MULTI-SECTORAL NUTRITION PLAN –

A KEY TO PLANNING WITH OTHER SECTORS

Experiences from Nepal

By: Dila Ram Panthi Planning Officer, Health & Nutrition, NPC

Prepared by:

National Planning Commission (NPC), GoN,

Involving 5 key sectors – MoHP, MoAD, MoE, MoFALD, and MoUD

Lead Technical Support: UNICEF

in close collaboration with WB, HKI, WFP and Other DPs

Rationale: why?

Improvement in nutritional status results to • Better immunity, lowered death rates, decreased

morbidity, protection from diseases in adult life • Improved growth • Improved cognitive development • Increased productivity • Increased GDP • Achieving MDGs Stunting at the age of 2 is the indicator for human capital

3

Growth and muscle mass Body composition

Metabolic Syndrome: programming of metabolism

of glucose, lipids, protein Hormone/receptor/gene

Diabetes, Obesity Heart Disease High blood pressure Cancer, stroke, and ageing

Poor nutrition in uterus and early childhood

(STUNTING)

Short term Long term

LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND CHILD UNDERNUTRITION (MCU) BETTER UNDERSTOOD BY GON

(James et al 2000)

Cognitive and educational performance

Immunity Work Capacity

Brain development

Death

Stunting is preventable and is no longer chronic:

Need to act when the women are pregnant to before the child is 2 years

The Critical “Window of Opportunity”:

1000 DAYS Pregnancy: 9*30= 270 days

2 years: 365*2=730 days

Strategic Shift Needed Priority focus on pregnancy to under 2 years:”

0 3 10 70

Brain’s development

potential

Age

Spending on Health,

Education and Welfare

Spending vs. Brain Development

Total National Budget ‘000s: NRs. 384900000 in F/Y 2068/69-2010/11) Health Budget: NRs. 28946250 (7.5% of Total National Budget) Nutrition Budget: NRs. 514208 (1.77 % of Total Health Budget) (0.13% of Total National Budget) about 1000 per capita.

Nutrition in National Budget

Background to MSNP

• Ministry of Food and Agriculture +FAO plan 1970

• NPC: Nutrition coordination committee 1977 leading to nutrition strategies 1978/86

• Joint Nutrition Support Program 1985-90

• National Plan of Action on Nutrition (NPAN) 1998

• National Nutrition Policy and Strategies (MoHP) 2004

• School Health and Nutrition Policy and Strategy, 2006

• NPC Technical Working Group: NPAN 2007 draft

• Nutrition Assessment and Gap Analysis NAGA: 2009

Key Learning from past Experience:

Thorough Consultation and Involvement, Ownership by each sectors and Including the plan in Sectoral Plans of the key Ministries

Nutrition Assessment and Gap Analysis (2009-2010)

Build the National “Nutrition Architecture”

(2010-2011):

– Identified strengths, weaknesses, and gaps;

– Need for a national nutrition architecture; and

– A multi-sectoral approach through an agreed nutrition determinants model.

• NPC led National Nutrition Steering Committee revitalized;

• High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC; and

• Technical working group to

guide multi-sectoral nutrition review, planning, implementation and monitoring.

Nutrition Multi-Sectoral Reviews: A consultative

Process (2011)

Costed Multi-sectoral Nutrition Plan of Action

(Ongoing)

• Nutrition reviews by sector: Health; Agriculture, Education, Urban Development, and Local development

• Defined scope: Global and national evidences for ‘what works’: essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors

• Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the cross-sectoral linkages

Clear leadership: the NPC and actively involving health & other sectors

Focused: the first 1,000 days of life and stunting reduction

Addressing the immediate, underlying and basic factors: • women and children’s access to

health and nutrition; • safe water & sanitation; and • education and inequity.

Emphasis on decentralized implementation: initially in selected districts (2012-2014)

Vision to gradually scale up: to all other districts by 2016 (A new approach: learning by doing)

Rationale: How? • Nutrition specific interventions: feeding and care practices and

protection from illnesses

aimed at individuals, mainly through health sector • Nutrition sensitive interventions: food availability, affordability and

access, quality, utilization

aimed at families and communities mainly through non-health sectors

i.e. agriculture, education, local development, water supply and sanitation sectors

