Cost of Nutritious Diet Experiences from Gaibandha District of Bangladesh

Cost of Nutritious Diet

Experiences from Gaibandha District of Bangladesh

Vulnerability Analysis and Mapping Unit, WFP11 April 2012. Hotel Lake Castle, Gulshan, Dhaka

2

“Which foods to get all the nutrients for my family? And how much would it cost for one week?”

3- 3 -

Agenda

What is the Minimum Cost of a Nutritious Diet?

Access to Food and Nutrition

Can Social Safety nets increase the accessibility to nutritious diet?

Can supplementary feeding & food fortification reduce the cost of nutritious diet?

Discussion

4

• List of available foods on markets and prices by 100 grams

• Model household composition

• Food consumption constraints

• Excel solver

• Food Composition Database

• Nutritional requirements

• Minimum Cost Nutritious Diet of a Family

• Minimum Cost Nutritious Diet of a Child 12-23 m

• Basis for modelling

How does the CoD Calculation work?

The tool calculates minimum cost of a nutritionally adequate diet for an individual child as well as a whole household based on region specific data on food availability and cost.

Inputs Excel Tool Outputs

5

Potential Use of CoD Tool

Cost of the Diet Analysis

“Fortification Advocacy”

“Food and nutrition as part of

Social Safety Nets?”

“Importance of supplementary

feeding for infants and the 1000

days”

“Programming information for

voucher interventions”

“Cost-Effectiveness of locally produced

specialized foods”

“Complementary tool for food

security analysis”

One possible tool to engage with the nutrition stakeholders and build a space for food based nutrition interventions

6

Analysis on Gaibandha district of Bangladesh: Prevalence of poverty and undernutrition are high in Gaibandha

High prevalence of poverty1................................................High prevalence of extreme poverty1………………………………..

53%36%

Households with poor or borderline food consumption scores higher than national score2………………………………….. 31%

Stunting rate higher than WHO threshold3……………………… 47%

Wasting rate higher than WHO threshold3………………………. 19%

Anaemia in U 5 children3…………………………………………………Anaemia in Women3…………………………………….....................Low birth weight very high4……………………………..................

73%74%54%

Source: 1) Poverty map 2005, WB,WFP, BBS; 2) HFSNA 2008, WFP, UNICEF, IPHN; 3) WFP CP impact evaluation, control group results in Gaibandha , 2011; 4)JiVita, JHU Study

7

Methods of Data collection: Market survey and Focus Group Discussion

Focus group discussions were conducted in first week of January 2012 in 3 villages to better understand the local diet pattern and household composition.

Six market surveys were carried out to collect food price data.

The CoD Team

8

For Gaibandha, we assumed the following HH composition based on HFSNA 2009 and FGD

Children under 2 years NumberBaby (either sex) 12-23 months 1 All other Members Child (either sex) 5-6 years 1Woman, >60y, 45 kg, light activity 1Woman, 18-29y, 55 kg, moderately active 1Man, 30-59y, 60 kg, moderately active 1 Pregnant or Lactating Women NumberPregnant Woman (2-3 trimester) 0Lactating Woman 1

9

“Min. Cost Diet” is the cheapest nutritionally adequate diet – any other adequately nutritious diet is more expensive

What is the “Minimum Cost Nutritious (MCNUT) Diet”?

A theoretical diet, fulfilling all nutritional needs of a specific age group at the lowest possible cost, based on local foods. This diet is theoretically possible to eat.

NOT what people are actually eating, NOR what they are supposed to eat

Calculations are based on linear optimization done by the Excel solver function

Example of minimum cost diet for a family of 5 in Gaibandha

Monthly cost BDTaka 5088 (USD 62.5) for a family of 5 (including child 12-23 m) without

preferences…

RICE

WHEAT FLO

UR

COWPEA

LENTIL

PALM O

IL

SOYBEAN OIL

POTATO

FISH, C

ARP, FRESH

MOLASSES, C

ANE ...

CORIANDER

AMARANTH, RED

PAPAYA, UNRIP

E

LEAF, T

ARO

LEAF, A

MARANTH, W...

MILK, C

OW, F

RESH 0

100

200

300

400

500

600

208

18 26 7

119

26 1

8315 39 35 51

0 0

543

Minimum Cost of Nutritious (MCNUT) DietWeekly cost BD Taka

10

Based on Focus Group Discussions, we added certain food consumption preferences to the diet – 24.6% price increase

Minimum Cost Diet: Cheapest possible combination of foods

Locally Adapted Cost Optimized Nutritious (LACON) Diets – including

habits

Monthly cost BDTaka 6342 (USD 77.8 ) for a family of 5 (inluding child 12-23 m) with

preferences.

