Shaping the future of CHT
Basic services must reach the children of deprived communities
The terrain at Rangamati, Khagrachhari and Bandarban is hilly, marshy and mostly unhospitable. Delivering basic services here is a challenge.
There are 1.6 million people living in the hill tracts. The region covers 10 per cent of Bangladesh’s land area but accounts for only 1 per cent of the population.
About half the population are from 13 small ethnic groups. These religious and ethnic minorities have been living in hill tracts for many generations. The other half, about 53 per cent, are Bengalees. Most of the people live in scattered habitats known as ‘Para’.
The CHT communities suffer from many deprivations due to challenges posed by its unique demography, socio-economic situations and diversities in culture and customs.
There is also not enough infrastructure, human resources and integration of CHT context in development planning, which all limit effective coverage of basic services.
For safe birth and healthy children, pregnant mothers must do at least four antenatal check-ups. In Khagracchari, only 17 per cent of mothers go to their doctors for these vital visits, according to data from Real Time Monitoring
The ethnic groups in CHT have different traditional practices on early childhood development and justice systems making for a complex socio-behavioural context.
Breastfeeding practices here are better when compared to the national level, but the knowledge varies among communities. For example, in the Mro community, two-month-old babies are fed rice pulp chewed by their grandmothers along with breastmilk.
Parents in Bangladesh generally have low awareness of complimentary feeding practices. But the dietary diversity of infants and young children in CHT are even poorer in comparison.
It is a strong predictor for stunting, which is a condition of chronic malnutrition. Children who are stunted are shorter for their age.
Around 49 per cent of children in the CHT suffer from stunting, which is much higher than the national average
Very few in the CHT can access nutrition supplements. In Rangamati, there is no record of anyone using iron-folic acid (IFA) tablets. The situation is better in Khagraccharhi, where these tablets are distributed by UNICEF-supported Para Centres.
In other parts of the country, sanitation practices have improved but the three CHT districts still account for 32 per cent of unimproved latrines. In Bandarban, open defecation is at staggering 23 per cent, while nationally the rate is only 5 per cent.
Communicating vital messages is also a challenge as the majority areas in these districts are ‘media dark’, meaning television, radio and print media have limited coverage. Bangladesh Betar has regional stations in Bandarban and Rangamati but does not cover all the sub-districts.
Because the ethnic groups speak different languages, there isn’t a common language for communication.
For women in the CHT, strong labour, child rearing, extensive engagement in household chores such as collecting firewood from forests and water from faraway points mean they suffer ‘time poverty’.
Moreover, women of these ethnic groups are malnourished and have low health-seeking behaviours due to harmful social norms.
The three districts continue to perform below national average and are listed at the bottom of the 20 underperforming Bangladeshi districts identified for UN Development Assistance Framework
UNICEF is one of the strongest and long standing development partners supporting the Bangladesh government in the CHT.
In the 80s, UNICEF began supporting the Integrated Community Development Project, which focused on child development, health, nutrition, water-sanitation and hygiene, as well as income generation.
Then in 1996, the project began a pioneering model for delivering services. The approach was centred around the small neighbourhoods or ‘Paras’ scattered on the remote hills.
A baby’s first 1000 days: The centres provide antenatal care, immunisation and supports newborn care and special care for premature babies. It promotes Kangaroo mother care, early initiation and responsive feeding. It teaches proper hygiene and manages acute malnutrition in babies besides monitoring growth and working to prevent gender violence. The Para workers also work to promote birth registration.
Early learning and protection: The centres provide pre-schooling and manages childhood illness with immunisation, deworming. Children learn handwashing practices and toilet use; teachers are educated on early health, growth and development and parents given support on stimulation and positive parenting.
Care for caregivers: This package offers care to multiple generations in a community and includes peer-to-peer support, social services, management of mental health issues, lessons in child development and positive discipline, nutrition counselling and hygiene practices such as water safety plan and toilet maintenance.
Family support: The centres work to promote community-based child care and strengthen access to basic health and nutrition services besides positive and responsive parenting. It offers social protection and safety networks including cash transfer.
UNICEF delivers basic services to children and women through its 5,000 Para Centres in the three CHT districts. The Para Centre network plays an effective role influencing positive social behaviour and is widely accepted by the community.
The success has led the government to become the major investor in ensuring resiliency of Para Centres in face of harsh surroundings and natural hazards.
Para Centres are at the heart of a new approach taken up by UNICEF and the government in 2017 which aims to provide sustainable social services.
UNICEF works to bolster the capacity of para workers, health workers and NGO workers to make sure interventions such as nutrition services for lactating mothers or referrals for sick newborns can be provided to more families.
The strategy for advocacy through Para Centres utilises the Early Childhood Development or ECD package. ECD being a global priority, has targets set for education, health, nutrition and protection up to 2030.
At the national level, the government’s Seventh Five Year Plan, National Children Policy and Early Childhood Development Policy reflect the commitment to make investment for the development and growth of children in their early years.