World Bank projects costing hundreds of millions of dollars and aimed at cutting malnutrition among children in developing countries have completely failed to make a difference, according to a report published last week.
The charity, Save the Children United Kingdom, claims the bank has not only continued with costly but failing projects in Bangladesh and Uganda, but is planning to expand, with a scheme billed for Ethiopia. It claims the money could be better spent.
The World Bank both designs the programmes and lends beneficiaries the money to carry them out, which increases the beneficiaries’ debt.
Fiona Weir, the charity’s policy and communication director, said: ”It is a matter of deep concern that the World Bank has recently loaned Bangladesh a further $124,6-million, and a projected 10-year investment loan plan of one billion dollars is under discussion.
”These projects threaten to plunge developing countries into further debt without making any substantial impact on malnutrition rates.”
John Seaman, a health adviser at Save the Children, claims the programmes are based on a ”widely discredited” approach, which assumes ” the child is malnourished because the mother isn’t doing something right, because she doesn’t know how to feed or lacks the food to support the child”.
In areas where the programmes operate, children are registered at a centre at birth. Their mothers then bring them to the centre each month to be weighed. If a child appears severely malnourished, it becomes eligible for feeding. The mother then has to bring her child to the centre everyday and is shown how and what to feed her child, while the infant gets a meal.
”It’s a considerable time investment for the mother,” said Anna Taylor, author of the charity report Thin on the Ground. ”The child could be receiving food for three to six months and she [the mother] is supposed to go every day and receive messages about how she is supposed to be caring for her child, and sit around waiting for the meal.”
The charity’s research showed that only 20% of the children eligible for extra feeding were receiving it, concluding that the World Bank had not taken account of the pressures on mothers to work and take care of their homes and the rest of the family. ”Our evidence suggests that too many mothers are too poor to act on their newly acquired knowledge about nutrition: they live in unhealthy, unsanitary environments lacking adequate and safe water,” the report says. ”They have little or no access to health services; they are often illiterate and they have inadequate time for childcare.”
The sums of money involved are large. One project in Bangladesh which ran from 1995 to 2002 had a $67-million budget. It has been replaced by a second scheme with a budget of $124-million. It could continue for 10 years, spending up to one billion dollars. The Uganda project —from 1998 to this year — is worth $40-million but there are further plans to expand provision.
Taylor says that malnutrition has improved overall in Bangladesh because of the slightly better economic position of the country as a whole. In six years, the World Bank programmes made no contribution, the charity’s analysis of the data shows.
The charity says that the money would be better spent on improving healthcare systems so that children get basic immunisation; on getting more children into schools; or on improving sanitation and clean-water supplies.
Milla McLachlan, the bank’s nutrition adviser, rejected the criticism, although she said it was valuable to have ”constructive dialogue around our work”. New data from the Bangladesh project, not yet made public, would show that the project has an impact, she said. ”It is quite clear that the project has had very positive outcomes regarding behaviour.”
There has been a 35% rise in the number of women undergoing antenatal check-ups, a doubling of those taking iron and folate supplements and a reduction in severe stunting of growth.
McLachlan said the bank did not operate nutrition programmes in isolation and would also be funding projects to improve sanitation, water, health and hygiene. The education and behaviour change projects were in addition to other efforts, she said. — Â