Monthly cost BDTaka 5088 (USD 62.5) for a family of 5 (inluding child 12-23 m)

without preferences.

RICE

WHEAT FLOUR

COWPEA

LENTIL

PALM O

IL

SOYBEAN OIL

POTATO

FISH, C

ARP, FRESH

MOLASSES, C

ANE SUGAR

CORIANDER

AMARANTH, RED

PAPAYA, UNRIP

E

LEAF, T

ARO

LEAF, A

MARANTH, WILD

MILK, C

OW, FRESH

0

100

200

300

400

500

600

208

18 26 7

119

261

83

1539 35 51

0 0

543

Weekly cost BD Taka

0

100

200

300

400

500

600

700

0

134108 95 96

1753

7 17 1951 45

6 23 1451

0 070

1

650

Weekly cost BD Taka

11

With local preferences added LACON diet increased for 12-23 month old child by 40%; for rest of the family by 17%

BREAST MILK

RIC

E

SOYBEAN OIL

EGG, CHIC

KEN

COWPEA

BEEF

MOLASSES

ONIONS

CORIANDER

JUJU

BE, FRESH

FISH, C

ARP, FRESH

AMARANTH, R

ED

PAPAYA, RIP

E

PAPAYA, UNRIP

E

LEAF, T

ARO

LEAF, A

MARANTH, WILD

BISCUIT

MILK, COW

, FRESH

0

10

20

30

40

50

0.0

6.4 5.0

35.0

8.0

17.2

0.4 1.0 1.1

6.04.1

2.1

14.1

2.90.0 0.0 1.3

41.7

LACON diet for a 12-23 months oldWeekly Cost in BDTaka

0

100

200

300

400

500

600

700

127

60103 88

537

6616 18

51 4521

480 0

609

LACON for rest of the family of 4Weekly cost BDTaka

Monthly cost BDTaka 636/month (USD 7.8) for child 12-23 m with preferences.

Monthly cost BDTaka 5705/month (USD 70 ) for a family of 4 (excluding child 12-23 m)

with preferences.

12- 12 -

Agenda


Access to Food and Nutrition

Can Social Safety nets increase the accessibility to nutritious diet?Can food supplementation & fortification reduce the cost of nutritious diet?

Discussion

13

CoD results indicate that in Gaibandha 80% of all HHs are not able to afford a Minimum Cost of Nutritious Diet

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 1011051091131171211251291331371411450

2000400060008000

1000012000140001600018000200002200024000260002800030000

60% of total monthly expenditure on food Total Monthly Expenditure Dec 2011MCNUT LACON

No. of households

Hou

seho

ld E

xpen

ditu

re i

n B

D T

aka

MCNUT BD Taka 5088/month

LACON BD Taka 6342/month

80 % of the households can not afford LACON

72 % of the households can not afford MCNUT

14

Given the economic access problem in Bangladesh, there is a need for increased income, food supplementation, food fortification in addition to education

DiseaseInadequate Dietary Intake

UnderlyingCauses

ImmediateCauses

Basic Causes

Mani-festation

InsufficientHealth Services &

Unhealthy Environment

Inadequate Access to

Food

Inadequate Carefor Mothers

and Children

Inadequate Education

Resources & ControlHuman, Economic &

Organizational

PotentialResources

Economic Structure

Political and Ideological Superstructure

MalnutritionTreatment of SAM & MAM,prevention of stunting

Supplementation with the rightquality food in the first 1000 days

Continued focus on improvingsanitary conditions & healthservices

Continued focus on breast-feeding practices and nutritioneducation

Continued focus on economicdevelopment and capacity building in Mozambique

15- 15 -


Access to food and nutrition


Can food supplementation & fortification reduce the cost of nutritious diet?

Discussion

Agenda

16

Extreme Poor (36%)

Poor (23%) Middle (21%) Better-off (20%)

0

4,000

8,000

12,000

16,000

1,6493,049

4,85912,881

1,099

2,032

3,239

8,588

1,000

1,000

0

6,342

Monthly value of social transfers Other uses of income60% expenditure on food Monthly cost of LACON diet

Monthly/ BDTaka

Cereal and cash transfers via major government social safety nets are not sufficient to meet the locally adjusted cost of nutritious diet

Average Transfer value from major SSNPs VGD, EGPP & TR is around Taka 1000/month/household

Gap of Taka 2,644 from the LACON diet line

• Safety nets do not provide sufficient transfers to the extreme poor to afford the minimum cost of a nutritious diet.

