Multi-sector Nutrition Plan 2018-2022

M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) a Multi-Sector Nutrition Plan Approved by the Cabinet Meeting of the Government of Nepal on 19 November 2017 (2018–2022) Government of Nepal National Planning Commission Government of Nepal National Planning Commission Singha Durbar, Kathmandu, Nepal 2017 Government of Nepal National Planning Commission Singha Durbar, Kathmandu, Nepal 2017 Multi-Sector Nutrition Plan-II Unofficial Translation (2018–2022) Approved by the Cabinet Meeting of the Government of Nepal on 19 November 2017 Multi-Sector Nutrition Plan-II 2018–2022 Published by Government of Nepal National Planning Commission Singha Durbar, Kathmandu Tel: (+977)-014211136, 4211158 Fax: (+977)-014211700 Email: npcs@npc.gov.np Web: www.npc.gov.np Year published: 2017 Copyright: National Planning Commission Photos: © UNICEF Nepal Recommended citation: NPC (2017). Multi-Sector Nutrition Plan: 2018–2022. Kathmandu: National Planning Commission. Designed and processed: Print Communication Pvt. Ltd. Tel: (+977)-01 4241355, 4244148, Kathmandu, Nepal Printed in Nepal iii Throughout the world, ending malnutrition is taken as a basis for achieving social, economic and human development as well as the Sustainable Development Goals. Studies have shown that the health issues caused by malnutrition are serious, long lasting and irreparable. Approximately 36 percent of Nepalese children suffer from stunting and 10 percent from wasting. Therefore, addi tional efforts from all relevant stakeholders are es sential to achieve the social and human develop ment commitments Nepal has made at regional and international forums. In this context, under the leadership of the Na tional Planning Commission, and with coor dinated support from relevant ministries and development partners, the Multi-Sector Nutri tion Plan (MSNP, 2013–2017) has been imple mented. It is essential to launch additional efforts targeted to reduce malnutrition in pregnant and lactating mothers, children under the age of two and adolescent girls. Similarly, as a continuation of the current plan, with participation from seven relevant ministries, development partners and other stakeholders, MSNP-II (2018–2022) has been formulated for the upcoming five years. This plan needs to be implemented with priority following the federal structure at all levels – fed eral, provincial and local, so as to reduce malnu trition which adversely affects social, economic and human development. The plan has the target of minimizing the adverse effects on human capital and social and economic development by reducing chronic malnutrition Message from the Prime Minister from the current 36 percent to 28 percent in the upcoming five years. As per the World Health As sembly global targets, malnutrition needs to be reduced to 24 percent of under-fives by the end of 2025. Similarly, the Sustainable Development Goals target is to reduce the percentage to 15 per cent by 2030. In line with this, the plan attempts to build capacity at all levels of government agen cies and relevant stakeholders by implementing promotional, preventive and therapeutic mea sures to reduce the problem of malnutrition in women, children and adolescent girls. It is essential, with our collective efforts, to re duce malnutrition among women, children and adolescent girls. For this, our additional commit ments are essential to achieve the neccessary addi tional progress while sustaining the achievements made at all levels across the various sectors. Jay Nepal! Mangsir, 2074 Sher Bahadur Deuba Prime Minister and Chairperson National Planning Commission KATHMANDU NEPALTHE PRIME MINISTER M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) iviv v Message from the vice Chair Malnutrition causes 45 percent of all deaths of under 5-year-olds worldwide. Undernutrition hampers their physical, mental and emotional development which in turn adversely affects the overall social, economic and human development of countries. Approximately 36 percent of Nepal’s children suffer from stunting, 10 percent from wasting and almost 53 percent from anaemia. Forty-one percent of women of reproductive age suffer from anaemia and 17 percent from long term energy deficits. These statistics differ by geographical re gion and social group. Studies have shown that malnutrition cannot be addressed by the efforts of the nutrition sec tor alone and hence the first Multi-Sector Nu trition Plan (2013–2017) was formulated and implemented in an integrated and coordinated way between nutrition specific and nutrition sensitive sectors. Taking stock of the achieve ments under MSNP (2013–17) pointed to the necessity of continuing these efforts and thus MSNP-II (2018-2022) has been conceptualized. This new plan aims to make a crucial contribu tion to achieve the Sustainable Development Goals related to health and nutrition and to help reap the benefits of the demographic dividend by strengthening the future economically productive population. To ensure its effective implementation, MSNP II was formulated by all the concerned ministries and development partners including the minis tries of health; agricultural development; live stock development; education; water supply and sanitation; women, children and social welfare; and federal affairs and local development, plus development partner agencies and other stake holders. The National Planning Commission played the coordinating role. Strong leadership is needed at the local level, as successful implementation at this level will de termine the achievement of the plan’s outcomes. In this context, various federal, provincial, local and ward level structures are being established to effectively undertake the plan’s programmes and activities. The NPC will extend various kinds of support, coordination and facilitation to ensure the imple mentation of this plan at all levels. I expect uni fied and consolidated support from all relevant stakeholders including all relevant ministries, local governments, development partners, civil society and the private sector. Swarnim Wagle Vice Chair National Planning Commission GOVERNMENT OF NEPAL National Planning Commission SINGHA DURBAR, KATHMANDU, NEPALVICE-CHAIRMAN M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) vivi vii Both undernutrition and overnutrition persist among Nepalese women and children although undernutri tion is more common. The problem of undernutri tion is specially seen in women of reproductive age and children under the age of five. The main causes of undernutrition are inadequate access to nutritious and diverse food, the poor use of available foods, infectious diseases due to unsafe water and poor hygiene, untimely treatment of diseases, poor use of health services, heavy workloads and poor aware ness. Stunting, wasting, under-weight, and maternal and child anaemia are the major problems caused by undernutrition. These problems are found in vary ing degrees among different social groups, classes and communities, and geographical regions. From the perspective of nutrition, the period from conception until a child’s second birthday are cru cial — it is known as the “golden thousand days”. During this period, the foods eaten by pregnant women, new mothers and newborns and childcare play a crucial role in growth and development of children. Scientific studies indicate that the prob lems of undernutrition, such as the breastfeeding of newborns and children, supplementary food, caring habits and behaviour, sanitation, cleanliness, and food security, can be resolved only if programmes are formulated and implemented in a consolidated way with a collective approach. Under the leadership and coordination of the Na tional Planning Commission (NPC), the ministries of health; agricultural development; livestock devel opment; water and sanitation; education; women, children and social welfare; federal affairs and local development, as well as national and international agencies working on nutrition are applying collab orative efforts through the multisectoral approach to address the problems of malnutrition. The Sustainable Development Goals for Nepal have targets to reduce stunting to 25 percent, wasting to 4 percent, and anaemia to 10 percent among children under five by the year 2030. Similarly, the government has set a target to reduce anaemia in women of reproductive age to 10 percent on the same timeline. Considering the research and study findings indicat ing the need of multisectoral efforts to address mal nutrition, the government formulated and imple mented the Multi-Sector Nutrition Plan (MSNP) 2013-2017. As the continuation of this plan, MS NP-II (2018-2022) has been formulated and will be expanded throughout the country. The Multi-Sector Nutrition Plan-II (2018-2022) will be implemented at all three levels of govern ment: federal, provincial and local, with active par ticipation from the relevant sectors with the local level playing a vital role. In this context, in order to identify various activities under the plan and de vise a detailed work plan and effectively implement it requires the participation of nutrition and food security committees at state, district, municipality, rural municipality and ward levels. This also requires the technical and financial contribution from devel opment partners. To conclude, I would like to express my sincere gratitude to the High Level Committee for Nutri tion and Food Security formed under the chair manship of NPC vice-chair for their direction and suggestions in formulating MSNP-II. I would also like to thank the members of the National Nutri tion and Food Security Coordination Committee (NNFSCC) for their help and suggestions. I also appreciate the contribution of the ministries, donor agencies and development partners for their contri butions to formulating the Multi-Sector Nutrition Plan-II. I also thank all the staff of the National Planning Commission Secretariat, National Nutri tion and Food Security Secretariat for helping to produce this new plan. Prof. Dr. Geeta Bhakta Joshi Member National Planning Commission GOVERNMENT OF NEPAL National Planning Commission SINGHA DURBAR, KATHMANDU, NEPALMEMBER Message from NPC Member M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) viii Message from the Prime Minister iii Message from the Vice Chair v Message from the NPC Member vii Abbreviations x Executive Summary xiii 1 Review of Multi-Sector Nutrition Plan (2013–17) 3 1.1 Background 3 1.2 Introduction 3 1.3 Global Nutrition Initiatives 4 1.4 Initiatives to Improve Nutrition in Nepal 5 1.5 Situation of Nutrition in Nepal 6 1.6 Progress of Nutrition Programmes 8 1.7 Analysis of Causes of Malnutrition in Nepal 10 1.8 Analysis of Other Issues that Affect Nutrition 13 1.9 Achievements of Multi-Sector Nutrition Plan (2013–17) 15 1.10 Analysis of Estimated Costs and Expenditure of Multi-Sector Nutrition Plan (2013–17) 18 1.11 Key Problems and Challenges 18 1.12 Lessons Learned Implementing MSNP (2013–17) 19 1.13 The Rationale for MSNP-II 20 2 Multi-Sector Nutrition Plan-II (2018–2022) 25 2.1 Vision 25 2.2 Goal 25 2.3 Objectives 25 2.4 Strategies 25 2.5 Policy-level Principles and Approaches 25 2.6 Theory of Change 26 2.7 Results Framework of MSNP-II (2018–22) 33 3 Implementation of MSNP-II (2018–2022) 43 3.1 Implementation Arrangements 43 3.2 Target Groups and Prioritization 43 3.3 Financial Management 44 3.4 Estimated Costs 44 3.5 Duration of MSNP-II 46 3.6 MSNP Committees 46 3.7 Power to Frame Guidelines 48 3.8 National Nutrition and Food Security Secretariat 48 3.9 Responsibilities of Private, Non-government and Academic Sectors 48 3.10 Capacity Development 50 3.11 Review, Monitoring and Evaluation 50 3.12 Documentation and Reporting 50 Contents viii M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) ix Annex 1: Multi-Sector Nutrition Plan-II (2018-2022) Results Framework 53 Annex 2: MSNP (2013–17) Related Programmes and Projects Supported by Development Partners 81 Annex 3: Commitments for Implementing MSNP 82 Annex 4: Contributors to Multisector Nutrition Plan II (2018-2022) 84 References 88 TABLES Table A: Goal, Outcomes and Outputs of MSNP-II xvi Table 1.1: Nepal’s Status Against Global Nutrition Targets 6 Table 1.2: Status of MSNP (2013–17) Nutrition Specific Indicators 16 Table 1.3: Budget Allocated to Nutrition by Government of Nepal (GoN) and Development Partners in MSNP (2013–17) Period 18 Table 3.1: Estimated NPC and Sectoral Ministry Costs of Implementing MNSP-II (NPR million) 45 Table 3.2: Estimated Nutrition-Specific and Nutrition-Sensitive Costs of Implementing MNSP-2 (NPR million) 45 Table 3.3: Estimated Costs of MSNP-II by Sources of funds 45 Table 3.4: Composition of High Level Nutrition and Food Security Steering Committee (HLNFSSC) 47 Table 3.5: Composition of National Nutrition and Food Security Coordination Committee (NNFSCC) 47 Table 3.6: Composition of Provincial Nutrition and Food Security Steering Committees (PLNFSSC) 47 Table 3.7: Composition of Local Government Nutrition and Food Security Steering Committees 49 Table 3.8: Composition of Ward-level Nutrition and Food Security Steering Committees 49 FIGURES Figure 1.1: Nepal’s progress on World Health Assembly target 1 (40% reduction in number of stunted under 5-year-olds) 7 Figure 1.2: Severity of stunting in Nepal’s provinces by WHO categories 8 Figure 1.3: Disparities in Stunting Prevalence Among Under-5s in Nepal in 2016 9 Figure 1.4: Coverage Progress of Nepal’s Nutrition Specific Interventions in MSNP (2013–17) period 10 Figure 1.5: Coverage Progress of Nepal’s Nutrition Sensitive Interventions in MSNP (2013–17) period 11 Figure 1.6: Timelines of Preparation of MSNP-II 21 Figure 2.1: MSNP-II’s Theory of Change 27 Figure 2.2: MSNP-II Results Structure — Outcome 1 on Nutrition Specific Services 29 Figure 2.3: MSNP-II Results Structure — Outcome 2 on Nutrition Sensitive Services 30 Figure 2.4: MSNP-II Results Structure — Outcome 3 on the Enabling Environment 32 ix M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) x AARR Average Annual Rate of Reduction ABPMDD Agribusiness Promotion and Marketing Development Directorate ANC Antenatal Care AWPB Annual Workplan and Budget BMI Body Mass Index CLC Community Learning Centre CMAM Community-Based Management of Acute Malnutrition DFID Department for International Development (UK Aid) DFTQC Department of Food Technology and Quality Control DoCR Department of Civil Registration DoE Department of Education DoHS Department of Health Services DoLS Department of Livestock Services DWC Department of Women and Children ECED Early Childhood Education and Development EMIS Education Management Information System FAO Food and Agriculture Organization FCHV Female Community Health Volunteer GoN Government of Nepal HLNFSSC High Level Nutrition and Food Security Steering Committee HMIS Health Information Management System IMAM Integrated Management of Acute Malnutrition IMNCI Integrated Management of Neonatal and Childhood Illness ITC Inpatient Therapeutic Care IYCF Infant and Young Child Feeding JMP Joint Monitoring Programme MIYC Maternal, Infant and Young Child MIYCN Maternal, Infant and Young Child Nutrition MIYCU Maternal, Infant and Young Child Undernutrition MNP Multiple Micronutrient Powder MoAD Ministry of Agriculture Development MoF Ministry of Finance MoFALD Ministry of Federal Affairs and Local Development MoH Ministry of Health MoLD Ministry of Livestock Development MoWCSW Ministry of Women, Children and Social Welfare MoWSS Ministry of Water Supply and Sanitation MSNP Multi-Sector Nutrition Plan NA Not Available NDHS Nepal Demographic and Health Survey abbreviations M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) x M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xi NFC Nepal Food Corporation NLSS Nepal Living Standards Survey NMICS Nepal Multiple Indicator Cluster Survey NMIP-DWSS National Management Information Project of the Department of Water Supply and Sewerage NNFSS National Nutrition and Food Security Secretariat NPC National Planning Commission NPR Nepali Rupees NRH Nutrition Rehabilitation Home O&M Organisation and Management ODF Open Defecation Free OPD Outpatient Department ORS Oral Rehydration Solution OTC Outpatient Therapeutic Care PHC-ORC Primary Health Care Outreach Clinics PNC Post-Natal Care PPE Pre-Primary Education ReSoMal Rehydration Solution for Malnutrition RUTF Ready to Use Therapeutic Food SAM Severe Acute Malnutrition SDG Sustainable Development Goal SUN Scaling Up Nutrition ToT Training of Trainers TWG Technical Working Group UNICEF United Nations Children’s Fund USAID United States Agency for International Development WASH Water, Sanitation and Hygiene WCF Ward Citizens Forum WFP World Food Programme WHA World Health Assembly WHO World Health Organisation WRA Women of Reproductive Age M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xi M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xiixii M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xiii Nepal has made strong efforts to address the problem of malnutrition. The Government of Nepal has recognized the need of multi-sectoral efforts to improve the nutrition of its citizens. It developed the first Multi-Sector Nutrition Plan, which was implemented from 2013 led by the National Planning Commission. The second Multi-sector Nutrition Plan (2018/19–2022/23) has been designed as a continuation of MSNP (2013–17). Nepal has made remarkable progress in the field of nutrition. According to the regular Nepal de mographic health surveys (NDHSs), stunting among under-five years children has reduced from 57 percent in 2001 to 35.8 percent in 2016. The process of stunting starts at concep tion, accelerates until two years of age, and is then irreversible. Therefore, nutrition needs to be improved among mothers and potential moth ers (i.e. during adolescence and pregnancy) and when children are under two years of age. Overweight and obesity is an emerging problem due to excessive intake of high amounts of fat, sugar and salt and inactive lifestyles. This is lead ing to a growing incidence of high blood pressure, diabetes and other non-communicable diseases. The undernutrition problems of stunting, wast ing and low weight in children contribute to 52 percent of child mortality in Nepal. And those who survive usually have limited intellectual growth and cognitive development that affects their education. The World Bank estimates that undernutrition causes losses of up to 3 percent of economic de velopment. Thus, improving nutrition is a pre condition to break the cycle of poverty and for sustainable economic development. Major causes of chronic malnutrition in Nepal are poor feeding and care practices, insufficient nutrient intake, and high rates of infection and teenage pregnancy. The Nepal Demographic Health Survey, 2016 reported that only 50 percent of babies were breastfed within one hour of birth. Although, the exclusive breastfeeding rate of newborns up to six months of age is 66 percent, only 17 percent of 6–8 months old babies were found receiving minimum acceptable diets while only 35 percent of children aged 6-23 months received minimum acceptable diets. Despite improvements in complementary feeding, families and fathers play little part in promoting this. According to the Nepal Multiple Indicator Clus ter Survey, 2014, 20 percent of children under 5 years of age had recently suffered from fever and 12 percent from diarrhoeal disease. These infec tions lead to malnourishment and the death of young children. According to the 2016 NDHS, 17 percent of women of reproductive age and 30 percent of adolescent girls had chronic energy de ficiency (BMI less than 18.5kg/m2), while 44 per cent of adolescent girls were anaemic. Pregnancy in these conditions results in low birth weight babies, a cycle that repeats from mother to child and onwards. Maternal and infant infections are also common problems as are intestinal parasites. Other problems that contribute to malnutrition are that 13 percent of women of reproductive age smoke, while 40 forty percent of women suffer from indirect smoking, and 75 percent are ex posed to smoke pollution from solid fuel cooking stoves. According to the Nepal Multiple Indicator Clus ter Survey, 2014, 48 percent of women aged 20 49 years were first married or in union before age 20 and so teenage pregnancies are common. And 16 percent of women delivered a baby before their eighteenth birthdays. In such cases, maternal care practices tend to be poor. The heavy workloads of many women after delivery is another problem. Access to and the use of health services has im proved. The 2016 NDHS reported 53 percent of married women aged 15-49 years using modern Executive Summary According to the regular Nepal demographic health surveys (NDHSs), stunting among under-five years children has reduced from 57 percent in 2001 to 35.8 percent in 2016. The process of stunting starts at conception, accelerates until two years of age, and is then irreversible. Multi-Sector Nutrition Plan-II (2018–2022) M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xiv family planning methods. Maternal care practices have also improved with 84 percent of pregnant women having at least one antenatal or postnatal checkup. Fifty-eight percent of pregnant women used the services of a skilled birth attendant for their deliveries. According to the Nepal Multiple Indicator Clus ter Survey, 2014, 93 percent of households used a source of safe drinking water. However only half of the population used toilet facilities while less care was taken for the safe management of cow dung and manure, which creates a