Healthy meals powering Bangladesh's factory workers and economy

Bangladesh’s garment factories have helped drive the country’s robust economic growth, accounting for more than 80% of exports earnings and 10% of the country's GDP. But the sector’s long-term growth and stability faces an insidious threat from an unexpected quarter – poor nutrition.

Just under half of the more than two million women who work in the country’s 3,500 garment factories are chronically undernourished and nearly 80% are anemic. The lack of iron and other micronutrients in workers’ diets can leave them fatigued and with impaired cognitive abilities. Indeed, Bangladesh’s factories consistently report low productivity. That lost productivity is estimated to cost the country around US$1 billion in lost earnings annually.

Determined to change this, GAIN (Global Alliance for Improved Nutrition) partnered with the factories and the Ministry of Health and Family Welfare and the Ministry Labor and Employment to pilot an innovative workplace-based nutrition program. It aims for a win-win – reducing workers’ undernutrition and boosting both health and factory productivity. Today their efforts, and those of many others working on workplace nutrition interventions, serve to inform other interested employers as part of the Workforce Nutrition Alliance. The WNA estimates that an estimated six million workers globally now have access to workforce nutrition programs.

The program in Bangladesh's factories has five parts: improving the nutrition of the free lunches served to factory workers in cafeterias; peer-to-peer nutrition education for all workers in the factory; free iron folic acid tablets for women factory workers provided by government; low-cost factory-based shops stocked with nutritious food offered in small, more affordable quantities, such as 250 gram packets of fish or meat; and establishing a “community nutrition center,” by renovating a local grocery shop to offer all workers blood pressure screenings and measure body mass index in addition to stocking more healthy foods.

During the pilot phase, the program succeeded in reducing anemia by 22%, reduced daily absenteeism at the factory by 1.5% to 2%, reduced the use of sick leave, and increased performance and worker retention.

The program has been rolled out in more than 100 factories across Bangladesh reaching more than 100,000 workers. In one factory, production increased 70% over the four years after implementation and workers saw an increase of 20% in their annual earnings. Anemia rates among workers in participating factories typically decline between 12% and 32%.

Many countries identify schools and homes as key targets for nutrition interventions. Fewer recognize the potential offered by workforce-based interventions. According to research published in the International Journal of Environmental Research and Public Health, the "workplace offers an important, relatively unexploited opportunity to address malnutrition in all its forms.” The study’s authors went on to say that such programs offer an opportunity for the private sector to demonstrate their environmental, social and governance commitments, and recognize the needs and health of their workers.

“We used to say that good nutrition is for all,” said Dr. Rudaba Khondker, GAIN’s Bangladesh director. “But the benefits of good nutrition were unknown by our factory workers who generally earn very limited wages. We saw they were trapped in a cycle: spending a lot of money on health care because of their poor nutrition and the poor nutrition of their family members. Their poor health was forcing them to miss work and undermining their earning potential and keeping healthy food economically out of reach. And their high health care expenses were also, in part, keeping them poor, undermining their ability to afford more nutritious food.”

Key to the program’s success is managing the costs of such programs for factory managers. “Factory managers are extremely price sensitive,” said Dr. Khondker. “In developing this program, we knew we needed to stay within their budget which was about 50 cents per meal, which is just over BDT 50.”

Cafeteria meals shifted from being a heaping mound of rice with a small piece of fish or meat on top and a thin lentil stew on the side to a more balanced meal that includes biofortified rice or potatoes, vegetables, and perhaps an egg or chicken with a thicker lentil stew with a side of green chili and lemon.

The project's biggest challenge was signing up the first factory manager to join the pilot back in 2014, recalled G. M. Reza Sumon, project manager and co-lead of the workforce nutrition program for GAIN. “We had a long pitch and that didn’t work. These businesses are busy. They need a clear quick pitch. But once the pilot program demonstrated results, more factory managers came on board,” said Sumon.

The model has been replicated beyond Bangladesh’s garment industry, including in leather factories and in the country’s ports. Sumon said participating factory managers quickly become champions for the program, which is called “Strengthening Workers’ Access to Pertinent Nutrition Opportunities” – or SWAPNO for short, which means “dream” in Bangla.

Managers from more than 160 factories in Bangladesh have joined a National Workforce Nutrition Alliance, established by the Ministry of Labor and Employment, to share learnings and advance the nutrition of their employees, suppliers, and communities. Other factory managers in Bangladesh have hired nutritionists to maximize the nutrition of the lunches they serve their employees.

Globally, GAIN has partnered with the Consumer Goods Forum to establish the Workforce Nutrition Alliance, which supports employers to adopt and expand healthier workforce nutrition programs.

A key learning from the project, said Dr. Khondker, is that factory management and workers must co-own the program. Joining together on Nutrition Improvement Committees at each factory, they decide on potential menus and seek feedback from colleagues on the meals and adjust them as needed. The committees also monitor meal quality and design nutrition education that suits the needs and tastes of a busy and diverse workforce. “This is a new experience for both the workers and management,” said Dr. Khondker. “In most cases, factory management has not included workers in decision making or asked workers’ for feedback before this intervention.”

Another key learning is focusing on both the supply of and demand for nutritious food. “This has been a journey for us,” said Dr. Khondker. “Before we saw people coming to work with empty bellies and they were hungry. They didn’t have access to healthy food and didn’t know what food was the healthiest. So, they couldn’t perform to their potential. That was a problem for us all. Their health is important in and of itself and their work is a key source of revenue for our country. So, it is important that they can perform to their potential. Investing in workers’ nutrition makes business sense.”

Editor’s Note: For more information about workforce nutrition, sign up to join GAIN’s Workforce Nutrition Masterclass on March 27, 2024, and access the Workforce Nutrition Alliance’s workforce nutrition guidebooks here, available in English, French, Spanish, Khmer, and Vietnamese. The Workforce Nutrition Alliance was launched in October 2019 by the Consumer Goods Forum and GAIN to help employers ensure their employees have access to and knowledge about healthy nutrition, breastfeeding support, and nutrition-focused health checks.