Voices from the field in Nepal: programming at district level
Nischal Raj Pandey (NRP) has served in the district government office, most recently as a Local Development Officer (LDO) in Parsa district and previously in Khotang district.
Arjun Prasad Subedi (APS) has worked as an LDO in Bajura district since October 2016.
1. What types of nutrition programmes were there in your districts before Multi-sector Nutrition Programming (MSNP)?
NRP: The districts were implementing routine nutrition-related activities as per the approved programmes, but these activities were not under the MSNP umbrella as they are now.
APS: Various nutrition-related programmes were being implemented before MSNP, such as vaccination campaigns, Golden 1,000 Days and Suaahara (Good Nutrition), which had some successes although they were limited in terms of their scope and target population. They were also conducted in isolation and an integrated approach was missing. There were no visible outcomes of these programmes.
2. In your understanding, why is this approach important?
NRP: If MSNP-targeted beneficiaries are to be reached in the real sense, the interventions need to be designed in such a way that the presence of all sectoral agencies is felt.
APS: Currently, the National Planning Commission (NPC), along with line agencies with help from donor organisations, has initiated this as a priority one project, which has eventually led to this multi-sector approach on a national and regional scale. They have prepared regional indicators as well as corresponding strategies and work plans.
3. What forms of malnutrition is this approach aiming to reduce?
NRP: The MSNP approach aims to address all forms of malnutrition, particularly among marginalised and hard-toreach communities by providing maternal and child nutrition services, providing life skills to adolescent girls, improving access to quality food products and reducing the work burden of women. The highest priority is given to address malnutrition caused by inadequate nutrient intake.
APS: MSNP has been implemented at the national and regional level, reaching out to community and household levels. Primarily, this programme focuses on the first 1,000 days for mothers and children in order to reduce wasting and stunting.
4. Do you have a target for reducing malnutrition in your district?
NRP: The District Coordination Committee (DCC) has set targets to reduce malnutrition prevalence in its district development plan that are in line with the WHA global nutrition targets1.
APS: To achieve the national target, we have prepared strategic work plans at district, community and household level to include all male and female members of the community and 1,000-day mothers and children, based on the MSNP framework and guidelines. Targeted groups are 1,000-day mothers, children, adolescent boys and girls, school children, parents involved in school management, and teachers.
5. Which are the key sectors involved in MSNP and how are they being coordinated?
NRP: The major stakeholder agencies are the district public health, livestock services, agriculture development, women and children, water supply and sanitation, and the district education offices. We have also coordinated with the District Chamber of Commerce and Industries and several other active NGOs (non-governmental organisations) and CBOs (community-based organisations) for effective implementation of the MSNP. Coordination includes regular district level Nutrition and Food Security Steering Committee meetings and organising workshops and trainings related to activity planning, joint monitoring and supervision so that MSNP activities are being carried out in an integrated manner.
APS: The major stakeholder agencies at the national level are the NPC, the offices of district public health, livestock services etc., and donor agencies. At the district level, we have these line agencies’ respective offices and local governing bodies like Gaupalika (village council) and municipalities.
6. Are there additional financial resources for MSNP? Is there a set budget?
NRP: A budget of 10 million Nepali rupees (estimated US$97,000) has been allocated in this fiscal year (this sum excludes the budget allocated for the District Public Health Office, which comes through the routine approved annual work plan and the government’s budget). Furthermore, the village district committees (VDCs) where MSNP has been implemented have also been allocated some additional budget to conduct nutrition-related activities.
APS: As per instructions for the fiscal year 2017/18 [2074/75 in the Nepali calendar] from the NPC and respective ministries, this plan has been set as a priority one programme, so that a pool fund has to be set up by all sectoral agencies at the local level. This will ensure better ownership of the agencies regarding the MSNP programme. The DCC has kept a separate fund of 200,000 Nepali rupees (US$1,940) to coordinate MSNP activities. All Gaupalikas and municipalities have been instructed to allocate a fund targeting 1,000-day mothers and children.