polluting en vironment and spreads disease and parasites. This indicates that personal hygiene and sanitation is still poor in many households. Although the literacy rate among young women has reached more than 88.6 percent, women’s voices are not adequately heard and they play little part in decision-making. Gender discrimi nation and social exclusion persist, although they are being addressed in many programmes of the government and its development partners. The underlying causes of malnutrition have di minished. Now, only 21.6 percent of the popu lation live below the poverty line. It however remains challenging to provide enough food in food deficit districts year-round to attain the SDG of zero poverty and hunger. But at the basic level of causality there have been overwhelming improvements in infrastructure including roads, schools and health facilities. According to the Global Nutrition Report, 2016, scaling up nutrition investments is a high-impact, high-return proposition, with a benefit-cost ratio of 16:1 and a compound rate of return of more than 10 percent. The costs of neglecting nutrition are high, causing economic losses of around 10 percent of gross domestic product. The design of this Multi-Sector Nutrition Plan II (2018/19–2022/23) addresses the achievement of the World Health Assembly global targets for 2025, the Sustainable Development Goals for 2030 and nutrition deprivation and causal ity analysis in Nepal. This plan addresses lessons The underlying causes of malnutrition have diminished. Now, only 21.6 percent of the population live below the poverty line. It however remains challenging to provide enough food in food deficit districts year-round to attain the SDG of zero poverty and hunger. xiv M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xv The implementation of MSNP (2013–17) started in 2013 with the aim of enhancing nutrition to remove it as an impeding factor for human development and for overall socioeconomic development. The new plan continues the MSNP (2013–17) interventions. learned from MSNP (2013–17). Nutrition re lated cultural trends, habits, weaknesses in the nutrition sector, gaps and the problems of under nutrition and over-nutrition have also been anal ysed. The plan’s logical framework leads on from its theory of change. This plan covers concepts and experiences shared by the related sectoral ministries. This final draft of MSNP-II was discussed in the National Nutrition and Food Security Coordi nation Committee and then submitted to the High Level Nutrition and Food Security Steer ing Committee for endorsement. The endorsed document from the HLNFSSC was approved by the Council of Ministers in November 2017. The implementation of MSNP (2013–17) start ed with the aim of enhancing nutrition to remove it as an impeding factor for human development and for overall socioeconomic development. The new plan continues the MSNP (2013–17) interventions. The goal for the next five years is “Improved maternal, adolescents and child nutri tion’” which will be achieved by taking to scale nutrition specific and sensitive interventions and by improving the nutrition enabling environ ment. The nutrition specific interventions will be large ly delivered through the health sector, and the nutrition sensitive interventions mainly by the education, agriculture, livestock, water and sani tation, women and children sectors in collabora tion with local governments. All these interven tions will aim to improve the status of nutritional as measured against the incidence of stunting and wasting among under 5-year-olds and low birth weight babies. The plan also aims to reduce chronic energy deficiency among women. The expectation is also to reduce the proportion of mothes and children who are overweight. xv M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xvi Table A: Goal, outcomes and outputs of MSNP-II Goal: Improved maternal, adolescent and child nutrition by scaling up essential nutrition-specific and sensitive interventions and creating an enabling environment for nutrition OUTCOME 1: IMPROVED ACCESS TO AND EQUITABLE USE OF NUTRITION-SPECIFIC SERVICES Output 1.1: Enhanced nutrition status of women of reproductive age including adolescents Output 1.2: Improved infant and young child nutrition and care practices Output 1.3: Improved maternal, infant and young child micronutrient status Output 1.4: Improved management of severe and moderate acute malnutrition Output 1.5: Enhanced preparedness for nutrition in emergency responses Output 1.6: Capacity built of nutrition-specific sectors OUTCOME 2: IMPROVED ACCESS TO AND THE EQUITABLE USE OF NUTRITION-SENSITIVE SER VICES AND IMPROVED HEALTHY HABITS AND PRACTICES Output 2.1: Increased availability and consumption of safe and nutritious food Output 2.2: Increased physical and economic access to diverse types of food Output 2.3: Increased access to safe drinking water Output 2.4: Increased access to safe and sustainable sanitation services Output 2.5: Improved knowledge of children and mothers and caretakers of under 5-year-old children on health and hygiene Output 2.6: Targeted groups have access to resources and opportunities that make them self-reliant Output 2.7: Nutrition component incorporated in women, adolescent girls and child development training packages Output 2.8: Women, children and out-of-school adolescent girls reached with health and nutrition care practices Output 2.9: Child care homes comply with minimum standards of nutrition care Output 2.10: Communities empowered to prevent harmful practices (menstrual seclusion [chhau padi], food taboos) Output 2.11: Enhanced enrolment of children in basic education Output 2.12: Increased adolescent girls’ awareness and improved behaviour on nutrition Output 2.13: Enhanced access to health and reproductive health services xvixvi M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xviixvii OUTCOME 3: IMPROVED POLICIES, PLANS AND MULTI-SECTORAL COORDINATION AT FEDERAL, PROVINCIAL AND LOCAL GOVERNMENT LEVELS TO ENHANCE THE NUTRITION STATUS OF ALL POPULATION GROUPS Output 3.1: MSNP-II included in local, provincial and federal government policies and plans Output 3.2: MSNP governance mechanism instituted and strengthened at federal, provincial, and local levels Output 3.3: MSNP institutional mechanisms established and functional at federal government level Output 3.4: Functional updated information system across all MSNP sectors Output 3.5: Enhanced capacity of federal, provincial and local level government to plan and imple ment nutrition programmes xvii M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) xviiixviiixviii M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 1 REVIEW OF MULTI-SECTOR NUTRITION PLAN, 2013–17 Chapter 1 11 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 22 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 3 1.1 Background The Government of Nepal and its development partners are committed to addressing the com plex problem of malnutrition. The government’s development objectives are outlined in the Con stitution of Nepal, the Fourteenth Development Plan and the Sustainable Development Goals (SDGs). Economic growth, employment promo tion, poverty alleviation, post-conflict reconstruc tion, social transformation and human resource development are the government’s development priorities. Improving the nutritional status of its citizens is a major priority of the government. Improving nu trition involves interventions in health and other sectors; thus policies, strategies and plans of the health, agriculture, livestock, water and sanita tion sectors emphasise good nutrition and food security. The government is addressing the complex causes of malnutrition through a multi-sectoral approach. Its first Multi-Sector Nutrition Plan (MSNP, 2013-2017) had the following out comes: 1. Improved maternal, infant and young child feeding. 2. Increased maternal, infant and young child micro-nutrient status. 3. Improved management of malnutrition in children. MSNP (2013–17) was implemented through the following nutrition-specific and nutrition-sensi tive programmes: • The ‘direct’ nutrition-specific interventions targeted individuals and included micronu trient supplements to under 5-year-olds and adolescents and women during pregnancy and lactation, micronutrient fortification (salt iodization and flour fortification), awareness raising and behaviour change communication on optimal infant and young child feeding, and the management of severe acute malnu trition. • The ‘indirect’ nutrition-sensitive interventions targeted families and communities including on hygiene and sanitation, with cash and in kind transfers (including child cash grants), nutritious food and diets, school feeding pro grammes and parental education. These programmes (most of which are ongoing) were implemented by government line minis tries, principally the Ministry of Health (MoH), Ministry of Agricultural Development (MoAD), Ministry of Livestock Development (MoLD), Ministry of Education (MoE), Ministry of Wa ter Supply and Sanitation (MoWSS), Ministry of Federal Affairs and Local Development (Mo FALD), and the Ministry of Women, Children and Social Welfare (MoWCSW). In addition to funding the regular cross-sectoral nutrition pro grammes nationwide, the government provided additional funding to implement MSNP (2013– 17) in 28 priority districts from its own resources and development partner support. 1.2 Introduction People are malnourished if their diet provides in adequate nutrients for growth and good health or if they are unable to fully use the food they con sume due to illness. They are also malnourished if they consume too many calories (overnutrition) (UNICEF 2012). Malnutrition is caused by poor health, diet, edu cation, access to resources, empowerment and other factors. Good nutrition, i.e. an adequate well-balanced diet, and regular physical activity are the cornerstones of good health. Poor nutri tion can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development and reduced productivity. Nutritional deficiencies among young children 1. Review of Multi-Sector Nutrition Plan (2013–17) Chapter 1 The government is addressing the complex causes of malnutrition through a multi sectoral approach. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 4 and mothers has large economic costs that mani fest later in an increased burden of disease and losses of human capital and economic productiv ity. Undernourished children suffer irreparable intellectual impairment and stunted physical growth. Hungry children make poor and less productive students and often make unhealthy workers. All this results in impoverished families and communities and an overburdened health care system. Undernourished mothers usually give birth to un derweight babies, thus transferring disadvantages to the next generation. From the perspective of nutrition, a young child’s first 1,000 days (from conception to the second birthday) are critical. Nutrition interventions can have a huge benefit during this period. Subsequent interventions can make a difference, but cannot undo damage re lated to malnutrition from the first 1,000 days. Children’s nutrition outcomes are closely related with maternal nutrition. Healthy, well-nourished mothers are more likely to give birth to and nur ture healthy children. Accordingly, it is important that adolescent girls, pregnant women and lactat ing mothers receive the range of nutrition-related services and information they need to support their good nutrition. 1.3 Global Nutrition Initiatives The main initiatives that guide and promote im proved nutrition at the global level are the Scal ing Up Nutrition (SUN) Framework, the SDGs and the World Health Assembly’s global nutrition targets (2012). The momentum to improve nutrition accelerated at the global level from 2009 with the initiation of a global collaborative process, the Scaling Up Nu trition (SUN) Framework (scalingupnutrition. org). The SUN framework has been endorsed by over 100 international development institutions working in the field of nutrition including UNI CEF, WFP, FAO, WHO, USAID, DFID, DFAT and the World Bank, and by the governments of 59 countries (the movement). The SUN Move ment works to build an enabling social, eco nomic and political environment that ensures all children can reach their full potential. The SUN Movement Strategy and Roadmap (2016-2020) (SUN Movement 2016) calls for the following: 1. Expanding and sustaining an enabling politi cal environment. 2. Prioritizing and institutionalizing effective ac tions that contribute to good nutrition. 3. Implementing effective actions aligned with common results frameworks. 4. Effectively using and significantly increasing financial resources for nutrition. The SUN framework calls for multi-sectoral ap proaches to improving nutrition, arguing that the essential complementary approaches of nutrition specific activities and nutrition-sensitive activities both need scaling up. Almost all countries signed up to the 2030 Agen da for Sustainable Development committing to comprehensive, integrated and universal trans formations, including ending hunger and malnu trition. The agenda focuses on achieving the 17 Sustainable Development Goals by 2030. SDG 2 calls for “Ending hunger, achieving food security and improving nutrition and promoting sustain able agriculture.” At least 12 of the 17 SDGs have indicators that are relevant to good nutrition with SDGs 1, 2, 3 and 6 closely related to nutrition. Nepal’s enactment of its new 2015 Constitution coincided with the beginning of the SDG period providing the opportunity for the new system of governance to focus on achieving the SDGs. In 2012, the World Health Assembly (WHA) agreed on the following six global nutrition tar gets by 2025 (WHO 2012): • 40 percent reduction in the number of chil dren under-5 who are stunted • 50 percent reduction of anaemia in women of reproductive age • 30 percent reduction in low birth weight ba bies • no increase in childhood overweight • increase the rate of exclusive breastfeeding in the first 6 months up to at least 50 percent • reduce and maintain childhood wasting to less than 5 percent. The following are other important global com mitments signed up to by Nepal: • In 2013, the World Health Assembly agreed to halt the rise in diabetes and obesity as part From the perspective of nutrition, a young child’s first 1,000 days (from conception to the second birthday) are critical. Nutrition interventions can have a huge benefit during this period. Subsequent interventions can make a difference, but cannot undo damage related to malnutrition from the first 1,000 days. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 5 of the adoption of the comprehensive global monitoring framework for the prevention and control of non-communicable diseases WHO 2013). • Many countries, including Nepal, endorsed the World Health Organisation’s Compre hensive Implementation Plan on Maternal, Infant and Young Child Nutrition (MIYCN) in 2012 (WHO 2014). 1.4 Initiatives to Improve Nutrition in Nepal The government has instituted a number of nu trition-related policies and plans: The National Nutrition Policy and Strategy, 2004 (CHD 2004) guides nutrition programmes and activities in the health sector. Other relevant policies and plans include the National Health Policy 2015, the Nepal Health Sector Strategy Action Plan (2016-2022) and the Food and Nu trition Security Plan of Action (2014-2024). The Agriculture Development Strategy, 2015– 2035 (MoAD 2015) calls for reducing food-re lated poverty from 27.6 percent in 2016 to 13 percent in 2026 and 6 percent in 2036. Food and Nutrition Security is one of the strategy’s flagship programs. The Nepal Health Sector Strategy, 2016-2021 (MoHP 2015) recognises nutrition as a multi sectoral issue and includes related programmes and activities under the following three action areas: • Maintain comprehensive extension and use of services — These programmes include dis tributing Vitamin A capsules to under 5-year olds and deworming tablets to 1–5 year olds, the distribution and use of zinc tablets for diarrhoea treatment, the distribution of iron folic acid tablets, deworming tablets and vita min A capsules to pregnant mothers, and the use of iodised salt. • Programmes to scale up — These pro grammes include exclusive breastfeeding af ter birth, complementary feeding (including breastfeeding after 6 months), providing Baal vita micronutrient powders to 2–23 month olds, handwashing at critical times, the in tegrated management of severe malnutrition and the production of fortified flour. • Programmes to assess and revise — These programmes include maternal and child nu trition improvement related activities, mixing micronutrients in fortified wheat flour and the treatment of child malnutrition. The Nepal Water Supply, Sanitation and Hy giene Sector Development Plan, 2016-2030 (MSWW 2016) calls for actions that enhance nutrition including frequent handwashing with soap, safe disposal of faeces, the safe handling and treatment of drinking water and regular nail cut ting, bathing, and tooth brushing. And above all, Nepal’s new 2015 Constitution grants all citizens the fundamental right to food and basic health care (GoN 2015). MSNP (2013-17) calls for nutrition-specific and nutrition-sensitive programmes to address under nutrition. The health, education, water and sani tation, agriculture and livestock, local governance and women, children and social welfare sectors have a leading role to play in improving nutri tion in Nepal. The interventions implemented by these six sectors in Nepal under MSNP (2013– 17) are summarised below. • Health — The wide range of health sector nu trition interventions included maternal infant and young child nutrition, maternal health care, micronutrient supplementation and the fortification of foodstuffs. • Education — Education has a large role to play in improving the nutritional knowledge and behaviour of the future generation. Ma jor MoE nutrition programmes under MSNP (2013–17) were the provision of midday meals in schools, improving water, sanitation and hygiene (WASH) facilities in schools and the inclusion of nutrition topics in curricula. • Water and sanitation — The water and sani tation sector is involved in nutrition by pro moting safe drinking water and sanitation, es pecially as diarrhoea is a major cause of child mortality. The interventions run in the MSNP (2013–17) period were mainly for safe water supplies and improving hygiene and sanita tion. • Agriculture and livestock — The develop ment of agriculture and livestock production is crucial for improving nutrition. Interven tions were run under MSNP (2013–17) to en MSNP (2013 17) called for nutrition-specific and nutrition sensitive programmes to address undernutrition. The health, education, water and sanitation, agriculture and livestock, local governance and women children and social welfare sectors have a leading role to play in improving nutrition in Nepal. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 6 hance homestead food and livestock produc tion, to increase the incomes of poor women through credit incentives, and to increase the consumption of micronutrient-rich foods. • Women children and social welfare — Dur ing MSNP (2013–17) MoWCSW helped increase the knowledge of children and the mothers and caretakers of young children on hygienic behaviour and empowered commu nities to address harmful traditional practices such as menstrual seclusion and food taboos. • Local governance— Local governments have a major role to play in improving nutrition including through social mobilization and the administration of cash transfers and social protection. The contributions to improved nutrition by MoFALD and the local bodies under the previous constitution focussed on the 28 MSNP (2013–17) districts. The new federal units of local governance — provinces and the four levels of local government (met ropolitan cities, sub-metropolitan cities, ur ban municipalities and rural municipalities) plus their wards have an important role to play in improving nutrition. Alongside these sectors, the Nepal Food Corpo ration and Salt Trading Corporation (under the Ministry of Supplies) supply food to remote dis tricts and distribute iodised salt and are therefore important MSNP-II stakeholders. 