Putting nutrition at the heart of primary healthcare
Although policies and strategies are in place, nutrition services remain poorly integrated into the primary healthcare system
Bangladesh has made notable progress in improving nutrition outcomes. Yet the country continues to face a triple burden of undernutrition, micronutrient deficiencies, and rising overweight and obesity.
Although policies and strategies are in place, nutrition services remain poorly integrated into the primary healthcare system.
Against this backdrop, Max Foundation Bangladesh organised the roundtable "Integration of Nutrition Actions in Primary Healthcare Systems through Public-Private Partnerships in Bangladesh" on 3 August, with The Business Standard as media partner.
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The discussion focused on integrating nutrition into primary healthcare, strengthening public-private collaboration, improving referral and data systems, and scaling up effective community-based initiatives.
DR SM Ziauddin Hyder
Special Assistant to the Prime Minister on Health Affairs
Bangladesh now has a unique opportunity to transform its health system, but we must first acknowledge that nutrition is a truly multi-sectoral issue. We have made progress in reducing stunting, but one in four children is still stunted, and most SDG health indicators remain off track.
That is why the government is committed to building a prevention-centred primary healthcare system without any urban-rural divide. Every ward and union will have an integrated primary healthcare unit supported by community health workers using AI, electronic health records and referral systems.
Nutrition should not be treated as a stand-alone programme. Health, food systems, agriculture, social welfare and other sectors all deliver interventions that influence nutrition outcomes. I will propose establishing a high-powered National Food Security and Nutrition Commission with strong inter-ministerial coordination, monitoring and technical capacity.
Prof DR Pravath Chandra Biswas
Director General, DGHS
Bangladesh cannot achieve its nutrition and primary healthcare goals without a truly integrated public-private approach. Currently, 60-70% of people in rural areas seek primary healthcare from private health facilities. Malnutrition, anaemia among pregnant women, childhood wasting, obesity and micronutrient deficiency continue to keep Bangladesh away from attaining the SDGs.
Nutrition must be addressed not only as a problem related to food but also as the foundation of the prevention of non-communicable diseases.
But the government alone will not achieve full coverage. We need better collaboration with the private sector, civil society, academics and local community organisations.
DR Mohammed Eunus Ali
Director, Institute of Public Health Nutrition
Nutrition must be placed at the centre of Bangladesh's primary healthcare system if we are to achieve meaningful improvements in public health.
However, Bangladesh continues to fail in meeting its SDG goals in nutrition, especially reducing child wasting. This is why nutrition needs to be integrated into primary healthcare.
Another major challenge is fragmented information. Public and private organisations often collect similar data without sharing it. We need an integrated national digital platform where information generated by all partners is uploaded and shared.
DR Rawshan Zahan Akhter Alo
Deputy Director, Institute of Public Health Nutrition
Institutional capacity can be strengthened further by expanding training and ensuring greater coordination across the health system.
We have also implemented Training of Trainers programmes on the management of severe acute malnutrition with support from Unicef and are scaling up these skills across districts.
Another important aspect is the "Golden Thousand Days", which spans from pregnancy until a child's second birthday. With proper focus on this vital stage, it is possible to address malnutrition, underweight, stunting and wasting.
DR Tahmeed Ahmed
Executive Director, icddr,b
There are two important evidence-based messages that we need to consider in formulating our approach to nutrition as part of our primary healthcare.
Firstly, despite many efforts, one out of four children in Bangladesh are still stunted, and I believe that it is unlikely for us to meet the 2030 SDG target. Recent scientific evidence suggests that stunting does not just happen due to food insecurity and recurring infections alone but also due to poor water, sanitation and hygiene.
Secondly, based on global evidence, more public spending on health results in reduced stunting rates. The current health budget allocation in Bangladesh is only 1% of the GDP, and this is not enough. Strengthening community-based nutrition services, alongside better WASH, increased investment and cross-sector collaboration, is essential.
DR ATM Tariqul Islam
Country Director, Max Foundation
Strengthening nutrition through primary healthcare requires genuine collaboration between the government, private sector, NGOs, academia and communities. At Max Foundation, we work with market-based solutions because nearly 70% of people's demand for health and nutrition services is met through the market.
Given the shortage of government health workers, these entrepreneurs can serve as a complementary workforce rather than a replacement.
Instead of ignoring existing private initiatives, we should regulate and integrate them into the health system. Affordable community-based screening, digital telemedicine and trained local entrepreneurs can support early detection and timely referrals.
Saiqa Siraj
Head of Fund Secretariat, Climate Bridge Fund, BRAC
Bangladesh attained notable achievements in nutrition, but the country still struggles with the triple burden of malnutrition — undernutrition, micronutrient deficiencies, and overweight and obesity. Despite good policies and strategies, the key challenge lies in implementation.
The first area of focus should be integrating nutrition into primary healthcare instead of keeping it parallel. Through a government-led public-private platform, it is possible to link public health facilities with community health entrepreneurs and private providers to provide nutrition screening, counselling, supplements and referrals.
Bangladesh needs to move from fragmented interventions to a coordinated and people-centric primary healthcare system.
Prof Kaosar Afsana
Professor and Lead, Humanitarian Hub, BRAC James P Grant School of Public Health
The most important challenge is not the lack of initiatives but the lack of strong links between systems.
Improvement of nutrition cannot solely rely on the health sector. It requires an integrated approach across the health sector, WASH sector, environment, agriculture, livestock, and food system. Public-private partnership will require more community involvement and effective coordination between different institutions.
Policy should respond to evidence, and evidence needs to inform policy.
