Report No: ACS22585 . People's Republic of Bangladesh Supporting Nutrition-Sensitive Safety Nets through Strengthened Local Government Administration Completion Note . September 2017 . GSP06 SOUTH ASIA . 1 . . Standard Disclaimer: . This volume is a product of the staff of the International Bank for Reconstruction and Development/ The World Bank. The findings, interpretatio and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments th represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and oth information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territo or the endorsement or acceptance of such boundaries. . Copyright Statement: . 2 The material in this publication is copyrighted. 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All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 Street NW, Washington, DC 20433, USA, fax 202-522-2422, e-mail pubrights@worldbank.org. 3 Supporting Nutrition-Sensitive Safety Nets through Strengthened Local Government Administration (P155638) Activity Completion Note Background and Objectives Although Bangladesh has made remarkable progress in poverty reduction and human development outcomes, extreme poverty and vulnerability remain stubborn problems. The country ranks sixth in the world on prevalence of stunting. The incidence of low birth weight is also among the highest at 22 percent, with maternal under-nutrition at about 24 percent. The poor in particular primarily experience under- nutrition. Despite the country’s achievements of increased access to education and gender parity, there are also marked disparities in participation and educational attainment rates for children in poor communities compared to their non-poor counterparts. Thus, improving nutrition and cognitive development opportunities for poor children is critical to arrest intergenerational transmission of poverty and presents an early window of opportunity to address inequality and improve outcomes for children later in life. Failure to invest adequately in the wellbeing of children from an early age has long-term implications, not only for children but also for society as a whole, because it increases the likelihood of poverty in adulthood and perpetuates intergenerational transmission of poverty. By focusing on lifecycle vulnerabilities, social protection can serve to address vulnerabilities associated with a particular stage in life. The Government implements a wide range of social safety nets (SSN) to address poverty and vulnerability from a broad perspective, although considerable overlap and fragmentation among SSNs are additional challenges. With over 100 programs implemented across 21 ministries, lack of coordination results in inefficiencies and confusion among beneficiaries regarding their entitlements. Local level governments (or Union Parishads) are responsible for determining beneficiary lists and for delivering benefits on behalf of various line ministries, yet do not receive an administrative budget for carrying out these activities. Nor do line ministries implementing various safety nets coordinate at the local level when developing their respective beneficiary lists through local government officials. In recognition of these concerns, the Government has formulated the National Social Security Strategy (NSSS), which builds on the country’s rich experience and seeks to streamline and strengthen existing safety net programs with a view to improving SSN impact on poverty reduction and human development outcomes. As part of instituting a comprehensive and inclusive form of social security, the proposed NSSS recommends consolidation of programs towards a lifecycle system, with greater focus on empowering women and the 1,000-day window from conception, which currently suffers significant gaps. As part of its implementation of NSSS recommendations, the Government approved the $300 million IDA- supported Income Support Program for the Poorest (P146520) in 2015, which will provide income support to poor mothers in selected locations while (a) increasing the mothers’ use of Child Nutrition and Cognitive Development (CNCD) services and (b) enhancing local-level capacity to deliver safety nets. The ISPP complements the Government’s existing health and nutrition services, which deliver nutrition- specific interventions at the community level through a comprehensive nutrition package, including support for breastfeeding and complementary feeding, dietary diversification, food supplementation and fortification, as well as management of severe malnutrition. Recent assessments find that key nutrition- specific ministries/agencies do not have the technical capacity to deliver quality and inclusive nutrition- related services and suffer from stretched capacity and resources. ISPP will serve to strengthen delivery 4 platforms for wider and more comprehensive interventions by identifying poor, and often under-served, women and incentivizing them to regularly utilize services important for child nutrition and growth, and supporting existing government institutions with the technical resources required to deliver their mandate. Through Rapid Social Reponses Trust Fund resources, the Bank provided support for coordinated social protection services at the Union Parishad (UP) level, with a focus on nutrition-sensitive safety nets, by developing, testing and validating (a) harmonized safety net administration at the local level and (b) innovative tools to promote beneficiary uptake of nutrition-related interventions. In order to support this objective, the activities under this grant provided the necessary input to build functional capacity of nutrition-sensitive service delivery agents and provide a coordinated framework for administration of safety nets in general. Review of