South-to-south SUN collaboration: A Tajikistan learning group visit to Nepal

Savita Malla is the Advocacy and Communication Advisor at the National Nutrition and Food Security Secretariat at the National Planning Commission in Nepal. Stanley Chitekwe is the Chief of Nutrition for UNICEF Nepal. Pradiumna Dahal is a nutrition professional experienced in designing, planning, implementing, monitoring and evaluating nutrition programmes in Nepal.

In the first venture of its kind between SUN countries in Asia, Nepal welcomed a Government group from Tajikistan on a nutrition study tour in May 2016. The six-day visit, initiated by the Tajik delegation, aimed to give the group practical insights into the initiatives taking place in Nepal aimed at tackling malnutrition.

Background

Nepal was the fifth country to join SUN in May 2011, and its Prime Minister has played an active role as one of the SUN’s lead group members. Despite considerable improvements in child undernutrition in Nepal over the last few decades, stunting prevalence remains high at 37% among young children (Nepal Multi Indicator Cluster Survey, 2014), and progress has slowed in recent years. To accelerate improvement in maternal and child undernutrition, the Government of Nepal launched its Multi-Sectoral Nutrition Plan (MSNP) for the period 2013- 2017. The MSNP prioritises nutrition in policies, plans and budgets and resides under the National Planning Commission, the highest planning level authority in the country. To facilitate implementation and coordination among stakeholders, a multi-sector architecture has been established at national, regional, district, municipal and village level. MSNP rollout began in Achham district in 2013 and by June 2016 the programme was being implemented in 16 districts. There is a plan for further scale-up in an additional 12 districts during 2016/2017.

Tajikistan had developed a number of laws and adopted strategic documents to improve on health, nutrition and food security since independence. The country joined the SUN Movement in 2013. In the same year, it established a Food Security Council to coordinate decision-making concerning food security, and the Nutrition and Food Safety Strategy 2013-2020, which focuses on the double burden of malnutrition and prevention of food borne diseases and nutrition-related non-communicable diseases (the strategy has yet to be approved by the Government). The country is the poorest of the five central Asian republics, with almost half the population living below the poverty line. The stunting rate in children under five has slightly decreased in the past few years (from 29% in 2009 to 27% in 2012), but acute malnutrition and underweight have increased (to 10% and 7% in 2012, respectively).

Study tour of Nepal

The visiting Tajik delegation, which included Government representatives from the Ministry of Health, Economic Development and Trade, Agriculture, Finance, Education and Science and United Nations’ agency representatives, wanted to learn from Nepal’s scaling up nutrition efforts. Particular areas of interest were the MSNP, the country’s nutrition architecture, and the budget-flow mechanism.

The study tour was planned in two phases: a central-level interactive session with the nutrition-related ministries and stakeholders, followed by field visits to understand the practical application of the multi-sector efforts at the district and community level.

An initial briefing meeting was organised at the National Planning Commission to share the expectations of the delegates and to have an update on SUN progress in Nepal from the SUN Country Focal person. This was followed by presentations on an overview of the country’s nutrition status, the SUN Framework in Nepal, MSNP process, structure, coordination mechanism and budget-flow modality, as well as the lessons learned from implementation of multi-sector nutrition projects.

The team then visited three districts: Nuwakot, one of the earthquake-affected districts, and Nawaparashi and Kapilvastu, two of the six MSNP districts. In Nuwakot the team met district-level stakeholders representing the institutional structures and members of the Village Development Committees (VDC) on the implementation of activities during both normal and emergency situations. The Tajik delegates also interacted with community members, including mothers’ groups, female community health volunteers and civil society organisations.

Progress and results

The study tour concluded with a sharing of outcomes from the field visit by delegates, primarily focusing on the ‘best practices’ of the Nepal multi-sector interventions that would help provide a roadmap for the future course of action for Tajikistan.

These included:

• Development and implementation of the MSNP, such as the creation of different multi-sector architectures for nutrition and their effective functioning at different levels;

• Coordination between the ministries and development partners facilitated by the Nutrition and Food Security Secretariat;

• Costing of the MSNP and the financial management mechanism, including the VDC level mechanism of budget allocation for nutrition;

• Identification of sector interventions in line with the MSNP;

• Capacity assessment and capacity-building efforts for multi-sector nutrition planning at district and VDC level; and

• Development of bottom-up plans at the district level and provisioning of additional budget from the Government.

Lessons learned

The Tajik delegation was highly impressed by the political commitment and priority afforded by the Government of Nepal to nutrition, the well-established planning processes and institutional structure for nutrition at all levels, and participation from multi-sector line ministries/agencies and civil societies. The plan of action and interventions for each sector, efficient budgeting system (with supplementary budget support from donor agencies in addition to the Government budget, and leveraging resources in addition to the block grant from the central level through local government at VDC) were also of interest to the delegation. The existence of a separate monitoring and evaluation framework for MSNP, strong communication and advocacy elements backed by the behaviour-change components, social protection programme for women to promote institutional delivery, and social safety net programme for children to improve nutrition, were also valued.

Some good practices that Nepal reported they had learnt from Tajikistan were the effective operation of the public health system and integrating nutritionists into the social sector programmes. The primary health centres and the systematic implementation of Tajikistan’s WASH plan and activities were of great interest to the Nepal delegation.

Next steps

Key technical people engaged in the development of the MNSP will continue to help Tajikistan in finalising the road map for scaling up nutrition and development of the common results framework for nutrition. Nepal is committed to supporting other countries and to learning from the successes of other SUN countries through similar visits. In a future issue of Nutrition Exchange, ENN hopes to include a follow-up to this article which will explore how the Tajik delegation was able to utilise the experiences and learning from the Nepal visit.