippines where consumption of rice is higher compared with Indonesia.
Conclusions: Our analysis shows that increasing zinc content in rice ≤45 ppm reduces the burden of zinc inadequacy substantially, after which we encourage programs to increase coverage to reach the highest number of beneficiaries.

The causal effect of early marriage on women's bargaining power: Evidence from Bangladesh

Early marriage restrains women's agency and bargaining strength in postmarital households, impairing their ability to make meaningful contributions to household decision making. This paper employs a comprehensive measure of women's empowerment in the domestic and productive spheres, and isolates the causal effect of age at marriage, instrumented by age at menarche, on their bargaining strength, using nationally representative data from Bangladesh. Results suggest that delayed marriages result in significantly higher empowerment scores and probability of being empowered for women, because of higher likelihood in achieving adequacy in their autonomy in agricultural production, control over income, ownership of assets and rights in those assets, and ability to speak in public. Favorable impacts of delayed marriage are also found on women's freedom of mobility, fertility choices, and their ability to decide on household expenses and investments, with the impacts likely coming via improvements in education and labor market outcomes when women married later.

Geospatial variation in dietary patterns and their association with heart disease in Bangladeshi population: Evidence from a nationwide survey

Heart disease is a significant public health threat, and its burden is increasing worldwide. Recent evidence suggests that dietary pattern is a key modifiable factor for heart disease. Research regarding dietary patterns and heart disease in Bangladesh with their spatial variability is limited. In this study, the spatial variation and relationship between dietary patterns and heart disease among Bangladeshi people was investigated. The country-representative Household Income and Expenditure Survey 2016 dataset was used, and a total of 77,207 participants aged 30 years and over were included. A principal component analysis was conducted to derive the dietary patterns. Both statistical and spatial analyses were performed. The overall prevalence of heart disease was 3.6%, with a variation of 0.6% to 10.4% across districts of Bangladesh. Three major dietary patterns, named “festival pattern”, “pickles and fast foods pattern”, and “rice and vegetable pattern” were identified, accounting for 25.2% of the total dietary variance. Both the dietary pattern and heart disease rate varied across the region. A higher risk of heart disease was persistent in the western-south, southern, central, and eastern regions, as was greater adherence to the “festival pattern” and “pickles and fast foods pattern.” After adjusting for confounders, participants with the highest adherence to the "rice and vegetable pattern" were associated with a lower likelihood of developing heart disease (AOR: 0.78, 95% CI: 0.64–0.95, p <0.05), while the highest adherence to the "pickles and fast foods pattern" was associated with a higher likelihood of developing heart disease (AOR: 1.50, 95% CI: 1.27–1.76, p <0.001). The spatial disparities in the prevalence of heart disease and dietary patterns underscore the significance of prioritizing intervention at the district level, especially in the western-south, southern, central, and eastern regions, to control the rising heart disease trends in Bangladesh.

Feasibility of nationwide warehouse receipt system: An assessment of the potential for a nationwide warehouse receipt system and recommendation for the requisite legal and regulatory framework

Warehouse receipts systems (WRS) have been used to tackle multiple challenges faced by farmers. In the absence of adequate collateral and consequent credit constraints, a WRS enables the use of inventory as collateral for loans, thus removing a key constraint farmers face. With growing digital reach, electronic based Negotiable Warehouse Receipts (e-NWR) that can be swapped, exchanged and traded and can assist in deepening financial markets while maintaining the integrity of the system. While e-NWRS can potentially address farmer level constraints, they can also be viewed from a larger policy perspective as a system that aids government plans for food security and manage public procurement operations better and more nimbly; it can also play a key role for enhancing the efficiency and food quality and safety along value chains by enabling mid-stream players like traders and importers to manage these chains better. This report seeks to inform the policy process around e-NWRS by focusing on the potential of Ware house Receipt Financing, more broadly, in the agricultural development of Bangladesh. To do this we review global evidence as well as evidence closer to home, within South Asia, to understand the pre-conditions and prerequisites for a successful system.

Diagnostic study of DG Food: An assessment of DG Food’s current mandates, performance, and capacity gaps, and a remedial program to strengthen the agency

This study conducts an assessment of the current mandates, performance, and capacity gaps of the Directorate General of Food (DG Food) and suggests remedies to strengthen the agency. Formed originally as the Supply Department in undivided Bengal under British rule in the early 1940s, the organization was named the Directorate General of Food by the provincial government of East Pakistan in 1956. Upon the independence of Bangladesh in 1971, DG Food became a part of the Ministry of Food and Civil Supplies and was later renamed as the Directorate General of Food in 1975. The last major reorganization of the agency took place in 1984. The current mandates and organogram are from 1984. As the custodian of the Public Food Distribution System (PFDS), DG Food plays an important role for the Government of Bangladesh (GoB). Under the Social Safety Net Programs (SSNP) of the GoB, DG Food ensures food security for vulnerable populations. In its sprawling countrywide network of 650-plus traditional warehouses, DG Food has an effective storage capacity of 1.9 million tons. In recent years, DG Food has procured and distributed approximately 3.0 million tons of foodgrains per year. A very large organization, DG Food has a sanctioned workforce of over 13,000 officers and employees, and an annual budget of approximately 1.5 billion U.S. dollars.