Multi-sectoral Nutrition Planning Framework

Child growth

failure/ death

Low Birthweight

baby

Low weight &

height in teenagersEarly pregnancy

Small adult

woman

Small adult man

The intergenerational transmission of growth

failure: When to intervene in the life cycle

SO 2. Ministry of Health

and Population R 2.1 Maternal Infant Young Child

(MIYC) micronutrient status

improved

R 2.2 MIYC feeding improved

R 2.3 IYC Malnutrition better

managed

R 2.4 Nutrition related policies,

standards and acts updated

SO 4. Ministry of

Education • R 4.1 Adolescent girl’s awareness

and behaviours in relation to

protecting foetal, infant and young

child growth improved

• R 4.2 Parents better informed

with regard to avoiding growth

faltering

• R 4.3 Nutritional status of

adolescent girls improved

• R 4.4 Primary and secondary

school completion rates for girls

increased

SO 5. Ministry of Federal

Affairs and Local

Development/ Social

Protection R 5.1 Nutritional content of local

development plans better articulated

R 5.2 Collaboration between local

bodies’ health, agriculture, and

education sector strengthened at

DDC and VDC level

R 5.3 Social transfer programmes

corroborated for reducing chronic

under nutrition

R 5.4 Local resources increasingly

mobilized to accelerate the reduction

of MCU

SO 6. Ministry of Agriculture Development R6.1 Increased availability of animal foods at the household level

R 6.2 Increased income amongst young mothers and adolescent girls from lowest

wealth quintile

R 6.3 Increased consumption of animal foods by adolescent girls, young mothers and

young children

R 6.4 Reduced workload of women and better home and work environment

Strategic Objective (SO) 1. National Planning Commission

Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased

R 1.2. Nutritional information management and data analysis strengthened

R 1.3 Nutrition capacity of implementing agencies is strengthened

SO 3. Ministry of Urban

Development R3.1 All young mothers and

adolescent girls use improved

sanitation facilities

R 3.2 All young mothers and

adolescent girls use soap to

wash hands

R 3.3 All young mothers and

adolescent girls as well as

children under 2 use treated

drinking water

Goal and Purpose of MSNP

Goal • To enhance human capital, especially among the

poorer segments of the society Purpose • to improve maternal and child nutrition by

accelerating the reduction in maternal and child under nutrition through implementation of nutrition specific and nutrition sensitive interventions aimed at the “window of opportunity of 1000 days from Pregnancy to 24 months”

Major Outcomes and Outputs Outcome 1: Policies, plans and multi-sectoral coordination improved at national and

local levels 1.1: Policies and plans updated/reviewed to incorporate nutrition specific indicators at national and local government levels 1.2: Multi-sectoral coordination mechanisms functional at national and local government levels Outcome 2: Practices that promote optimal nutrition behaviors improved 2.1: Maternal and child care service utilization pattern changed 2.2 : Adolescent girls’ education, life skills and nutritional status improved 2.3 : Reduced episodes of diarrheal diseases and ARI among mothers, adolescents and IYC 2.4 : Feeding behaviors improved with increased availability and access to appropriate food (in quality, quantity, frequency and safety) Outcome 3: Strengthened capacity of central and local governments on nutrition to provide basic services in an inclusive and equitable manner 3.1 : Capacity of national and local government enhanced to provide appropriate support to improve maternal and child nutrition 3.2 : Multi-sectoral nutrition information updated and linked both at national and local government level

Schedule for Roll-out and Scale-up

• Gradual and incremental • Within 5 years, scale up to 75 districts: 6, 12, 16, 15 and 16

districts respectively • Each starting districts to start work in 2 VDCs and expand

gradually so that by the end of the year 50% of VDCs are covered

• Selection criteria: Based on 13 set of indicators (malnutrition, poverty, HDI, Water sanitation, ecology, region, delivery by SBAs, school enrollment, Girls/boys enrollment etc)

• Not all VDCs will be covered, cover at least 50%, those most disadvantaged!

• MSNP implementation period (First Phase): 2012-2016

MNSP Management Arrangements At National Level

• National Nutrition and Food Security Steering Committee chaired by the Honorable Vice-Chair of NPC (HLNFSC)

• National Nutrition and Food Security Coordination Committee (NNFSCC) formed under the chairmanship of honorable member (Health) of NPC.

• Technical Committee with key technical experts from government, DPs, the private sector, academia, and CSOs under NNFSCC.

• Nutrition Secretariat: Nutrition information management and M/E, Advocacy & coordination and capacity building to be established.

