Bangladesh has made great strides in many areas, including poverty eradication and life expectancy. There are still many opportunities for investments that improve the nation’s future and transform lives.

Recently, a high-level team of prominent Bangladeshi development and economics leaders and a Nobel Laureate in Economics identified a prioritised list of such opportunities. They were tasked with answering the question: “What policies and investments would give Bangladesh the most impact for every taka spent?”

My think-tank, the Copenhagen Consensus Center, commissioned teams of dozens of specialist economists from Bangladesh, South Asia, and around the world to study 76 concrete solutions to improve the future of the country.

This eminent panel met in Dhaka to examine and test all of this research, and found the top two investments were TB treatment and implementation of an e-procurement system for government. The third best investment (as well as the seventh) was on nutrition, which just underlines how vital it is for Bangladesh.

And for nutrition, too, Bangladesh has seen great progress. The UN Food and Agricultural Organization estimates that in 1993, the average Bangladeshi had access to 2,000 calories per day, whereas today that number has increased to 2,450 calories. The prevalence of underweight children under five years of age declined from 66 percent in 1990 to 33 percent in 2014, meeting the Millennium Development Goal target one year early.

But poor nutrition continues to impede Bangladesh’s progress. The effects include maternal mortality, infant mortality, and stillbirths. Also, poor growth among small children results in stunting, which in turn has life-long consequences. Affecting about six million Bangladeshi children under the age of five, the condition decreases cognitive development, leads to worse health outcomes and school performance, and lowers productivity throughout adult life. The rate of stunting in Bangladesh is significantly higher than the global average.

The Seventh Five Year Plan states, “A particular challenge faced by the nutrition sub-sector is that it is perceived as a low priority relative to other development issues.” The Plan identifies institutional limitations, persistent micronutrient deficiencies, lack of public awareness, maternal under-nutrition, acute malnutrition and lack of dietary diversity as the key problems that need tackling.

My think-tank, the Copenhagen Consensus Center, has partnered with the Bangladesh think-tank Centre for Research and Information to look at nutrition.

This partnership saw us hold a high-level nutrition policy seminar in Dhaka this month.

Publishing new research on nutrition investments and their costs and benefits in Bangladesh, and bringing together key decision-makers and academics to discuss the policy framework, the Policy Seminar provided an opportunity for a proactive and focused discussion on nutrition priorities and policy options.

The seminar was addressed by the Honourable Minister of the Ministry of Health and Family Welfare, Mr. Mohammed Nasim. The discussion was moderated by Professor Abdul Bayes, Director, BRAC-RED who also leads the BRAC-LANSA (Leveraging Agriculture for Nutrition in South Asia) Team in Bangladesh.

Attended by stakeholders and experts of nutrition from the government, NGOs and international agencies, the policy seminar discussed different ways of responding to malnutrition.

One such intervention is to try to stop pregnant women from consuming smokeless tobacco. Bangladesh has the highest prevalence of smokeless tobacco use among women in the world. This behavioural intervention would include face-to-face counselling by a health care provider, the use of printed materials and it would be run by community health workers responsible for home visits and delivering change and communication messages. Examining the costs and benefits, researchers for Copenhagen Consensus have worked out that for every taka we spend trying to change the behaviour of pregnant women, the benefits – from things like reduced healthcare costs and better health – would be worth 7 taka to society.

Another intervention is to focus on providing nutritional supplements during pregnancy. Different supplements do different things; for example, calcium given to pregnant women can reduce the chances of a complication called pre-eclampsia during childbirth. Here, every taka spent just on this specific supplement would generate 12 taka of benefits to society. Iron-folate supplements would have benefits 28-times the costs, and balanced energy protein intake would be 17-times.

Encouraging girls to enrol and stay in school via stipends would increase the age of starting a family, which can lift the potential earnings of mothers. This, in turn, will lead to improved nutrition and reduced stunting of children, with greater earning potential passed onto their children in the long term. Each taka spent on the stipend programme will generate around 8 taka of social and economic benefit.

Supplementary foods are important not just for pregnant mothers. We can provide nutrients that would otherwise not be consumed in sufficient quantities (such as vitamins, minerals, fibres, fatty acids and amino acids). Promoting dietary diversification through nutrient dense foods, both in quality and quantity, will lead to better nutritional status of women and children. Each taka spent on designing complementary and supplementary feeding programmes will generate a benefit of around 15 taka for society.

Besides complementary and supplementary feeding, direct nutritional interventions aimed at mothers, babies and small children in the first 1,000 days would yield improvements in physical and cognitive development. This can lead to better educational achievements for children as they embark upon a healthier lifestyle, and increased earnings later, upon entering the labour market. Every taka spent in delivering a bundled nutritional package of maternal and child interventions would generate a return to society of around 19 taka.