the Work Program and Deliverables The three components under the grant include: (1) developing a strategy for coordinated administration and service delivery at the local level; (2) developing and testing curriculum and material focused on child nutrition and cognitive development (CNCD) and associated monitoring and assessment tools, and (3) developing a strategy to promote social mobilization. Component 1: Developing a strategy for coordinated administration and service delivery at the local level As part of enhancing local level government capacity to facilitate and coordinate implementation of safety nets, the Project has set up a Safety Net Cell (SNC) at UP offices in ISPP locations. Staffed by a Safety Net Program Assistant (SPA) and in coordination with elected members of the Union Parishad and other local level administration officials, the objective of the SNC will be to function as a “one -stop shop� to provide the local community information on safety net programs operating in the Union, their eligibility criteria and benefit amounts, and other associated processes and procedures. Citizens often have to deal with a multitude of agencies/institutions in order to collect or to apply for benefits and may not always be aware of the full range of services available to them. By concentrating the processes and procedures of various safety nets into one contact point operating at the level closest to the beneficiaries, the one-stop shop function of SNCs can help enhance accessibility, transparency and overall relations with the local community and beneficiaries. SNCs would thereby constitute the “entrance point� to the social security system. Local level coordination in SSN delivery will allow SNCs to initially compile a beneficiary registry at the Union level and over time, track beneficiaries receiving benefits from different programs and provide referral services for households that are potentially eligible for other safety net programs, and other relevant informational support. This information can eventually feed into the central-level beneficiary registry tracking system being developed by the Ministry of Finance (MOF), with support from UK-DFID, and the Ministry of Disaster Management and Relief’s (MODMR) Management Information Systems (MIS) supported under the Safety Net Systems for the Poorest project. By improving administrative efficiency and performance, the SNCs have the potential to eventually minimize fragmentation among safety nets across ministries. The deliverables under this activity comprised: 1.1. One-stop shop framework for Safety Net Cells While the initial proposal comprised the design and pilot of a one-stop shop strategy and technical manuals, project implementation delays necessitated a curtailing of proposed outputs. The strategic governance 5 framework that was prepared under the grant will provide the foundation for development of detailed manuals to facilitate the SPA’s day to day activities. 1.2. Design of Management Information System Grant resources were used to design the overarching framework and architecture for the program MIS to capture, manage and monitor real-time data on beneficiary enrolment; compliance with co-responsibilities; payments; case management and grievance redress. The MIS is at the heart of the program and will enable strategic planning, management and operational control, transaction processing and reporting against results indicators and targets. Support towards the design of the MIS was critical and enabled the Project to procure firm services for the development and maintenance of the program MIS. This is currently under development and is expected to be ready for pilot testing by June 2017. 1.3. International knowledge sharing Grant resources were used to facilitate learning opportunities by funding Government participation at the “Global Forum on Nutrition-Sensitive Social Protection Programs: Towards Partnerships for Development� held in Moscow in September 2015, where Bangladesh featured as a country case study. Participation at the Forum encouraged improved access to knowledge and awareness related to nutrition-sensitive social protection and facilitate South-South learning from other countries on global practices and innovative approaches. Component 2: Developing and testing curriculum and material focused on child nutrition and cognitive development (CNCD) and associated monitoring and assessment tools 2.1 Development of Child Nutrition and Cognitive Development Curriculum This activity funded the development of a customized curriculum on child nutrition and cognitive development, drawing from existing local and global best practice material. A leading research institution (International Centre for Diarrhoeal Disease Research, Bangladesh) was commissioned to prepare the curriculum, which also incorporated latest research and evidence in this field. The curriculum will guide the monthly counseling sessions offered to ISPP beneficiaries and provide a holistic approach to children’s nutrition and cognitive development by promoting parental practices. The curriculum comprises modules for a defined category/age group of beneficiaries and covers topics involving nutrition; dietary diversity; hygiene; safety; physical, language and social development, and effective parenting techniques. Relevant books, material and toys have also been identified and form part of the package of services to mothers and children. The curriculum was reviewed and endorsed by the Directorate General of Health Services’ Curriculum Approval Committee, following which master-level training on the material was conducted. The curriculum is expected to be available for other service delivery agents in future, including government agencies, non-government organizations and development partners, who are involved in nutrition-related interventions. 