Private investments in modern food storage: An economic feasibility analysis for private investments in modern food storage and potential public sector roles in promoting such investments

Unprecedented growth in rice production in Bangladesh over the last four decades has outpaced the capacity of post-harvest operations, resulting in substantial grain losses. While production technology has changed dramatically over time, there has been relatively little private investment in transforming storage capacity in the country. This paper explores the lack of widespread private investment in improved grain storage and examines the potential for public support to stimulate greater private sector investment in modern storage. We calculate the returns to investment in bulk grain silos and hermetic cocoons that could upgrade warehouse storage, and calculate the grain loss that conversion to those technologies would prevent. We then assess the public support that would be required to trigger private investment in modern storage systems. Our analysis shows that storage in jute bags in warehouses or homes outperforms the modern technologies in terms of financial returns at observed prices. Our analysis further shows that given the observed price changes during the harvest and post-harvest periods from 2008 to 2018, cocoon and silo storage as well as conventional warehouse storage were unprofitable in most years and on average overall. Although seasonal variation in market prices for paddy is sometimes pronounced, the pattern of the variation is not sufficiently large or consistent to make paddy storage reliably profitable. Conventional warehouse storage implied an average loss of BDT 2,877/MT/season over the 20 seasons considered. Use of modern storage methods would have implied average losses of BDT 3,200/MT/season to BDT 4,950/MT/season, depending on technology used. These results imply that a public sector co-investment on the order of BDT 300/MT would be required to trigger a shift from conventional to modern storage by traders or millers. This shift would imply a reduction in grain loss of 30kg to 80kg per MT stored for a public cost of BDT 3.75 to BDT 10.00 per kilogram of loss avoided. To make it profitable for intermediaries to provide commercial storage services to farmers who currently store on-farm would require a much larger co-investment of about BDT 3,200/MT stored, implying BDT 40 to BDT 106 per kilogram of loss avoided. Removal of import tariffs on storage technologies or realization of a price premium for silo-stored or hermetically stored grain could be sufficient to encourage millers to adopt modern storage, but would be inadequate to trigger increased off-farm storage as an independent activity. There is anecdotal evidence of a price premium for paddy that has been stored using improved technology. Existence of such a premium could significantly reduce public support needed to trigger private investment in improved storage.

Effectiveness of current and alternative procurement modalities: An evaluation of the effectiveness of current and potential alternative grain procurement modalities, and development of a framework for stock turnover

This report has been prepared as one of the deliverables of the Bangladesh Integrated Food Policy Research Program (BIFPRP) implemented by the Ministry of Food, Government of Bangladesh under a World Investment for Modernizing Food Storages Facilities in the country. The key arguments and recommendations drawn up for the report are based on both quantitative and qualitative data. Food and agricultural policies have historically played a crucial role in triggering growth in many developing countries. While there were debates, public procurement and distribution of food are widely accepted as a “second best” solutions for countries characterized by markets and institutional failures. However, Bangladesh has done remarkably well in adjusting to changing realities and the country is now widely recognized for its agricultural policy reforms. But there is still room for further improvement and efficiency gains for which two broad sets of recommendation can be considered:
1) Pricing and procurement targets - Pricing in Bangladesh continues to be based on the average cost of production but with the application of satellite imageries, app-based small area estimation, the procurement price estimates can be improved substantially. Also, the current procurement target determination formula misses out on some key aspects of production, marketing, and macroeconomic parameters. The quota for each upazila is based on total production and milling capacities but it also needs to consider the net surplus to calculate how much could be procured in each Upazilas.
2) Alternative procurement modalities
a) The report recommends changing this modality to Delivered to Destination Warehouse (DDW) through the open tendering method and undertaking pilots and learning from experiences to enhance efficiency can be important.
b) Linking smallholders to markets through product aggregation has received renewed attention globally. Available data suggests that Bangladesh’s public procurement has thus far not managed to effectively integrate small farmers to its procurement system. To scale up nationally, we believe that more innovation in technology and a new institutional set up will be necessary.
c) Implementing Delivered Duty Paid Modality on a pilot basis where the seller assumes all responsibilities and costs for delivering the goods to the named place of destination.
d) Piloting Deficiency Payment Method as an effective method to provide both income and price to farmers of a wide range of agricultural commodities. Two key instruments of implementing this method would be Marketing Assistance Loan (MAL) and the Loan Deficiency Payment (LDP), which are tools available to the farmers. A recent report by the NITI Aayog of India also makes a strong case for this procurement modality and we also argue in favor of undertaking this pilot.