1.5 Situation of Nutrition in Nepal Although there have been significant improve ments across the different types of malnutrition (stunting, wasting, underweight, low body mass index, micronutrient deficiency, overweight and obesity), malnutrition continues to constrain hu man lives and Nepal’s socioeconomic develop ment. Malnutrition contributes to more than a third of child mortality in Nepal, and children who survive often lead diminished lives due to impaired cognitive development, reduced eco nomic productivity and the increased risk of mal nutrition-related chronic diseases. Overweight and obesity are emerging amongst certain groups. Nepal made mixed progress on the achievement of the World Health Assembly’s global nutrition targets for 2025 between the base year of 2011 and 2016. It must be noted though that Nepal has made great progress on these indicators over the last two decades. There were small improvements in stunting (WHA target 1), childhood overweight (WHA 4), exclusive breastfeeding (WHA 5) and child hood wasting (WHA 6) (Table 1.1). There was a worsening in the situation of anaemia among women and children and a doubling in the preva lence of low birth weight (although the latter was probably due to the increased number of institu tional deliveries meaning it was detected more). The childhood overweight and breastfeeding tar gets have been achieved and efforts need acceler ating to achieve the other targets. Note that although overweight is only a minor problem amongst children it has become a seri ous concern among adults with the 2016 NDHS finding that 22.2 percent of women and 17.1 percent of men were overweight (MoH, New ERA and ICF 2017). The highest incidence was in the highest wealth quintile where 45 percent TABLE 1.1: NEPAL’S STATUS AGAINST GLOBAL NUTRITION TARGETS Global nutrition targets for 2025 and 2030 Base year situation Progress Nepal's WHA target Nepal’s SDG targets 2011 2016 2025 2030 1 Achieve 40% reduction in the number of children under-5 who are stunted 40.5% 35.8% 25% 15% 2a Achieve a 50% reduction of anaemia in women of reproductive age 35% 40.8% 18% 10% 2b Achieve a 50% reduction of anaemia in children 46.2% 52.7% 23.1% 10% 3 Achieve a 30% reduction in low birth weight 12.1% 24.2%* 8% – 4 Ensure no increase in childhood overweight 1.4% 1.2% ≤1.4% – 5 Increase rate of exclusive breastfeeding in first 6 months to at least 50% 69.6% 66.1% >50% – 6 Reduce and maintain childhood wasting to less than 5% 10.9% 9.7% 5% 4% There has been a large reduction in childhood stunting (short height for age) in Nepal in recent years; reducing from 57 percent of under 5-year-olds in 2001 to 35.8 percent of them in 2016. Source of information: MoH, New ERA and ICF (2017) and *CBS 2015 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 7 Note: AARR = average annual rate of reduction FIGURE 1.1: NEPAL’S PROGRESS ON WORLD HEALTH ASSEMBLY TARGET 1 (40% REDUCTION IN NUMBER OF STUNTED UNDER 5-YEAR-OLDS) 20 01 20 03 20 05 20 07 20 09 20 11 20 13 20 15 20 17 20 19 20 21 20 23 20 25 20 27 20 29 20 31 20 33 60 55 50 45 40 35 30 25 20 15 49.3 57.3 40.5 37.4 35.8 29.4 24.7 24.3 19.5 Existing (AARR 0.031) Required (AARR 0.043) of women and a third of men were overweight or obese in 2016. There has been a large reduction in childhood stunting (short height for age) in Nepal in recent years; reducing from 57 percent of under 5-year olds in 2001 to 35.8 percent of them in 2016 (MoH, New ERA and ICF 2017). Note that the stunting of under 5-year-olds is recognised as the main indicator of malnutrition and so receives the most coverage here. However, Nepal has fallen behind on the average annual rate of reduction needed to achieve WHA target 1 of a 40% reduction by 2025 in the num ber of stunted under 5 year-olds (Figure 1.1). The prevalence of stunting in this age group in the 2011 WHA base year was 40.5 percent, amount ing to 1,108,573 stunted children (CBS popula tion projection 2011). To reduce the prevalence by 40 percent entails reaching 24.3 percent by 2025, which means having 661,860 fewer stunt ed children. The average annual rate of reduction between 2001 and 2016 was 3.09 percent. To reach the WHA target of 24.2 percent therefore requires an average annual rate of reduction from 2016 onwards of 4.26 percent. Note that the same kind of trend and disparity analysis was carried out for all six WHA indica tors as background analysis for MSNP-II. Only the stunting analysis is included here. The 2016 NDHS found that 35.8 percent of under-5-year-olds were stunted, although there were considerable variations, as illustrated in Fig ure 1.2: • 40.2 percent of children stunted in rural areas compared to only 32.0 percent in urban areas • Children from the poorest wealth quintile were three times more likely to be stunted (49.2%) than children from the richest quin tile (16.5%) • Children of mothers who were not educated were twice as likely to be stunted (45.7%) as children of educated mothers (22.7%) • Children below 18 months old were less stunted than older children • 46.8 percent of children in mountain areas were stunted compared to 36.7 percent in the Tarai plains and 32.3 percent in the hills • Provinces 2, 5, 6 and 7 had above national average rates of stunting with a very high However, Nepal has fallen behind on the average annual rate of reduction needed to achieve WHA target 1 of a 40% reduction by 2025. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 8 1 The dataset used for this paragraph includes NDHS 2016, Nepal Multiple Indicator Cluster Survey (NMICS) 2014, Annual Reports of the Department of Health Services for 2012/2013 and 2014/2015, Nepal Health Facility Survey (NHFS) 2015 and other statistics from government ministries. The prevalence of wasting (low weight for height) has fluctuated in recent years in Nepal from 9.6 percent of under 5-year-olds in 2001 to 11.4 percent in 2014 and 9.7 percent in 2016 FIGURE 1.2: SEVERITY OF STUNTING IN NEPAL’S PROVINCES BY WHO CATEGORIES . Creation Date: Map data source(s): 10 April 2017 Nepal Gazette (10 March 2017) DoS, GoN 07 51 5037.5 KM Province 7 (35.9%) Province 6 (54.5%) Province 4 (28.9%) Province 3 (29.4%) Province 1 (32.6%) Province 2 (37.0%) Province 5 (38.5%) Source: Nepal Demographic Health Survey, 2016 Legend Very high: => 40 percent High: 30-39 percent Medium: 20-29 percent Low: <20 percent Disclaimers: The map is based on The Constitution of Nepal Published by Government of Nepal, Ministry of Law, Justice and Parliamentary Affairs. Law Book Management Board The boundaries are derived using spatial operation in GIS environment on old ward level administrative data from DoS. prevalence in Province 6 (mid-western Nepal) (54.5%), almost double that in Province 4 (28.9%) (Figure 1.3). The prevalence of wasting (low weight for height) has fluctuated in recent years in Nepal from 9.6 percent of under 5-year-olds in 2001 to 11.4 percent in 2014 and 9.7 percent in 2016 (MoH, New ERA and ICF 2017). Wasting is a measure of acute undernutrition and represents the failure to receive adequate nutrition in the period im mediately before the survey. There was little difference in the rate of wasting between boys (9.5%) and girls (9.8%) in 2016 and only a small difference by residence with 10.2 percent of under 5-year-olds wasted in rural ar eas versus 9.2 percent in urban areas. Children in the Tarai had the highest prevalence of wasting (12%) compared to children in the hills (6.4%) and mountains (6.1%). And the prevalence of wasting among infants aged 0-23 months was al most twice (ranging from 15.2% to 21.3%) that among 48-59 month old infants (6.2%).1 1.6 Progress of Nutrition Programmes In 2017 UNICEF analysed the coverage trends of nutrition specific and sensitive interventions from the MSNP (2013–17) period (and in some cases earlier). This analysis was carried out using sectoral ministry data. Sufficient data was not available to do this analysis for enabling environ ment interventions. Figures 1.4 and 1.5 show the results of this analysis, with: • the level of coverage of target groups along the horizontal axis (up to maximum 100% cover age) and associated recommendations • the progress of coverage of along the vertical M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 9 FIGURE 1.3: DISPARITIES IN STUNTING PREVALENCE AMONG UNDER-5S IN NEPAL IN 2016 Source: MoH, New ERA and ICF 2017 P R E V A LE N C E % Male Female Urban Rural Lowest No Education 24-35m 18-23m 36-47m 12-17m 9-11m 6-8m ≤6m 48-59m Primary Mountain Province 6 Province 5 Province 2 Province 7 Province 1 Province 3 Province 4 Terai Hills Secondary Higher Middle Fourth Highest Second 40.236.0 35.7 49.2 45.7 44.5 41.9 38.5 32.632.3 20.0 36.7 22.7 32.0 35.7 38.7 32.4 16.5 31.5 40.0 39.8 31.9 17.6 13.5 46.8 36.7 29.4 28.9 35.9 37.0 54.5 60 55 50 45 40 35 30 25 20 15 10 5 0 Gender Area of Residence Wealth Quintile Maternal Education Age Groups in Months Ecological Zones Federal Provinces National Average 35.8 axis ranging from programmes that have ex panded significantly to ones that have shrunk. The recommendations for the interventions in both graphs for the three levels of coverage are: • Need scaling up, strengthening or sustaining for positive coverage trend interventions. • Need attention, reversing negative trend or sustaining for negative trend coverage. Based on the limited data available for this exer cise, Figure 1.4 shows a mixed trend of progress of the nutrition-specific interventions during the MSNP (2013–17) period, with: • flour fortification being unchanged at 100 percent targeted coverage • the coverage of the treatment of diarrhoea cases increased by 250 percent, but still only covers about 20 percent of cases • the proportion of households using iodised salt increased by 50 percent to reach about 80 percent targeted coverage • exclusive breastfeeding declined to about 56 percent of babies • the needed financial resources for improving nutrition increased by about 40 percent. The UNICEF Nepal analysis of the progress of nutrition-sensitive interventions found that 11 of the major selected nutrition sensitive indicators increased their coverage in the MSNP (2013–17) period (Figure 1.5). Only the two married-before age-18-years indicators had a negative trend. The increases in coverage were for secondary school enrolment, disposal of child faeces, handwashing, and and access to improved sanitation. The most remains to be done on reducing early marriage and installing well-functioning water supply sys tems, with less than a third of targeted coverage achieved. Children in the Tarai had the highest prevalence of wasting (12%) compared to children in the hills (6.4%) and mountains (6.1%). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 10 1.7 Analysis of Causes of Malnutrition in Nepal The following text discusses the main health-re lated causes of malnutrition in Nepal. 1) Causes — Nepal’s population faces a range of nutritional problems from deficits in energy intake to imbalances in the consumption of macro and micronutrients. The causes include imbalanced diets; inadequate family care; poor quality water, sanitation and hygiene; in adequate access to health services; child mar riage; women’s heavy workloads; women’s lack of access to economic resources; gender-based violence and cultural taboos. The problem of excess intake is also surfacing as changing dietary patterns and lifestyles result in over weight and obesity. 2) Causes of stunting — The underlying causes of stunting in Nepal are inadequate mater nal, infant and young child feeding practices, untreated episodes of acute malnutrition, in fections, and micronutrient deficiencies. Ex clusive breastfeeding is sufficient for the first six months after birth while the timely intro duction of appropriate complementary foods with breastfeeding is essential after six months of age. Nepal achieved the World Health Assembly target of exclusive breastfeeding of 50 per cent of infants in early 2015. However, fur ther efforts are needed to reach the target of the National Infant Young Child Feeding Strategy (CHD 2014) of 80 percent exclusive breastfeeding in the first six months of life by 2020 as in 2016 only 66% of this age group were exclusively breastfed (MoH, New ERA and ICF 2017). The 2016 NDHS found major disparities around this average figure with only 48.6 of female infants exclusively breastfed compared to 63.8 percent of male infants and only 48.3 percent of lowest wealth quintile infants compared to 70.8 percent of infants in the second wealth quintile (MoH, New ERA and ICF 2017). The underlying causes of stunting in Nepal are inadequate maternal, infant and young child feeding practices, untreated episodes of acute malnutrition, infections, and micronutrient deficiencies. FIGURE 1.4: COVERAGE PROGRESS OF NEPAL’S NUTRITION SPECIFIC INTERVENTIONS IN MSNP (2013–17) PERIOD Po si ti ve T re n d N eg at iv e Tr en d Source: DHS MICS 2014, NDHS 2011, NDHS 2006 and MoHP Annual Reports 2009/2010, 2010/2011 and 2014/2015 PP Vit-A Supplementation Coverage MNP all 0 25% 50% 75% 100% 125% 350 300 250 200 150 100 50 0 50 Treatment of Diarrhea (Zinc+ORS) 45-days PP IFA Feeding during Illness Financial Resources for Nutrition MNP Districts MDD CMAM Districts 180+IFA (PW) IFA (WRA) Any IFA (PA) HH Iodized Salt Vit-A (6-59m) Flour Fortification Exclusive Breast Feeding ANC MMF MNP 1st Early Initiation of BF SAM Cure Rate Deworming (12-59 Vit-A (6-11m) Introduction to CF Deworming (PW) Any IFA (PLW) Attention and scale-up Reverse negative trend & strengthen Sustain M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 11 in 2016, only 17 percent of children aged 6–8 months and only 35 percent of children aged 6–23 months had minimum acceptable diets. In terms of the introduction of appropriate complementary foods after six months of age: • in 2016, only 17 percent of children aged 6–8 months and only 35 percent of chil dren aged 6–23 months had minimum acceptable diets (MoH, New ERA and ICF 2017) • in 2014, only 17 percent of children aged 6-23 months in the mid-western Ta rai had minimum acceptable diet (CBS 2015) • only 23.5 percent of young children from the middle wealth quintile had at least the minimum acceptable diet compared to 50.2 percent from the richest quintile (CBS 2015). 3) Disease — In Nepal, maternal and infant infections are common and intestinal para sites are a major public health problem. The 2014 Nepal Multiple Indicator Cluster Survey (NMICS) found that 20.1 percent of under 5-year-olds had suffered fever in the previous two weeks while 12 percent had suffered diar rhoea and 7 percent acute respiratory infec tions in the same period (CBS 2015). These diseases cause malnutrition and can cause the deaths of young children. A major cause of acute respiratory infection is exposure to in door air pollution — principally smoke from cooking with firewood and other solid fuels. And, although the prevalence of diarrhoea in young children has decreased over the last decade, only 47 percent of children sought advice and treatment from a health facility or provider (CBS 2015). 4) Immunisation — In 2016, only 87 per cent of children aged 12–23 months had re ceived all the vaccinations as per the national schedule by their first birthday (MoH, New ERA and ICF 2017). The percentage of non immunised children reduced to 1 percent in 2016 from 3 percent in 2011. 5) Adolescent nutrition — The NDHS 2016 found that many adolescents, and especially adolescent girls, were malnourished, with 30 percent of 15 to 19 year old girls being under weight, while 44 percent of them were anae FIGURE 1.5: COVERAGE PROGRESS OF NEPAL’S NUTRITION SENSITIVE INTERVENTIONS IN MSNP (2013–17) PERIOD Attention & scale-up SustainReverse negative trend & strengthen 20-24 Women married before 15 years 20-24 Women married before 18 years 25-29 Women married before 15 Well-functioning water supply scheme Child faeces disposed safely Access to Improved Sanitation Literacy rate (15-24 years) Cash grants Net Enrolment Primary Education Improved Drinking Water Source Secondary school set enrolment prevalence Coverage 25%0% 50% 75% 100% Hand washing soap + water 25-29 Women married before 18 years 150 100 50 0 50 Po si ti ve T re n d N eg at iv e Tr en d Recommendations: M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 12 Although the poverty level reduced from 49 percent in 1992 to 21.6 percent in 2016 (NPC 2016a), certain areas of the country are food insecure and suffer food deficits. The affordability, consumption and absorption of local food is a problem in the Tarai, Mid-West and Far Western regions. mic (MoH, New ERA and ICF 2017). This means they are poorly prepared for the rigours of motherhood, which often translates into them having low birth weight babies. 6) Harmful practices — Maternal and child care is still beset by too frequent pregnancies, inadequate awareness of health services, unse cured deliveries, inappropriate care of babies, and the lack of qualified health workers’ in ru ral areas. The other factors that compromise health and nutrition are as follows: 7) Food security — Although the poverty lev el reduced from 49 percent in 1992 to 21.6 percent in 2016 (NPC 2016a), certain areas of the country continue to be food insecure and suffer food deficits. The affordability, con sumption and absorption of local food is a problem in the Tarai, Mid-West and Far West ern regions. 8) Early marriage — Teenage marriage is com mon in Nepal with 48 percent of women aged 20-49 years having first married or been in a union before age 18 years (CBS 2015). This results in almost a quarter of mothers (16 per cent) having a live birth before the age of eigh teen (CBS 2015). And maternal care practices are often poor with only 57 percent of women having received a health check following de livery or a post-natal care visit within two days of delivery of their most recent live birth (CBS 2015). 9) Smoke — The 2016 NDHS found that 13 percent of women smoked while far more were exposed to domestic smoke pollution from the use of solid fuel for cooking inside homes (MoHP, New ERA and ICF 2012). 10) WASH — The lack of proper sanitation threatens the health of many people. About half the population still defecate in the open, 27.5 percent of households lack a specific place for hand washing (CBS 2015) and cow manure and dung is often carelessly managed, creating a polluting environment that spreads disease and parasites such as worms. 11) Traditional harmful practices — Tradi tional practices that are harmful to health per sist in certain areas and among certain caste groups. This includes adolescent girls and women not being allowed to consume milk, yoghurt or ghee during menstruation. Men strual seclusion (chhaupadi) is still practised in the Mid-West and Far West. And inadequate 12 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 13 Nepal has seen impressive improvements in recent years on human development, infrastructure, transport networks, communication, social services, the expansion of cooperatives and self-initiated local development. These provide the foundation for many kinds of improvements including for improved nutrition. menstrual hygiene is commonplace leading to infection and disease, sometimes triggering anaemia, resulting in undernutrition. 12) Natural disasters — Nepal’s vulnerability to natural disasters was demonstrated by the impact of the 2015 earthquakes that displaced many people from their homes, destroyed crops and disrupted healthy nutrition in thou sands of households. 13) Education and infrastructure — Large im provements in education and infrastructure have ameliorated major causes of malnutri tion. The literacy rate among young women (15-24 years) now stands at 88.6 percent meaning they are more educated and aware about health and nutrition issues. The large improvements in Nepal’s road network makes it easier to transport foodstuffs around the country. 1.8 Analysis of Other Issues that Affect Nutrition Nepal’s current situation provides many oppor tunities and significant challenges to improve nu trition as a key driver of socioeconomic growth. Nepal has seen impressive improvements in re cent years on human development, infrastruc ture, transport networks, communication, social services, the expansion of cooperatives and self initiated local development. These provide the foundation for many kinds of improvements including for improved nutrition. The major development challenges faced by Nepal include the lack of jobs, reliance on remittance incomes, deep-rooted discrimination, the underdevelop ment of agriculture and unplanned urban growth. 1.8.1 ECONOMIC In 2015, Nepal adopted the ambitious aims of graduating from least developed country status (LDC) to developing country status by 2022, and middle-income country status by 2030 (NPC 2015). To become a developing country Nepal needs to achieve a certain human asset index score. This score is calculated based on (i) per centage of population undernourished; (ii) mor tality rate of children under 5-years of age; (iii) gross secondary school enrolment ratio; and (iv) adult literacy rate. These are all affected by nu tritional status meaning that good nutrition is a precondition for Nepal to graduate to developing and middle income status. This ambition is a spur for improved nutrition. The third Nepal Living Standards Survey (NLSS 3) reported a shrinking income gap between the poor and the rich (CBS 2011). Although the annual income of the poorest 20 percent of the population had increased consider ably, poverty persists among a fifth of the popula tion. The rate of joblessness remains high, par ticularly among women and young people, with youth unemployment being the major cause of the high rate of migration of young people from rural to urban areas and to work abroad. In 2011, 55 percent of households were receiving remit tance incomes with an average of $773 per year (CBS 2011). And the trend has increased with remittances accounting for 29.2 percent of gross domestic product in 2014/15. NLSS 3 found that agricultural development was neglected with the percentage of irrigated land remaining stagnant at 54 percent compared to NLSS 2 in 2003/04 while the percentage of farmers holding less than 0.5 hectares of land had increased. 1.8.2 SOCIAL NLSS-3 found that people’s access to basic fa cilities had improved. It found that 95 percent of households could reach a primary school and 74 percent a health centre within 30 minutes’ travel. It also reported improved access to banking, mar ket centres, paved roads and safe drinking water. The 2016 NDHS found that the use of health services had increased: • The proportion of married women (15-49 years) using any modern method of contra ception increased from 48 percent in 2011 to 53 percent in 2016. • The proportion of pregnant women receiv ing at least one antenatal check-up by skilled health personnel increased from 58 percent in 2011 to 84 percent in 2016 with 69 percent of women having received the recommended four antenatal check-ups. • The percentage of women delivering their ba bies in a health facility increased from 36 per cent in 2011 to 58 percent in 2016 (MoHP, New ERA and ICF 2016). