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NEPAL NUTRITION AND FOOD SECURITY PORTAL

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To meet the World Health Assembly 2025 target and the SDG 2030 target for nutrition and combat all forms of malnutrition among women, children, and adolescents, Nepal adopted a multi-sectoral approach and formulated Multi-sectoral Nutrition Plan (MSNP). The MSNP in Nepal is the culmination of thirty years of policy development in improving nutritional outcomes for mothers and children.

Since 2006, by observing the result of the Nepal Demographic Health Survey 2006, the national stakeholders felt that only the health sector interventions are not sufficient to address the nutrition issues in Nepal and the nutrition-sensitive interventions should go together with specific interventions with strong national nutrition governance mechanism. Meanwhile, Nutrition Assessment and Gap Analysis (NAGA) was done in 2009-2010 and the NAGA report recommended that the nutrition is multiple determinants and to address the nutrition issues, multisector nutrition interventions are necessary. With this idea, NPC was identified as the national coordinating body for nutrition-specific and sensitive interventions at all levels by bringing five key sectors namely the Ministry of Health and Population, Ministry of Education, Science and Technology, Ministry of Agriculture and Livestock, Ministry of Urban Development and Ministry of Local Development and development partners together. Moreover, sectoral evidence was reviewed of the key five aforementioned sectoral ministries. Based on the outcomes of sectoral reviews, and global and national evidence National Planning Commission developed the national Multi-sector Nutrition Plan (MSNP) with 10 years vision (2013-2022) and five years plan (2013-2017) together with key five sectoral Ministries, departments, donors, UN agencies, external development partners, academia and private sector. Later, during the implementation of MSNP from 2013-to 2017, the Ministry of Women, Children, and Social Welfare was the sixth ministry added for MSNP implementation in Nepal.

The MSNP-I (2013-2017) was endorsed by the Council of Ministers and launched by Dr. Baburam Bhattarai the then Rt. Honorable Prime Minister of Nepal on September 20, 2012. With the endorsement of the Cabinet, the implementation of the MSNP-I was launched in six districts in 2014, to add ten districts in 2015, and an additional 12 districts in 2016. By the end of MSNP-I (201-2017), the program was implemented in 308 local levels of 30 districts.

After the completion of MSNP-I (2013-2017) and as a continuation of MSNP-I, the Government developed MSNP-II (2018-2022) to scale up interventions of nutrition-specific and nutrition-sensitive interventions as well as create an enabling environment. MSNP- II was formulated with slight modifications reflecting the lessons learned from the first phase and adapted to the three-tier government system following federalization in 2015. The MSNP-II was launched by Honourable Deepak Bohara, Minister of Health and Population of Nepal on December 14, 2017. Alike MSNP-I (2013-2017), MSNP-II (2018-2022) was formed by GoN under the leadership of NPC in coordination with six different sectors (Health, Education, WASH, Women, Children, and Senior Citizens, Agriculture, and Livestock, Local Governance). The Government of Nepal and the European Union (EU) signed an agreement to support the MSNP-II with a total budget of €23.35 million. Out of the total financial support, €20 million is the direct budget support through the government treasury system and €3 million to the UNICEF for the complementary support where UNICEF will add €1 million on top-up for the technical support.

The MSNP seeks to facilitate systemic change to ensure that the policy and funding mandate at all levels of Nepal’s government (federal, provincial, and local) supports the improved nutritional status of children under five years of age, adolescents, and women in vulnerable social conditions. The MSNP- II has six outputs and 33 activities under nutrition-specific interventions that are managed by the Ministry of Health and Population. There are 13 outputs and 59 key activities under nutrition-sensitive interventions that are implemented by sectoral ministries with the facilitation and coordination of the Ministry of Federal Affairs and General Administration.

Since the beginning of the MSNP in 2013, the Government of Nepal has collaborated with development partners to scale up multi-sectoral “nutrition-specific” and “nutrition-sensitive” interventions, while simultaneously implementing interventions to improve the ‘enabling environment’. Currently, MSNP-II nutrition-specific and nutrition-sensitive interventions are being implemented under the aegis of the National Planning Commission, with technical and financial support from a range of development partners predominately from the EU and UNICEF Nepal. To date, MSNP has been scaled up and is being implemented in 720 out of 753 local levels of 72 districts out of 77 districts and the plan is to cover all 753 Local Levels by the end of the current fiscal year 2078/079 (2021/022).