Foresight for food markets: Developing and implementing market forecasting methods/models

The “Foresight for Food Markets: Developing and Implementing Market Forecasting Methods/Models with Hands-on Training at the FPMU” is an element of Integrated Food Policy Research Program (IFPRP). Originally signed in 2016 between the Government of Bangladesh (GoB) and the Joint Venture (JV) comprising the International Food Policy Research Institute (IFPRI), the Bangladesh Institute of the Development Studies (BIDS), and the University of Illinois, IFPRP was extended and modified in subsequent periods. The most recent updated contract between the GoB and the JV was signed in mid-2022. Deliverable 4.3, Foresight for Food Markets: Developing and Implementing Market Forecasting Methods/Models with Hands-on Training at the FPMU is one of the new deliverables included in the updated contract. Rising prices of essential commodities affect consumer welfare and pose a serious challenge to the Government of Bangladesh. Knowing prices of essentials in advance would allow the government to take necessary measures to restrain the extent of price increases or to mitigate effects of rising prices; such measures could include provisions of direct distributions of rice and wheat through social safety net programs or of subsidized open market sales on the one hand and engaging in direct imports of essentials or easing import restrictions for the private sector, on the other. Because price fluctuations are a feature of a free market, there is a persistent need for the government to be able to project consumer prices in advance. Accordingly, it is important that in addition to receiving estimates prepared by external experts, the government has the ability to obtain its own price projections; the government should have the estimates when it needs them and for commodities for which such information is needed. Against this backdrop, IFPRP is providing hands-on training on price projection techniques to officials from the Food Planning and Monitoring Unit (FPMU), the Directorate General of Food (DG Food), and the Ministry of Food (MoFood). It is envisioned that trained officials from the DG Food, the Ministry of Food, and mostly from the FPMU will produce price projection estimates on their own with IFPRP personnel helping a consultative capacity.

Implementation of paddy drying technology: Introducing small/medium paddy dryers in remote areas

Grain drying has become increasingly challenging for the Bangladesh food system as postharvest innovations have not kept pace with production growth and an increasing volume of grain is harvested during wet or foggy periods, when conventional open-air drying is problematic. This activity sought to build capacity for mechanical dryer service provision by small-scale entrepreneurs and to demonstrate a model for providing mobile grain drying services through entrepreneurs using a locally manufactured small-scale dryer. In coordination with Ministry of Food officials, the project selected 20 farmers to train as mechanized drying service providers, provided them with use of small-scale mobile batch dryers, and deployed them in rural areas from which Local Supply Depots (LSDs) source grain. The service providers were active in Bogura and Rangpur Districts in late May 2023, during the closing phases of the Boro harvest season. The pilot revealed nuances of the costs of operation and indicated potential for viable business activities, especially in areas where open-air drying is relatively costly or inadequately available. Additionally, a scoping visit to Naogaon District revealed significant interest in mechanized drying services. The findings suggest a value to additional observation of the service providers to document capacity utilization over an Aman season and a full Boro season. Such observations would allow confirmation about parameters related to annual capacity utilization which are important determinants of business viability

Gender disparities in food shopping patterns: Evidence from rural Bangladesh, India, and Nepal

Objectives: Understanding gender differences in food acquisition and decision-making is needed to inform policies promoting healthy diets for all. We compare food acquisition patterns and preferences of men and women in three South Asian countries.
Methods: In 2023, 4,000 rural households with adolescents were randomly selected with a proportional probability per village in five districts: Rajshahi and Rangpur in Bangladesh, Nalanda in India, and Banke and Surkhet in Nepal. Adults primarily responsible for household food purchases were asked where, why, and how they acquired frequently consumed foods. Foods were categorized as healthy or unhealthy. Analyses compared shoppers’ responses by country, district, and gender.
Results: Food shoppers (n=2,555) were primarily men in India and Bangladesh, women in Nepal, and averaged 41 years of age. Food purchases were mostly from retail outlets in India and Nepal, and wholesale open-air markets in Bangladesh. Shoppers’ preferred purchasing source was primarily based on cost and distance. On average, shoppers traveled 2.9 km to purchase food, women 0.9 km further than men. Unhealthy foods were purchased more than healthy foods (2.6 vs 1.3 times/mo), with biscuits most often (3.8 times/mo). Nepal had 66% lower food purchase frequency than Bangladesh. Purchases varied by gender and country: healthy and unhealthy foods were purchased more by men in Bangladesh and women in India. In Nepal, men purchased more healthy foods than women, and women purchased more unhealthy foods than men. In India and Nepal, shoppers found unhealthy foods as more accessible and affordable than healthy foods; in Bangladesh, shoppers found healthy foods more accessible and affordable. Perceptions varied by gender and country: men found healthy and unhealthy foods more accessible and affordable than women in Bangladesh and Nepal, in India, such perceptions were predominant among women. With more income, men and women would purchase more animal-sourced foods and produce and fewer unhealthy foods. Women would purchase more legumes and grains than men.
Conclusions: In rural South Asia, women perceived healthy foods as less affordable and accessible and purchased unhealthy foods more frequently than men. Policies and programs are needed to improve healthy food access, lower costs, and promote gender equity in food acquisition.