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 14 Job creation and other development efforts are hindered by persistent discriminatory socio-cul tural practices that cause the social and economic exclusion of women and people from marginal ized groups. The development-related results of gender discrimination and social exclusion vary between Nepal’s urban and rural areas and be tween its regions/provinces. For example, the Mid and Far-western regions ranked the lowest on the Gender Empowerment Measure and the Gen der-related Development Index (GDI) (UNDP 2015). It is likely that deep-rooted exclusionary practices will remain in the near future. 1.8.3 POLITICAL Nepal is instituting a federal system of gover nance under its 2015 constitution with a three tiered structure that devolves executive and legis lative powers to provincial and local governments (metropolitan cities, sub-metropolitan cities, ur ban municipalities and rural municipalities). This involves restructuring the civil service and laws to protect and empower women and other tradi tionally marginalized people. This system of de volved governance provides many opportunities for improving the health and nutritional status of Nepal’s people. 1.8.4 DEMOGRAPHY Nepal has a young population. It is estimated that 44 percent of its 28.4 million people are under 19-years-old. Given current trends, Ne pal should be able to benefit from its youth based demographic dividend until at least 2050 (UNCT Nepal 2017). The rapid demographic changes are due to declining birth and death rates and improved life expectancy. Nepal needs to prepare itself for these changes and invest in today’s children so they become more productive on entering the workforce. There is a finite win dow of opportunity until the proportion of the working-age population starts to decrease. Dur ing this time, the proportion of working-age peo ple is high compared to dependent young and old people, which provides favourable conditions for socioeconomic development. This highlights the urgency of investing in children to ensure they are more productive when they enter the work force. At the same time investments need making to reduce malnutrition and develop human capi tal focusing on children under-5 and adolescents. Eighteen percent of Nepal’s population live in urban and peri-urban areas with an estimated ur ban growth rate of 3 percent per year (in 2014) Nepal is instituting a federal system of governance under its 2015 constitution with a three tiered structure that devolves executive and legislative powers to provincial and local governments. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 15 2 Achham, Baitadi, Bajhang, Bajura, Bara, Bardiya, Dadeldhura, Dailekh, Dhanusha, Dolpa, Doti, Humla, Jajarkot, Jumla, Kalikot, Kapilvastu, Khotang, Mahottari, Mugu, Nawalparasi, Panchthar, Parsa, Rautahat, Rolpa, Rukum, Saptari, Sarlahi and Udayapur (Bakrania 2015). However, much of this popula tion growth is amongst the urban poor, who live in unsanitary, overcrowded and unhealthy condi tions that especially put mothers and children at risk (HEART 2013). 1.9 Achievements of Multi Sector Nutrition Plan (2013–17) MSNP (2013-2017) was implemented from 2014 in 28 districts.2 It was also partially im plemented in other districts with the support of non-government organisations. Its main aim was to reduce chronic malnutrition (stunting) by achieving the following three outcomes that broadly match the nutrition specific, nutrition sensitive and enabling environment outcomes of MSNP-II (see Section 2.1): 1. Improved maternal, infant and young child feeding. 2. Increased maternal, infant and young child micro-nutrient status. 3. Improved management of malnutrition in children. A) LONG-TERM IMPACT During the MSNP (2013–17) period chronic malnutrition (stunting) reduced by 12 percent from 40.5 percent in 2011 to 35.8 percent in 2016, which is a great achievement. This achieve ment was greatly facilitated by the Fourteenth Plan prioritising improved nutrition (NPC 2016b) with a tripling of the budget for nutrition programmes from NPR 5,220 million spent in FY 2013/14 to NPR 19,260 million allocated in 2017/18. However, much remains to be done as 27 per cent of under 5-year-olds remain moderately or severely underweight and 5.4 percent severely un derweight. Ten percent are moderately or severely wasted or too thin for their height and 2 percent are severely wasted (MoH, New ERA and ICF 2017). During the MSNP (2013–17) period chronic malnutrition (stunting) reduced by 12% from 40.5% in 2011 to 35.8% in 2016. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 16 TABLE 1.2: STATUS OF MSNP (2013–17) NUTRITION SPECIFIC INDICATORS Indicator Baseline Progress Status MSNP target 2012 2016 2017 Outcome 1: Improved maternal, infant and young child feeding 1.1. % of children born in last 24 months who were put to the breast within one hour of birth 44.5 55 56 1.2. % of infants 0–5 months of age who received only breast milk during the previous day 70 66 88 1.3. % of infants registered for growth monitoring who reached 6 months in the last month who were exclusively breastfed for the first 6 months NA 28.5 36 1.4. % of infants registered for growth monitoring who reached 6 months in the last month who were timely initiated complementary feeding at 6 months of age NA 27.5 34 1.5. % of infants 6–8 months of age surveyed who received solid, semi-solid or soft foods in the previous day 70 73.5 88 1.6. % of children 6-23 months of age who were receiving a minimum acceptable diet (apart from breast milk) 24 36 42 Outcome 2: Increased maternal, infant and young child micro-nutrient status 2.1. % of children under 5-69 months with anaemia 46 52.7 69 2.2. % of women aged 15-49 years with anaemia 35 40.8 53 2.3. % of women who delivered in previous 6 months who reported consuming all 180 iron folic acid tablets during pregnancy 49.8 42 75 2.4. % of women surveyed who delivered in previous 6 months who reported consuming anthelminthics during pregnancy 55.1 70 83 2.5. % of women who delivered in previous 6 months who reported consuming all 45 tablets of iron folic acid postpartum 55.6 45 83 2.6. No. of students in grades 1-10 in private and public schools who received deworming tablets in previous six months (1,000s) 1,919 1,636 2,581 2.7. % of households where adequately iodized (>15ppm) salt was present 80 95 >95 2.8. % of children aged 6-23 months surveyed who consumed multiple micronutrient powder (MNP) in previous 7 days NA 78.8 80 2.9. % of children under-5 who had diarrhoea in two weeks preceding the survey 14 8 7 2.10. % of children under-5 who had symptoms of acute respiratory infections in two weeks preceding the survey 5 6.7 3 2.11. % of children aged 6-59 months who received vitamin A supplements in previous six months 90.4 90.3 >95 2.12. % of children aged 12-59 months who received antihelminthics in previous six months 83.7 79 >95 2.13. % of women reporting receiving vitamin A supplementation within 6 weeks following a live birth in previous three years 40.3 49.1 60 Outcome 3: Improved management of malnutrition in children 3.1. % of cases of severe acute malnutrition discharged who recovered 89 84 >75 3.2. % of cases of severe acute malnutrition discharged who defaulted 4.8 9 <15 3.3. % of cases of severe acute malnutrition discharged who died 1.3 0 <10 3.4 % of children aged 0-23 months underweight among those registered for growth monitoring 3 3.3 12 3.5. No. of children under-5 with severe acute malnutrition registered 6,646 11,517 8,308 Source: MoH, New ERA and ICF 2017; DoHS 2016 Note: All Outcome 1 and Outcome 2.1 to 2.5 targets were based on the WHA targets (2012–2025). Since 2017 is about midway to 2025, it was assumed that the target for 2017 would be half the WHA target for most of the indicators. The outcome 3 targets were based on the minimum standard in humanitar ian response (SPHERE Standard). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 17 Most programmes implemented under MSNP (2013–17) addressed the causes of malnutrition and contributed to improving the nutritional status of all Nepal’s women and children. B) PROGRESS AGAINST NUTRITION SPECIFIC OUTCOME Although good progress was made against many of the MSNP (2013–17) targets, only the follow ing five had been achieved or almost achieved by 2016: immediate breastfeeding (target 1.1), the presence of adequately iodized salt (2.7), the con sumption of MNP (2.8), children who suffered diarrhoea (2.9) and deaths among discharged se vere acute malnutrition cases (3.3) (Table 1.2). There has been progress on mitigating micro nutrient deficiencies (vitamin A, iron and iodine) of essential dietary components (USAID nd), al though a below average proportion of households use iodized salts, vitamin A supplementation and iron supplementation in the hills and mountain regions of the Mid-west (CBS 2015). In 2014, 81.5 percent of households nationwide were us ing adequately iodized salt (15 parts per million), which is less than the targeted 90 percent (CBS 2015). Maternal care has improved with increased access to antenatal care with 6% of pregnant women having at least one session with a skilled health worker and 59.5% at least four sessions by any provider (MoH, New ERA and ICF 2017). In 2014, 58 percent of mothers had a post-natal health check-up (CBS 2015). Two major concerns are the management of di arrhoea and anaemia in children, with the rate of anaemia among 15-59 month olds increasing between 2011 and 2016 (MoH, New ERA and ICF 2017). The recently conducted Nepal Mi cronutrient Survey hopes to identify the cause of this. Also, see Figure 1.5 for progress of nutrition sensitive interventions. C) PROGRESS AGAINST NUTRITION SENSI TIVE OUTCOME Most programmes implemented under MSNP (2013–17) addressed the causes of malnutrition and contributed to improving the nutritional sta tus of all Nepal’s women and children. Among the achievements, the 2016 NDHS found that: • 72.5 percentage of households had specific places for hand washing where water and soap or another cleansing agent was present • 53 percent of married women of 15-49 years were using family planning methods. The agriculture sector has added nutrition indi cators into its management information system (NEKSAP), which further strengthen monitor ing and evaluation. And with support from UNI CEF, bottom-up planning has been started in both nutrition specific and nutrition sensitive ar eas. Also, See Figure 1.5 for progress of nutrition sensitive interventions. D) PROGRESS AGAINST ENABLING ENVIRON MENT OUTCOME MSNP (2013–17) activities strengthened the enabling environment for nutrition. An MSNP institutional mechanism is now in place with the lead role taken by the National Planning Com mission (NPC). A High-Level Nutrition and Food Security Steering Committee and a Na tional Nutrition and Food Security Coordination Committee were formed in 2011. District level nutrition and food security steering committees were formed in most districts over the course of MSNP. External development partners are sup porting the National Nutrition and Food Securi ty Secretariat (NNFSS), which helps NPC man age nutrition-related issues. The sectoral ministries responsible for health; ag riculture; livestock; water and sanitation; educa tion; women, children and social welfare; and lo cal governance implemented MSNP (2013–17). Three technical working groups were formed in 2011/12 to support i) advocacy and communi cation, ii) capacity development, and iii) moni toring, evaluation and information management. The six sectoral ministries have all included nutri tion and food security in their working policies. An M&E framework was used to measure the progress of MSNP. The programmes under MSNP (2013–17) were implemented in the 28 districts through the Ministry of Health, MoFALD and the other sec toral ministries in coordination with NPC. The government allocated budget to the district level for implementing the plan, which was reflected in district development committees’ annual pro grammes. These funds were spent by sectoral line agencies according to the decisions of district nu trition and food security steering committees. A range of development partners provided tech nical and financial support to the government to formulate and implement MSNP (2013–17). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 18 From 2013, the partners implemented MSNP activities through their projects and programmes. Some worked in the same districts and deciding in which areas they would work. The govern ment and its development partners implemented MSNP in a total of 60 districts. A summary of MSNP (2013–17) programmes and projects sup ported by donors is given in Annex 2. 1.10 Analysis of Estimated Costs and Expenditure of Multi-Sector Nutrition Plan (2013–17) The amount allocated for nutrition by the gov ernment and its development partners almost tripled over the course of MSNP (2013–17) from NPR 7,210 million ($69 million) in 2013 to NPR 19,241 million ($184.9 million) in 2017. The proportion provided by the government and its development partners varied from year to year with the government overall contributing 46 per cent and development partners 54 percent. GoN Development partners Total 2013 Budget (NPR million) 3,408 3,802 7,210 Proportion 47% 53% 100% 2014 Budget (NPR million) 3,889 27,094 30,983 Proportion 13% 87% 100% 2015 Budget (NPR million) 12,717 6,056 18,773 Proportion 68% 32% 100% 2016 Budget (NPR million) 6,627 5,653 12,281 Proportion 54% 46% 100 2017 Budget (NPR million) 13,773 5,469 19,241 Proportion 72% 28% 100 Total (2013–2017) Budget (NPR million) 40,414 48,074 88,488 Proportion 46% 54% 100% TABLE 1.3: BUDGET ALLOCATED TO NUTRITION BY GOVERNMENT OF NEPAL AND DEVELOPMENT PARTNERS IN MSNP (2013–17) PERIOD Source: NPC, Annual Development Programme, Part 1: Including on and off-budget figures two-thirds of MSNP (2013–17) expenditure came from development partner support. These local bud gets were planned by the district nutrition and food security steering committees and were spent through sectoral line agencies to reach the various target groups. 1.11 Key Problems and Challenges The following were the main issues that hindered the implementation of MSNP (2013–17): 1. Disparities — The large disparities in access to adequate nutrition and good quality health care between people living in urban and rural areas and between the wealthiest and poorest people make it difficult for poor rural dwellers to improve their nutritional status. 2. Quality of services — Poor quality health care sometimes impedes the delivery of health services to the populations who are most vul nerable to undernutrition. The amount allocated for nutrition by the government and its development partners almost tripled over the course of MSNP (2013–17) from NPR 7,210 million ($69 million) in 2013 to NPR 19,241 million ($184.9 million) in 2017. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 19 3. Traditional practices — Erroneous food and social practices in more conservative commu nities impede the correct intake of nutrients for mothers and children and their care. 4. Inadequate data — Inadequate data on the nutritional status of women and children af fected the adoption of evidence based plan ning. 5. Budgets — The insufficient and late release of budgets led to inadequate health services and made it difficult to run local nutrition and awareness programmes. This was a cause of the limited progress on increasing awareness and protection for mothers and their children, and ending child marriage and harmful food practices during menstruation and pregnancy. 6. Assessment of financial investments — It was difficult to assess the financial invest ments by the different sectors as their budget and programme codes differed. 7. Weak institutional structure — Inadequate personnel, institutional and individual capac ity gaps, and rapid staff turnover hindered the implementation of MSNP (2013–17). Existing institutional structures and human resources were not fully mobilised to improve nutrition and food security and there was, in some cases, inadequate coordination between higher and lower authorities. Also, sectoral ministries gave a low priority to nutrition. 1.12 Lessons Learned Implementing MSNP (2013–17) • More convergence and complementarity are needed while implementing MSNP interven tions. • Improved information management and the sharing of information is needed for the suc cess of the multi-sectoral nutrition approach. • The MSNP key sectors need to improve own ership, the assignment of roles and respon sibilities and the commitment of time and More convergence and complementarity are needed while implementing MSNP interventions. 19 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 20 resources to nutrition as competing priorities and workloads delayed MSNP (2013–17) in terventions. • There needs to be more technical assistance and capacity building support to all MSNP sectors at community and institutional levels. 1.13 The Rationale for MSNP-II This introductory chapter concludes with a sum mary of the main reasons for producing the fol low-on MSNP-II: • Impact of stunting — In Nepal, one out of three children still suffer from stunting. Stunt ed children under-5-years-old are less likely to survive their fifth birthdays, and those who survive are unlikely to achieve adequate physi cal growth and mental and cognitive develop ment. The stunting process occurs from con ception to two years of age and is irreversible. • Micronutrient deficiency — Many Nepalis, and especially the most vulnerable and wom en and children, are affected by micronutrient deficiencies. This increases the risk of mortali ty in infancy and childhood, impairs cognitive functions and hinders national socioeconomic development. • Build on MSNP (2013–17) — Most of the proposed MSNP-II activities will build on the achievements of MSNP (2013–17) • Graduation from LDC status — The gradu ation of Nepal from LDC status by 2022 is contingent on improving nutrition. All the criteria needed to graduate (income, human assets index and economy vulnerability index) demand nutrition programmes for children and women in one way or another. • Reaping the demographic dividend — The demographic window of opportunity for Ne pal began around 1992 and will start to close around 2047. During this time the number and proportion of working-age population will be high providing very favourable condi The graduation of Nepal from LDC status by 2022 is contingent on improving nutrition. 20 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 21 June 2016-May 2017 : Desk review of imple mentation of MSNP-I (2013-2017) 9 September 2016 : Malnutrition causality analysis workshop 31 August 2016 : Nutrition deprivation analysis workshop 21-22 February 2017 : MSNP-II theory of change workshop April-May 2017 : Draft MSNP-II shared for feedback and inputs August 2017 : Costing of MSNP-II 19 November 2017 : MSNP-II approved by Cabinet 30 March 2017 : MSNP-II results framework work shop May-September 2017 : MSNP-I review by NPC October 2017 : Endorsement of MSNP-II by NPC (Coordination Comittee, Steering Comit tee and NPC Board) FIGURE 1.6: TIMELINE OF PREPARATION OF MSNP-II tions for socioeconomic development. To reap this dividend the government must invest in early childhood development, health, nutri tion, education, water, sanitation and hygiene, child protection, adolescents’ development and social protection. • Global development imperatives — Malnu trition is a major issue to be addressed under the SDGs (2016-2030). These new develop ment goals provide a massive opportunity for the national and international community to upscale nutrition initiatives and secure good nutrition for all. And the Lancet causality framework for maternal and child undernutri tion (The Lancet 2013) and the Global Scal ing Up Nutrition (SUN) Movement remain key driving forces for improvements worl wide. Set against this strong rationale, in 2016/17 the National Planning Commission (NPC) formu lated the second MSNP (MSNP-II) with support from its development partners to outline a set of core values that reflect the country’s social and economic priorities. The plan is based on consul tations with a wide range of public and private stakeholders and on the analysis of nutrition de privations, causality, disparities, inequities, bot tlenecks, a desk review, recommendations from the Lancet 2013 series on maternal and child nu trition (The Lancet 2013) and other global and national priorities. Figure 1.6 shows the process undertaken to prepare MSNP-II beginning in June 2016 and concluding with the plan’s ap proval by the Cabinet in November 2017. Malnutrition is a major issue to be addressed under the SDGs (2016 2030). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 2222 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 23 MULTI-SECTOR NUTRITION PLAN-II (2018–2022) Chapter 2 23 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 2424 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 25 2.1 Vision To reduce malnutrition so that it no longer im pedes people’s potential and performance towards enhanced human capital and overall socioeco nomic development. 2.2 Goal Improved maternal, adolescent and child nutri tion by scaling up essential nutrition-specific and sensitive interventions and creating an enabling environment for nutrition. 