7. Do you get specific guidance from the national level?
NRP:We are provided with directions and guidance from time to time by the national level for MSNP implementation. This mainly involves orientation on mainstreaming MSNP at the district level using an integrated approach, capacity development trainings and workshops, advocacy and awareness campaigns to bring multiple stakeholders on board, and conducting joint monitoring and supervision visits to observe implementation of activities. We have also been receiving guidance from the national bodies on improving the nutritional value of locally available food products and ensuring that these products are consumed.
APS: Because MSNP is a priority one status programme, we have received clear instructions and guidelines from the central level for setting work plans and implementing programmes, as well as monitoring and evaluation. For example, the MSNP plan document includes various indicators, such as reduction in the prevalence of stunting among children under five years old to below 29% by 2017, to ensure a multi-sector approach. We also have a robust advocacy and communications plan to ensure reach and effective implementation of MSNP at the local level.
8. What MSNP activities are being implemented in your district?
NRP: Various MSNP activities have been implemented in the district, in particular raising nutrition-related awareness, especially for the first 1,000 days, providing education to adolescent girls, raising cattle and encouraging agricultural food production, initiating kitchen gardens for availability of nutritious food, ensuring safe drinking water and sanitation, encouraging delivery of babies in healthcare facilities, regular intake of iron pills, completing vaccinations and regular growth monitoring.
APS: In Bajura district the DCC organises various trainings and regularly monitors them. This includes the distribution of chickens and their multi-use for meat and eggs, trainings to encourage usage of livestock, 1,000-day mothers and children; interaction programmes with pregnant women; cleanliness campaigns on using toilets and handwashing in schools aimed at students and parents; and water purification demonstration campaigns.
9. Are you facing any challenges in implementing MSNP?
NRP: We have experienced several challenges in the district, such as unavailability and lack of timely disbursement of budgets, lack of competent and committed human resources, possibility of duplication of programmes by sectoral agencies, irregular operation of community outreach clinics, low and misutilisation of resources, lack of stakeholder ownership and consultation, and lack of public awareness and knowledge of the importance of nutrition.
APS: Since the entire nation is moving towards a federalist structure, there are some difficulties in terms of budget-release procedures. Frequent transfer of trained officials (such as those who have received Master Training of Trainers on the MSNP) to other districts has also been a challenge. Refresher training is required on the importance of the plan. MSNP focal persons of all sectoral agencies need to spend more time ensuring the effective implementation of the plan in an integrated and coordinated manner to meet the programme’s national goals.
10.Are there key lessons learnt that you would like to share?
NRP: In my experience, the MSNP modality can be instrumental in changing the current malpractice of designing isolated and small-scale interventions based on the preferences of certain influential persons in sites of their choice. MSNP can actually promote integrated development planning, budget allocation, programme implementation and joint monitoring and supervision to foster better ownership and accountability of the stakeholders concerned. Currently we have been able to extend MSNP programmes in only 21 out of 67 VDCs in the district, but from the next fiscal year this will be extended to cover at least half of the VDCs and municipalities.
APS: Coordination needs to be enhanced among all the sectoral agencies at both central and district level to embody the spirit of the multi-sector approach; timely development of annual plans and disbursement of budgets pave the way for effective implementation; and at the beneficiary level, advocacy, social mobilisation and behaviour-change communication interventions need to be well planned and executed to promote demand-driven initiatives.
Acknowledgements: The interviews were organised by Sudeep Uprety, Research Uptake and Communications Manager at Health Research and Social Development Forum (HERD). Sudeep would like to acknowledge support from Santosh Pudasaini, Documentation Officer at HERD as well as district teams of Parsa (Gyanendra Dawadi and Sushil Kumar Sah) and Bajura (Ganesh Prasad Joshi and Damodar Neupane) for their efforts in arranging and translating the interviews with the LDOs.
1Global Targets 2025 to improve maternal, infant and young child nutrition; see www.who.int/nutrition/global-target-2025/en/