Utilization of maternal nutrition services during antenatal care and its association with nutrition practices in Bangladesh, Burkina Faso, Ethiopia, and India

Objectives: Adequate coverage of antenatal care (ANC) and its related services are essential for maternal and newborn health and nutrition. Interventions to strengthen health systems in the delivery of nutrition interventions during ANC were implemented in Bangladesh (BD), Burkina Faso (BF), Ethiopia (ET), and India (IN). This study examined the coverage and equity of ANC services and the association between service utilization and maternal nutrition practices.

Market and retail food environments in South Asia: A comparative analysis of five rural districts

Objectives: Safe, nutritious foods are out of reach for many consumers in South Asia. Variations in food environments across the region are not well understood. This study examines food environment infrastructure and availability of healthy foods in three South Asian countries.
Methods: An agri-food systems assessment surveyed 50 villages per district in Bangladesh (Rajshahi, Rangpur), India (Nalanda), and 25 wards per district in Nepal (Banke, Surkhet) from December 2022 to June 2023. Villages were randomly selected with a probability proportional to the number of households per village. Shops were categorized into market or retail by operational structure and types of food sold. Observations and structured interviews with vendors, shop owners, and managers were used to compare food market and retail infrastructure, healthy food availability, and food promotion.
Results: A total of 247 formal and informal markets and 3,117 retail outlets were surveyed. Semi-permanent market structures were common in all districts (67%). In Bangladesh, 62% of retail outlets were semi-permanent structures. Most retail outlets in Nepal (81%) had no structural damage; in Bangladesh, 50% had some damage. Over 60% of markets in India and Bangladesh had some structural damage. Infrastructure to facilitate safe hygiene practices (water and waste services) was 95% in Bangladesh and 56% in Nepal. Although generally low, retailer adherence to food safety and hygiene practices was highest in India (25%). Local grocery stores, with limited selections of fresh produce, were the dominant retail type in Bangladesh (71%) and India (77%). Nepal had the highest percentage (16%) and density (mean 3) of vegetable and fruit shops, with high variability (SD 4.82). Retail stores had similar ratios of healthy and unhealthy foods. Ratio of healthy food retail outlets was highest in Nepal (17%) and lowest in Bangladesh (4%). Whereas overall promotion of foods was low, all districts promoted unhealthy foods over healthy foods, with India (60%) and Bangladesh (50%) leading.
Conclusions: Retail outlets were in good structural condition, retailer adherence to food safety practices was low, healthy retail outlets were sparse, and promotion of unhealthy foods was higher than healthy foods, highlighting a need for interventions to improve availability and access to healthy foods.

Consumption, sources, and perceptions of unhealthy foods Among adults and adolescents in rural South Asia

