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The Government of Nepal developed a Multi-Sectoral Nutrition Plan (MSNP) for the improvement of maternal and child nutrition and accelerated reduction of chronic under nutrition under the strategic leadership of the National Planning Commission (NPC) and Ministry of Federal Affairs and Local Development (MoFALD).

As per Programme Cooperation Agreement (PCA) between Health Research and Social Development Forum (HERD) and United Nations Children’s Fund (UNICEF), HERD is providing technical support to implementation of MSNP through deployment of District Coordinator (DC) and Planning, Monitoring & Information Management Officer (PMIMO) in 28 MSNP districts. MSNP staff have shared what they have observed in the districts and how they have contributed in improving the nutritional status of the country.

Ishwori Prasad Neupane, District Coordinator, Kapilbastu

The nutrition status of Kapilbastu district is not very good as compared to other districts. The nutritional scenario in the areas near the East-West highway are relatively good but as we go south of the highway, the situation in Madhesi community is worse.

The main reason for such scenario is the disadvantaged position of women in the Madhesi community. The women in the community are not socially active, they are not allowed to talk freely, they are forced to stay home and have very less say in decision making. Since they are not active socially, they aren’t aware about nutrition related information. Very few are aware about the issue but bringing the knowledge in practice in the community is difficult.

The MSNP intervention has reached the then-34 VDCs of the district. Not much work has been done; some programmes have just been initiated in the 7 VDCs added in previous fiscal year 2073/74 BS. There are some places where nutrition programmes have been implemented very well, while in some areas, the programme doesn’t seem much effective. HERD team with District Co-ordination Committee (DCC) has been involved in planning, quality implementation and making focal persons more active. After that, MSNP interventions were also started to be implemented resulting in benefit to the people of the district.

We have been contributing much for raising the nutritional status in the district by reaching villages, communities and providing various nutrition related information’s. We have also sensitized the VDC secretaries and persuaded them to allocate budget for nutrition, helped associated organizations in developing nutrition plans. Not only that, we have also emphasized on working through an integrated approach of activities like kitchen gardening, poultry farming, following measures for sanitation and ensuring provisions for safe drinking water. In addition, we have also taken commitments from the VDCs for improvement in the nutrition scenario of the working district.

To bring a change in the nutrition situation, it is important to create awareness in every village and community. Along with awareness, kitchen garden, poultry, sanitation related programmes must also be simultaneously implemented in an integrated approach. There is need of increased willingness for quality implementation among the governmental officers from line agencies. To improve this, there is a need of award and punishment mechanism. The initiative by HERD team to bring a change in the supporting districts needs to be carried on for more than 4- 5 years, or else the situation of zero achievements as per the budget expenditure might arise. The organizations that are working in this sector are not much pleased to hear the word “multi sector nutrition”. They tend to work alone. In order to improve this situation, programmes need to be implemented in an integrated approach under the multi sector nutrition arena.

Purusottam Aryal, District Coordinator, Rukum

The situation of nutrition in the district is not very satisfactory. Most of the people in this district are suffering from stunting and wasting. The problems of anaemia is also common while many children seem to be clenched with severe malnutrition.

The reasons behind such situation are child marriage, illiteracy, social and cultural norms and values and low level of awareness. Child marriage leads to early pregnancy, and since the parents aren’t well educated, it which leads to the birth of the malnourished child.

Different programmes related to nutrition have been implemented in district and has reached all local units of the district, which have benefitted the local people. Exemplary activities like distribution of Balvita and iron-folic tablets by District Health Office, orientation on how to make nutritious jaulo by SUAAHARA, other reproductive health programmes, hygiene related activities, awareness related activities have benefitted the local people. However, there is not much change as expected due to lack of simulation by the local beneficiaries.

We have contributed in improving the nutritional status through conduction of various nutrition related awareness and orientation programmes in targeted groups and communities. We have been coordinating and collaborating with different stakeholders, line agencies, local bodies and communication channels among others. We have also been helping the line agencies in development and implementation of different intervention measures. In addition, we have been involved in relevant data collection and entry in Online Reporting System (ORS) prepared by MoFALD in technical assistance from HERD for monitoring of ongoing activities related to nutrition.