At Local Level

• District Level Nutrition and Food Security Steering Committee chaired by DDC Chairperson

• Municipality Nutrition and Food Security Steering Coordination Committee chaired by Mayor

• VDC level Nutrition and Food Security Steering Coordination Committee chaired by VDC Chairperson

Implementing Agencies at Central

Level •MoHP •MOE •MoUD •MoAD

•MoFALD

Implementation Modality

Coordination and Facilitation

• NPC

District Level • DDC

Line Agencies

Municipality VDC

Authorization

NEPAL Far-Western Region

Mid-Western Region

Western Region

Central Region

Eastern Region

Proposed Initial MSNP Roll-out Districts

Proposed Initial MSNP Roll-Out Districts

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWAL PARASI

KAPIL- BASTU

RUPAN- DEHI

DANG

BANKE

ACHHAM KALIKOT

JHAPA MORANG

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL- DHURA

KANCHAN- PUR

BAJURA

PARSA

BARA RAUT- AHAT

DHANUSA

MAHO- TARI

SUNSARI

SARLAHI

DHADING

MAKAWAN- PUR

CHITWAN

KASKI

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAK HACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ- PUR DHAN-

KUTA

TAPLEJUNG

OKHAL- DHUNGA

TERHA- THUM

KHOTANG

LALIT

BHAK KATHM SULUK-

HUMBU

DOLAKHA

SANKHUWA- SABA

NUWAKOT SINDHU- PALCHOK

KAVRE

RASUWA LAMJUNG

GORKHA

PYUT- HAN

ROLPA SALYAN

MYAGDI

DAILEKH JAJARKOT

RUKUM

MUSTANG

MANANG

SIX INITIAL DISTRICTS (Bajura, Achham, Jumla, Kapilvastu, Nawalparasi and Parsa) PROPOSED BASED ON ABOVE MENTIONED INDICATORS

Summary of Ongoing Nutrition Actions in the Proposed MSNP Initial Roll-Out Districts

Districts Development Region Nutrition Related Actions

Bajura Achhaam Jumla Parsa Kapilvastu Nawalparasi

FW Hills MFW Hills MW Mountains Central Terrai Western- Terrai Western- Terrai

CFLG, Suaahara, FtF, WB/NASP, HKI/Homestead food production, WFP CFLG, UNICEF IYCF/MNPs, CMAM, FtF, WB NASP, WFP CFLG, UNICEF/ADB IYCF/CG, MI/UNICEF VAS, USAID FtF, WB NAFSP, SCF/UNICEF GM , WFP, WV CFLG, UNICEF IYCF/MNPs, ECD, Health CFLG, UNICEF IYCF/MNP, CMAM, WASH, ECD, Health CFLG, Suaahara, WASH, Health, ECD

Role of Sectoral Ministries

• Mainly responsible for

– mainstreaming nutrition in sectoral programs,

– mobilization of resources and implementation through their regional and district networks.

– providing technical backstopping

– carrying out monitoring and evaluation of the implementation process.

Role of EDPs and I/NGOs

• Support and Strengthen Government System

• Technical Support in rolling out MSNP, M/E, Capacity Building of sectors to implement it

• Joint Planning, Budgeting, Monitoring and Review

• Support on Basket Funding System

• Joint Financial Arrangement (JFA) and provide support to the government

Key Innovative Approaches

• Process Led by the highest Planning Body- National Planning Commission and their commitment

• Management Arrangements made at Central, District and Community Levels

• Reference Groups for each sectors: key experts for each sectors from Govt, NGOs and Pvt Sectors

• For Each Sectors: Strategic Objectives, Plans, Interventions were identified/selected by each sectors

• Thorough Discussions/Consultations within each sectors • Joint Meetings of All Sectors for Linkages • Linked to Annual Planning Processes • Joint Initiative of Government and Development partners

and joint ownership

Major Challenges

1. Sensitizing of Each Sectors and ownership

2. Time Consuming

3. Coordination among many Key Government Sectors

4. Coordination among Development agencies

5. Budget Allocation by each sector ministry and Donors for MSNP: Sectoral Nutrition Interventions

Responses to Overcome

1. Importance of Nutrition for each sector, their roles and linkages clearly explained, internalized

2. Needed for Consultations and Ownership

3. Sectoral reviewers well understand/coordinating sectors- Extra Support to NPC for Sectoral Coordination

4. Joint Funding for review, continues sharing of progress in National Nutrition Group and other coordination mechanisms

5. Still Challenging, NPC coordinating with Sectoral Ministries, but for Development partners- Strong Government stand/action necessary

Challenges to Overcome

Next Steps

• Cabinet Approval

• Launching Program

• Budgetary Resources and Commitment

• Phased Plan for Implementation with clear Implementation guideline (6 Districts for Year 1)

• More detailed strategies and plans on: Multi-sectoral Nutrition Advocacy & Communication, Nutrition Capacity Development, and Monitoring & Evaluation

THANK YOU ALL !!!