Objectives: South Asian nations are experiencing a nutritional shift, transitioning from traditional diets to more energy-dense and processed alternatives containing added sugars, high salt, and saturated or trans fats, commonly known as unhealthy foods. This study examined unhealthy food consumption patterns, sources of acquisition, perceptions, and information sources among adults and adolescents in rural South Asia.
Methods: The Transforming Agrifood Systems in South Asia survey was conducted in 2023 across five rural districts (Bangladesh: Rangpur and Rajshahi; Nepal: Banke and Surkhet; India: Nalanda). In each district, 25 villages/wards and 4,000 households were selected (n=6,007 adults and n=3,995 adolescents). Dietary intake was assessed using 24-hour dietary recall via the Global Diet Quality Score application and a 7-day food frequency questionnaire. Information on eating occasions, purchasing habits, perceptions, and exposure to food advertisements was also collected.
Results: Among all unhealthy foods, sweets and ice cream had the highest daily consumption, ranging from 42-75% among respondents based on respondent type and district. Compared to India and Nepal, daily consumption of processed meat was 10-15 times higher in Bangladesh. Bangladeshi males consumed twice as much unhealthy food in the afternoon per day than other countries. Over the last 7 days, 38% adults and 22% adolescents consumed tea/coffee with sugar daily. Biscuits were perceived as safer and more nutritious compared to other unhealthy foods in Bangladesh (70%) and India (60%) than in Nepal (37%). Most unhealthy foods were purchased from large open-air markets in Bangladesh (60%) or small retail shops in Nepal (85%) and India (78%). Adolescents (47%) were more exposed to unhealthy food advertisements than adults (33%) in the past month, especially for soft drinks. However, adolescents (26%) also received more information on avoiding unhealthy foods than adults (14%), mostly from family/friends (44%) and schools (42%).
Conclusions: In South Asia, adults and adolescents consume a notable portion of their diets from unhealthy foods, with easy access and extensive exposure to unhealthy food advertisements. Further research on how lived experiences of the food environment impact the demand and consumption of unhealthy foods is needed.

Achieving sustainability and scalability of a large-scale prenatal cash and food transfer intervention in Bangladesh

Objectives: The WHO (2016) antenatal care guidelines recommend research on alternatives to prenatal energy and protein supplements – such as cash or food distribution. The Bangladesh government is currently implementing the Mother and Child Benefit Programme (MCBP) to improve prenatal nutrition and child health. We conducted implementation research that aimed to understand how the MCBP, and augmented versions of it, 1) stimulated behavior changes, 2) enabled or prevented participants to sustain behavior changes, and 3) achieved conditions required for program scale-up.

Changes in norms about infant and young child feeding in rural Bangladesh during the Alive & Thrive Initiative

Objectives: Norms play an important role in shaping infant and young child feeding (IYCF) practices. IYCF interventions to improve child feeding practices among mothers may ultimately translate into norms in their communities. The Alive and Thrive (A&T) initiative, beginning in 2009, implemented social, and behavior change interventions to improve IYCF practices like breastfeeding and complementary feeding in rural Bangladesh. This study aimed to understand the normative patterns of IYCF practices and how they changed over time.

Consumer preferences matter for transforming food systems for sustainable healthy diets: Evidence from rural Bangladesh

Food system transformation strategies rely on consumer demand response for achieving sustainable healthy diets, but food consumption patterns and consumer preferences are often not well understood in many countries of the global South. This brief examines consumer demand in Bangladesh, a country in the take-off stage of agrifood system transformation, that has experienced improvements in diet quality but also an increasing incidence of overweight, with faster increases in rural than urban areas. The authors estimate responses in consumer demand to changes in incomes and changes in food prices, finding that rural consumer demand is driven by strong preferences for animal-source foods, while the demand for sugar and highly processed foods increases faster than total food demand when income rises. They conclude that agricultural value chain development can be an important policy instrument for improving household diet quality but can also lead to undesirable dietary change if food consumption incentives conflict with nutritional needs.

IFPRI's country programs: Facilitating country-led food systems transformation

In most low- and middle-income countries, agrifood systems constitute a sizable share of economic activity and serve as a primary source of livelihoods, especially for poorer members of the population. As a result, national development strategies frequently put strong emphasis on the agrifood sector to achieve key goals, such as accelerating economic growth, reducing poverty, improving food and nutrition security, and confronting climate change. This emphasis was confirmed at the 2021 United Nations Food Systems Summit, where more than 100 countries committed to transforming their food systems to make them more productive, nutrition-focused, inclusive, resilient, and sustainable, and it was further reinforced by the Food and Agriculture Declaration at COP28. To achieve these desired transformations, governments require data and research based evidence to assess the situation, identify solutions, and prioritize actions. Governments are also increasingly interested in enhancing institutional capacity to support country-led development pathways.

A network-driven data collection approach for agri-food value chains

A key challenge in systematically collecting data on intermediary agri-food value chain actors is that value chains take the form of a network, with actors linked by a series of transactions. Moreover, we have limited ex ante knowledge about the structure or scale of these networks, which complicates the construction of valid sampling frames and limits traditional random sampling approaches to collect data. To address these challenges, we adapt the respondent-driven sampling approach to collect data on intermediary agri-food value chain actors within their transaction-linked network and implement this approach in the arabica coffee and soybean value chains in Uganda and the rice and potato value chains in Bangladesh. We observe meaningful heterogeneity in the structure and scale of agri-food value chains across commodities and countries. Focusing on traders, we show that the respondent-driven sampling approach generates a larger sample of traders who differ in observable characteristics (i.e., value added, enterprise scale, and financial access) compared to a sub-sample of traders generated in a way that mimics traditional random sampling approaches used to study traders. We conclude by discussing how this respondent-driven sampling approach, applied within transaction-linked networks, can provide a useful data collection method for studying intermediary agri-food value chain actors.