• If transfers do not happen along with nutrition education or vice versa access to nutritious diet is not guaranteed.

Expenditure quintile

17- 17 -


Food access and food based nutrition



Discussion

Agenda

18

BREAST MILK

RIC

E

SOYBEAN OIL

MOLASSES, CANE S

UGAR

ONIONS

CORIANDER

JUJU

BE, FRESH

FISH, C

ARP, FRESH

AMARANTH, R

ED

PAPAYA, RIP

E

PAPAYA, UNRIP

E

LEAF, T

ARO

LEAF,

AMARANTH

MILK, COW

, FRESH

SUPER CEREAL +

0

5

10

15

20

25

30

35

40

45

0

6 5

0.4 1 1

64 2

14

30 0

42

0

LACON Diet for s 12-23 month old w fortified riceWeekly cost

BREAST MILK

RIC

E

SOYBEAN OIL

EGG, CHIC

KEN

COWPEA

BEEF

MOLASSES

ONIONS

CORIANDER

JUJU

BE, FRESH

FISH, C

ARP, FRESH

AMARANTH, R

ED

PAPAYA, RIP

E

PAPAYA, UNRIP

E

LEAF, T

ARO

LEAF,

AMARANTH, WILD

BISCUIT

MILK, COW

, FRESH

0

10

20

30

40

50

0

6 5

35

8

17

0 1 1

64

2

14

30 0 1

42

LACON diet for a 12-23 months oldWeekly Cost in BDTaka

Distribution of 50 gram of Super cereal+ free of cost for a u 2 child can lower the LACON diet for the child by 42% and for the entire hh by

4.2%Locally Adapted Minimum Cost of Diet for

a 12-23 month old child……can be lowered by 42 % including 50

grams of super cereal in their diet every day

From BDTaka 146/week for a child 12-23 months (1.8 USD)

To BDTaka 85/week for a child 12-23 months (USD 1.04)

HHs who can not afford expensive protein for children, super cereal can be a less costly nutritional substitute.

19

How cost-efficient is Super Cereal+ for household from programme perspective ?

Savings accrued per month/household due to inclusion of Super Cereal for U-2 children in the LACON diet is 63% percent higher than the total programming cost of the Super Cereal . From programming perspective, giving super cereal is cost-effective.

Note; : 1 USD = BDTaka 81.45, UN rate March 2012

Price in BDTaka (@ 50 gram Super Cereal+ per day)

269/child/month

100/child/monthSavings is 63% Higher than programming cost

0.09 cents/month/hh

Household “Savings” transferred via SSNP

Programming cost for 50 gram Super cereal : Procurement + int & local transport costs

Price in USD

3.30/child/month

20

BREAST MILK

RICE, M

ILLED

SOYBEAN OIL

PALM O

IL

COWPEA

BEEF

POTATO

MOLASSES, C

ANE SUGAR

ONIONS

CORIANDER

SPINACH, R

AW

PLAIN

TAIN

JUJU

BE, FRESH

AMARANTH, RED

PAPAYA, RIP

E

PAPAYA, UNRIP

E

LEAF, T

ARO

LEAF, A

MARANTH, WILD

FISH, C

ARP, FRESH

BISCUIT

MILK, C

OW, F

RESH0

100

200

300

400

500

600

700

0

134108 95 96

1753

7 17 1951 45

6 23 1451

0 0

70

1

650

Weekly cost BD Taka

Fortified rice if purchased locally reduces the LACON diet by 5.5 %; with free distribution of fortified rice the cost reduces by 22 %

LACON Diet w normal rice for a 5 member family

LACON Diet w fortified rice for a 5 member family (purchased)

BREAST MILK

FORTIFIE

D RIC

E

WHEAT, F

LOUR

PALM O

IL, LO

CAL

SOYBEAN OIL

EGG, CHIC

KEN

FISH, C

ARP, FRESH

COWPEA, W

HOLE D

RIED

MOLASSES, C

ANE SUGAR

ONIONS

CORIANDER

LEAF, T

ARO

LEAF, A

MARANTH, WILD

JUJU

BE, FRESH

LEAF, T

URNIP

AMARANTH, RED

PAPAYA, RIP

E

PAPAYA, UNRIP

E

MILK, C

OW, F

RESH

BISCUIT

0

100

200

300

400

500

600

700

0

141

72 60

115

354

128

7 17 190 0 6 14

3614

51

651

9

Weekly cost BDTaka

HHs who can not afford beef and potato can partly substitute their nutrient needs from less costly fortified rice.

