OPINION: Scaling up nutrition in Nepal

KATHMANDU (The Kathmandu Post/ANN) - The country needs to make significant efforts to address the gaps in coverage and utilisation of services.  

Global food price hikes and financial crises leading to the establishment of a high-level task force on food and nutrition security, the Lancet series on Maternal and Child Nutrition 2008 and the Copenhagen consensus paved the way for the rise of the Scaling-Up-Nutrition movement. The Scaling-Up-Nutrition initiative calls for multi-sectoral collaborative action among governments, UN agencies, businesses, donors, civil society organisations and individuals in a collective mission for improved nutrition during the first 1,000 days of life.

In May 2011, Nepal joined the movement to work across sectors to embrace nutrition-sensitive and nutrition-specific approaches, and address the underlying causes and manifestations of malnutrition. Nepal developed and implemented the Multi-sector Nutrition Plan I for the period 2013-17. Six line ministries--Agriculture and Livestock Development; Water Supply, Sanitation and Hygiene; Women, Children and Social Welfare; Health; Education; Federal Affairs and Local Development--worked under the National Planning Commission to end malnutrition in the country.

Notable achievements

Improved maternal, infant and young child feeding, increased micronutrient status of the target population and improved management of malnutrition in children are a few of the notable achievements the country has made over the years. Additionally, there are various projects under the Multi-sector Nutrition Plan portfolio working aggressively to end malnutrition in the country.

Building on the success and lesson learned from Multi-sector Nutrition Plan I, the government has implemented Multi-sector Nutrition Plan II (2018-22) taking into account the global targets for nutrition. Commendable efforts have been made after the launch of this second phase: orientation on nutrition for local leaders; commitment by local leaders for a nutrition friendly community; establishment and operationalisation of nutrition and food security coordination committees in 148 local units for evidence-based planning; budget allocation by 95 percent of the local units for activities in the plan; and recruitment of volunteers.

Nepal just ended a long political transition, promulgated a new constitution, and switched to a federal system. It also had to endure a major earthquake and numerous floods. Amid these tumultuous times, the percentage of children under five years of age who are stunted decreased from 49 to 35.8 percent from 2006 to 2016. The country needs to achieve an average annual rate of reduction of 4.26 percent from 2016 onwards to meet the global target for stunting. The prevalence of wasting has also declined from 13 percent in 2006 to 9.7 percent in 2016. Anaemia is 53 percent among children 6-59 months and 41 percent among all women. Maternal nutrition is also a problem with 17 percent suffering from chronic energy deficiency. While the progress is encouraging, Nepal still needs to make significant efforts to address the gaps in coverage and utilisation of services while addressing the barriers to achieving the global targets for nutrition.

The global target for nutrition in Nepal will be achieved if the right policies and legislation, institutional arrangements, collaboration, enabling environment, investments, and implementation along with data monitoring systems are in place. The various policies that were developed subsequently are aligned with the global targets, but many of them have proposed creating coordination committees and horizontal coordination structures at the federal, regional, district and local levels. These arrangements and institutional mechanisms have to be revisited. Instead of having multiple coordination committees, food security and nutrition coordination committees have to be institutionalised and regularised if that has not already been established.

While policies and institutional arrangement are important, collaboration and partnership with private partners, civil society organisations and academia are key to achieving global targets for nutrition in Nepal. The involvement of the private sector is not very visible. There has to be a strategic roadmap on collaborating with the private sector to stamp out malnutrition in the country. Local governments have a decisive role in the federal structure. Therefore, the capacity development of the local and municipal governments for accountability is imperative for creating an enabling environment for nutrition-sensitive and nutrition-focused interventions.

Future priority areas

Investment is critical to achieving the nutrition target. Multi-sector Nutrition Plan II has an estimated budget of $470.20 million to achieve the goal. Looking at investments in Food Security and Nutrition, Nepal ranks low among 152 countries. In order to meet the global Sustainable Development Goals target, robust financing in nutrition-sensitive and nutrition-specific activities is necessary to keep up the momentum. In addition to the existing challenges, we witness major shifts in income and wealth. These shifts are accompanied by other major trends like environmental degradation, climate crisis, rapid urbanisation, major demographic shifts, advances in new technologies, increasing over-nutrition, and artificial intelligence. The responses to these major trends will also require the mobilisation of resources.

One of the future priority areas could be strategies to manage over-nutrition in the country by 2030. Nepal is at a high risk of suffering disasters requiring humanitarian actions. The next generation of Scaling-Up-Nutrition movement could bridge the current humanitarian-development divide and create an enabling environment for nutrition. Data monitoring helps to keep track of the progress, prioritise implementation and support planning and budgeting. Crowdsourcing data through open data portals is an apt decision to monitor progress and plan future programmes. Considering all these facts, the global Scaling-Up-Nutrition movement remains key driver to achieve the global target for nutrition in Nepal. The Scaling-Up-Nutrition global gathering slated for November should focus on these opportunities and the new challenges ahead while also celebrating the achievements and lessons learned from each other.

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