Assessing the impact of rice price stabilization policies in Bangladesh: Results from a stochastic spatial equilibrium model

Rice plays a central role in the diet in Bangladesh and as a source of income for farmers. Although Bangladesh has largely liberalized international trade in rice, it maintains a public food distribution system to stablize prices, distributing an average of 2 million tons of rice per year at a cost of almost US$ 800 million per year. This study explores whether alternative policies could achieve similar stabilization at a lower cost. It uses a stochastic spatial-equilibrium model of rice markets to simulate monthly prices in eight regions of the country. Stochastic shocks are used to simulate fluctuations in regional production, replicating historical patterns at the region-season level, as well as inter-regional correlation in production shocks. It also simulates fluctuation in world rice prices, mimicking the mean, variance, and serial correlation of historical wholesale prices of rice in Delhi. Public procurement and distribution follow historic averages by month and region. Private storage is represented by a simplified version of rational expectations models, in which net storage is a non-linear function of availability in the previous month.

One set of simulations tests alternative levels of distribution, finding that cutting distribution to 1 million tons would have minimal effects on the level of rice price stability. Another set of simulations tested different import tariff levels, including the baseline rate of 25%1. We find that lower tariffs result in both lower rice prices and less price instability, as world rice prices tend to be more stable than local prices. Simulating a buffer stock with different price bands shows that a narrow band can achieve high price stability but at a high fiscal cost. A 20 T/kg (USD 0.26/kg) price band generates similar price stabilization at a lower cost compared to current policy. However, it is difficult to set the “right” purchase and sale price, and many simulations result in exhausting reserves or reaching warehouse capacity. An adaptive buffer stock, in which the price is adjusted as the stock runs too low or too high, solves some of these problems. In general, the study finds that current procurement and distribution patterns do not match well with the regional and monthly patterns of surplus and deficit, possibly reflecting multiple and conflicting goals of the public food distribution system.

Increasing production diversity and diet quality: Evidence from Bangladesh

In the context of rural Bangladesh, we assess whether agriculture training alone, nutrition behavior communication change (BCC) alone, combined agriculture training and nutrition BCC, or agriculture training and nutrition BCC combined with gender sensitization improve: (a) production diversity, either on household fields or through crop, livestock, or aquaculture activities carried out near the family homestead; and (b) diet diversity and the quality of household diets. All treatment arms were implemented by government employees. Implementation quality was high. No treatment increased production diversification of crops grown on fields. Treatment arms with agricultural training did increase the number of different crops grown in homestead gardens and the likelihood of any egg, dairy, or fish production but the magnitudes of these effect sizes were small. All agricultural treatment arms had, in percentage terms, large effects on measures of levels of homestead production. However, because baseline levels of production were low, the magnitude of these changes in absolute terms was modest. Nearly all treatment arms improved measures of food consumption and diet with the largest effects found when nutrition and agriculture training were combined. Relative to treatments combining agriculture and nutrition training, we find no significant impact of adding the gender sensitization on our measures of production diversity or diet quality. Interventions that combine agricultural training and nutrition BCC can improve both production diversity and diet quality, but they are not a panacea. They can, however, contribute toward better diets of rural households.

Resilience of social transfer programs to large unexpected shocks

Large, unexpected shocks are becoming more frequent, making the design of robust social transfer programs more vital than ever. We evaluate the performance of the Food Friendly Program (FFP), the largest in-kind social transfer program in Bangladesh, before and during the nation-wide COVID-19 lockdown. Using two-rounds of nationally representative household surveys combined with administrative data, we document that high leakages and large welfare losses are related to corruption. This contrasts with the performance of the pre-lockdown FFP, when leakage was low and coverage high. We then compare the performance of the FFP with two initiatives launched following the pandemic: an in-kind and cash transfer program, respectively. These programs have markedly higher levels of leakage than the FFP. Our findings are relevant to other large shocks, such as those caused by climate change, and have important policy implications for the design and delivery of transfer programs in developing countries characterized by institutional weaknesses.

Transformation of the “hidden middle” of aquaculture value chains: fish wholesalers in Bangladesh

Wholesalers in food value chains in developing countries are often criticized as exploitative, offering high output-tied credit to farmers and insufficient with high loss and waste. Recent research highlights their importance as the "hidden middle", often overlooked in policy debates due to insufficient survey research (Reardon 2015). Aquaculture has rapidly expanded in Bangladesh in four decades, attributed to aquatic food traders and off-farm businesses. However, little is known about wholesalers’ behavior and organization within the 'hidden middle' of aquatic food value chains, impeding result generalization due to inadequate sampling techniques in previous research. Thus, this study aimed to evaluate structure, technological changes, and wholesalers’ performance, informing policy debates on aquatic food value chains in Bangladesh.

