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Background

Globally, more than 45% of the child deaths are attributed by maternal and child under nutrition (Lancet, 2013). A global burden of disease study indicated that maternal and child undernutrition contributes the highest global disease burden at 11% worldwide (IHME, 2010). Malnutrition in all its forms comprises:  wasting (low weight for height):  underweight (low weight for age), overweight  (high weight for height), micronutrient deficiency (Iron, folic acid, vitamin A, zinc, iodine blow healthy thresholds),  overweight (carrying excess body fat with a body mass index >=30 Kg/m²),  and  non-communicable disease due to metabolic disorders (diabetes, heart disease, and some cancers). More importantly, undernutrition is the major global health problem in low- and middle-income countries.

Globally, nutrition has been a neglected issue, however the reason for neglect is not justifiable as it is important for millennium development goals (MDGs), sustainable development goals (SDGs), human capital, and economic productivity. The Lancet nutrition series in 2008 and 2013 indicated that nutrition should be taken as a global health and development priority and highlighted an urgent need to scaling up of effective community-based nutrition interventions. The things have changed now, nutrition is identified as a developmental priority and 12 out of the 17 SDGs contain indicators that are highly relevant of nutrition.

Undernutrition in numbers

Globally, out of 667 million children under five years of age, 159 millions are stunted (too short for their age), 17% are underweight (low weight  for their age), 50 million are wasted (do not weight enough for their height), and 41 million are overweight (GNR, 2016). Nepal remains one of the countries where prevalence of stunting is at greater than 40% (Lancet, 2013). A nationwide survey shows that  41% of the under five children are stunted, 29% are underweight, 11% are wasted, and  46%  of under five children are anemic (NDHS, 2011). In women, 18% of them in the reproductive age has low BMI (<18Kg/m²), 11% has overweight (BMI 25-29 kg/m² ),  2% are obese (BMI 30 kg/m² or above), and 35% of women age 15-49 are anemic. The huge gaps exist in terms of geographical variation and socio-economic status.

Global and national initiatives on nutrition

Global community has given nutrition a priority development agenda. International Conference on Nutrition‐2 (ICN‐2), UN General Assembly has declared the period of 2016‐ 2025 as the Decade of Action on Nutrition.  Additionally, Scaling up Nutrition (SUN) movement has also set a common goal  for improved nutrition during the first critical 1000 days of life (Nepal is an early member) with the principle of engage, inspire, and invest. The movement has set the common goals of 57 countries to end malnutrition in all its forms by 2030. Moreover, SDG Goal 2 aims to end hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

Nepal has also committed to improve nutritional status of children and formulated various plans and strategies since 1998. Major gradual initiatives are:  National Plan of Action on Nutrition (NPAN) 1998,  National School Health and Nutrition Strategy, 2006,  National Nutrition Policy and strategy, 2004 (revised  2008), Nutrition Assessment and Gap Analysis (NAGA)-2009, and Multi Sector Nutrition Plan (MSNP) 2012.

What has been done so far for nutrition in Nepal?

To address the nutrition gaps, various national level and project level nutrition programs  targeting mothers, infants, and children are being implemented in Nepal. Nationwide programs include growth monitoring and counseling, prevention and control of micronutrient deficiencies. Further scale up programs are also in effect including maternal, infant, and young child nutrition (MIYCN) program, integrated management of acute malnutrition, micronutrient supplementation. Moreover, new integrated nutrition programs such as SUAAHARA, Agriculture and Food Security Project, Golden 1000 days program, and SABAL programme are also contributing for nutrition.

Need for multisectoral nutrition plan (MSNP) and its challenges of implementation

According to framework on undernutrition devised by UNICEF in 1990, undernutrition has three levels of causes. In the first layer, immediate cause comprises poor nutrition intake and childhood morbidity. The second layer, underlying causes comprise low household food security, inadequate water, sanitation, and hygiene (WASH), and women’s levels of care and accessibility in resources.  The third layer, basic cause in which immediate and underlying causes directly/indirectly depends on the institutions, political commitment, economic structure, and technical capacity of the country.  This framework provides a guideline that nutrition should be given a comprehensive effort from various development sectors.

Evidences such as Nutrition Assessment and Gap Analysis (NAGA)-2009  recommended that a comprehensive sectoral contribution is necessary to reduce maternal and child nutrition. Further Nepal’s commitment on the SUN and SDGs attainment also requires for multi-sectoral nutrition approach.

How MSNP works?

MSNP is the Government approved plan endorsed in June 14, 2012. The  goal of the program is to improve maternal and child nutrition through reduction of maternal infant and young child (MIYC) undernutrition in terms of maternal BMI and child stunting, by one third by 2017 from the level of 2011 (stunting: below 29%, wasting below: 5%, BMI women (<15%). To achieve this, the plan  set the outputs of nutrition concerned sectors covering  ministry of health, ministry of federal affairs and local development,  ministry of agriculture development (now ministry of livestock development also included), ministry of education, ministry of water supply and sanitation, and ministry of women, children, and social welfare. In national level, the high level nutrition and food security steering committee led by vice chairman of national planning commission will provide suggestions for policy direction, coordination, and monitoring and evaluation at all key levels. Similarly, in district level, nutrition and food security steering committee led by president of district development committee will oversee the district level nutrition specific and nutrition sensitive interventions. Since the inception, MSNP is supported by UNICEF and implemented by MoFALD. Health Research and Social Development Forum (HERD) through a programme cooperation agreement (PCA) with UNICEF is providing support on MSNP programme in 28 targeted districts. 

Some of the snapshots of the recent orientation programme held for District Coordinators and Planning, Monitoring and Information Management Officers (PMIMOs) in 17 districts.