BRAC's experience in scaling-up MNP in Bangladesh

Despite progress in health status and achievements in Millennium Development Indicators, Bangladesh presents a gloomy scenario for nutrition. In 2009, BRAC (formerly known as Bangladesh Rural Advancement Committee) has begun to implement a community-based approach of Alive & Thrive with Family Health International 360, aiming to reduce undernutrition among children under two by promoting exclusive breastfeeding and appropriate complementary feeding practices. To address anemia and other micronutrient deficiencies, home-fortification with micronutrient powders (MNP) has been promoted among under-fives across Bangladesh along with the Global Alliance for Improved Nutrition (GAIN). BRAC's frontline community health workers play a critical role in promoting micronutrient powders with better feeding practices. Over the years, improvements have been observed in the intervention areas: exclusive breastfeeding rose from 49% to 83% of children (0-6 months), 86% of children received complementary feeding at 6-8 months with about two/thirds being fed the recommended number of times; and 70% of children (6-59 months) adhered to MNP use, ie consumption of 1 sachet per day in the past 60 days. However, many challenges are still observed in traditional feeding practices, along with limited skills of community health workers and households' poor access to quality food, necessitating constant interactions between caregivers, mothers-in-law and fathers with the frontline workers. Maintaining the supply chain of micronutrient powders and a visible and convincing change in nutritional status of children are key success factors. The partnerships between BRAC, GAIN and Renata, the producer of MNP in Bangladesh, have given birth to a home-fortification model that can deliver impact at scale.