GLOBAL HEALTH AND FOOD SECURITY: IMPERATIVES FOR THE FUTURE
Nutrition, Women and Children
Thursday, October 16, 2003
Speaker:  Dr. Mushtaque Chowdhury

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Dr. Mushtaque Chowdhury
Co-Chair, UN Millennium Task Force on Child Health and Maternal Health
Executive Director, Bangladesh Rural Advancement Committee

            Thank you, Mr. Chairperson.  Excellencies, ladies and gentlemen, good afternoon. It is indeed a great pleasure for me to be here at the World Food Prize Symposium, on behalf of BRAC, which I represent, and the Task Force on Child Health and Maternal Health of the Millennium Project.

            I congratulate Catherine Bertini – I’m not sure if she is here now – for winning this year’s prestigious prize. This is well deserved, given her contribution in securing food for millions of hungry people around the world, including in Bangladesh. As a tribute to her contribution, I will today describe how the World Food Programme is collaborating with my organization in Bangladesh in helping millions of extremely poor women and their families defeat hunger, famine and other deprivations.

            I feel proud that part of the laureates of the World Food Prize are from South Asia, including Dr. Vasal, B.R. Barwale, Dr. Khush, Dr. Kurien, Dr. Swaminathan, and also Dr. Yunus who is also from Bangladesh. So we are really proud of our achievement in this area.

            There are two persons represented here today. I will start with some deflections on the work that the Task Force on Child Mortality and Maternal Mortality are currently doing, and as I just said, present the case from Bangladesh on what we are doing with the World Food Programme.

            Ladies and gentlemen, the Millennium Development Goals are a clear call for a new kind of action. Health forms a central plank in this agenda. Substantial evidence suggests that health is a crucial precondition for economy growth, and conversely that economy development can yield enormous advances in public health.

            There are two goals dedicated to child mortality and maternal health, as you can see in this slide. The target is to reduce child mortality by two thirds and maternal mortality by three fourths. While all the past goals and targets mentioned about health, the MDGs are conspicuous by its absence. We in the task force want this back and have set an additional target to ensure universal access to public health by the year 2015.

            Most of you know that ten million children die every year. Of this six million are easily preventable. There is great inequity in child mortality between the developed and developing regions in the world, as you can see here in this slide. While the infant mortality in the north is less than ten, it is over a hundred in Africa. The intercountry and interregional infant mortality and maternal mortality is even worse. While child mortality shows a 24 difference, it is over 304 between the richer and poorer countries. Norway, for example, has a maternal mortality of 5 compared to 1800 in Ethiopia, as we learned from the most recent report.

            South Asia and sub-Saharan Africa are the hot spots, regions of greatest in the fight for achieving Millennium Goals.

            The inequities are not only between countries or regions but are within countries as well, between different groups in a population. This figure shows differences in access to immunizations in Bangladesh. While the overall coverage is over 50%, there are some groups in the population for which the coverage is less than 10%.

            This slide shows the prospects for reaching the targets for child mortality for seven different regions of the world. South Asia and sub-Saharan Africa are the middle two in the bottom row. This has been taken from the World Bank web site, and I’m sorry that the projection is not correct. Based on this... experience, while most of the regions would be able to reach the infant mortality targets, South Asia and sub-Saharan Africa will not probably be able to do this.

            The same is true for maternal health. Here a similar picture is depicted for proportion of births attended by skilled attendants, an... indicator of maternal mortality. ... sub-Saharan Africa again appears to fail the target shown here in the bottom row.

            But it doesn’t have to be this grim. It is possible to change the course for the countries of South Asia and sub-Saharan Africa. For this we need new thinking and new commitment at the country and at the global level.

            The task force has been discussing the prospects for reaching the goals, and based on the deliberations, they have sent three messages to the world. The goals are largely visible for effective technologies... most of the diseases are available in an affordable way. We have just heard from Dr. Sachs that they are... available all over the world.

            Still the attendants at births and emergency obstetric care can save most of the half a million maternal deaths that happen now. The need of dollars, however, is scaling up to reach these technologies where the problem is.

            Secondly, access and utilization of health interventions ultimately depend on a functioning health system – and this does not mean sparkling, new hospitals. A functioning health system means an infrastructure of people, supplies, facilities and outreach that engages households and communities.

            And finally there is a necessity for substantial increase of investment in health. We endorse the recommendations of the Commission on Macroeconomy and Health, which is headed by Jeffrey Sachs, for a quantum increase in aid to the health sectors.