2.3 Objectives The three objectives (that are directly related to MSNP-II’s three outcomes): • To increase the number of service delivery in stitutions to improve access to and the use of nutrition-specific services. • To increase access to and the use of nutrition sensitive services including improving health related behaviour. • To improve policies, plans and multi-sectoral coordination at federal, provincial and local government levels to create an enabling envi ronment to improve nutrition. 2.4 Strategies MSNP-II will take the following strategies: 1. Scale up multisector nutrition programmes across Nepal to ensure qualitative, equitable and gender-informed nutrition services for all. 2. Develop positive nutrition behaviour by run ning advocacy, communication and participa tion campaigns and through public engage ment programmes. 3. Foster cooperation, partnership, coordination and the sharing of lessons learned and best practices on improving nutrition. 4. Promote and use innovative technologies and initiatives for improving nutrition. 5. Internalise and implement nutrition interven tions in federal, provincial and local govern ment policies and plans. 6. Strengthen monitoring, evaluation, study and research for evidence-based planning, decision making and implementation. 2.5 Policy-level Principles and Approaches • Prevailing government policies and per spective plans — MSNP-II will be the basis for the implementation of the parts of the Fourteenth Plan (2016/17–2018/19) (NPC 2016b) on improving nutrition. MSNP-II has been designed and will be implemented in compliance with the Constitution of Nepal, 2015 (GoN 2015) and with related regula tions. • Inclusiveness and gender equity — Inter ventions under MSNP-II will promote social inclusion and gender equity especially in the hills and mountains of the Mid-West and Far West and in the central Tarai. MSNP-II will support the socially inclusive, gender sensitive and child-friendly continuum of care. • Affirmative action — Affirmative action poli cies will be introduced in favour of poor peo ple, women and disadvantaged communities to maximise their participation in, and ben efits from, MSNP-II’s interventions. The lead ership and management skills of women and disadvantaged communities (Dalit, Janajatis [ethnic groups] and others) will be improved. The plan will seek to ensure that their voices are heard in local decision-making processes, including by mainstreaming and institution alizing their participation in local institutions. • Flexible and process-oriented approach — MSNP-II will translate the government’s commitments on improving nutrition, state restructuring and the engagement of line agencies with communities to improve the de livery of public goods and services. The sup 2. Multi-Sector Nutrition Plan-ii (2018–2022) Chapter 2 Improved maternal, adolescent and child nutrition by scaling up essential nutrition-specific and sensitive interventions and creating an enabling environment for nutrition. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 26 port provided to line agencies and local gov ernments will be flexible and process-oriented and will include innovative and context-spe cific approaches for responsive, inclusive, and accountable governance through participatory development. Procedures for working with communities and targeting the poorest and most disadvantaged people will be rationalised and harmonised. • Transparency and accountability — MSNP-II will be transparent in its operations, budgets, decision making, communications, coordination among line agencies and non state agencies and in reaching remote areas. It will delineate the roles and responsibilities of all actors and take a systemic approach to increase accountability at all levels. • Information and communication — Behav iour change communication will be organised to raise civic awareness about chronic malnutri tion and actions needed to improve maternal and child nutrition, focussing on reaching the most marginalized, poorest segments and tak ing into account gender related factors. Civil society organisations, parliamentarians, other elected representatives, and decision makers will be mobilised with advocacy activities. 2.6 Theory of Change Theories of change explain how activities are understood to produce results that contribute to achieving intended impacts. Using this tool sharpens the focus on what needs to be addressed and the changes needed at government, commu nity, family, and individual levels to reduce mal nutrition. MSNP-II’s theory of change (Figure 2.1) helps the different sectors to see their roles in imple menting MSNP-II. It shows the desired impact of MSNP-II to address the main nutrition-relat ed problems, which range from stunting of under 5-year olds to childhood wasting. Below are the three outcomes of MSNP-II and the intervention areas (outputs) that the five sectors, plus NPC and local governance, need to carry out under to achieve the desired impact. MSNP-II’s theory of change helps the different sectors to see their roles in implementing MSNP-II. 26 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 27 FI G U R E 2 .1 : M S N P II ’S T H E O R Y O F C H A N G E D es ir ed i m pa ct : O u tc om es : In te rv en ti on s G ov er n an ce A p p ro ac h Im p ro ve m at er n al , a do le sc en t an d ch il d n u tr it io n , s o th at m al n u tr it io n n o lo n ge r im p ed es h u m an c ap it al a n d th e so ci oe co n om ic d ev el op m en t of N ep al 1. (N ut ri tio n sp ec ifi c) I m pr ov ed a cc es s to a nd e qu ita bl e us e of n ut ri tio n sp ec ifi c se rv ic es 2. (N ut ri tio n se ns iti ve ) I m pr ov ed a cc es s to a nd th e eq ui ta bl e us e of n ut ri tio n se ns iti ve s er vi ce s an d im pr ov ed h ea lth y ha bi ts a nd p ra ct ic es 3. ( E na bl in g en vi ro nm en t) I m pr ov ed p ol ic ie s, p la ns a nd m ul ti se ct or al c oo rd in at io n at f ed er al , pr ov in ci al a nd lo ca l g ov er nm en t le ve ls to en ha nc e th e nu tr iti on s ta tu s of a ll po pu la tio n gr ou ps Im pa ct I nd ic at or s (W H A G lo ba l N ut ri tio n Ta rg et s, 2 02 5) : St un tin g A na em ia Lo w b ir th w ei gh t C hi ld ho od o ve rw ei gh t B re as tf ee di ng W as tin g 1. I nc or po ra te n ut ri tio n in s ec to ra l p ol ic ie s an d pl an s w ith a fo cu s on g en de r eq ua lit y an d so ci al in cl us io n 2. I nc re as e th e bu dg et fo r in te gr at ed n ut ri tio n pl an ni ng to a dd re ss g en de r, re gi on al a nd s oc ia l i m ba la nc es 3. I nc re as e ca pa ci ty o n m ul ti se ct or c oo rd in at io n an d hu m an re so ur ce s fo r nu tr iti on 4. S tr en gt he n in fo rm at io n m an ag em en t. 5. P ro m ot e ac co un ta bi lit y by s tr en gt he ni ng th e M & E s ys te m Fe de ra l A ff ai rs a n d L oc al D ev el op m en t 1. E ns ur e th e in cl us io n of M SN P II in fe de ra l, pr ov in ci al a nd lo ca l g ov er nm en t p la ns 2. S tr en gt he n M SN P go ve rn an ce m ec ha ni sm s at fe de ra l, pr ov in ci al a nd lo ca l l ev el s 3. D ev el op p ol ic y fr am ew or k fo r ex pl ic it bu dg et in ve st m en t a rt ic ul at io n on n ut ri tio n at fe de ra l, pr ov in ci al a nd lo ca l l ev el s 4. A pp oi nt a nd p ro vi de le ad er sh ip tr ai ni ng to lo ca l n ut ri tio n ch am pi on s to c oo rd in at e lo ca l i m pl em en ta tio n 1. R ed uc e M IY C & im pr ov e ad ol es ce nt m ic ro nu tr ie nt s ta tu s to r ed uc e an ae m ia & o th er d efi ci en ci es 2. Im pr ov e IY C f ee di ng p ra ct ic es a nd th e di et ar y di ve rs ity o f W R A 3. E nh an ce p re pa re dn es s fo r nu tr iti on in e m er ge nc ie s 4. In cr ea se c ov er ag e of d is ea se p re ve n tio n an d m an ag em en t 5. A pp ro pr ia te ly t re at a nd m an ag e se ve re ly m al no ur is he d an d si ck c hi l dr en 6. Im pr ov e co ve ra ge an d qu al ity of he al th a nd n ut ri tio n se rv ic es , i nc lu d in g fa m ily p la nn in g an d re pr od uc tiv e he al th s er vi ce s. 1. Im pr ov e ea rl y ch ild ho od de ve lo pm en t fo r al l c hi ld re n 36 59 m on th s. 2. E ns ur e th at a ll gi rl s co m pl et e se co nd ar y ed uc at io n. 3. Im pr ov e lif e sk ill s an d nu tr iti on al st at us f or a ll ad ol es ce nt g ir l s tu de nt s. 1. E ns ur e th e ec on om ic a nd s oc ia l em po w er m en t o f w om en 2. St re ng th en c hi ld p ro te ct io n an d de ve lo pm en t 3. St re ng th en s oc ia l p ro te ct io n se r vi ce s 4. E lim in at e ch ild m ar ri ag e an d ot he r ha rm fu l tr ad iti on al p ra c tic es 5. Im pr ov e th e av ai la bi lit y of a nd ac ce ss to m at er na l m en ta l h ea lth se rv ic es 1. In cr ea se ac ce ss to sa fe dr in ki ng w at er 2. In cr ea se a cc es s to i m pr ov ed sa ni ta tio n 3. Im pr ov e hy gi en e be ha vi ou r pr ac tic es a nd t he ir m an ag em en t 1. Im pr ov e th e av ai la bi lit y of , ph ys ic al a nd ec on om ic a cc es s to ,a nd th e co ns um pt io n of , d iv er si fie d fo od g ro up s, es pe ci al ly in di ge no us lo ca l fo od (c er ea ls, le gu m es a nd oi lse ed s) a nd fr ui ts a nd ve ge ta bl es . 1. Im pr ov e th e av ai la bi lit y of , p hy si ca l an d ec on om ic ac ce ss to , an d th e co ns um pt io n of d iv er si fie d fo od g ro up s, es pe ci al ly fl es h m ea t, da ir y pr od uc ts a nd eg gs H ea lt h W o m en , C h il d re n a n d S o ci al W el fa re W at er S u p p ly , S an it a ti o n a n d H yg ie n e A gr ic u lt u ra l D ev el o p m en t L iv es to ck D ev el o p m en t E d u ca ti o n M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 2828 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 29 G O A L : IM P R O V E D M A T E R N A L , A D O L E SC E N T A N D C H IL D N U T R IT IO N B Y S C A L IN G U P E SS E N T IA L N U T R IT IO N S P E C IF IC A N D S E N SI T IV E I N T E R V E N T IO N S A N D C R E A T IN G A N E N A B L IN G E N V IR O N M E N T F O R N U T R IT IO N O u tc om e 1: I m pr ov ed a cc es s to a nd e qu ita bl e us e of n ut ri tio n sp ec ifi c O u tp u t 1. 1 E nh an ce d nu tr iti on s ta tu s of W R A in cl ud in g ad ol es ce nt s O u tp u t 1. 2: Im pr ov ed in fa nt a nd yo un g ch ild n ut ri tio n an d ca re p ra ct ic es O u tp u t 1. 4: Im pr ov ed m an ag em en t of s ev er e an d m od er at e ac ut e m al nu tr iti on O u tp u t 1. 5: E nh an ce d pr ep ar ed ne ss fo r nu tr iti on in em er ge nc y. r es po ns es O u tp u t 1. 6: C ap ac ity b ui lt of nu tr iti on s pe ci fic se ct or s O u tp u t 1. 3: Im pr ov ed M IY C m ic ro nu tr ie nt st at us 1. 1. 1 O rg an iz e an d im pl em en t f ul ly no ur is he d vi lla ge s/ w ar ds in cl ud in g G 10 00 D c om m u ni ca tio n ca m pa ig n 1. 1. 2 R ev ita liz e Sc ho ol H ea lth a nd N ut ri tio n Pr og ra m m e in cl ud in g pr om ot io n of h ea lth y di et ar y ha bi ts a nd p hy si ca l ac tiv iti es 1. 1. 3 R ai se a w ar en es s an d se rv ic es fo r he al th y tim in g an d sp ac in g of p re gn an cy 1. 1. 4 C on du ct b ar ri er a na ly si s fo r in cr ea se d A N C se rv ic e ut ili za tio n 1. 1. 5 In te gr at e an d ex pa nd a do le sc en t fr ie nd ly h ea lth a nd nu tr iti on s er vi ce s 1. 2. 1 C on du ct M IY C N c ou n se lli ng a t a ll he al th s ec to r pl at fo rm s vi z. h ea lth m ot he r’s g ro up m ee tin gs , im m un iz at io n, A N C , PN C , G M P, P H C O R C , IM N C I & O PD s er vi ce s 1. 2. 2 C on du ct re gu la r gr ow th m on ito ri ng c ou ns el lin g at PH C O R C s an d he al th fa ci lit ie s 1. 2. 3 D is se m in at e IE C & B C C m at er ia ls th ro ug h he al th fa ci lit ie s, & F C H V s to co m m un iti es & h ou se ho ld s re gu la rl y 1. 2. 4 C on du ct fo od p re pa ra tio n & c oo ki ng d em on st ra tio ns to p re pa re lo ca l nu tr iti ou s fo od s (e .g . nu tr iti ou s flo ur /p or ri dg e (li to ), ja ul o/ kh ic ha di u s in g lo ca l f oo ds tu ffs 1. 2. 5 E ng ag e m ed ia fo r do cu m en ta tio n an d di s se m in at io n of M IY C N pr og ra m m e 1. 2. 6 R ai se a w ar en es s on n ut ri tio n in cl ud in g es se nt ia l ne w bo rn c ar e 1. 3. 1 M ai nt ai n an d su st ai n ro ut in e di st ri bu tio n of V ita m in A c ap su le a nd d ew or m in g ta bl et s to ch ild re n un de r 5 ye ar s 1. 3. 2 In cr ea se c ov er ag e an d co m pl ia nc e of ir on fo lic ac id a nd d ew or m in g am on g pr eg na nc y an d po st p ar tu m w om en 1. 3. 3 Sc al e up h om e fo od fo rt ifi ca tio n w ith M N P in ta rg et ed a re a 1. 3. 4 R ai se a w ar en es s to p ro m ot e ho us eh ol d us e of tw o ch ild lo go io di ze d sa lt 1. 3. 5 R ai se a w ar en es s to p ro m ot e co ns um pt io n of ro lle r m ill p ro du ce d fo rt ifi ed fl ou r an d ri ce 1. 3. 6 In iti at e ri ce fo rt ifi ca tio n in g ov er nm en t (N FC ) a nd s el ec te d la rg e ri ce m ill s. 1. 3. 7 C on du ct r es ea rc h to im pr ov e co m pl ia nc e of IF A s up pl em en ta tio n 1. 3. 8 C on du ct b ar ri er a na ly si s on lo w c ov er ag e/ co m pl ia nc e of M N P 1. 3. 9 Pr oc ur e an d su pp ly n ut ri tio n co m m od iti es fo r re gu la r an d em er ge nc y pr og ra m m es ( V ita m in A , I FA , d ew or m in g ta bl et s, M N P, R U T F, th er ap eu tic m ilk , R eS oM al ) 1. 3. 10 S ca le u p fo rt ifi ed s up er c er ea l fl ou r di st ri bu tio n in d is tr ic ts w ith h ig h pr ev al en ce o f ac ut e m al nu tr iti on to p re gn an t a nd la ct at in g w om en a nd 6 2 3 m on th s ch ild re n un de r M C H N p ro gr am m e 1. 4. 1 E xp an d an d es ta bl is h O T C an d IT C c en tr es fo r m an ag em en t of s ev er e ac ut e m al nu tr iti on in ch ild re n un de r 5 1. 4. 2 Sc al e up N R H in 5 0+ b ed ho sp ita ls 1. 4. 3 C on du ct p er i od ic n ut ri tio n as se ss m en ts a nd co un se lli ng a t co m m un ity le ve ls 1. 4. 4 C on du ct b ar ri er a na ly si s on se rv ic es re la te d to SA M m an ag e m en t 1. 4. 5 Sc al e up a nd st re ng th en I M N C I pr og ra m m e 1. 4. 6 E st ab lis h an d st re ng th en n ut ri tio n in fo rm at io n an d su rv ei lla nc e sy st em in n or m al an d hu m an ita r ia n si tu at io ns 1. 5. 1 E st ab lis h lo ca l l ev el nu tr iti on cl us te rs a nd co nd uc t qu ar te rl y co or di na tio n m ee tin g 1. 5. 2 U pd at e an d de ve lo p nu tr iti on in em er ge nc y pr ep ar ed ne ss fo r re sp on se a nd co nt in ge nc y pl an ni ng a t lo ca l l ev el s. 1. 6. 1 R ef re sh er tr ai ni ng fo r H W s & FC H V s at a ll le ve l o n M I YC N p ac ka ge 1. 6. 2 O rg an iz e ba si c tr ai ni ng on M IY C N pa ck ag e to ne w ly re cr ui t ed n ut ri tio n su pe rv is or s an d nu tr iti on offi ce rs 1. 6. 3 O rg an iz e nu tr iti on ch am pi on le ad er sh ip de ve lo pm en t ev en ts 1. 6. 4 C on du ct ro ut in e da ta q ua lit y as se ss m en ts (R D Q A ) u s in g nu tr iti on pr og ra m m e re la te d H M IS to ol s FI G U R E 2 .2 : M S N P II R E S U LT S S T R U C T U R E — O U TC O M E 1 O N N U T R IT IO N S P E C IF IC S E R V IC E S M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 30 O u tc om e 2: Im pr ov ed a cc es s to a nd th e eq ui ta bl e us e of n ut ri tio n se ns iti ve s er vi ce s an d im pr ov ed h ea lth y ha bi ts a nd p ra ct ic es O u tp u t 2. 1: In cr ea se d av ai la bi lit y an d co ns um p tio n of s af e an d nu tr iti ou s fo od s O u tp u t 2. 2: In cr ea se d ph ys ic al a nd ec on om ic a c ce ss to d iv er se ty pe s of fo od O u tp u t 2. 3: In cr ea se d ac ce ss to s af e dr in ki ng w at er O u tp u t 2. 4: In cr ea se d ac ce ss to s af e an d su st ai n ab le s an ita tio n se rv ic es O u tp u t 2. 5: Im pr ov ed k no w le dg e of c hi ld re n an d m ot he rs an d ca re ta ke rs o f u nd er 5 ch ild re n on h ea lth an d hy gi en e O u tp u t 2. 6: T ar ge te d gr ou ps h av e ac ce ss to re so ur ce s an d op po rt un iti es th at m ak e th em se lf re lia nt O u tp u t 2. 7: N ut ri tio n co m po ne nt in co rp or at ed in w om en , ad ol es ce nt g ir ls an d ch ild d ev el op m en t tr ai ni ng p ac ka ge s 2. 1. 1 M ak e av ai la bl e ag ri cu ltu re a nd li ve st oc k in pu ts (i .e . s ee ds , f er til iz er s, b re ed s) a t ho us eh ol d an d co m m un ity le ve ls 2. 1. 2 Pr ov id e te ch ni ca l s up po rt (t ra in in g, de m on st ra tio n) to p ro m ot e pr od uc tio n of fr ui ts , v eg et ab le s, n ut ri tio us r oo ts , c er ea ls an d pu lse s to in cr ea se c on su m pt io n of di ve rs ifi ed fo od s in h ou se ho ld s 2. 1. 3 In cr ea se p ro du ct io n an d pr om ot e co n su m pt io n of fr es h fr ui ts a nd g re en le af y ve ge ta bl es 2. 1. 4 B ui ld c ap ac ity o f l iv es to ck fa rm er s an d en tr ep re ne ur s to in cr ea se m ilk , m ea t a nd eg g pr od uc tio n 2. 1. 5 Te ch ni ca l s up po rt fo r m ic ro a nd a lte rn at iv e sm al l i rr ig at io n to p ro du ce d iv er si fie d an d m ic ro nu tr ie nt r ic h fo od s 2. 1. 6 Su pp or t f oo d pr od uc in g in du st ri es to a do pt go od m an uf ac tu ri ng p ra ct ic es (G M P) a nd re la te d sy st em s 2. 1. 7 Tr ai n ag ri cu ltu re a nd li ve st oc k ex te ns io n offi ce rs a nd s ta ff on fo od s af et y, fo od p ro ce ss in g an d nu tr iti on 2. 1. 8 Tr ai n fa rm er s on fo od s af et y, fo od p ro ce ss in g an d nu tr iti on 2. 1. 9 St ud y an d im pr ov e lo ca l f oo d re ci pe s 2. 1. 10 U pd at e an d di ss em in at e fo od c om po si tio n ta bl es 2. 1. 11 D is se m in at e fo od b as ed d ie ta ry g ui de lin es to lo ca l g ov er nm en ts 2. 1. 12 D ev el op a nd m ul tip ly B C C m at er ia ls in cl ud in g au di o vi su al s on fo od s af et y, fo od pr oc es si ng a nd n ut ri tio n 2. 2. 1 E nh an ce ac ce ss a nd ut ili za tio n of an im al s ou rc e fo od s 2. 2. 2 Pr om ot e an d su pp or t pr od uc tio n an d co ns um pt io n of fi sh in cl ud in g su pp or t to e st ab lis h co m m un ity po nd s fo r pr od uc tio n an d lo ca l co ns um pt io n 2. 5. 1 C on st ru ct , es ta bl is h an d pr om ot e us er fr ie nd ly ha nd w as hi ng fa ci lit ie s in ho us eh ol ds an d in st itu tio ns 2. 5. 2 R ai se a w ar e ne ss o n ha nd w as hi ng a t cr iti ca l t im es in co m m un iti es , sc ho ol c hi ld re n an d he al th w or ke rs . 2. 5. 3 R ai se a w ar e ne ss o n m en st ru al h yg ie ne m an ag em en t in c om m u ni tie s an d sc ho ol s. 2. 5. 4 R ai se a w ar e ne ss a bo ut fo od h yg ie ne in c om m un i tie s 2. 3. 1 C on st ru ct an d re pa ir w at er s up pl y sc he m es in co m m un i tie s an d in st itu tio ns th ro ug h w at er s af et y pl an s an d pr oj ec ts 2. 3. 1 Pr om ot e al te rn a tiv e an d in no va tiv e te ch no lo gi es fo r su pp ly w at er 2. 3. 3 Pr om ot e ho us eh ol d w at er tr ea tm en t op tio ns 2. 6. 1 Su pp or t c om m un ity se ed b an ks . 2. 6. 2 Su pp or t w om en a nd di sa dv an ta ge d gr ou ps to p ro du ce a nd c on su m e an im al li ve st oc k pr od uc ts . 2. 6. 3 Pr ov id e st ar t up e nt re pr en eu rs hi p gr an ts to w om en c oo pe ra tiv es fo r so ci al a nd e co no m ic e m po w er m en t 2. 6. 4 Pr ov id e st ar t up en tr ep re ne ur sh ip gr an ts to w om en gr ou p m em be rs fo r so ci al a nd e co no m ic em po w er m en t. 2. 6. 5 Tr ai ni ng a nd o ri en ta tio ns fo r in co m e ge n er at io n an d bu si ne ss pr om ot io n (v eg et ab le & fr ui t p ro du ct io n, an im al h us ba nd ry , liv es to ck , t ai lo ri ng ) 2. 6. 6 Li nk th e di st ri bu tio n of c hi ld p ro te ct io n gr an ts to n ut ri tio n in al l d is tr ic ts . 2. 6. 7 In cl ud e nu tr iti on as a m aj or o bj ec tiv e of s oc ia l p ro te ct io n pr og ra m m es 2. 4. 1 Se ns iti ze c om m un iti es to ra is e aw ar en es s fo r co ns tr uc tio n, m ai n te na nc e an d hy gi en ic u se of im pr ov ed ho us eh ol d to i le ts in cl ud in g sa fe d is po sa l o f ch ild fa ec es 2. 4. 2 Su pp or t a nd st re ng th en W A SH co or di na tio n co m m itt ee s an d lo ca l g ov er nm en t t o ac ce le ra te O D F ca m pa ig ns . 2. 4. 3 Su pp or t co ns tr uc tio n an d m an ag e m en t o f c hi ld , ge nd er a nd d if fe re nt ly a bl ed fr ie nd ly to ile ts in cl ud in g m en st ru al h yg ie ne m an ag em en t fa ci lit ie s at in st itu tio ns 2. 7. 1 In te gr at e nu tr iti on m od ul es in tr ai ni ng pa ck ag es in cl ud in g G B V p re ve nt io n an d re sp on se tr ai ni ng , le ad er sh ip , co m m un ity pr ot ec tio n, bu si ne ss de ve lo p m en t a nd lif e sk ill s tr ai ni ng . FI G U R E 2 .3 : M S N P II R E S U LT S S T R U C T U R E — O U TC O M E 2 O N N U T R IT IO N S E N S IT IV E S E R V IC E S G O A L : I M P R O V E D M A T E R N A L , A D O L E SC E N T A N D C H IL D N U T R IT IO N B Y S C A L IN G U P E SS E N T IA L N U T R IT IO N S P E C IF IC A N D S E N SI T IV E I N T E R V E N T IO N S A N D C R E A T IN G A N E N A B L IN G E N V IR O N M E N T F O R N U T R IT IO N 30 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 31 O u tp u t 2: 8: W om en , ch ild re n an d ou t of s ch oo l a do le sc en t gi rl s re ac he d w ith he al th a nd n ut ri tio n ca re p ra ct ic es O u tp u t 2. 10 : C om m un iti es e m po w er ed to p re ve nt h ar m fu l pr ac tic es (m en st ru al se cl us io n [c hh au pa di ], fo od ta bo os ) O u tp u t 2. 12 : In cr ea se d ad ol es ce nt gi rl s’ aw ar en es s an d im pr ov ed b eh av io ur on n ut ri tio n O u tp u t 2. 9: C hi ld c ar e ho m es c om pl y w ith m in im um st an da rd s of nu tr iti on c ar e O u tp u t 2. 11 : E nh an ce d en ro lm en t o f ch ild re n in ba si c ed uc at io n O u tp u t 2. 13 : E nh an ce d ac ce ss to h ea lth a nd re pr od uc tiv e he al th s er vi ce s 2. 8. 