These are among the ideas examined in seven new nutrition research papers released by Copenhagen Consensus.

Direct nutritional interventions are simple and relatively cheap. As the Bangladesh Priorities eminent panel found, these investments compete very favourably with other policy options.

We know that if we can get certain micronutrients to infants, we can rescue them from stunting. Achieving wider coverage should be a top goal.

To fund such investments, firstly, existing nutrition strategies need to spend the budget allocated, and more needs to be spent across all of government on proven nutrition interventions. There is a compelling economic case to do so. Poor nutrition has an impact on economic outcomes, on health, on education; improving nutrition can bring about positive change in the short and long term and is essential to Bangladesh’s Vision 21.

Fortunately, there are smart nutrition interventions, packages and policies like those analysed by researchers for the Copenhagen Consensus Center. By pursuing cost-effective responses to malnutrition, Bangladesh can own the problem and its solutions. Bangladesh can exercise control over its own budgets and policy priorities, and draw on international agendas.

Substantive progress on nutrition policy can be made with strong leadership and coordination across government departments. Prioritising nutrition in the government budget would provide huge benefits to Bangladesh.

The writer is president of the Copenhagen Consensus Center, ranking the smartest solutions to the world’s biggest problems by cost-benefit. He was named one of the world’s 100 most influential people by Time Magazine.

This story was originally published by The Daily Star, Bangladesh

Over the past two decades, Bangladesh has remarkably managed to feed an increasing population better – the UN’s Food and Agricultural Organization estimates that in 1993, the average Bangladeshi had access to just 2,000 calories per day, whereas today that number has increased to 2,450 calories per day. To a large extent, this success comes on the back of ever-higher rice production – rice makes up 70 percent of the average daily calorie intake.

Golden Opportunity?

One solution is to provide vitamin A in capsules, which reach about 63 percent of children. It would also be good to get more children to eat other foods rich in vitamin A, but this is a challenge of both education and income, bounded by the 70 percent of rice intake. But what if there was a cheap and effective way to exploit that rice to get more vitamin A to everyone?

New research by Uttam Deb, an economist at the International Crops Research Institute for the Semi-Arid Tropics, suggests that investment in the development and dissemination of golden rice can help Bangladesh overcome vitamin A deficiency and its related blindness and deaths. Each taka spent on golden rice could do up to 329 takas of good.

Research on golden rice began in the 1990s as an effort to develop a type of rice that could counter malnutrition. The rice is fortified with beta-carotene, which is converted into vitamin A inside the body, and also gives the strain of rice it its colour. Because the rice is enhanced with micronutrients, widespread adoption of it holds the potential to combat the critical vitamin A deficiency in Bangladesh, which would be incredibly valuable for the country.

Not only would the beta-carotene-fortified rice combat malnutrition, golden rice also has higher crop yields than many improved varieties. So benefits from its cultivation would arise both from increased crop productivity as well as the positive health effects. Furthermore, golden rice is a Boro rice, so the geographic areas where it is most likely to succeed in the field overlap considerably with the areas where nutrition deficiencies are highest in Bangladesh.

The costs to release golden rice for cultivation by 2018 include funding for research and development to continue to adapt it to the Bangladesh environment. It would also require paying costs for crop trials, extension services, seeds, marketing, and education. In total, the costs would be more than Tk. 800 million.

When it comes to benefits, golden rice is not a panacea for fighting vitamin A deficiency in Bangladesh, it should rather be seen as a complement to existing initiatives that provide nutritional supplements to unreached people. Deb’s analysis estimates that this strategy holds the potential to reduce vitamin A deficiency nationwide by roughly 3 percent, assuming that 30 percent of the population would adopt the rice as part of their regular diet.

In reviewing Deb’s research, Saul Morris of the Children’s Investment Fund Foundation and Sue Horton of the University of Waterloo separately noted the lack of significant causal relationship between vitamin A deficiency and the greater risk of stunting. However, Deb points out that most studies show that fighting vitamin A deficiency can have a positive, if small, impact on stunting. He concludes that the cultivation and dissemination of golden rice could decrease stunting by up to 3 percent nationwide, perhaps preventing approximately 165,000 children from becoming stunted. When added together, the value of these health benefits is more than Tk. 175 billion.

In addition, golden rice stands to increase rice yields by up to 10 percent. This estimated productivity gain should be taken as optimistic, given that scientists are also breeding other new, higher-yielding rice varieties that could benefit farmers in the absence of golden rice. But even if the average yield increases by just 5 percent when compared to the existing BRRI dhan29 rice variety, Bangladeshi farmers would still benefit by nearly Tk. 110 billion.