  • Figure:1
    Historical journey of Nutrition Policies leading up to MSNP II 2018-2022
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  • Figure:2
    Roadmap for implementation of MSNP II 2018-2022
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This page attempts to elucidate the basic concepts related to nutrition and food security. An understanding of the causes and consequences of poor nutrition and food insecurity as well as the potential solutions based on global evidence and recommendations can be found here.


Nutrition

Figure 1 shows the conceptual framework for understanding the causes of maternal and child undernutrition. This framework was published in the 2008 Lancet Nutrition Series adapted from an original framework developed by UNICEF in 1990. It highlights the short and long term consequences of undernutrition as well as depicts that the causes are interrelated and operate at three different levels. The immediate causes are inadequate dietary intake, a high burden of disease or, an interaction between the two. Similarly, the underlying causes are organised into three groups: household food insecurity; inadequate care and unhealthy household environment and lack of health services. Income poverty is placed as another underlying cause as well as a driver of the other three underlying causes. Underlying causes are the product of a set of basic causes, including the lack of financial, human, physical, social and natural capitals. Yet more basic causes are the social, economic and political contexts that determine the ways in which those potential resources are controlled and managed.


Figure 2 shows a conceptual framework for actions published in the 2013 Lancet Nutrition Series. It outlines the factors that lead to optimum nutrition and development and the resulting benefits throughout the life course. Also depicted are the necessary and proven nutrition specific and nutrition sensitive interventions and approaches.

Undernutrition to a large extent perpetuates itself as an intergenerational cycle carrying on for generation after generation. The vicious cycle is depicted in figure 3 and it must be broken in order to eliminate undernutrition. It is now better understood that the period of growth from conception up to around two years of age provides a critical window of opportunity for ensuring adequate future growth, development, and nutritional status. Hence, the importance of optimal nutrition for women before and during pregnancy cannot be undermined. Taking a life-cycle approach, if sound nutritional status of women is ensured during early childhood, adolescence and adulthood, then the new generation of babies will be born healthy thereby interrupting the intergenerational cycle.



Food Security

“Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.” -World Food Summit (October 1996).

Until the decade of 1970s, food security was understood more generally as the ability of a nation to meet its aggregate food needs in a constant manner. Aggregate food need is calculated by multiplying per capita annual food requirement (200 kg/capita/year) by total population in the country. However, food security is not merely food self-sufficiency. This school of thoughts is dominantly over-ridden by the principle that describes food security as food availability; and, attempt enhancing food availability by increasing food grain production at a higher level than requirements. However, the evidence shows that there are cases of persistent food poverty, malnutrition, and food vulnerability in food self-sufficient and even food surplus areas. There are continuous advances in the understanding and working approaches of food security issue.

In 1974, the World Food Summit identified reliable supply and less fluctuating prices (in addition to sufficient food production) as essential factors for meeting food security. With this food security, being attempted merely by technological means, attracted other factors like market, transport, supply, food price etc. The food security until then was attempted through strengthening factors influencing ‘supply’ aspects. Later Nobel laureate Amartya Sen put forward an alternative view during 1980s, which emphasised the importance of access or entitlements to food in achieving food security. With this the focus on food security tilted towards ‘demand’ aspects instigated to receive attention.

At present, the concept of food security assumes to meet the following conditions: food available at all times; that all persons have means of access to it; that it is nutritionally adequate in terms of quantity, quality and variety; and that it is acceptable within the given culture. Only when all these conditions are in place can a population be considered ‘food secure’. Thus the focus of food security is on four key dimensions (availability, access, utilization and stability), known as the four pillars of food security (figure 4.)

Food availability is the physical presence of food in the area through all forms of domestic production, commercial imports and food aid. Food availability in the area is determined by considering production, trade, stocks and transfers.

Food access is the ability of a household to acquire adequate amounts of food. Food may be available in the market in sufficient quantity and diversity, but this may not necessarily be in the access of people with low income and/or low purchasing power. Food access of individual household is determined by considering food production and stocks, purchases, barter, gifts, borrowing and food aid.

Food utilisation refers to proper use of food. This considers food storage, processing and preparation methods, including the water and cooking fuel used, and hygiene conditions maintained during preparation and consumption. Food utilization also concerns about the conversion of diet into nutrition and its use in body physical functioning. Individual food requirement generally remains different as the food requirement of children, pregnant women and elderly within the household is not same to that of healthy adults. Therefore this also takes account of use of food by individuals in the household according to their nutritional need.

can be achieved once availability, access and utilization of food are ensured at all time and without significant fluctuation in the situation. Stability concerns about the sustainability of the satisfactory achievement of conditions related to all three aspects of food security discussed above.