South Asia Nutrition Knowledge Initiative: Abstract digest April 2024

Welcome to the first edition of South Asia Nutrition Knowledge Initiative’s (SANI) Abstract Digest! In each issue, we aim to curate a selection of the latest and relevant studies on maternal and child nutrition for the South Asia region. We conduct literature search across peer-reviewed journals and identify studies of relevance. The abstracts in this document are reproduced in their original form from their source, and without editorial commentary about specific articles.

In this first edition, we include global studies on trends in malnutrition, health inequalities of common nutrition deficiencies in children and the importance of gender-sensitive social safety nets and nutritionspecific and -sensitive interventions in the low-and middle-income countries. There are interesting studies from South Asia with a focus on Bangladesh, India and Nepal on topics including geospatial and environmental determinants of undernutrition, dietary diversity assessment of pregnant adolescent girls and nutrition interventions such as mid-day meal program in India and Suaahara in Nepal.

Below is the list of peer-reviewed articles. Please click on the title if you wish to go straight to the article or scroll down to explore the abstracts in the pages that follow.

Happy reading!

Who is absent and why? Factors affecting doctor absenteeism in Bangladesh

Absenteeism by doctors in public healthcare facilities in rural Bangladesh is a form of chronic rule-breaking and is recognised as a critical problem by the government. We explored the factors underlying this phenomenon from doctors’ perspectives. We conducted a facility-based cross-sectional survey in four government hospitals in Dhaka, Bangladesh. Junior doctors with experience in rural postings were interviewed to collect data on socio-demographic characteristics, work and living experience at the rural facilities, and associations with professional and social networks. Multiple logistic regression was used to determine the factors associated with rural retention. Of 308 respondents, 74% reported having served each term of their rural postings without interruptions. The main reasons for absenteeism reported by those who interrupted rural postings were formal training opportunities (65%), family commitments (41%), and a miscellaneous group of others (17%). Almost half of the respondents reported unmanageable workloads. Most (96%) faced challenges in their last rural posting, such as physically unsafe environments (70%), verbally abusive behaviour by patients/caregivers (67%) and absenteeism by colleagues that impacted them (48%). Respondents who did not serve their entire rural posting were less likely to report an unmanageable workload than respondents who did (AOR 0.39, 95% CI 0.22–0.70). Respondents with connections to influential people in the local community had a 2.4 times higher chance of serving in rural facilities without interruption than others (AOR 2.40, 95% CI 1.26–4.57). Our findings demonstrate that absenteeism is not universal and depends upon doctors’ socio-political networks. Policy interventions rarely target unsupportive or threatening behaviour by caregivers and community members, a pivotal disincentive to doctors’ willingness to work in underserved rural areas. Policy responses must promote opportunities for doctors with weak networks who are willing to attend work with appropriate support.

Prevalence, trends, and inequality in noncommunicable diseases in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys 2011 and 2017–2018

We investigated the change of the prevalence of noncommunicable diseases (NCDs) in Bangladesh from 2011 to 2018 across different socioeconomic groups as well as the factors associated with the changes in prevalence. We used the two waves of the Bangladesh Demographic and Health Surveys conducted in 2011 and 2017–2018. Modified Poisson regression model was used to estimate the prevalence rate and ratio of NCDs and to test the association with different demographic and socioeconomic variables. The study found an upward trend of NCDs from 2011 to 2017 in which overweight and obesity, hypertension, and diabetes increased by 1.8, 1.5, and 1.1 times, respectively. In 2011, people from the richest households had 5.6 higher odds of being overweight compared to the poorest, which was reduced to 3.0 in 2017. However, the increment for overweight and hypertension was the highest among the poor and manual workers from 2011 to 2017. The age-adjusted prevalence ratio of overweight increased 4.4 times for the poorest, compared to 1.7 times for the richest. For manual workers, overweight increased 3.8 times, whereas hypertension increased by 2.4 times. The pooled analysis revealed that participants from the richest households have the highest risk of NCDs, with 3.3 times for overweight, 2.3 times for diabetes, and 1.3 times for hypertension, compared to the poorest. However, the prevalence of NCDs is rising quickly among the low socioeconomic groups in Bangladesh, narrowing the gap with higher socioeconomic groups. Our findings call for immediate policy interventions and targeted programs to curb NCD escalation in Bangladesh.