2.2 Development of Knowledge, Attitude and Practice Assessments In addition to the CNCD curriculum, associated monitoring tools - Knowledge, Attitude and Practice (KAP) assessments - were developed under the grant to test the effectiveness of the CNCD material and assess mothers’ retention and application of knowledge from the sessions. These assessments will be administered 6 as part of the periodic Project operational review to provide timely feedback and inform any course correction and update to the curriculum and material. The assessments will also be administered as part of the impact evaluation of the program and will thereby enable validation of government efforts to promote early childhood nutrition and cognitive development and can serve as a catalyst to leverage additional resources, thereby enabling expansion of child nutrition services nationwide and supporting the young population to grow into healthy, educated and capable adults. Component 3: Developing a strategy to promote social mobilization 3.1 Development of Social Mobilization Framework Through the Project and outreach activities of the Ministry of Health & Family Welfare’s Community Clinics, community leaders, particularly women’s empowerment and support groups, will be trained to engage with the local community to communicate knowledge and motivate practices developed under the CNCD curriculum to build a shared understanding of nutrition and increase commitment and capacity to deliver services. A social mobilization framework was prepared to guide the development and delivery of the curriculum and the associated follow-up with mothers and awareness-raising within the community. The framework was provided to icddr,b as part of curriculum development and will also be shared with the NGO responsible for counseling sessions and social mobilization activities. This is expected to stimulate demand-side awareness on government services and galvanize women’s empowerment to initiate change and progress through community-led initiative and creativity. 3.2 Publicity material The Government finalized branding of the program as Jawtno (“nurture�), reflecting the nature of services that beneficiary mothers will receive and creating a marketable identity that will be useful in establishing further value propositions in the future. At the Project’s request, the grant supported development of a short promotional video to publicize the program and inform stakeholders of design and targeted outcomes. In addition, the logo and tagline were designed and are being used for all program related goods and material. Lessons Learned Effective capacity building through timely technical support RSR resources enabled the task team to provide valuable technical assistance and support to the Project in addition to regular implementation support. The ability of the Bank team to bring in the necessary expertise for specific tasks that are central to the effective delivery of ISPP’s services for beneficiaries, such as technology experts for the MIS design and a leading research institution for curriculum development, not only meant inputs to the program design were of high quality, but also offered the Project Management Unit the flexibility to be involved in the substance of the process while focusing their efforts on other administrative and logistical preparatory activities for the cash transfer program. In addition, grant resources facilitated just-in-time outputs that had not initially been part of the Project’s design, such as the branding and publicity material. These outputs formed a visual demonstration of the objectives and envisioned outcomes. The material has been used by both Government and the Bank to reemphasize the critical importance of the Project in the country’s development strategy. Need for continuity of support Grant implementation was not able to coincide with field-level implementation of the cash transfer program. When tools developed through the grant are utilized, adjustments are likely to be required based on practical implementation and experience with beneficiaries. Based on this need, especially in the early years of 7 Project implementation, it will be important to be able to respond to technical challenges through continued support. As such, the task team has sought additional resources under the RSR 12th Round Call for Expression of Interest – the proposed activities build upon the previous grant through an innovative approach by piloting institutional structures to improve coordination and operational efficiency of the safety net system at the local level, while assessing and improving operational efficiency of the cash transfer program. 8 Summary Table of Deliverables Component Activities Deliverable Progress Strategy for coordinated One-stop shop framework Strategic framework for Completed administration and for Safety Net Cells one-stop shop service delivery at the Design of Management MIS technical Completed and local level Information System specifications delivered to client International knowledge Participation at global Completed sharing forum on nutrition Curriculum and material Development of Child CNCD curriculum Completed and focused on child nutrition Nutrition and Cognitive delivered to and cognitive Development Curriculum client development (CNCD) and Development of KAP tools Completed and associated monitoring and Knowledge, Attitude and delivered to assessment tools Practice Assessments client Strategy for social Development of Social Social mobilization Completed and mobilization Mobilization Framework framework delivered to client Publicity material Branding video Completed and Jawtno branding and logo delivered to client 9