1 O rg an iz e tr ai ni ng s fo r m em be rs o f w om en co op er at iv es a nd c hi ld cl ub s on n ut ri tio n se ns iti ve s er vi ce s. 2. 8. 2 L ife s ki ll de ve lo pm en t pr og ra m m es fo r ou t of s ch oo l a do le sc en t gi rl s 2. 9. 1 M on ito r ch ild ca re h om es co m pl ia nc e w ith m in im um st an da rd s of pr ov is io n of n u tr iti on s en si tiv e se rv ic es . 2. 9. 2 P ro m ot e nu tr i tio n se ns iti ve se rv ic es a t c hi ld ca re h om es . 2. 9. 3 I nt eg ra te n ut ri tio n co m po ne nt in c hi ld pr ot ec tio n ca se m an ag em en t tr ai ni ng a nd se rv ic es . 2. 9. 4 D ep ri ve d (B ip an na ) i nf an t nu tr iti on p ro gr am m e (N PR 50 ,0 00 g ra nt fo r w om en c oo pe ra tiv e) 2. 10 .1 R un b eh av io ur al c ha ng e co m m un ic at io n ac tiv iti es to pr ev en t h ar m fu l t ra di tio na l pr ac tic es . 2. 10 .2 R un c am pa ig ns to p re ve nt m ar ri ag e un til a ge 20 (3 50 a do le s ce nt s, 3 90 s ta ke ho ld er s, 8 40 dh am i jh ak ri in 39 in te ra ct io n pr og ra m m es . 2. 10 .3 C ar ry o ut p ro gr am m es to sh ift so ci al n or m s an d ha rm fu l pr ac tic es o n fo od ta bo os th at p re ve nt m en st ru al h y gi en e, a de qu at e nu tr iti on fo r ad ol es ce nt s, e tc . 2. 11 .1 R un w el co m e to sc ho ol c am pa ig ns fo r ba si c ed uc at io n. 2. 11 .2 P ro vi de a de qu at e re so ur ce s to a ll sc ho ol s to h av e E C E D /P PE . 2. 11 .3 P ro vi de d iv er si fie d an d nu tr iti ou s m id da y m ea ls to c hi ld re n in b as ic e du ca tio n. 2. 11 .4 E C E D fa ci lit at or s, co m m un ity le ar ni ng ce nt re s (C LC ) f ac ili ta to rs , f oc al te ac he r an d he al th te ac he rs an d fo od m an ag e m en t c om m itt ee s in co or di na tio n w ith FC H V s en ga ge pa re nt s to im pr ov e th ei r kn ow le dg e on he al th , h yg ie ne a nd nu tr iti on . 2. 11 .5 N ut ri tio n m on ito ri ng of b as ic e du ca tio n st ud en ts . 2. 11 .6 B ui ld n ut ri tio n ca pa ci ty o f E C D fa ci lit at or s, C LC fa ci lit at or s, h ea lth te ac he rs a nd fo od m an ag em en t c om m itt ee in s ch oo ls 2. 12 .1 R un c am pa ig ns fo r gi rl s’ ed uc at io n to in cr ea se en ro lm en t i n sc ho ol s in ta rg et ed a re a. (G en de r Pa ri ty I nd ex in N E R 1: 00 (1 8 ). 2. 12 .2 C re at e pr io ri ty m in im um en ab lin g co nd iti on s (c la ss ro om s, te ac he rs , te xt b oo ks , W A SH , b oo k co rn er s) in s ch oo ls. 2. 12 .3 B ui ld s ep ar at e fu nc tio na l to ile ts w ith g ro up h an d w as h fa ci lit ie s, e sp ec ia lly fo r gi rl s in s ch oo ls. 2. 12 .4 P ro vi de s af e dr in ki ng w at er in s ch oo ls. 2. 12 .5 P ro m ot e he al th y be ha v io ur th ro ug h sk ill s ba se d he al th e du ca tio n in sc ho ol s. 2. 12 . 6 R ev is e he al th a nd n ut ri tio n cu rr ic ul um . 2. 12 .7 E st ab lis h fo od m an ag e m en t c om m itt ee s in a ll sc ho ol s pr ov id in g m id da y m ea ls. 2. 12 .8 D ev el op a s et o f e du ca tio na l t ra in in g pa ck ag es on d is as te r ri sk re du ct io n (D R R ) f or s tu de nt s, te ac he rs a nd s ch oo l m an ag em en t c om m itt ee s. 2. 13 .1 P ro vi de re pr od uc tiv e he al th in fo r m at io n se rv ic es in s ch oo ls an d he al th fa ci lit ie s fo r bo ys a nd gi rl s. 2. 13 .2 P ro vi de k no w l ed ge o n im po r ta nc e of d el ay ed fir st p re gn an cy af te r m ar ri ag e. 2. 13 .3 P ro vi de in fo rm a tio n to s ch oo l st ud en ts o n be ne fit s of u se o f fa m ily p la nn in g m et ho ds . 2. 13 .4 B eh av io ur c ha ng e co m m un ic at io n fo r in cr ea si ng up ta ke o f r ou tin e m ea sle s an d ru be lla im m un i za tio n. 31 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 32 3. 1. 1 In co rp or at e M SN P II in fe de ra l p la ns an d po lic es 3. 1. 2 In co rp or at e M SN P II in p ro vi nc ia l l ev el pl an s a nd p ol ic ie s 3. 1. 3 In co rp or at e M SN P II in lo ca l go ve rn m en t p la ns an d pl an ni ng pr oc es se s 3. 1. 4 O rg an iz e jo in t an nu al re vi ew m ee tin gs a m on g M SN P II se ct or m in ist rie s a t f ed er al le ve l 3. 1. 5 A dv oc ac y m ee tin gs fo r i nc re as in g nu tr iti on b ud ge t (a t l ea st 3 .5 % o f to ta l) at fe de ra l a nd pr ov in ce le ve ls 3. 1. 6 D ev el op n ut rit io n bu dg et c od e 3. 5. 1 D ev el op n at io na l ca pa ci ty b ui ld in g m as te r pl an fo r M SN P II . 3. 5. 2 Im pl em en t c ap ac ity de ve lo pm en t m as te r pl an a t a ll le ve ls. O u tc om e 3: I m pr ov ed p ol ic ie s, p la ns a nd m ul ti se ct or al c oo rd in at io n at fe de ra l, pr ov in ci al a nd lo ca l go ve rn m en t l ev el s to e nh an ce th e nu tr iti on s ta tu s of a ll po pu la tio n gr ou ps . O u tp u t 3. 1 M SN P II in cl ud ed in lo ca l, pr ov in ci al an d fe de ra l g ov er nm en t po lic ie s an d pl an s 3. 2. 1 O rg an is e H ig h Le ve l N ut ri tio n an d Fo od S ec u ri ty S te er in g C om m itt ee (H LN FS S) m ee tin gs tw ic e a ye ar . 3. 2. 2 O rg an is e N at io na l N ut ri tio n an d Fo od S ec ur ity C oo rd in at io n C om m itt ee m ee tin gs q ua rt er ly . 3. 2. 3 Se nd c ir cu la r an d fa ci lit at e fo rm at io n of n ut ri tio n an d fo od s ec ur ity s te er in g co m m itt ee in p ro vi nc es . 3. 2. 4 Fo rm n ut ri tio n an d fo od se cu ri ty s te er in g co m m it te es a t p ro vi nc e le ve l 3. 3. 1 St re ng th en N at io na l N ut ri tio n an d Fo od Se cu ri ty S ec re ta ri at a t N PC . 3. 3. 2 C ar ry o ut o rg an iz at io n & m an ag em en t su rv ey o n in cl ud in g N N FS S in N PC . 3. 3. 3 Fa ci lit at e en do rs em en t o f t he O & M su rv ey re po rt . 3. 3. 4 R ec ru it st aff fo r N FS S as p er a pp ro ve d or ga no gr am . 3. 2. 5 O rg an is e nu tr iti on a nd fo od s ec ur ity st ee ri ng c om m itt ee m ee tin gs tw ic e a ye ar a t p ro vi nc e le ve l. 3. 2. 6 Fo rm n ut ri tio n an d fo od s ec ur ity c oo rd i na tio n co m m itt ee s at p ro vi nc e le ve l. 3. 2. 7 O rg an is e nu tr iti on a nd fo od s ec ur ity co or di na tio n co m m itt ee m ee tin gs q ua r te rl y at p ro vi nc e le ve l. 3. 2. 8 A pp oi nt n ut ri tio n fo ca l p er so ns fo r al l se ct or al m in is tr ie s at p ro vi nc e le ve l. 3. 2. 9 O rg an is e th em at ic te ch ni ca l w or ki ng gr ou p m ee tin gs a t f ed er al le ve l q ua rt er ly . 3. 2. 10 F or m n ut ri tio n an d fo od s te er in g co m m itt ee s at lo ca l g ov er nm en ts le ve l a nd m ee t r eg ul ar ly . 3. 2. 11 F or m n ut ri tio n an d fo od s te er in g co m m itt ee a nd re gu la r m ee tin gs a t w ar d le ve l i n M SN P lo ca l g ov er nm en ts . 3. 2. 12 F ac ili ta te to a ss ig n co or di na to rs (e xi st in g st aff o r ou ts ou rc ed ) a t l oc al go ve rn m en ts to o ve rs ee M SN P II in te rv en tio ns . 3. 4. 1 U pd at e M SN P in fo rm a tio n po rt al a nd m ak e it fu nc tio na l. 3. 4. 2 Li nk a nd u pd at e nu tr iti on in fo rm at io n at c en tr al le v el (H M IS , E M IS , W A SH , ag ri cu ltu re , l iv es to ck a nd lo ca l g ov er na nc e) . 3. 4. 3 Pr ov id e tr ai ni ng o n w eb ba se d M SN P re po rt in g sy st em a t f ed er al a nd pr ov in ce le ve l. 3. 4. 4 D oc um en t & d is se m in at e go od p ra ct ic es , l es so ns le ar ne d an d ca se s tu di es . 3. 4. 5 D ev el op a nd re vi ew m on i to ri ng a nd e va lu at io n fr am ew or k fo r al l M SN P se ct or s at fe de ra l l ev el . 3. 4. 6 D ev el op a nd re vi ew m on i to ri ng a nd e va lu at io n fr am ew or k fo r al l M SN P se ct or s at p ro vi nc e le ve l. 3. 4. 7 E ns ur e de ve lo pm en t o f m on ito ri ng a nd e va lu at io n fr am ew or k fo r al l M SN P se ct or s at lo ca l le ve l. O u tp u t 3. 2: M SN P go ve r na nc e m ec ha ni sm s tr en gt h en ed a t f ed er al , p ro vi nc ia l, an d lo ca l l ev el s O u tp u t 3. 3: M SN P II in st itu tio na l m ec ha ni sm s fu nc tio na l a t f ed er al go ve rn m en t l ev el O u tp u t 3. 4: F un ct io na l up da te d in fo rm at io n m an ag em en t s ys te m a cr os s al l M SN P II s ec to rs O u tp u t 3. 5: E nh an ce d ca pa ci ty o f fe de ra l, pr ov in ci al a nd lo ca l g ov er n m en t t o pl an & im pl em en t n ut ri tio n pr og ra m m es FI G U R E 2 .4 : M S N P II R E S U LT S S T R U C T U R E — O U TC O M E 3 O N T H E E N A B LI N G E N V IR O N M E N T G O A L : IM P R O V E D M A T E R N A L , A D O L E SC E N T A N D C H IL D N U T R IT IO N B Y S C A L IN G U P E SS E N T IA L N U T R IT IO N S P E C IF IC A N D S E N SI T IV E I N T E R V E N T IO N S A N D C R E A T IN G A N E N A B L IN G E N V IR O N M E N T F O R N U T R IT IO N M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 33 2.7 Results Framework of MSNP-II (2018–22) Based on the theory of change, MSNP-II aims to achieve the following three outcomes: 1. Improved access to and the equitable use of nutrition-specific services. 2. Improved access to and the equitable use of nutrition-sensitive services and improved healthy habits and practices. 3. Improved policies, plans and multi-sectoral coordination at federal, provincial and lo cal government levels to enhance the nutri tion status of all population groups. Outcome 1: Improved equitable utilization of nutrition specific services. The outputs under this outcome address the im mediate causes of malnutrition. The health sec tor is responsible for achieving the following six outputs and implementing the associated 33 key activities (see Figure 2.2): OUTPUT 1.1: ENHANCED NUTRITION STATUS OF WRA INCLUDING ADOLESCENTS Key interventions: 1.1.1 Organize and implement fully-nourished village/ward including Golden 1000 Days communication campaign. 1.1.2 Revitalize School Health and Nutrition/ Weekly Iron Folic Acid Supplementation programme including promoting healthy dietary habits and physical activities. 1.1.3 Raise awareness and services for healthy timing and spacing of pregnancy and in crease access to and utilisation of family planning tools. 1.1.4 Conduct barrier analysis for increased ANC services utilization. 1.1.5 Integrate and expand adolescent-friendly health and nutrition services. OUTPUT 1.2: IMPROVED INFANT AND YOUNG CHILD NUTRITION AND CARE PRACTICES Key interventions: 1.2.1 Conduct maternal, infant, young child and newborn (MIYCN) counselling at all health sector platforms viz. health moth er’s group meetings, immunization, ANC, PNC, growth monitoring, PHC-ORC, IMNCI and OPD services. 1.2.2 Conduct regular growth monitoring coun selling at PHC-ORCs and health facilities. 1.2.3 Disseminate IEC and BCC materials through health facilities and FCHVs to communities and households regularly. 1.2.4 Conduct food preparation and cooking demonstrations on preparing local nutri tious foods (e.g. nutritious flour/porridge (lito), jaulo/khichadi using locally avail able food products. 1.2.5 Engage media for documentation and dis semination of MIYCN programme. 1.2.6 Raise awareness on nutrition including on essential newborn care. OUTPUT 1.3: IMPROVED MIYC MICRONUTRIENT STATUS Key interventions: 1.3.1 Maintain and sustain routine distribution of Vitamin A capsules to children under 5 years and deworming tablets to children of 1-5 years. 1.3.2 Increase coverage and compliance of iron folic acid and de-worming among women during pregnancy and post-partum. 1.3.3 Scale-up home fortification with MNP in targeted areas. 1.3.4 Raise awareness to promote household use of two-child-logo iodized salt. 1.3.5 Raise awareness to promote consumption of national roller-mill produced fortified flour. 1.3.6 Initiate fortification process in production of national roller mills and in foods sup plied by Nepal Food Corporation. 1.3.7 Conduct qualitative study for improved compliance of IFA supplementation. 1.3.8 Conduct barrier analysis for low coverage and compliance of MNP. 1.3.9 Procure and supply nutrition commodities for regular and emergency programmes (VAC, IFA, deworming tablets, MNPs, RUTF, therapeutic milk, ReSoMal). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 34 OUTPUT 1.4: IMPROVED MANAGEMENT OF SEVERE AND MODERATE ACUTE MALNUTRI TION Key interventions: 1.4.1 Expand and establish OTC and ITC to manage severe acute malnutrition in chil dren under 5 years. 1.4.2 Scale-up nutrition rehabilitation homes (NRHs) in 50+ bed hospitals. 1.4.3 Conduct periodic nutrition assessments and counselling at community level. 1.4.4 Conduct barrier analysis to identify barri ers to seek services related to SAM man agement. 1.4.5 Scale-up and strengthen IMNCI pro gramme. 1.4.6 Establish and strengthen nutrition infor mation and surveillance system in normal and humanitarian situations. OUTPUT 1.5: ENHANCED PREPAREDNESS FOR NUTRITION IN EMERGENCY RESPONSES Key interventions: 1.5.1 Establish local nutrition clusters and con duct quarterly coordination meetings at local levels. 1.5.2 Update and develop nutrition in emergen cy preparedness for response and contin gency plans at local levels. OUTPUT 1.6: BUILT CAPACITY OF NUTRITION SPECIFIC SECTORS The aim of this output is to implement the ca pacity development measures recommended in the capacity development plan that will be implemented by the nutrition specific sector. Key activities: 1.6.1 Conduct refresher training for health work ers and FCHVs at all level on the MIYCN package. 1.6.2 Organize basic training on the MIYCN package to newly recruited nutrition super visors and nutrition officers. 1.6.3 Organize nutrition champion leadership development events. 1.6.4 Conduct routine data quality assessment (RDQA) for nutrition programme related HMIS tools. Outcome 2: Improved access to and equitable utilisation of nutrition sensitive services and improved healthy habits practices. The outputs under this outcome address the basic causes of malnutrition. These outputs are clus tered under nutrition sensitive elements. Health, agriculture, livestock, WASH, education women and children, and local governance will be re sponsible to attain this outcome. There are 13 outputs and 59 key activities under this outcome (see Figure 2.3). OUTPUT 2.1: INCREASED AVAILABILITY AND CONSUMPTION OF SAFE AND NUTRITIOUS FOODS The following key interventions will be imple mented by the agriculture and livestock sector: 2.1.1 Make available agriculture and livestock inputs (i.e. seeds, fertilizers, breeds) in cluding at households and community levels. 2.1.2 Provide technical support (training, dem onstrations) to promote the production of fruits, vegetables, nutritious roots, cereals and pulses to improve the consumption of diversified foods at household level. 2.1.3 Increase production and promote con sumption of fresh fruits and green leafy vegetables. 2.1.4 Build capacity of livestock farmers and en trepreneurs to increase milk, meat and egg production. 2.1.5 Provide technical support for micro and alternative small irrigation to produce di versified and micronutrient rich foods. 2.1.6 Technical support to food processing in dustries on good manufacturing practices and quality promotion measures through training, workshops and observation. 2.1.7 Training on food safety, food processing and nutrition to farmers. 2.1.8 Study and improve local food recipes. 2.1.9 Update the food composition table. 2.1.10 Update and disseminate the food compo sition table. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 35 2.1.11 Update and disseminate food-based di etary guidelines in local governments. 2.1.12 Develop and multiply BCC materials in cluding audiovisuals on food safety, food processing and nutrition. OUTPUT 2.2: INCREASED PHYSICAL AND ECONOMIC ACCESS TO DIVERSIFIED FOOD The following key interventions will implement ed by the agriculture and livestock sector: 2.2.1 Enhance access to and use of animal prod uct foods. a) Establish livestock and food markets. b) Distribute chilling vats to dairies. c) Raise awareness about consumption of livestock related foodstuff. 2.2.2 Promote and support production and con sumption of fish including support for establish ing community ponds. OUTPUT 2.3: INCREASED ACCESS TO SAFE DRINKING WATER The following key interventions will be imple mented by the water and sanitation sector: 2.3.1 Construct and repair water supply schemes in communities and institutions ensuring water safety plan. 2.3.2 Promote alternative and innovative tech nologies for providing water supplies. 2.3.3 Promote household water treatment op tions. OUTPUT 2.4: INCREASED ACCESS TO SAFE AND SUSTAINABLE SANITATION SERVICES The following key interventions will be imple mented by the water and sanitation sector: 2.4.1 Sensitize communities to raise awareness for construction, maintenance and hygien ic use of improved household toilet includ ing the safe disposal of child faeces. 2.4.2 Support and strengthen WASH coordina tion committees, and local government to accelerate ODF campaigns. 2.4.3 Support for construction and management of CGD friendly toilet facilities including menstrual hygiene management facilities at institutions. 2.4.4 Support to construct safe food hygiene fa cilities (silauta covers, dish drying racks). OUTPUT 2.5: IMPROVED KNOWLEDGE ON HYGIENIC BEHAVIOUR OF CHILDREN AND MOTHER AND CARETAKERS OF UNDER 5 CHILDREN The water and sanitation sector is responsible for implementing the following key activities. 2.5.1 Construct, establish and promote user friendly hand washing facilities in house holds and institutions. 2.5.2 Raise awareness on hand washing at criti cal times to communities, school children and health workers. 2.5.3 Raise awareness on menstrual hygiene management in communities and schools. 2.5.4 Raise awareness to promote safe food hy giene at community level. OUTPUT 2.6: TARGETED GROUPS HAVE AC CESS TO RESOURCES AND OPPORTUNITIES THAT ARE ESSENTIAL FOR MAKING THEM SELF-RELIANT All the plan’s sectors will be responsible to attain this results, particularly the women and children, agriculture and livestock sectors. The key inter ventions under this output are the following: 2.6.1 Support community seed banks. 2.6.2 Support women and disadvantaged group participation in producing and marketing safe and nutritious food. Raise awareness to increase consumption of these foods. 2.6.3 Provide start-up entrepreneurship grants to women group members for social and economic empowerment. 2.6.4 Provide basic entrepreneurship training to women entrepreneurs groups for the socio economic empowerment of women. 2.6.5 Provide training and orientation for IGA and business promotion (vegetable, fruits, production, animal husbandry, livestock lining with agricultural sector, tailoring). 2.6.6 Link child protection grants to child nu trition in all districts (including distribu tion). 2.6.7 Include nutrition as a major objective of the Social Protection Programme. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 3636 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 37 OUTPUT 2.7: NUTRITION COMPONENT INCORPORATED IN WOMEN, ADOLESCENT GIRLS AND CHILD DEVELOPMENT TRAINING PACKAGES The women and children sector will be respon sible to coordinate and attain this result and carry out the following activity: 2.7.1 Integrate nutrition module in existing training packages: Gender based violence prevention and response training, leader ship, community protection, business de velopment and life skills training. OUTPUT 2.8: WOMEN, CHILDREN AND OUT OF SCHOOL ADOLESCENT GIRLS REACHED WITH HEALTH AND NUTRITION CARE PRAC TICES The women and children sector is responsible to coordinate and attain this result and carry out the following activities: 2.8.1 Training members of women cooperatives and child clubs on nutrition sensitive ser vices: a) Leadership development b) Gender based violence management c) Social protection d) Entrepreneurship development e) Reproductive health f ) Gender based violence management (male and female participation). 2.8.2 Life skill development programmes to ado lescent girls in and out of school: a) Menstrual hygiene management b) Gender violence management, women trafficking orientation to adolescent girls. c) Life skill development training to ado lescent girls. d) Nutrition and child care related train ing to child club and village child pro tection committees. OUTPUT 2.9: CHILD CARE HOMES COMPLY WITH MINIMUM STANDARDS OF NUTRITION CARE SERVICES The women and children sector will be respon sible to coordinate and attain this result and carry out the following activities: 2.9.1 Monitor child care homes for compliance with minimum standards of nutrition sen sitive services. 2.9.2 Promote nutrition sensitive services at child care homes. 2.9.3 Integrate nutrition component in child protection case management training and services. 2.9.4 Deprived (bipanna) infant nutrition pro gramme grant for women cooperatives. OUTPUT 2.10: COMMUNITIES EMPOWERED TO ADDRESS HARMFUL PRACTICES The women and children sector will be respon sible to coordinate and carry out the following activities: 2.10.1 Conduct behavioural change communi cation activities to prevent harmful tradi tional practices. 2.10.2 Run campaigns to prevent child mar riage. 2.10.3 Carry out programmes to shift social norms and harmful practices on food taboos preventing adequate nutrition for adolescents, menstrual seclusion, etc. OUTPUT 2.11: ENHANCED ENROLMENT OF CHILDREN IN BASIC EDUCATION The education sector will be responsible to attain this result and carry out the following activities: 2.11.1 Run welcome to school campaigns for basic education students. 2.11.2 Provide adequate resources to all schools to have ECED/pre-primary education (PPE). 2.11.3 Provide diversified and nutritious mid day meals and other nutrition services to children in basic education. 