Field Stories
Ten inspiring global nutrition stories
December 17, 2024
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Story
Q&A with Dr. Titu Chandra Shil, Upazila Health and Family Planning Officer in Cox’s Bazar
The Adopting a Multisectoral Approach to Nutrition project united eight ministries to improve the health and wellbeing of people in Cox’s Bazar, Bangladesh. We spoke with a local health department leader about his experience and the project’s impact.
Posted on April 9, 2025
Members a farmer’s club gather for a meeting. The farmer’s clubs were one point of entry to share critical information on nutrition through the AMAN project.
With high malnutrition rates and significant poverty, Cox’s Bazar faces some of the most pressing nutrition challenges in Bangladesh. Nearly one-third of residents live below the poverty line,[1] and malnutrition remains widespread ‒ 29% of children are underweight, 35% are stunted and only 35% of mothers initiate breastfeeding within the first hour of birth[2].The district also has more than one million Rohingya refugees, further straining resources and disproportionately impacting women, children, and adolescent girls.
The Adopting a Multisectoral Approach for Nutrition (AMAN) project, implemented in partnership with the Government of Bangladesh with support from the Government of Canada, worked to improve access to nutrition services delivered through eight government departments and their relevant ministries.
Dr. Titu Chandra Shil, Upazila Health and Family Planning Officer for Cox’s Bazar Sadar Upazila, plays a vital role in these efforts. As the administrative leader of the health department at the upazila level (a district subunit), Dr. Shil contributes to the planning, budgeting and monitoring of the department’s annual nutrition action plan and serves as the member secretary of the Upazila Nutrition Coordination Committee.
In this Q&A, Dr. Shil shares insights into how AMAN helped to improve nutrition and health outcomes in Cox’s Bazar, the challenges faced, and opportunities to strengthen services for people living in vulnerable contexts.
Why was this project needed in Cox’s Bazar?
Despite significant progress in nutrition coverage, Cox’s Bazar faces considerable challenges due to a shortage of personnel in the health and family planning departments. This hindered our ability to fully meet the nutritional needs of the community.
The AMAN project addressed this critical need by appointing community health workers and volunteers to conduct household visits and deliver essential nutritional services. Efforts in community engagement and door-to-door counselling have significantly boosted awareness and practices around nutrition. This has led to improvements such as increased exclusive breastfeeding, regular antenatal care visits and the cultivation of nutritious food in household gardens.
What are the specific challenges that exist in Cox’s Bazar and how is a multisector approach making a difference?
Cox’s Bazar faces unique challenges, including its large population, the influx of refugees and limited resources. The AMAN project’s multisectoral approach has been instrumental in addressing the region’s nutritional challenges.
Numerous nutrition services have been implemented across sectors, such as livestock, agriculture, food and nutrition, health, family planning, and more. Effective implementation of these activities requires strong collaboration and coordination among all departments. Nutrition International, in partnership with BRAC and the World Food Programme, has facilitated collaboration across all sectors, leading to unprecedented development in the region. The collaborative effort has led to significant improvement in community awareness and practices related to nutrition. For instance, mothers are now more aware of the importance of nutrition and are taking active steps to ensure their families consume nutritious food.
What’s one major change that stands out to you?
The most significant change observed was the increase in nutritional awareness and practices among the community. During field visits, I noticed the establishment of vegetable gardens, cattle rearing and fish farming in front of community clinics and households. Mothers are now more aware of nutrition and regularly attend courtyard meetings.[3]
What impact have you seen this project have on the lives of women, children and adolescent girls in Cox’s Bazar?
The AMAN project conducted door-to-door visits, courtyard sessions, counselling, supported community clinics, and worked with priority line departments to implement nutrition activities. These departments also use their existing community platforms to deliver nutrition and health-related messages. As a result, we see a positive impact at the field or grassroots level, including increased counselling for adolescents, pregnant women, and lactating mothers. Pregnant women, their husbands, children, and mothers are all connected in these efforts.
What health and nutrition challenges still need to be addressed in Cox’s Bazar?
In our work on nutrition, we sometimes encounter children with severe or moderate acute malnutrition. These children suffer due to malnutrition, and because of poverty, often do not access the service needed for proper care. In other cases, we encounter pregnant women who would benefit from institutional deliveries who often end up delivering at home because they cannot afford hospital costs.
Our monitoring and rapid response teams try to support these cases, but the lack of patient transportation is a significant barrier. If we could provide our first-line supervisors with transportation for their regular monitoring visits, the frequency and effectiveness of supervision would improve. This would also help keep government activities more updated and enhance service quality. It would also enable us to conduct regular field visits in hard-to-reach areas.
Why are the changes brought on by the project significant to you and to the Cox’s Bazar district overall?
The AMAN project had a positive impact on both my professional responsibilities and personal inspiration.
Since AMAN started, community clinics hold regular community group meetings, and we organize household sessions. We use banners and posters to educate people about pregnancy check-ups, nutritious food and family planning services. This makes a big difference because we can now inform and motivate both husbands and wives together.
When the AMAN project began, the team briefed me on their activities and support at the upazila level. Seeing their work align so well with government efforts inspired me. During my field visits, I noticed how their counselling sessions have motivated people to understand and seek nutritious foods for themselves and their children. This initiative has been well-received by all stakeholders, demonstrating its effectiveness and importance.
Learn more about our work in Bangladesh.
[1] Cox’s Bazar Urban Vulnerability Assessment Cox’s Bazar, Bangladesh. July 2020.
[2] Cox’s Bazar District Nutrition Profile. The website can be accessed by – District – Nutrition Profile of Bangladesh.
[3] A courtyard meeting in Bangladesh is a gathering of people in a village courtyard to discuss issues and find solutions. These meetings can be used to raise awareness, promote health and family planning, nutrition and improve food safety.
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