21

From SSNP perspective fortified rice is more cost effective than normal rice

Note; : 1 USD = BDTaka 81.45, UN rate March 2012

With fortified rice Price BDTaka @ 20 kg/hh/month

1439/month/hh

346/month/hh

650/month/hh

770/month/hhSavings is 46% higher than the

programming cost

638 /month/hh

No savings

510/month/hh

Household “Savings” if transferred via SSNP

Household “Savings” if purchased

Programming cost @ 20 kg/hh : Procurement + int transport & local transport cost

With normal ricePrice BDTaka @ 20 kg/hh

Estimated purchasing cost(if locally produced)

700/month/hhSavings 12% higher

than the programming cost

22

0

1000

2000

3000

4000

5000

6000

7000

No fortificationMulti micronu-trient fortifica-

tionMulti mi-

cronutrient fortification

Multi micronu-trient fortifica-

tion

Multi micronutrient fortification

4 % decrease2.7 %

decrease

No fortifica-tion

Fortification: Multi micro-nutrient fortification can lower the Minimum Cost of a Nutritious Diet for a household up to 20%...

10% decrease5.5% decrease

22% decrease

23

Extreme Poor (36%)

Poor (23%) Middle (21%) Better-off (20%)0

4,000

8,000

12,000

16,000

1,6493,049

4,85912,881

1,099

2,032

3,239

8,588

1,000

1,000

0

1439

14390

6,342

Savings from fortified rice Savings from Super cerealMonthly value of social transfers Other uses of income60% expenditure on food Monthly cost of LACON diet

Monthly/ BDTaka

Supplementary and fortified food along with cash transfers can increase the affordability of the poor to purchase a nutritious diet

Gap reduces Taka 900

Despite supplementary feeding, fortified food and cash based transfers the gap remains for the extreme poor.

Expenditure quintile

24

Key messages Extreme poor households and poor households which are the majority in the community are

unable to afford the minimum cost of a nutritious diet.

Safety nets become more cost effective when micronutrient enriched food are provided instead of non fortified food or instead of only cash.

Inclusion of fortified rice in social safety nets returns highest savings for the household compared to other micronutrient enriched food commodities so far available in the country.

Cereal and cash transfers via major government social safety nets are not sufficient to meet the locally adjusted cost of nutritious diet. Despite the transfer a huge gap remains for the income group in the poorest expenditure quintile.

Supplementary and fortified food along with cash transfers can increase the affordability of the extreme poor to purchase a nutritious diet.

Given the problem of economic access to nutritious food in Bangladesh (lack of purchasing power of the extreme poor), there is a need to link food supplementation, food fortification and nutrition education with income generating or household/individual asset creation activities.

25- 25 -

Agenda


Food access and food based nutrition



Discussion

26

How can the CoD Tool be useful

Cost of the Diet Analysis

“Fortification Advocacy”

“Food and nutrition as part of

Social Safety Nets?”

“Importance of supplementary

feeding for infants and the 1000

days”

“Programming information for

voucher interventions”

“Cost-Effectiveness of locally produced

specialized foods”

“Complementary tool for food

security analysis”

One possible tool to engage with the nutrition stakeholders and build a space for food based nutrition interventions

27

Thank you

28

Which countries are currently applying this tool?

Africa Latin America

Zambia

Mozam-bique

Djibouti

Colombia

Domin. Republic

Ecuador

First Pilot Used for

Advocacy

Second pilot Used for

fortification discussion

Used within large vulnerability assessment

Results used by MoH

Small regional workshop in October 2011

First Pilot November 2011

First discussions

First discussions

Asia

Indo-nesia

Philip-pines

Cambo-dia & Nepal

Small regional Workshop in Oct.