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Community

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at supporting actions that improve equitable access to sustainable healthy diets, enhance farmers’ livelihoods and resilience, and conserve land, air, and water resources in South Asia. The TAFSSA district agrifood systems assessment aims to provide a reliable, accessible, and integrated evidence base that links farm production, market access, dietary patterns, climate risk responses, and natural resource management with gender as a cross-cutting issue in rural areas of Bangladesh, India, and Nepal. It is designed to be a district-level multi-year assessment. Data were collected in February-March 2023 in the Rangpur and Rajshahi districts in Bangladesh. Three respondents were interviewed per household: a female adult (aged 20+ years) primarily responsible for managing the household, a male adult (aged 20+ years) primarily responsible for agricultural activities, and an adolescent (aged 10-19 years). The assessment also included a community questionnaire, which interviewed a key informant in the district villages. The community questionnaire was conducted using pretested, structured questionnaires. Information was collected on village demographic composition, wage rates, and machine rental costs during the agricultural season, infrastructure, and groundwater and land use.

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Female

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at supporting actions that improve equitable access to sustainable healthy diets, enhance farmers’ livelihoods and resilience, and conserve land, air, and water resources in South Asia. The TAFSSA district agrifood systems assessment aims to provide a reliable, accessible, and integrated evidence base that links farm production, market access, dietary patterns, climate risk responses, and natural resource management with gender as a cross-cutting issue in rural areas of Bangladesh, India, and Nepal. It is designed to be a district-level multi-year assessment. Data were collected in February-March 2023 in the Rangpur and Rajshahi districts in Bangladesh. Three respondents were interviewed per household: a female adult (aged 20+ years) primarily responsible for managing the household, a male adult (aged 20+ years) primarily responsible for agricultural activities, and an adolescent (aged 10-19 years). The assessment also included a community questionnaire, which interviewed a key informant in the district villages. The female household respondent interviews were conducted using pretested, structured questionnaires. Information was collected on food intake in the past 24 hours, frequency of consumption of foods, food sources, drivers of food choices, exposure to food advertisements and nutrition-related messages, household food security, water access, food shopping practices, food aspirations, food consumption outside of the home, household tasks, perceptions of leisure, and household decision-making.

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Male

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at supporting actions that improve equitable access to sustainable healthy diets, enhance farmers’ livelihoods and resilience, and conserve land, air, and water resources in South Asia. The TAFSSA district agrifood systems assessment seeks to provide a reliable, accessible, and integrated evidence base that connects farm production, market access, dietary patterns, climate risk responses, and natural resource management, with gender as a cross-cutting issue in rural areas of Bangladesh, India, and Nepal. It is designed as a district-level multi-year assessment. Data were collected in February-March 2023 in the Rangpur and Rajshahi districts in Bangladesh. Three respondents were interviewed per household: a female adult (aged 20+ years) primarily responsible for managing the household, a male adult (aged 20+ years) primarily responsible for agricultural activities, and an adolescent (aged 10-19 years). The assessment also included a community questionnaire, which interviewed a key informant in the district villages. The interviews with male household respondents were conducted using pretested, structured questionnaires. Information was gathered on food intake in the past 24 hours, household composition, agricultural land and activities, crop production and sales, homestead crops, livestock, fish cultivation, future farming aspirations, climate risk and adaptation, asset ownership, access to amenities, social safety net programs, organization membership, migration, and access to credit.

TAFSSA District Agrifood Systems Assessment in Bangladesh 2023: Adolescent

TAFSSA (Transforming Agrifood Systems in South Asia) is a CGIAR Regional Integrated Initiative aimed at supporting actions that improve equitable access to sustainable healthy diets, enhance farmers’ livelihoods and resilience, and conserve land, air, and water resources in South Asia. The TAFSSA district agrifood systems assessment aims to provide a reliable, accessible, and integrated evidence base that links farm production, market access, dietary patterns, climate risk responses, and natural resource management with gender as a cross-cutting issue in rural areas of Bangladesh, India, and Nepal. It is designed to be a district-level multi-year assessment. Data were collected in February-March 2023 in the Rangpur and Rajshahi districts in Bangladesh. Three respondents were interviewed per household: a female adult (aged 20+ years) primarily responsible for managing the household, a male adult (aged 20+ years) primarily responsible for agricultural activities, and an adolescent (aged 10-19 years). The assessment also included a community questionnaire, which interviewed a key informant in the district villages. The adolescent household respondent interviews were conducted using pretested, structured questionnaires. Information was collected on food intake in the past 24 hours, school attendance, and aspirations.

Availability of national policies, programmes, and survey-based coverage data to track nutrition interventions in South Asia

Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems.