Background

The Chars Livelihoods Programme is a livelihoods programme focused on the extreme poor in the riverine islands of north-west Bangladesh – people that live far below the poverty line.  Because they are so poor, their needs and vulnerabilities are greater even than people who are ‘only poor.’

Because these needs and vulnerabilities cover many different aspects of life, CLP aims to support its participants in a number of different ways.  CLP’s approach looks at a number of changes that are required for the extreme poor to gain a sustainable livelihood, get away from poverty and then stay out of it for good.

The related issues of food security and nutrition are part of CLP’s overall package, because without regular, good quality food at appropriate quantities, it is much more difficult to sustain a livelihood.

The development literature abounds with evidence that poor nutrition leads to life-long disadvantages, such as poor physical and mental development, as well as the immediate disadvantages of hunger, lack of energy and susceptibility to illness.

So, along with its ‘core package’ of infrastructure, asset transfers, social development and other capacity-building activities, CLP has components that focus on food security and nutrition.

Food security – what does it mean?

The 1996 World Food Summit defined food security as existing when “all people, at all times, have sufficient, safe and nutritious food to maintain a healthy and active life”.  Previous CLP studies broke food security down into three pillars (Cordier et al, 2012):

1.         Food access: households must be able to regularly acquire adequate amounts of food.

2.         Food availability: food must be available in sufficient quantities on a consistent basis.

3.         Food utilisation: consumed food must have positive nutritional impact on people.

The World Food Summit definition includes the phrase “at all times”. Each pillar of food security therefore has an aspect of stability. Shocks that affect the stability of food security include volatile food prices; drought; flooding; and political instability.

Food Access

To look at whether CLP participants have good food access, CLP collects data on households’ dietary diversity, the frequency with which they consume different food groups, the proportion of their expenditure that goes on food, and the frequency with which they use using coping strategies.

A ‘coping strategy’ is when a household does something they would not normally do in order to access food, such as selling something (their livestock, for example), reducing the number of meals they eat, or reducing portion sizes.

For many households, their personal indicator of ‘food security’ revolves around whether they can eat three meals in a day, so this is an important indicator.  Recent data shows that just over a quarter (26.3%) of a recent cohort (2.5) of CLP entrants reported being able to eat three meals per day (3MD) at baseline.  Looking back at previous cohorts that have received CLP support, this rises dramatically: between 95.4 and 99.7% of households report eating three meals a day – a truly significant achievement towards food security.

However, simply eating three meals per day is not enough to claim that ‘food security’ has been achieved.  If the meals are mainly rice-based, or feature a very limited range of foods, people’s nutritive intake may still be limited.  CLP also therefore tracks the Food Consumption Score (FCS).  This is a World Food Programme method that tracks the quantity and quality (nutritive value) of the food that people eat. The maximum FCS has a value of 112, which would be achieved if a household ate each food group every day during the last 7 days. In order to score an ‘acceptable’ FCS, in Bangladesh people need to score 42 or over.

Predictably, given that CLP works with the poorest of the poor, the control group shows few participants achieving this ‘acceptable’ score: less than 19%.  This rises significantly once CLP has worked with them, with cohorts ranging between 51.7% and 70.3%.

Further analysis of one cohort’s data (Cohort 2.1) showed that there’s a big change at the bottom end of the scoring.  Over 60% of participants scored ‘poor’ when they joined CLP in 2010.  By 2013, only around 8% showed a ‘poor’ score on this measure, with 70.3% scoring ‘acceptable in 2014.  This illustrates a significant impact at both the top and bottom of the FCS range.

Food Availability

Looking at food availability, CLP tracks the possible sources households use to access food – particularly livestock and land.  Both land and livestock are used to provide food for household consumption, as well as to earn income.

Data from the October 2013 survey showed that, of the control Group (Cohort 2.5 at the time), only 12% had access to livestock.  For previous cohorts, who had already received CLP support, this ranged between 62% and 93%.  The lower figures aren’t surprising.  While 98% of participants choose livestock as their Income Generating Asset (IGA), there is a trend for some previous participants to diversify away from livestock and into land or business ownership.

This is borne out by the percentages of previous cohort participants that have access to land, which range between 14% and 30%.  

Food Utilisation

Food utilisation is the third pillar of food security and specifically refers to appropriate food preparation as well as an individual’s ability to metabolise nutrients.  It largely focuses on household’s Water, Sanitation and Hygiene (WASH) practices.