Dr Rudaba Khondker
Country Director, GAIN
Strengthening primary healthcare requires us to look beyond the health system alone. We need to connect health systems with food systems while also considering the growing impact of climate change.
At present, we have data on public expenditures, but hardly any on private investments. This lack of data makes it hard to plan effectively.
Additionally, we require a governance structure, which should include conflict of interest policies to maintain transparency and standards for public health.
Sustainable financing is another significant priority area that needs attention. We need to think of creative financing mechanisms rather than relying entirely on donations.
Dr Iqbal Kabir
Public Health Nutrition Specialist
Nutrition has long been an integral part of primary health care. This is not a new idea. The actual problem now is to implement it in practice through meaningful public-private partnerships.
The challenge is no longer policy; it is implementation.
Around one-third of sanctioned health posts remain vacant, frontline health workers are in short supply, and primary healthcare currently reaches only about one-quarter of the population.
Dr Santhia Ireen
Deputy Director, Education and Research, BRAC James P Grant School of Public Health
Implementation research is essential if we want public-private partnerships to succeed in strengthening primary healthcare.
We already know many effective nutrition interventions, but we still need to understand how they can be implemented successfully through partnerships, particularly in rural areas where experience remains limited.
Public-private partnership should remain government-led with proper guidelines, standards, and accountability frameworks in place.
Finally, the fragmented reporting system needs to be connected with the national HMIS (Health Management Information System).
Faria Shabnam
National Professional Officer, Nutrition and Food Safety, WHO
From WHO's standpoint, I think the private sector can contribute to enhancing nutrition services and improving last-mile delivery. However, it should be done based on stringent safeguarding mechanisms.
The key here is to develop conflict-of-interest policy for institutions and individuals.
Manufacturers of products like breast milk substitutes, junk food and unhealthy drinks should be kept outside nutrition-related partnerships.
The government should take charge of the whole process in accordance with a standardised national protocol.
Anjuman Tahmina Ferdous
Nutrition Specialist, Unicef Bangladesh
We have long been aligned on the importance of strengthening nutrition through effective public-private partnerships.
Any engagement with the private sector must be child-oriented, equitable and compliant with nutritional standards.
Current policies and global compliance norms have limited collaboration, so now is the time for us to embrace a governance model that clearly spells out the responsibilities of all partners.
The selection process has to be transparent, but data integration has to be given importance.
Shihab Uzzaman
Country Director, Bopinc Bangladesh
The entrepreneur-based model is a strong and practical approach for delivering nutrition products and services.
Our experience from programmes in different countries shows that entrepreneurs are often more effective than volunteers in reaching communities and ensuring sustainability.
The affordability issue is more than just about finance – it is essentially about the business model.
But we need to think of a different approach to finance, especially blended finance.
Mohammad Solaimun Rasel
Chief Technology Officer and Chief Business Officer, Grameen HealthTech Ltd (Shukhee)
The biggest challenge lies not in the technology but in the adoption of the technology.
All of us are comfortable in using digital media such as Facebook, WhatsApp, etc, but most of the healthcare providers are unwilling to adopt digital healthcare as they feel it is complex and costly. However, digital healthcare has become inexpensive due to the availability of mobile phones and easy-to-use apps.
What we want is to bridge people on the bottom of the pyramid, particularly in the regions where there was no regular access to medical care.
We need the entire healthcare system to be linked from consultation to prescription to diagnostics to referrals to authentic medicines.
Mohammed Soeb Iftekhar
Director, Programme, iDE
Nutrition-specific and nutrition-sensitive interventions must be differentiated in our efforts instead of adopting one blanket guideline for all initiatives. Through our intervention in 12 districts identified as nutrition vulnerable, we are piloting 450 nutrition enterprises to know what works and to develop evidences which will aid in shaping our future policies.
These entrepreneurs can play an instrumental role in connecting the gap but they cannot succeed without incubation, mentoring and constant support. We need stronger collaboration between public and private sector and inter-ministerial coordination.
ASM Shahidul Alam
Team Leader, MMS Project, SMC
Our work, at SMC, is closely aligned with the objectives discussed here. We work with around 4,500 women entrepreneurs across Bangladesh who run their businesses with their own resources.
One of the biggest challenges is that we are all working in isolation. We provide growth monitoring, antenatal care and many other services free of cost, but none of this data is integrated into the national health information system.
If all the information from different organisations could be compiled in one single government database, this would immensely improve planning, monitoring and decision-making.
Key recommendations
- Integrate nutrition assessment, counselling and referral into routine primary healthcare.
- Strengthen public-private partnerships involving government, NGOs, businesses, academia and development partners.
- Develop a national roadmap for integrating nutrition into primary healthcare.
- Include routine nutrition screening for early detection and management of malnutrition and nutrition-related diseases.
- Develop an integrated referral system linking community clinics, family welfare centres, private providers and higher-level facilities.
- Recognise and regulate informal private healthcare providers through quality assurance and supervision.
- Strengthen frontline health workers' capacity through regular nutrition counselling training.
- Establish an integrated health and nutrition information system for timely data collection, monitoring and evidence-based decisions.
- Integrate successful community-based models into government health systems for sustainability and wider coverage.
- Improve coordination among government agencies, local government, development partners, academia and civil society.
- Increase domestic investment in nutrition and encourage innovative financing.
- Strengthen coordinated community awareness and behaviour-change programmes.
- Promote digital solutions for nutrition counselling, screening, referral, monitoring and follow-up.
- Encourage operational research to identify effective nutrition interventions.
- Strengthen community participation and local ownership of nutrition promotion and service delivery.