Key frameworks for food security monitoring, analysis and response design:


Integrated Phase Classification (IPC) Analytical Framework
IPC Analytical Framework is used for food security, nutrition, and livelihoods analysis. This framework provides emphasis on analysing food security at household level. Figure 5 illustrates the key aspects of these frameworks and their inter-linkages.


Nepal Food Security Monitoring System (NeKSAP) Framework
A collaborative effort between Government of Nepal, WFP and FAO have developed a framework for the Food Security Monitoring System in Nepal (Figure 6). The framework is designed to provide basis for analysis of all paradigms (availability, access, utilization and stability) of food security for different purposes (sectoral analysis, generate baseline information, establish surveillance systems, assessment)and at different socio-organisational level (micro, meso and macro level analysis) (Figure 7). The aim of this system is to inform government and development/emergency actors in order to design and implement appropriate and timely policies and actions leading towards a more food secure Nepal.


Food Security Response Analysis (FSRA) framework
The NeKSAP has advanced further from monitoring and analysis and developed a framework for food security response analysis. This framework shown in figure 8 provides the tools and processes for response design integrating the information generated from food security monitoring and analysis.


References

1. Lancet (2008). Maternal and Child Undernutrition Nutrition Series 2008.
2. Lancet (2013). Maternal and Child Undernutrition Nutrition Series 2013.
3. United Nations Standing Committee on Nutrition (UNSCN) (2010.) Maternal Undernutrition and the Intergenerational Cycle of Growth Failure.
4. ADB (2011). Agricultural Development Strategy: Inception Report. Technical Assistance for the Preparation of the Agricultural Development Strategy,Asian
    Development Bank. Kathmandu, Nepal.
5. Adhikari J (2010).Food insecurity, conflict and livelihood threats in Nepal. In: Livelihood Insecurity and Social Conflict in Nepal. Bishnu Raj Upreti and Ulrike
    Müller-Böker (eds). South Asia Regional Coordination Office, Swiss National Centre of Competence in Research (NCCR) North-South. Kathmandu, Nepal.
6. IPC Global Partners. 2012. Integrated Food Security Phase Classification Technical Manual Version 2.0.Evidence and Standards for Better Food Security Decisions.
    FAO. Rome.
7. GoN, WFP and FAO (2010). Framework Document for Institutionalizing National Food Security Monitoring in Nepal. The Government of Nepal (GoN), the UN World
    Food Programme (WFP) and the Food and Agriculture Organization (FAO).

  • Figure:1
    Lancet conceptual framework of maternal and child undernutrition
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  • Figure:2
    Lancet framework for actions to improve nutrition
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  • Figure:3
    UNSCN intergenerational cycle of growth failure
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  • Figure:4
    Four pillars of food security
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  • Figure:5
    IPC Analytical Framework
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  • Figure:6
    NeKSAP Framework
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  • Figure:7
    NeKSAP Framework (adapted from NeKSAP Framework Document)
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  • Figure:8
    NFood Security Response Analysis Framework
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Nutrition and food security issues by nature call for effective multi sector and multi stakeholder coordination, cooperation and collaboration for collective and concerted efforts to produce good results. Given the strong government as well as donor priority on nutrition and food security, many government and non-government actors are involved in numerous multi-sector activities related to nutrition and food security throughout Nepal. The purpose of this page is to provide an outline of the overall multi-sector and multi-stakeholder governance that currently exists for nutrition and food security in Nepal. Figure 1 provides a summary of it.

The National Planning Commission (NPC) is the apex and overarching government body which assumes a stewardship and coordination role to bring the various government sectors and non-government entities including the external development partners under one umbrella. A High Level Nutrition and Food Security Steering Committee (HLNFSSC) has been established at NPC is chaired by the Honorable Vice Chairman. The committee members include three Honorable Members of the NPC looking after Health and Nutrition; Agriculture and Commerce Sectors, secretaries of selected ministries and selected senior subject matter experts. Similarly, a National Nutrition and Food Security Coordination Committee (NNFSCC) has also been established which is chaired by Honorable Member for Health and Nutrition Sector and co-chaired by Honorable Member for Agriculture Sector. Members of the NNFSCC include joint secretary level representation from selected ministries, representatives from concerned national and international organizations and selected subject matter experts. The coordination platforms extend down to sub-national levels in the form of Nutrition and Food Security Coordination Committees at District, Municipality and VDC levels.