With good WASH practices, households reduce their risk of disease, such as diarrhoea, increasing the absorption of nutrients during food digestion, maximising their food’s nutritional value.

CLP’s Food Utilisation indicators are:

• proportion of households with access to a sanitary latrine up to CLP standards;
• proportion of households with access to an improved water source up to CLP standards;
• proportion of women reporting hand washing at critical times.

CLP households’ access to sanitary latrines (up to CLP standards) increases substantially after receiving the CLP support package. For example, Cohort 2.4 showed just 7% of households at baseline with access to a sanitary latrine in 2012, but this figure jumped to almost 72% in 2013.

The proportion of households with access to an improved water source (IWS) also changes dramatically.  In 2013, the control group showed only 5.2% of participants had access to a water source that met CLP standards.  For previous cohorts, the percentage ranged between 43% and 46%.  This is likely to rise by the end of the programme, given that CLP has been ‘re-sweeping’ areas to install IWSs for ex-core participants that did not receive one.

Hand-washing is important to reduce the risk of illnesses being passed on.  Reports of participants washing hands at critical times show huge changes – almost 0% for a control group, but ranging between 71% and 83% for previous cohorts. The trend is upwards over time too, with cohorts from longer ago reporting higher rates than more recent cohorts.

One problem with this data, however, is that it is self-reported, raising questions of accuracy.  To mitigate this problem, CLP has also been collecting data on the presence of soap or ash close to latrines or water points. Recent CLP research (Kenward et al, January 2015), shows that over 90% of surveyed households have soap or ash close to their latrine or water source after CLP support.

Nutrition

The Programme has tracked a range of nutrition indicators since 2008, such as mothers’ Body Mass Index (BMI), haemoglobin counts, and measures related to children’s height for age (stunting), weight for age (underweight) and height for weight (wasting).

The results show some positive movements and ‘direction of travel (Goto, R, 2015).’[1]  All CLP cohorts showed significant improvement in mothers’ BMI throughout the surveys in the post-intervention period. BMI increased on average by 1.8 units over 6 years for CLP1 participants; by just about 1 unit over 4 years (Cohorts 2.1 and 2.2) and by 0.24 units over 2 years for Cohort 2.3.

Children’s chronic under-nutrition (HAZ, also known as stunting) showed significant improvements in the post-intervention period.  For example, Cohort 2.1’s baseline (May 2010) indicated that 53.6% of children showed stunting.  By October 2014, this had dropped to 35.7%.  Cohort 2.2 showed an improvement from their baseline in October 2010 of 42.9% showing stunting, to 35.4% by October 2014.

However, the results are not entirely intuitive, in that there remain areas where there have not been improvements.  For example, mothers’ haemoglobin counts (anaemia) did not show significant improvement in any of the cohorts.  Cohort 2.1’s baseline in May 2010 showed an average haemoglobin count of 11.94g/dl; by October 2014, it showed 11.80.  Cohort 2.2 showed 11.79g/dl on average at baseline of Oct 2010, with an average of 11.81 by October 2014.

Children’s under-nutrition – weight for age (WAZ) and weight for height (WHZ, wasting) – actually worsened in some cases over the period.  For example, 37% of all children showed underweight in March-July 2008 during CLP1.  By Oct 2014, this had become 55.8%.  For Cohort 2.1, the May 2010 baseline showed 22.8% of all children were wasted (WHZ), while in October 2014 this had increased to 33.3%.

These counter-intuitive results need to be seen against the generally improving poverty status of these families.  They may also be related to the fact that generally children’s heights are increasing, showing better nutrition, but they are still not getting quite enough to put on weight, thus depressing the weight-for-age scores.

Even if this is not the case, the evidence shows that nutrition and the associated behaviour change is a difficult area to tackle, and one to which the programme – and indeed both the donor and the Government of Bangladesh – need to pay closer future attention.

Conclusion

The Chars Livelihoods Programme’s package of support shows good progress in the vast majority of food security and nutrition indicators that it tracks.  Nevertheless, it is recognised that in some areas, particularly around mother and child nutrition, there is more work required to dig into the reasons that some indicators are not showing significant improvements.

[1] Goto, Dr R (2015), “CLP Annual Nutritional Survey Report 2008 – 2014”, CLP IMLC Division, Bogra, Bangladesh

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