To bring about a change in the nutritional status, it is necessary to emphasise implementation of awareness related activities. Nutrition related curriculum should be developed in school level. Trainings and meetings with the concerned bodies have to be held. Targeted group and individuals have to be informed about importance and necessity of nutrition through various means of communication. Focus should be given in conducting street drama and other activities to eliminate child marriage.

Bhumishwar Sharma, District Coordinator, Rolpa

The nutritional status of Rolpa District is weak in comparison to other district. According to the Growth Monitoring Data of fiscal year 2072/73, 3.21% of under 2 years’ children are malnourished while 42% children are suffering from stunting. In the district, 98% of new born babies are breastfed within 1 hour of birth while exclusive breastfeeding for 6 months is only 10%. Similarly, 42% of pregnant mothers have received Vitamin A.

Some of the reasons behind the poor nutritional status of the district are lack of awareness, weak economic status, child marriage, and superstitious beliefs in traditional healers (Dhami and Jhakri) as well as heavy workload among women and the increasing trend of eating junk food.

The nutrition interventions have the coverage of only half of the district, where people of those particular areas have been benefitted. SUAAHARA has been implemented in 12 Village Development Committees (VDCs), Agriculture and Food Security Programme (AFSP) in 10 VDCs and Promoting Agriculture, Health, and Alternative Livelihoods (PAHAL) in 6 VDCs. SUAAHARA has been working for agriculture and production in an integrated approach while AFSP is working for improvement in nutrition status through agricultural production. Similarly, PAHAL program has been working for farmers’ production promotion and market management of agricultural yields. Besides these, governmental offices are also working for improvement in nutrition status of the district.

We have been contributing in the nutritional sector by, helping and facilitating 7 line agencies in implementation of nutrition targeted and nutrition sensitive programmes under multi sector plan implementation strategy. We have been regularly monitoring line agencies, advocating and lobbying on nutrition at community level as well as co-ordinating and collaborating with other projects working in nutrition.

To improve the prevalent nutrition scenario, it is important to increase agricultural and livestock production, country wide implementation of nutrition targeted programs such as Integrated Management of Acute Malnutrition (IMAM) and improvement in the rampant nutrition related eating habit and production mechanism and implementation of programs such as Multi Sector Nutrition Plan and SUAAHARA.

 Dinesh Bam, District Coordinator, Humla

The nutrition status of Humla district is poor compared to other district. According to Nepal Demographic Health Survey (NDHS) 2016, 54.4% of malnutrition cases are seen in the district. In Humla district, highest cases of Severe Acute Malnutrition (SAM) were seen in Tajakot Rural municipality while no cases of SAM was seen in Namkha Rural municipality. Similarly, there were 94 cases of SAM in Simikot Rural Municipality, 73 in Kharpunath Rural Municipality, 148 in Adanchuli Rural Municipality, 136 in Chankheli Rural Municipality and 110 in Sarkegaad Rural Municipality.

The main reasons behind this situation are geographical difficulty, lack of human resources, lack of production of yield crops and use of local resources and absence of food diversity. In addition, lack of effective implementation of nutrition programmes, absence of proper environment to carry out desired work, unavailability of equipment and fuel, lack of co-ordination between concerned stakeholders and lack of capacity development of NGOs has also affected the scenario.

Not all the programmes have covered the entire district. We have been contributing in the nutrition sector by making nutrition the local level agenda, sharing knowledge and skills and by co-ordinating and contacting different stakeholders at district and VDC level.

To improve the scenario, emphasis should be given to nutrition sensitive and nutrition specific interventions need to be aligned. Efficient human resource and information management is necessary. Various awareness activities need to be implemented in the district. Importance needs to be given to local level production and consumption. Nutrition needs to be integrated in the curriculum as well.

Rishav Pokhrel, District Coordinator, Udayapur

Severe Acute Malnutrition and Moderate Acute Malnutrition (MAM) cases in the district are reported mostly in Dalits and Musahar children especially due to early pregnancy. According the recent health profile of DPHO, prevalence of stunting in Udayapur district is around 27 percent, wasting around 10.8, underweight around 20 percent, and anemia among under 5 children is around 43 percent. In terms of highlighting agriculture sector of Udayapur district, the lowlands are fertile while hilly areas have less production and are dependent on other areas for food accessibility. Crops such as millet and vegetables are readily available on high hills, however dietary behaviour observed shows locally available crops are not used as regular diet.