2.11.4 Increase knowledge of ECED facilita tors, community learning centre (CLC) facilitators, focal teacher, health teach ers and food management committees in coordination with FCHVs to activate them on health, hygiene and nutrition. 2.11.5 Carry out nutrition monitoring of basic education children. 2.11.6 Build nutrition capacity of ECD facili tators, CLC facilitators, health teachers and food management committees. 2.11.7 Prepare study materials and demonstrate them to CLC facilitators, focal teachers, health teachers and food management committees on regular dietary (food, vegetable and fruits) calendar. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 38 OUTPUT 2.12: INCREASED ADOLESCENT GIRLS’ AWARENESS AND BEHAVIOURS IN NUTRITION The education sector will be responsible to carry out the following activities. 2.12.1 Run campaigns for girls education to in crease their enrolment in schools in tar geted areas. 2.12.2 Create priority minimum enabling con ditions (class room, teacher, text book, WASH, book corners) in schools. 2.12.3 Construct separate toilets with group hand wash facility especially for girls in schools. 2.12.4 Provide safe drinking water in schools. 2.12.5 Promote healthy behaviours through skills-based health education in schools. 2.12.6 Revise health and nutrition curriculum. 2.12.7 Establish food management committees in all schools providing midday meals. 2.12.8 Develop educational training packages on DRR for students, teachers and school management committees (SMCs). OUTPUT 2.13 PROMOTE ACCESS TO HEALTH AND REPRODUCTIVE HEALTH SERVICES The health sector will be responsible to acarry out the following activities: 2.13.1 Provide reproductive health and nutri tion information services at schools and health facilities to provide access to boys and girls. 2.13.2 Provide knowledge on the importance of delayed first pregnancy after marriage (if married before 20 years). 2.13.3 Raise knowledge of students at commu nity schools on benefits of family plan ning methods. 2.13.4 Run behaviour change communication programmes for improving routine mea sles and rubella immunization. Outcome 3: Improved policies, plans and multi sectoral coordination at federal, provincial and local government levels to create enabling environment to improve nutrition status Outcome 3 is the enabling environment out come. This outcome aims to increase multi-sec toral commitment and resources for nutrition, strengthen nutritional information management and data analysis and establish protocol for nu trition profiles (as the basis for planning) at fed eral, provincial and local government levels. The NPC, NPC, MoFALD and other sector minis tries will be responsible for the accomplishment of the following 5 outputs and 31 key activities (see Figure 2.4). OUTPUT 3.1: MSNP INCLUDED IN LOCAL, PROVINCIAL AND FEDERAL GOVERNMENTS’ POLICIES AND PLANS The NPC, MoFALD, MoF and other sectoral ministries will be responsible for the accomplish ment of the following key activities: 3.1.1 Incorporate MSNP-II in federal sectoral plans and polices. a) Update MSNP in the policy, long-term plan and strategies of federal level sector ministries in line with MSNP-II. b) Provide guidelines from NPC to incor porate MSNP-II activities in the annual programme and budget of sectoral minis tries. c) Monitor to ensure incorporation of MSNP -II activities in the annual pro grammes and budgets of sectoral minis tries. 3.1.2 Incorporate MSNP-II in province level plans and policies. a) Organise workshops at provincial level to provide advocacy and counselling on MSNP-II. b) Send circular to all provicncial govern ments to incorporate nutrition in their relevant policies, long-term plans and strategies in line with MSNP-II. 3.1.3 Incorporate MSNP-II in local govern ments’ plans and planning processes. 3.1.4 Organize joint annual review meeting among MSNP-II sectoral ministries at fed eral level. 3.1.5 Advocacy meeting for budget increment at federal, province and local government level. a) Conduct advocacy meetings with fed eral and provincial level parliamentar ians to arrange resources and allocation of adequate budget for the implementa tion of MSNP-II. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 39 b) Conduct advocacy meetings with MoF at federal and provincial levels to ar range resources and allocation of ade quate budget for implementing MSNP II. c) Conduct advocacy and counselling with educational agencies, private sec tor, entrepreneurs etc. to arrange ade quate resources for the implementation of MSNP-II. d) Conduct advocacy and counselling with NGOs and civil society organisa tions to arrange adequate resources for the implementation of MSNP-II. 3.1.6 Develop a nutrition budget code. OUTPUT 3.2: MSNP GOVERNANCE MECHA NISM STRENGTHENED AT FEDERAL, PROVIN CIAL, AND LOCAL LEVEL The NPC, MoFALD and other sectoral min istries will be responsible for implementing the folllowing activities: 3.2.1 Organise High Level Nutrition and Food Security Steering Committee (HLNFSS) meeting twice a year. 3.2.2 Organise Nutrition and Food Security Coordination Committee meetings in every trimester. 3.2.3 Send circular and facilitate formation of nutrition and food security steering com mittees at province level. 3.2.4 Form nutrition and food security steering committees at provincial level. 3.2.5 Organise nutrition and food security steering committee meetings at provin cial level twice a year. 3.2.6 Form nutrition and food security coordi nation committee at provincial level. 3.2.7 Organise nutrition and food security co ordination committee meetings in every trimester. 3.2.8 Assign a focal person for MSNP-II in provincial level sectoral ministries. 3.2.9 Organise thematic technical working group meetings at federal level each quar ter. 3.2.10 Ensure formation of nutrition and food security steering committees and their regular meetings at local government level. 3.2.11 Ensure formation of nutrition and food security steering committees and regular meeting at ward level in MSNP imple mented local government areas. 3.2.12 Assign coordinators (from existing staff or outsourced) in local governments. OUTPUT 3.3: MSNP INSTITUTIONAL MECHA NISMS FUNCTIONAL AT FEDERAL GOVERN MENT LEVEL. NPC will be responsible to attain this result and carry out the following activities: 3.3.1 Strengthen the National Nutrition and Food Security Secretariat at NPC. 3.3.2 Conduct O&M survey to establish NNFSSC within NPC. 3.3.3 Establish NNFSSC within NPC and re cruit staff as per approved organogram. OUTPUT 3.4: STRENGTHENED INTEGRATED INFORMATION MANAGEMENT SYSTEM ACROSS THE SECTORS IN LINE WITH MSNP-II. NPC, MoFALD and other sector ministries will be responsible to attain this result and carry out the following activities: 3.4.1 Update the MSNP information portal (www.nnfssp.gov.np) and all relevant sec tor ministries information on the portal. 3.4.2 Link and update the nutrition information management system of sectoral ministries with the MSNP information portal at the central level. 3.4.3 Provide training on web-based MSNP re porting system to MSNP related staff at federal and province levels. 3.4.4 Document and disseminate good practic es, lessons learned and case studies through the MSNP portal. 3.4.5 Update the existing MSNP M&E frame work used at federal level. 3.4.6 Facilitate preparation of MSNP M&E framework development and implementa tion at the provincial level. 3.4.7 Facilitate MSNP M&E framework devel opment at local level and ensure its imple mentation. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 40 OUTPUT 3.5: ENHANCED CAPACITY OF FED ERAL, PROVINCE AND LOCAL LEVEL GOVERN MENT TO PLAN AND IMPLEMENT NUTRITION PROGRAMME. NPC and all MSNP-II sectors will be responsible to attain this output and carry out the following activities: 3.5.1 Develop capacity building master plan for the implementation of MSNP-II 3.5.2 Build capacity of relevant staff at federal, provincial and local government level as per the capacity development master plan. a) Prepare training manual for the imple mentation of MSNP-II. b) Provide ToT to implement MSNP-II at federal level. The full MSNP-II results framework is given in Annex 1 including the goal and outcome level in dicators with annual targets for 2018 to 2022, the means of verification and the responsible sectors; the output level indicators and the key activities. The outcomes, outputs and key activities are also presented graphically in Figures 2.2, 2.3 and 2.4. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 41 IMPLEMENTATION OF MSNP-II (2018–2022) Chapter 3 41 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 4242 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 43 3.1 Implementation Arrangements The key sectors for implementing MSNP-II are health, education, agriculture, livestock, water and sanitation, women, children and social wel fare and federal affairs and local development. The finance, communication, commerce and supply sectors are also partners. NPC will lead the coordination with and between these sectors and facilitate the implementation of MSNP-II. MSNP-II will be scaled up across the country to address malnutrition and will be rolled out to all local governments. It will initially be rolled out in the areas of greatest need — the remote and severe food deficit areas in the Mid-West and Far Western hills and mountains and in the mid Tarai. The Local Government Operation Act, 2074 (GoN 2017) gives additional guidelines on implementing this plan at the local level. The arrangements for implementing MSNP-II will be as follows: a) Planning and budgeting — MSNP-II will be incorporated in provincial and local govern ment policies and plans. Annual programmes and budget will be prepared in line with MSNP-II in all seven provinces and all local governments. Budgetary arrangements will be ensured for this purpose. b) Institutional strengthening and human re sources management — Necessary human resources will be assigned for managing nu trition programmes at all levels of involved ministries and focal persons will be assigned at all levels to strengthen institutional, organ isational and human resource capacities for implementing the plan at all levels and sectors linked to nutrition. The capacity of these of ficials will be developed. c) Coordination and management — The co ordination and management of MSNP-II will be the responsibility of NPC at the federal level and the entities responsible for planning at provincial and municipality levels. Com mittees will be formed and made functional to give technical guidance on MSNP-II related functions (see Section 3.6). These commit tees will coordinate vertically and horizontally with the line agencies to implement MSNP-II. d) Information and Communication — Be haviour change communication will be organ ised to raise civic awareness about the major problem of chronic malnutrition and the ac tions needed to improve maternal and child nutrition, thus ensuring equity, and facilitat ing access to information, to promoting be haviour change, with a focus on reaching the most marginalized and poorest segments of the population, and taking into account gen der related factors. The mobilization of civil society organisations, parliamentarians, other elected representatives, and decision making authorities for advocacy activities will acceler ate this process. 3.2 Target Groups and Prioritization As already mentioned, MSNP-II will initially be rolled out in the areas of greatest need — the remote and severe food deficit areas in the Mid West and Far Western hills and mountains and in the mid-Tarai. Although MSNP-II will benefit a wide range of people, it’s main focus will be on the following two groups: • Nutritional investments are most effective and yield the greatest returns in the window of opportunity of the 1,000 days from concep tion. Therefore, women of reproductive age, adolescent girls and under-3-year olds will re ceive greater attention. Mothers, adolescents, infants’ grandmothers and husbands of preg nant women will also be targeted. 3. implementation of MSNP-ii (2018–2022) Chapter 3 MSNP-II will be scaled up across the country to address malnutrition and will be rolled out to all local governments. MSNP-II will initially be rolled out in the areas of greatest need. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 44 • Pocket areas and communities that suffer higher levels of deprivation or are vulnerable to undernutrition will be prioritised. As many of the causes of undernutrition are related with feeding and care practices and socio cultural traditions, MSNP-II will address the needs of all citizens including males and fe males of all ages, castes, ethnicities, religions and geographical areas. Information, communication and education pro grammes will target all people nationwide. Other interventions will gradually be geared up to meet the needs of all citizens. 3.3 Financial Management At the beginning of MSNP-II, in coordination with the Ministry of Finance, the NPC will de velop a programme and financial planning frame work with well-defined budget lines. The NPC will coordinate, facilitate, guide and monitor implementation. The huge amount needed to scale up nutrition programmes nationally will be provided by the government and development partners. Imple mentation will follow the financial administra tion rules and regulations with auditing carried out by the Office of the Auditor General. The Ministry of Finance will maintain updated re cords of off-budget grants received from develop ment partners. Donors and international agencies who wish to channel their support through development partners should first get endorsement from the HLNFSSC. Donors should submit proposals to the NPC stating total amounts, budget code and mode (lump sum or instalments). All support received to implement MSNP-II, in cluding from the government, foreign grants and the private sector will be entered into the govern ment’s Budget Management Information System and Financial Management Information System. MSNP-II grants will be allocated to local gov ernments based on fixed criteria including per centage of children with malnutrition, causes of malnutrition, status of nutrition and food secu rity, geographical remoteness and availability of local resources. Nutrition analysis in local govern ments will also cover the nutrition status of preg nant women, mothers and adolescents. Also, provincial and local governments will con tribute at least 15 percent of their internal re sources (revenue) and grants for improving the nutrition of women and children. NPC will assess the funds spent on implement ing MSNP-II separately for nutrition specific, nutrition sensitive and enabling environment activities. It will coordinate the ratio of expendi ture and issue guidance and directives for needed changes. Various government ministries and agencies and non-government agencies were involved in im plementing MSNP (2013–17). It was difficult to assess the financial investments made as budget and programme codes differed. The NPC will thus coordinate with the Ministry of Finance to implement a separate nutrition budget code. This will help in the preparation of the Medium Term Expenditure Framework, and the monitoring and evaluation of expenditure on nutrition in cluding the allocation of budgets for MSNP-II’s programme, and budget preparation by provinces and local governments. 3.4 Estimated Costs The estimated cost of implementing MSNP-II is NPR 48,901 million ($470 million at exchange rate of NPR 104.04). The budget is segregated thus: • By seven sectors plus NPC ,with the Ministry of Education needing the most funds (35% of total) followed by the Ministry of Health (25%) (Table 3.1). • By nutrition specific and nutrition sensitive programming with nutrition sensitive pro gramming accounting for 76 percent of esti mated costs (Table 3.2). • The proportion of funding provided by the government is planned to increase from 47 percent in 2018 to 69 percent in the final year of MSNP-II, with the government providing 59 percent of funds and development partners 41 percent (Table 3.3). These estimates are based on 2017/18 fixed cost prices, the present or past unit cost of planned activities, existing fixed rates of the government, The huge amount needed to scale up nutrition programmes nationally will be provided by the government and development partners. 4444 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 45 TABLE 3.1: ESTIMATED NPC AND SECTORAL MINISTRY COSTS OF IMPLEMENTING MNSP-II (NPR MILLION) NPC/sectoral ministries 2018 2019 2020 2021 2022 Total % Health 2,223 2,403 2,615 2,497 2,464 12,202 25% Education 3,428 3,434 3,444 3,455 3,467 17,228 35% Agricultural development 1,652 1,728 1,812 1,900 2,006 9,098 19 Livestock development 101 87 108 96 118 510 1% Drinking water and sanitation 568 1,021 1,865 2151 2,431 8,036 16% Women, children and social welfare 188 196 211 223 235 1,053 2% Local governance 42 78 91 97 104 412 1% NPC 55 76 75 79 77 362 1% Total 6,937 7,704 8,900 9,178 9,559 48,901 100% TABLE 3.2: ESTIMATED NUTRITION-SPECIFIC AND NUTRITION-SENSITIVE COSTS OF IMPLEMENTING MNSP-2 (NPR MILLION) Programmes 2018 2019 2020 2021 2022 Total Nutrition sensitive 6,111 6,709 7,717 8,122 8,562 37,211 76% Nutrition specific 2,146 2,314 2,504 2,376 2,340 11,680 24% Total 8,256 9,023 10,221 10,498 10,902 48,901 100% TABLE 3.3: ESTIMATED COSTS OF MSNP-II BY SOURCES OF FUNDS GoN Development partners Total 2018 Budget (NPR million) 3,260 3,677 6,937 Percentage 47% 53% 100% 2019 Budget (NPR million) 4,409 4,119 8,528 Percentage 52% 48% 100% 2020 Budget (NPR million) 6,032 4,514 10,546 Percentage 57% 43% 100% 2021 Budget (NPR million) 6,973 4,148 11,121 Percentage 63% 37% 100% 2022 Budget (NPR million) 8,156 3,613 11,769 Percentage 69% 31% 100% Total Budget (NPR million) 28,830 20,071 48,901 Percentage 59% 41% 100% 4545 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 46 national and international costs and discussions with the concerned line ministries. The annual financial tracking of nutrition-related expenditure carried out by the NPC covers all of the nutrition-related programmes in the govern ment’s AWPB. The programmes proposed under MSNP-II do not necessarily cover all nutrition related programmes and therefore the proposed above budget is less than the figures in NPC’s an nual financial tracking exercises. 3.5 Duration of MSNP-II MSNP-II will be implemented from Nepali FY 2075/76 to 2079/80 (mid-July 2018 to mid-July 2022). 