Assessment under way

Assessment under way

First Discussions how to use the method in workshop

29

Nutrient met based on MCNUT

Energy

Protein Fat

Vitamin

A

Vitamin

C

Vit B1 (

Thia)

Vit B2 (

Ribf)

Nia Equ

ivVit B

6

Folic A

cid

Vit B12

Pantot

h Acid

Calcium

(abs

)

Magne

sium

Iron (

abs)

Zinc0%

50%

100%

150%

200%

250%

300%

350%

Nutrient requirement met based on MCNUT12-23 month-old

Ene

rgy

Pro

tein

Fat

Vita

min

A

Vita

min

C

Vit

B1

(Thi

a)

Vit

B2

(Rib

f)

Nia

Equ

iv

Vit

B6

Folic

Aci

d

Vit

B12

Pan

toth

Aci

d

Cal

cium

(abs

)

Mag

nesi

um

Iron

(abs

)

Zinc

0%

100%

200%

300%

400%

500%

600%

Nutrient requirement met based on MCNUT Rest of the family

30

The locally adjusted cheapest nutritious diet in Gaibandha is not sufficient to meet some micronutrient requirements

The LACON diet meets the nutrient requirements of a 4 member household at or over 100 percent.

The LACON diet falls short of Calcium and Iron requirements of children 12-23 months.

Ene

rgy

Pro

tein

Fat

Vita

min

A

Vita

min

C

Vit

B1

(Thi

a)

Vit

B2

(Rib

f)

Nia

Equ

iv

Vit

B6

Folic

Aci

d

Vit

B12

Pan

toth

Aci

d

Cal

cium

(abs

)

Mag

nesi

um

Iron

(abs

)

Zinc

0%

25%

50%

75%

100%

125%

150%

Nutrient Requirement Met (Rest of the Family)

Ene

rgy

Pro

tein

Fat

Vita

min

A

Vita

min

C

Vit

B1

(Thi

a)

Vit

B2

(Rib

f)

Nia

Equ

iv

Vit

B6

Folic

Aci

d

Vit

B12

Pan

toth

Aci

d

Cal

cium

(abs

)

Mag

nesi

um

Iron

(abs

)

Zinc

0%

25%

50%

75%

100%

125%

150%

Nutrient Requirement Met (12-23 month-old)

31

Inclusion of super cereal in the local diet significantly reduces iron deficiency of a child aged 12-23 months

Ene

rgy

Pro

tein

Fat

Vita

min

A

Vita

min

C

Vit

B1

(Thi

a)

Vit

B2

(Rib

f)

Nia

Equ

iv

Vit

B6

Folic

Aci

d

Vit

B12

Pan

toth

Aci

d

Cal

cium

(abs

)

Mag

nesi

um

Iron

(abs

)

Zinc

0%

25%

50%

75%

100%

125%

150%

92.1%

82.6%

Ene

rgy

Pro

tein

Fat

Vita

min

A

Vita

min

C

Vit

B1

(Thi

a)

Vit

B2

(Rib

f)

Nia

Equ

iv

Vit

B6

Folic

Aci

d

Vit

B12

Pan

toth

Aci

d

Cal

cium

(abs

)

Mag

nesi

um

Iron

(abs

)

Zinc

0%

25%

50%

75%

100%

125%

150%

95%

Nutrient requirement met by LACON Diet for a Child 12-23 months

Nutrient requirement met by LACON Diet with super cereal for a Child 12-23 months

Iron deficiency fully met & calcium need improved but not fully met

32

Energ

y

Protei

nFat

Vitamin

A

Vitamin

C

Vit B1 (

Thia)

Vit B2 (

Ribf)

Nia Equ

ivVit B

6

Folic A

cid

Vit B12

Pantot

h Acid

Calcium

(abs

)

Magne

sium

Iron (

abs)

Zinc0%

25%

50%

75%

100%

125%

150%

82.6%

12-23 month-old Rest of Family

Protein Fat

Vitamin

A

Vitamin

C

Vit B1 (

Thia)

Vit B2 (

Ribf)

Nia Equ

ivVit B

6

Folic A

cid

Vit B12

Pantot

h Acid

Calcium

(abs

)

Magne

sium

Iron (

abs)

Zinc0%

25%

50%

75%

100%

125%

150%

101.5%

12-23 month-old Rest of Family

Nutrient requirement met by LACON Diet for a Family of 5

Iron requirement improved for 12-23 month

Nutrient requirement met by LACON Diet w fortified rice for a Family of 5

Inclusion of fortified rice in the local diet reduces iron deficiency of a child aged 12-23 months

Documents

Cost of Nutritious Diet Experiences from Gaibandha District of Bangladesh