There has been cases of poverty especially in the Dalit community. The reasons for prevalence of malnutrition are lack of awareness, lack of birth spacing, lack of utilization of health services, poor sanitation, lack of exclusive breast feeding practices, low consumption of nutritious food, consumption of junk food, traditional practices like consumption of alcohol by children or pregnant mother, lack of utility of locally available nutritious food, early marriage, drinking water shortage etc.

Government's regular nutrition specific programs such as vaccination has full district coverage. Other nutrition related NGOs and projects such as Sustainable Action for Resilience and Food Security (SABAL) has full district coverage, programmes by World Vision has covered 11 wards, Golden 1000 days’ program has covered 11 wards and MSNP in 7 ward. These programs focus especially on orienting about nutrition for golden 1000 days’ mothers and other activities such as chicken distributions, vegetable gardens etc. Some benefits to local people from nutrition related activities are voluntary support from FCHV in primary health care and family planning. They further support in institutional delivery, identify cases related to nutrition and try to solve it on the site or refer to appropriate institution.

We, the MSNP team have contributed by supporting line agencies through knowledge transfer. We are involved in record keeping and reporting. We have been making sure program benefits are reaped up by target group. We have done advocacy and oriented different stakeholders at local level. We have also provided help in planning of nutrition related activities.

In our view, to improve status of nutrition, establishment of nutrition sensitive and specific norms are necessary. For e.g. vaccination, handwashing, education, maintaining sanitation, marriage at proper age.  Secondly, improvement of life skill and livelihoods of people, women empowerment can help in improving nutrition status. Thirdly, food accessibility and availability plays great role in improving nutrition of the people. Therefore, agriculture sector needs special attention because high production and nutritious food contributes in improvement of nutrition status. Finally, awareness on diet intake amount and diet variety can be pointed out as one of the most important aspect, which can improve current status of nutrition. Even if there are norms, skills along with food availability but people are not aware about nutrition, then status of nutrition cannot be improved.

Sudip Devkota, PMIMO, Nawalparasi

It is evident that there are many malnourished children in Nawalparasi district. Referring the HMIS data, we can see that there are many malnourished children in the rural municipalities of southern part of the district, i.e. the part connected to Indian border. Although the data from growth monitoring shows the declining number of malnourished children, the number is not satisfactory.

In past years, nutrition related activities have been only limited to training and meetings. No monitoring and supervision of activities was implemented at lower levels of district. Lack of availability of nutrition related data at different level and places within district due to which, the situation might vary from one rural/urban municipality to the other. During programme implementation, activities have not reached every targeted group. Lack of advocacy to preserve the achievements made in the nutrition sector are some of the reasons for the current nutritional scenario of the district.

In general, throughout the district, tangibly or intangibly, there are some kind of activities being implemented in all VDCs through one or the other medium. But, if we talk about the necessity of the areas, types of programmes being implemented and the mechanism of programme development and implementation, achievements in the nutrition sector seem to be quite difficult in the district.

If we look at some past programs, some of the people are definitely benefitted but in statistical terms, the number is very low. If these are to be compared with the goals and indicators, these are by no means expected outcomes that we would want to achieve. However, there is an increase in awareness among the people but behaviour is not satisfactory. What is appraisable is that, the communication campaign and prominent use of communication channel in information delivery has resulted in increased awareness among the people of the district.

We have contributed by developing a local level programme based on the local situation and necessity. We have also worked to create awareness among the local planning bodies about the contribution of nutrition sensitive activities rather than nutrition specific activities for elimination and control of malnutrition. In addition, we have also made people realize that health and other sectors have equally important role for eliminating malnutrition and there is a necessity for integrated joint effort to eliminate malnutrition.

To improve the scenario of nutrition, evidence based planning according to local level necessary. Programme implementation and monitoring needs to be done in very effective and technical way. It is necessary to help stakeholders understand that nutrition, in their sector, is not only a health issue. Looking at the achievements made till date as a learning and using the positive aspects as an example creates motivation to work. Priority must be given to activities that create awareness and behaviour change. Integrated joint activities are necessary among various stakeholders. It is important to integrate nutrition in school and make it a base for nutrition education.

Contributors: Kritagya Regmi and Aanchal Parajuli