National and Sub-national Nutrition Food Security Committees

Nutrition and food security portfolios in the NPC are overseen by Social Development Division and Agriculture and Rural Development Division respectively. In addition, a National Nutrition and Food Security Secretariat (NNFSS) has been set up to support the HLNFSSC and NNFSCC. The Secretariat works closely with both the Divisions to provide overall coordination support and technical backstopping for nutrition and food security matters handled by the NPC. Further, three multi-Sector thematic working groups on ‘Capacity Development,’ ‘Monitoring and Evaluation/Management Information System’ and ‘Advocacy and Communication’ as well as an Academia platform under the NPC are in the process of establishment.

A concept note on NNFSS, NNFSS brochure, Terms of References of multi-sector working groups and platforms can be accessed here.

National Nutrition and Food Security Secretariat Brochure
National Nutrition and Food Security Secretariat Concept Note
Multi Sector Working Groups ToR_English
Multi Sector Working Groups ToR_Nepali

Sectoral Ministries including Ministry of Agriculture and Livestock Development, Ministry of Education, Science and Technology, Ministry of Health and Population, Ministry of Federal Affairs and General Administration, Ministry of Water Supply and Ministry of Women, Children and Senior Citizen, Ministry of Communication, Information and Technology, Ministry of Finance are part of the multi sector and multi stakeholder coordination for nutrition and food security in Nepal. A good example of multi-sector collaboration and commitment is the Multi Sector Nutrition Plan (MSNP) 2013-2017 of Nepal depicted by its framework as well as endorsement (figures 2 and 3).

On the external development partners front, there are two organized platforms for coordination and collaboration in the field of nutrition and food security in Nepal. One is the Nepal Nutrition Group (NNG) comprised of UN agencies, donor agencies and international NGOs and the other one is the Food Security Donor Working Group (FSDWG) comprising of UN and donor agencies. Both groups are active with meetings held on a regular basis.

The Terms of References of both NNG and FSDWG can be accessed here.

Nepal Nutrition Group ToR
Food Security Donor Working Group ToR

Civil Society Alliance for Nutrition in Nepal (CSANN) has also been established as a network of all Civil Society Organizations (CSOs) implementing community level nutrition and related interventions on different sectors such as nutrition, sanitation and hygiene, livelihood, education, urban development and local development.

MSNP Implementation Mechanism

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  • Figure:1
    Multi Sector and Multi Stakeholder Governance for Nutrition and Food Security in Nepal
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  • Figure:2
    National MSNP Framework
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  • Figure:3
    MSNP Commitment
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Multisector Nutrition Plan II (2018-2022): Activity Based Budget

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Budget allocation in the fiscal year 2021/2022 (2078/79)

SN Description Nutrition Sensitive (million) Nutrition Specific (million) Total (million)
1 Federal/ Province 43.703 29.000 72.703
2 District 16.338 0 16.338
3 Local level 1212.469 225.290 1437.759
Total 1272.510 254.290 1526.800
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MSNP Implemented Province, District and Local level by FY 2021/22

SN Province Total District Full Package District/ Local level Partial Package District/ Local level Total Package District/ Local level
1 Province #1 14 3/26 11/111 14/137
2 Madhesh Province 8 8/136 0 8/136
3 Bagmati Province 13 3/30 6/61 9/91
4 Gandaki Province 11 1/8 9/27 10/80
5 Lumbini Province 12 6/47 6/62 12/109
6 Karnali Province 10 9/70 1/9 10/79
7 SudurPashchim 9 7/66 2/22 9/99
Total 77 37/383 35/337 72/720

Implementation of MSNP at local level

Full Package

  • Full participation of all seven sectors (health, education, agriculture development, livestock development, women and children development, WASH and local governance) with minimum program and have an integrated action plan
  • Integrated planning, implementation and reporting of 7 sectors
  • School WASH or Female Cooperative intervention for income generating of poor women at local level.
  • Technology based information management system established and reporting ensured
  • Availability of MSNP Volunteers or MSNP focal person at Local level.
  • Availability of MSNP Volunteers or MSNP focal person at Local level.

Partial Package

  • Formulation of the Nutrition and Food Security Steering Committee
  • Involvement of at least health or/and governance sector
  • Preparation of integrated MSNP action plan
  • Orientation to mothers and care-givers on utilization of Child Cash Grants.
  • Ensure linkage of the child grant with IYCF interventions.
  • Technology based information management system established and reporting ensured