            Ladies and gentlemen, let me now share with you a story from Bangladesh. It is about BRAC, an NGO, and how it is working to change the lives of the poor women. But first a few words about Bangladesh itself. As you know, it is still one of the poorest countries of the world, but improvements in some of its critical indicators is indicative of its enormous potential and is set to achieve several of the MDGs.

            With 130 million people living in a land as large as Wisconsin, Bangladesh is the most densely populated rural-based country in the world. However, in recent times we have been able to drastically reduce the population growth. The..., as you can see here, has been..., and the infant mortality rate has been reduced from 140 in 1970 to 66 in 2000. Life expectancy has increased by 40%. What is significant here in this figure is the change in gender difference. In 1970 Bangladesh was one of the few countries where women lived a shorter life than men. This has been corrected now.

            In education the girls’ enrollment ratio has reached a hundred percent. What is notable here also is the fact that gender difference in enrollment has disappeared. Compare this with what it was like in 1970. This has happened by certain affirmative actions taken by the state and private sectors to promote education. In fact, we have already achieved the target of the MDGs.

            Additionally, there have been improvements in the poverty situation. The income poverty has declined from 58% in early 1980s to 50% in 2000.

            Now, a little bit about BRAC, the NGO, which was set up in 1972 in response to a humanitarian need. It promotes the holistic approach to development. BRAC believes that poverty is a complex syndrome, presenting different deprivations, not only lack of income but lack of... to health, education empowerment, particularly women.

            BRAC works in 75% of the villages of Bangladesh. Its education program runs 34,000 schools, and the health program which is 700 million people. The organization is quite large with over 60,000 staff working with a budget of $170 million, 80% of which comes from its own sources internally in Bangladesh. For the remaining 20%, we depend on our donors, including the World Food Programme.

            Macrofinancing... poverty alleviation efforts. It lends to poor women; there are over a million borrowers. This makes the BRAC program the largest macrofinancial institution in the world, even bigger than the famous Gramin Bank. So far, $1.3 billion have been disbursed as loans, with 98% recovery. Members have saved over $73 million. BRAC provides skilles to its members and sustainability of the enterprises of poor women. BRAC promotes backward and forward leakages.

            For example, to supply day-old chicks to the women rearing poultry, BRAC has set up several poultry farms. And to market the milk produced by poor women through BRAC loans, we have set up a milk processing plant for the urban market.

            BRAC has been promoting new technologies and new crops.. Of all the corn that is produced in Bangladesh, nearly half is produced through support provided by BRAC.

            Researchers in Bangladesh and outside have found many positive impacts of BRAC... in terms of increased income for security, employment, better nutritional status, improved school enrollment, increased family planning acceptance, better gender relations, and decreased child mortality.

            This chart shows the impact of BRAC on child survival. There are three.  The middle line presents the survival probability of children whose mothers join BRAC. The top line is that of well-to-do children. The bottom line is the survival probability of poor children whose mothers did not join BRAC. It shows that by joining BRAC, the members improve the survival chances of their children. The mortality rate for the BRAC member children has now equaled those of the well-to-do children.

            Ladies and gentlemen, this is not the end of the BRAC story. I don’t have much time, but BRAC is a learning organization, and it continuously works to improve its performance. As early as the mid-1980s, BRAC discovered that, although it was doing fine for the poor it was working with, but more groups among the poor were being left out. BRAC called this “the other poor.”

            And they were also systematically bypassed by other macrofinancial programs as well. Following the famine of 1974, the World Food Programme supported a valuable food program, which provided food rations to the other poor women. BRAC came to an agreement with the World Food Programme and the government to work with this group, promoting livelihood development. This has not evolved into a large program.

            This program indicates protection with promotion of livelihood. The protection component is food rations for 18 months, and the promotion component includes skill training and provision of macroloans. After the food ration is over, these women are then absorbed into the mainstream poverty alleviation programs of BRAC and other NGOs.

            BRAC’s ultra poor food program beneficiaries include poorest women who are often abandoned by dead husbands and often have no working children in the household.

            This shows the growth of the ultra-poor food program in 1988 and ‘89. There were about 40,000 women participating in this program. This is increased to 300,000 in 1998, ‘99. ...Over one and a half million have been brought under this program.

            Ladies and gentlemen, based on this experience, BRAC has continued scaling up its ultra-poor program with newer products and better results. Through this, a large number of destitute women are being rehabilitated in life and share two square meals a day for themselves and for their children. BRAC has continued to serve the needs of the poor women and children in Bangladesh and... in the years.

            We are hopeful of the future with the right kind of strategies, programs and... will be able to defeat hunger and deprivations.

            Thank you.