Overall, the health and productivity benefits combined could equal up to Tk. 285 billion. Each taka spent toward adoption of golden rice in Bangladesh could do up to 329 takas in benefits. The eminent panel of local and international experts, who reviewed all Bangladesh Priorities research, concluded that Deb’s analysis may be on the optimistic side. However, they also noted that most of the costs to develop golden rice have already been incurred, that the variety holds potential to improve upon the status quo, and farmers can choose to use it or not. For those reasons, they found it a worthwhile strategy that could provide net benefits regarding both farmer productivity and health measures.

Is golden rice one of the smartest solutions for Bangladesh? Let us hear from you at https://copenhagen.fbapp.io/malnutritionpriorities. We want to continue the conversation about how to do the most good for every taka spent.

The writer is president of the Copenhagen Consensus Center, ranking the smartest solutions to the world’s biggest problems by cost-benefit. He was named one of the world’s 100 most influential people by Time magazine.

This story was originally published by The Daily Star, Bangladesh

Between 2011 and 2020, more than 140 million girls worldwide will become child brides – defined by the United Nations as marriage before age 18. The effects from such early marriage can be devastating and long-lasting for women: lower education levels and lower lifetime earnings, higher rates of domestic violence, greater risk of dying from pregnancy complications, and increased mortality rates for the children of these young brides.

Photo: worldpulse.com

What are the best strategies to empower young women and avoid the harms of early marriage?

A new analysis by economists from Duke University, and MIT’s Abdul Latif Jameel Poverty Action Lab examines various strategies to prevent child marriages. It finds that providing financial incentives to delay marriage is most effective.

Child marriage disproportionately affects poor households: girls in the poorest 20 percent worldwide are more than twice as likely to marry early than those in the wealthiest 20 percent. Bangladesh has one of the largest populations vulnerable to early marriage, with more than 15 million girls aged 10-19.

Families often see early marriage as a financial necessity, which may help explain why numerous laws that prohibit early marriage and dowrieshave had virtually no effect in Bangladesh. Similarly, programmes run by community groups that give adolescent girls life-skills and vocational training have had no impact in Bangladesh (nor in Tanzania, but some impact in Uganda). So focusing on laws or empowerment will likely do less than 1 taka of good for each taka spent.

The analysis examines other proposals from Bangladesh, across South Asia, and in sub-Saharan Africa. The most promising is a programme from southern Bangladesh run by Save the Children that uses a conditional stipend to encourage parents to delay marriage for adolescent daughters.

From 2008-2010, the programme gave cooking oil to parents of unmarried girls aged 15-17. Every four months, participants received four liters of oil – conditional upon a monitor confirming that they were still unmarried. A year’s supply of cooking oil costs Tk. 1,250 per girl and aims to offset the economic burden of delaying marriage.

The modest financial incentive had significant effects. Recipient girls were up to 30 percent less likely to marry before age 16, and they were up to 22 percent more likely to remain in school. Each taka of spending on such conditional transfer programmes does about 4 takas of social good.

Raising the age of marriage would do a lot of good, but early marriage is far from the only challenge Bangladeshi girls and women face. New research by Ahsan Zaman, an assistant economics professor at North South University, examines two other pressing gender issues: access to education and family planning.

Educational access for girls is important, because more education means higher productivity and earnings over their own working lives. But it also turns out to be crucial for the eventual health of their children. A higher level of education improves a mother’s health awareness. Research shows that this leads to better nutrition status for her children – and malnutrition is one of the factors that influences child disease and mortality the most. Each taka spent to get girls more education does 3 takas of social good, thanks to improved child health and increased income from higher earnings.

A second issue is family planning, which can save lives of mothers and children by widening the time gap between births, improve health for both, and empower women by allowing them to stay in school longer. A year of family planning services that delays pregnancy costs just 655 takas and can add nearly half a year of extra schooling for one girl. And in Bangladesh, an additional year of school boosts girls’ lifetime earnings by an estimated 13.2 percent. When combining the health and education benefits, the small investment in family planning gives 3 takas of benefits for each taka spent.

Smart policies can help delay female marriage and promote gender equality. Where would you want to spend resources to do the most good for Bangladesh? Let us hear from you at https://copenhagen.fbapp.io/genderequalitypriorities. We want to continue the conversation about how to do the most good for every taka spent.

The writer is president of the Copenhagen Consensus Center, ranking the smartest solutions to the world’s biggest problems by cost-benefit. He was named one of the world’s 100 most influential people by Time magazine.

This story was originally published by The Daily Star, Bangladesh