3.6 MSNP Committees Two existing high-level committees will govern the implementation of MSNP-II at the national level. The High Level Nutrition and Food Secu rity Steering Committee (HLNFSSC) (see com position in Table 3.4) is the highest level govern ing body and will provide high level guidance and endorse policies and programmes. Its roles and responsibilities are as follows: a) Formulate and endorse macro level policies and strategies on nutrition and food security. b) Ensure necessary resources for MSNP-II. c) Make policy decisions on foreign grant needs and development partner support for MSNP II. d) Advocate and counsel on nutrition and food security related issues at national and interna tional conferences, workshops, and meetings on behalf of the country. e) Review MSNP-II’s progress and evaluate its performance and effects. f ) Coordinate about MSNP-II with sectoral ministries at federal level. g) Provide guidelines and directives to the Fed eral Level Nutrition and Food Security Steer ing Committee. The National Nutrition and Food Security Co ordination Committee (NNFSCC) (Table 3.5) will be responsible for national level coordination of the implementation of MSNP-II. Its roles and responsibilities oare as follows: a) Implement MSNP-II related national policies and strategies b) Arrange budget for federal level sectoral min istries to implement MSNP-II. c) Implement decisions of the HLNFSSC. d) Provide guidelines and directives to provincial level NFSSCs. e) Facilitate the formation and operation of pro vincial and local government nutrition and food security steering committees. f ) Form federal level technical groups and deter mine their roles and responsibilities for imple menting MSNP-II. g) Review progress of MSNP-II at province and local government levels. h) Form technical working groups for MSNP-II at the federal level. i) Coordinate and perform other functions to implement, monitor, review and evaluate MS NP-II at the federal level. j) Provide guidelines to NNFSS and responsible NPC divisions. New committees will be formed as the main bod ies for overseeing the implementation of MSNP II in provinces, local governments and wards. District coordination committees will also be formed. Provincial nutrition and food security steering committees (PLNFSSC) (Table 3.6) will have the following responsibilities: a) Formulate provincial level policies and strate gies on nutrition and food security that com ply with HLNFSSC and NNFSCC federal level policies. b) Identify available resources for MSNP-II and ensure necessary resources for its implementa tion at provincial and local government levels. c) Advocate and guide on nutrition and food security at national level conferences, work shops and meetings on behalf of provinces d) Review MSNP-II progress and evaluate its performances and effects at the local level. e) Provide guidelines and directives to provin cial level sectoral ministries and agencies on implementing MSNP-II. f ) Facilitate the formation and operation of local government nutrition and food security steer ing committees. g) Review performance of local nutrition and food security steering committees. MSNP-II will be implemented from Nepali FY 2075/76 to 2079/80 (mid July 2018 to mid July 2022). M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 47 TABLE 3.4: COMPOSITION OF HIGH LEVEL NUTRITION AND FOOD SECURITY STEERING COMMITTEE (HLNFSSC) Office holders Position on committee Hon. Vice Chairman, National Planning Commission (NPC) Chairperson Hon. Member, Health and Nutrition, NPC Co-chair Hon. members NPC (agriculture, livestock development, WASH, women children and social welfare, education, federal affairs and local development, communication, commerce and supplies) Members Secretaries of federal ministries of health, agriculture development, livestock development, drinking water and sanitation, women children and social welfare, education, federal affairs and local development, communication, commerce and supplies Members Nutrition and food security experts (4, nominated by the Chair) Members Member Secretary, National Planning Commission Member Secretary Joint Secretary, Social Development Division, NPC Joint Member Secretary TABLE 3.5: COMPOSITION OF NATIONAL NUTRITION AND FOOD SECURITY COORDINATION COMMITTEE (NNFSCC) Office holders Position on committee Hon. Member, Health and Nutrition Sector, NPC Coordinator Hon. NPC members responsible for health, agriculture, livestock, WASH, women children and social welfare, education, federal affairs and local development, communication, commerce and supplies. Members Chiefs of the Policy Planning and International Cooperation Division, the Budget and Programme Division and Nutrition Division from the federal ministries of health, agriculture, livestock, drinking water and sanitation, women, children and social welfare, education, federal affairs and local development, communication, commerce and supplies. Members Director generals of federal departments of health, agriculture development, livestock development, drinking water and sanitation, women, children and social welfare, education, federal affairs and local development Members Executive Director, Nepal Health Research Council Member Two nutrition and food security experts (nominated by the Coordinator) Members Representative of civil society network working on nutrition and food security Member Representative responsible for health and nutrition from FNCCI or other representative body Member Joint Secretary, Social Development Division, NPC Member Secretary TABLE 3.6: COMPOSITION OF PROVINCIAL NUTRITION AND FOOD SECURITY STEERING COMMITTEES (PLNFSSC) Office holders Position on committee Chief of body responsible for provincial level planning Chair Chief of agencies responsible for health, agriculture development, livestock development, drinking water and sanitation, women children and social welfare, education, federal affairs and local development, finance, communication, commerce and supplies in the province Members Two local nutrition and food security experts Members Development partners working in the nutrition and food security sector in the province. Can be invited to meetings as per need M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 48 h) Regularly submit MSNP progress report to National Nutrition and Food Security Coor dination Committee. District coordination committees will carry out monitoring and coordination within provinces by carrying out the following responsibilities: a) Conduct MSNP-II monitoring in local gov ernments where it is implemented. b) Coordinate with provinces and between local governments. c) Facilitate the incorporation of MSNP-II in lo cal governments’ long-term, periodic and an nual programmes. d) Advocacy and guidance on nutrition and food security at local conferences, workshops, and meetings on behalf of provincial governments. e) Review MSNP-II progress and evaluate its performance and effects at the local level. Local government nutrition and food security steering committees will be formed in metropoli tan cities, sub-metropolitan cities, urban munici palities and rural municipalities (Table 3.7). They will have the following responsibilities: a) Formulate local government policies and strategies on nutrition and food security that comply with federal and provincial policies. b) Identify resources for MSNP-II and ensure necessary resources for its implementation. c) Incorporate MSNP-II activities in long-term, periodic and annual programmes of local gov ernments. d) Advocate and counsel on nutrition and food security at national conferences, workshops, and meetings. e) Facilitate the formation of ward level nutri tion and food security steering committees, review their progress and provide guidelines and directives. f ) Review MSNP-II related performance of ward level nutrition and food security steer ing committees and provide directions for im provement. g) Regularly submit MSNP-II progress reports to district coordination committee and prov ince level nutrition and food security coordi nation committees. Ward-level nutrition and food security steering committees (Table 3.8) will have the following responsibilities: a) Identify nutrition programmes in a participa tory way and submit for support to local gov ernment councils. b) Identify local nutrition deficient communities. c) Assess needs of nutrition deficient communi ties and support prioritization of programmes for them with their participation. d) Mobilise communities to run nutrition spe cific and sensitive campaigns. e) Assign NGOs and other agencies to monitor local nutrition programmes and report find ings to the committee. 3.7 Power to Frame Guidelines The NPC may frame guidelines and issue direc tives to provincial and local levels to implement MSNP-II. 3.8 National Nutrition and Food Security Secretariat A National Nutrition and Food Security Secre tariat (NNFSS) will be established under the NPC Secretariat to provide technical and mana gerial support to the national committees (HL NFSSC and NNFSCC) for the smooth operation of MSNP-II. The organogram and staffing of the secretariat will be as assigned by NPC. 3.9 Responsibilities of Private, Non-government and Academic Sectors MSNP-II will be implemented by government agencies, national and international NGOs, pri vate sector agencies and community and civil so ciety organisations. The plan will be implemented through the coordinated efforts of national and international agencies, professional bodies, civil society and academia. At the local level, the range of stakeholders will be involved in formulating policies, and planning, implementing and moni toring nutrition and food security programmes. Civil society organisations, the private sector and other stakeholders will participate in nutrition and food security-related advocacy and commu nication. Their cooperation will also be sought for the organisation of nutrition-related public hearings and grievance handling. Public-private partnerships will help implement MSNP-II with NPC responsible for coordinating this process. MSNP-II will be implemented by government agencies, national and international NGOs, private sector agencies and community and civil society organisations. M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 49 TABLE 3.7: COMPOSITION OF LOCAL GOVERNMENT NUTRITION AND FOOD SECURITY STEERING COMMITTEES Office holders Position on committee Chief of local government authority Chair Deputy chief of local government Deputy chair All ward chairpersons of local government Members Woman member of local government designated by the chair Member Dalit woman member of local government designated by the chair Member Coordinator designated for planning and implementation of nutrition and food security programmes Member Section chiefs of health, agriculture, livestock development, WASH, women, children and social welfare, education, federal affairs and local development, communication, finance, commerce and supplies and documentation and information section of local government Members Programme officer of social development section of local government Member President of local chambers of commerce and industry Member President of local NGO federation Member Executive officer of local government or a designated officer Member Secretary Executive member who looks after the social sector or executive woman member Coordinator Nutrition and food security experts from local government and development partners. Can be invited as per need TABLE 3.8: COMPOSITION OF WARD-LEVEL NUTRITION AND FOOD SECURITY STEERING COMMITTEES Office holders Position on committee Ward chair Chair Female ward member Member Unit chiefs of health, agriculture, livestock development, WASH, women children and social welfare, education, federal affairs and local development, communication, commerce and supplies unit in the ward (if any) Members Local female teacher Member Representative of an NGO working in the ward Member Coordinator of ward citizens forum Member One local female community health volunteer (FCHV) Member Representative of a local school management committee Member Representative of a local health service management committee Member Ward secretary Member Secretary M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 50 3.10 Capacity Development The capacity of staff and officials involved in implementing MSNP-II will be developed in cluding their knowledge and skills on nutrition and food security, documentation and reporting, information dissemination and training skills. 3.11 Review, Monitoring and Evaluation A) NEED AND PROCESS The review, monitoring and evaluation of MSNP-II will assess progress of MSNP-II pro grammes principally in terms of the attainment of outcomes and outputs and impact on target groups. Annex 1 lists the indicators for measuring progress against the annual targets. A monitoring and evaluation framework will be prepared as per the National Monitoring and Evaluation Guidelines to measure programme delivery and sectoral performance. Information will be collected on all indicators. The capacity of stakeholders will be developed at all levels to monitor the achievement of results. Nutrition improvements will indirectly help to achieve all 17 SDGs, particularly SDGs 2 and 3. B) REGULAR MONITORING AND REVIEW Much of the data for measuring the indicators will come from regular national surveys including the Nepal Demographic and Health Survey, the Nepal Multiple Indicators Cluster Survey, and Nepal Living Standards Surveys. The periodic reports of government agencies will be another important source of information and means of verification. Further surveys may be carried out to gather data not available from existing surveys. Capacity will be built to carry out monitoring. C) STUDIES, RESEARCH AND EVALUATION Applied and action research will be carried out to identify and address bottlenecks to implementing MSNP-II. Status and progress information will be regu larly posted on the nutrition and food security web portal (http://www.nnfsp.gov.np). Relevant policy making-related information will also be posted here. Consultations will be held with NPC’s Monitor ing and Evaluation Division to guide decisions on monitoring, review and evaluation. A Tech nical Working Group for monitoring and evalu ating MSNP-II will be formed under the joint secretary of NPC’s Social Development Division to supervise MSNP-II’s management informa tion system. Each involved sectoral ministry will nominate an M&E focal person to this TWG who will be responsible for updating their min istry’s progress. 3.12 Documentation and Reporting Local governments will be responsible for report ing on the physical and financial progress of MS NP-II to district coordination committees, pro vincial level and federal level sectoral ministries. Local governments will submit four monthly and annual physical progress reports and statements of expenditure to their district coordination com mittees and sectoral ministries at provincial and national levels. The sectoral ministries will pre pare integrated reports for submission to NPC and will document the implementation status of MSNP-II and update physical and financial progress reports in the prescribed format. Status and progress information will be regularly posted on the nutrition and food security web portal (http://www.nnfsp. gov.np) 50 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 51 Annexes 51 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 5252 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 53 a nn ex 1 : M ul ti se ct o r N ut ri tio n Pl an i i ( 20 18 2 02 2) R es ul ts F ra m ew o rk R es u lt s ch ai n R es u lt in d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 G o al (I m p ac t) Im p ro ve d m at er n al , ad o le sc en t an d ch ild n u tr it io n b y sc al in g u p e ss en ti al n u tr it io n s p ec ifi c an d s en si ti ve in te rv en ti o n s an d c re at in g an e n ab lin g en vi ro n m en t fo r n u tr it io n 1. P re va le n ce o f s tu n ti n g a m o n g u n d er 5 y ea rs c h ild re n re d u ce d 35 .8 N D H S 20 16 34 31 31 29 28 N D H S, N M IC S H ea lt h 2. P re va le n ce o f w as ti n g a m o n g u n d er 5 ye ar o ld c h ild re n re d u ce d 9. 7 N D H S 20 16 9. 5 8 8 7 7 N D H S, N M IC S H ea lt h 3. P re va le n ce o f l o w b ir th w ei g h t re d u ce d 24 N M IC S 20 14 20 17 13 11 10 N D H S, N M IC S H ea lt h 4. % re d u ct io n in c h ild re n u n d er 5 w it h o ve rw ei g h t an d o b es it y 2. 1 N D H S 20 16 2 1. 9 1. 7 1. 6 1. 4 N D H S, N M IC S H ea lt h 5. % re d u ct io n in o ve rw ei g h t an d o b es e w o m en o f r ep ro d u ct iv e ag e (W R A ) 22 N D H SS 2 01 6 22 21 20 19 18 N D H S, N M IC S H ea lt h 6. % o f w o m en w it h c h ro n ic e n er g y d efi ci en cy (m ea su re d a s b o d y m as s in d ex ) r ed u ce d 17 N D H S 20 16 12 N D H S, N M IC S H ea lt h O u tc o m es 1: N u tr it io n s p ec ifi c o u tc o m e O u tc o m e 1: Im p ro ve d a cc es s to a n d e q u it ab le u se o f n u tr it io n sp ec ifi c se rv ic es 1. 1. In cr ea se d % o f c h ild re n a g ed 6 23 m on th s h av in g m in im u m ac ce p ta b le d ie t 35 N D H S 20 16 40 45 50 55 60 N D H S, N M IC S H ea lt h 1. 2. In cr ea se d % o f c h ild re n u n d er 6 m o n th s w it h e xc lu si ve b re as tf ee d in g 66 N D H S 20 16 68 70 74 77 80 N D H S, N M IC S H ea lt h 1. 3. R ed u ce d % o f a n ae m ia a m o n g ch ild re n a g ed 6 5 9 m o n th s 52 .7 N D H S 20 16 40 37 33 30 28 N D H S, N M IC S H ea lt h 1. 4. R ed u ce d % o f a n ae m ia a m o n g ad o le sc en t g ir ls (1 0 19 y ea rs ) 39 N D H S 20 16 20 25 N D H S, N M IC S H ea lt h G o al a nd O ut co m e in di ca to rs M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 54 R es u lt s ch ai n R es u lt in d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 O u tc o m e 1: Im p ro ve d a cc es s to a n d e q u it ab le u se o f n u tr it io n sp ec ifi c se rv ic es 1. 5. R ed u ce d % o f a n ae m ia a m o n g W R A (1 5 49 y ea rs ) 40 .8 N D H S 20 16 26 24 N D H S, N M IC S H ea lt h 1. 6. R ed u ce d p re va le n ce o f u n d er 5 ye ar s o ld c h ild re n w it h d ia rr h o ea in la st t w o w ee ks 14 % N D H S 20 16 10 % 7% N D H S, N M IC S H ea lt h 1. 7. M ea n d ie ta ry d iv er si ty s co re am o n g W R A (1 5 49 y ea rs ) TB D N D H S 20 16 TB D N D H S, N M IC S H ea lt h 2: N u tr it io n s en si ti ve o u tc o m e O u tc o m e 2: Im p ro ve d a cc es s to an d t h e eq u it ab le u se o f n u tr it io n se n si ti ve s er vi ce s an d im p ro ve d h ea lt h y h ab it s an d p ra ct ic es 2. 1. R ed u ce d p ro p o rt io n o f p o p u la ti o n b el o w m in im u m le ve l o f d ie ta ry en er g y co n su m p ti o n 22 .8 N M IC S 20 14 17 15 .5 14 12 .5 11 SD G s ta tu s re p o rt s, N M IC S A g ri cu lt u re an d li ve st o ck 2. 2. In cr ea se d % p eo p le u si n g s af e d ri n ki n g w at er 15 JM P 20 17 33 .7 38 .4 43 .1 47 .8 52 .5 Jo in t M o n it o ri n g Pr o g ra m m e (J M P) W A SH 2. 3. In cr ea se d % p eo p le u si n g im p ro ve d s an it at io n fa ci lit ie s th at ar e n o t sh ar ed 92 .6 to ile t co ve ra g e: 20 17 N M IP D W SS , 20 17 95 98 10 0 10 0 10 0 N M IC S & N M IP D W SS W at er a n d sa n it at io n 2. 4. In cr ea se d % o f p eo p le p ra ct is in g h an d w as h in g w it h s o ap a n d w at er b ef o re fe ed in g b ab y (0 2 y rs ) a n d af te r c le an in g b ab ie s’ b o tt o m s K n o w le d g e 6 an d 5 .5 N M IC S 20 14 15 20 30 40 50 N M IC S W at er a n d sa n it at io n 2. 5. P er ce n ta g e o f w o m en a g ed 2 0 24 ye ar s w h o w er e m ar ri ed o r i n u n io n b ef o re a g e 18 40 .7 % N D H S 20 11 5% re d u ct io n p er y ea r N D H S W o m en , C h ild re n a n d So ci al W el fa re an d H ea lt h 2. 6. In cr ea se d g ro ss e n ro lm en t ra te (G ER ) ( b o ys a n d g ir ls ) i n e ar ly ch ild e d u ca ti o n a n d d ev el o p m en t (E C ED )/ p re p ri m ar y ed u ca ti o n (P PE ) 81 (8 1. 2, 8 0. 9) 82 .6 (8 2. 8, 8 2. 5) 84 .3 (8 4. 5, 8 4. 2) 86 (8 6. 2, 8 5. 9) 87 .7 (8 7. 9, 8 7. 6) 89 .4 (8 9. 4, 8 9. 5) Ed u ca ti o n M an ag em en t In fo rm at io n Sy st em (E M IS ) Ed u ca ti o n 2. 7. D ec re as ed % o f o u t o f sc h o o l ch ild re n (b o ys a n d g ir ls ) i n b as ic ed u ca ti o n 10 .6 (1 0. 8, 1 0. 4) 9. 06 (9 .2 , 9 .8 ) 7. 5 (7 .6 , 7 .3 ) 6. 0 (6 .1 , 5 .8 ) 4. 5 (4 .6 , 4 .6 ) 3. 0 (3 .1 , 2 .0 ) EM IS Ed u ca ti o n 2. 8. In cr ea se d b as ic e d u ca ti o n c yc le co m p le ti o n ra te (b o ys a n d g ir ls ) 69 .6 (6 8. 8, 7 0. 5) 72 .4 (7 1. 6, 73 .4 ) 75 .4 (7 4. 5, 7 6. 4) 78 .5 (7 7. 6, 7 9. 5) 81 .7 (8 0. 8, 82 .8 ) 85 .0 (8 4. 1, 8 6. 1) EM IS Ed u ca ti o n M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 55 R es u lt s ch ai n R es u lt in d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 3: E n ab lin g e n vi ro n m en t o u tc o m e O u tc o m e 3: Im p ro ve d p o lic ie s, p la n s an d m u lt i se ct o ra l co o rd in at io n a t fe d er al , p ro vi n ci al an d lo ca l g o ve rn m en t le ve ls to e n h an ce t h e n u tr it io n s ta tu s o f a ll p o p u la ti o n g ro u p s 3. 1. % o f f ar m la n d o w n ed b y w o m en o r i n jo in t o w n er sh ip 10 (2 01 0) 12 13 15 18 21 A D S A g ri cu lt u re an d L iv es to ck 3. 2. N o. o f l o ca l, p ro vi n ci al a n d fe d er al g o ve rn m en t p la n s th at in cl u d e n u tr it io n a n d fo o d s ec u ri ty p ro g ra m s in li n e w it h M SN P II 30 d is tr ic ts 29 9 lo ca l g o ve rn m en ts 60 d is tr ic ts 75 3 lo ca l g o ve rn m en ts 75 3 lo ca l g o ve rn m en ts 75 3 lo ca l go ve rn m en ts G o ve rn m en t p la n s an d M SN P II an n u al p ro g re ss re p o rt s Lo ca l G o ve rn an ce 3. 3. A va ila b ili ty o f n at io n al M SN P II d o cu m en t M SN P I 1 M SN P II d o c N PC 3. 4. A va ila b ili ty o f n at io n al b u d g et co d e fo r n u tr it io n a n d fo o d se cu ri ty 0 1 M o F b u d g et co d e N PC , M o F 3. 5. N at io n al C ap ac it y D ev el o p m en t M as te r P la n fo r i m p le m en ta ti o n o f M SN P II Pr o d u ce d 0 1 C ap ac it y D ev el o p m en t Pl an N PC , a ll se ct o rs 3. 6. M u lt i se ct o r c o m m it m en t an d re so u rc es fo r n u tr it io n in cr ea se to at le as t 3. 5% o f t o ta l g o ve rn m en t b u d g et 1. 08 1. 5 2 2. 5 3 3. 5 M o F re d B o o k N PC 3. 7. F in an ci al re so u rc e tr ac ki n g in p la ce 1 1 1 1 1 1 Fi n an ci al re so u rc e tr ac ki n g to o ls N PC , M o F M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 56 O ut pu t in di ca to rs R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 N u tr it io n s p ec ifi c o u tp u ts O u tc o m e 1: Im p ro ve d a cc es s to a n d e q u it ab le u se o f n u tr it io n s p ec ifi c se rv ic es O u tp u t 1. 1: En h an ce d n u tr it io n st at u s o f W R A in cl u d in g a d o le sc en ts M ed ia n a g e at fi rs t b ir th a m o n g W R A (1 5 49 y ea rs ) 17 N D H S 20 16 2 0 N D H S H ea lt h % o f i n st it u ti o n al d el iv er y 57 N D H S 20 16 65 70 N D H S, N M IC S H ea lt h % g et ti n g a p o st n at al c h ec k u p fo r e ss en ti al n ew b o rn c ar e an d se rv ic es w it h in 2 4 h o u rs o f d el iv er y 57 N D H S 20 16 75 N D H S H ea lt h O u tp u t 1. 2: Im p ro ve d in fa n t an d yo u n g c h ild n u tr it io n an d c ar e p ra ct ic es % o f n ew b o rn s in it ia ti n g b re as tf ee d in g w it h in o n e h o u r o f b ir th 55 N D H S 20 16 80 N D H S, N M IC S H ea lt h Pr o p o rt io n o f i n fa n ts 6 –8 m o n th s o f a g e re ce iv in g s o lid , s em i so lid o r s o ft fo o d s 73 .5 N M IC S 20 14 95 N D H S, N M IC S H ea lt h % o f c h ild re n a g ed 0 5 9 m o n th s w h o re ce iv ed m o re fr eq u en t fe ed in g (b re as t m ilk a n d ap p ro p ri at e fo o d ) d u ri n g e p is o d es o f d ia rr h o ea 29 N D H S 20 16 50 N D H S, N M IC S H ea lt h O u tp u t 1. 3: Im p ro ve d m at er n al , in fa n t an d y o u n g c h ild (M IY C ) m ic ro n u tr ie n t st at u s % o f c h ild re n a g ed 6 –5 9 m o n th s w h o re ce iv ed V it am in A c ap su le in la st s ix m o n th s 86 N D H S 20 16 95 N D H S, N M IC S H ea lt h % o f c h ild re n a g ed 1 2 59 m o n th s w h o re ce iv ed d ew o rm in g t ab le t in la st s ix m o n th s 83 N D H S 20 16 90 N D H S, N M IC S H ea lt h % o f p re g n an t an d la ct at in g w o m en w h o to o k 18 0 + IF A ta b le ts 42 N D H S 20 16 65 > 80 N D H S, N M IC S H ea lt h % o f p re g n an t w o m en w h o re ce iv ed d ew o rm in g t ab le ts 55 N D H S 20 16 80 N D H S H M IS H ea lt h M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 57 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 % o f s ch o o l a g e ch ild re n w h o re ce iv ed d ew o rm in g t ab le t in cr ea se d 65 H M IS 80 H M IS H ea lt h % o f h o u se h o ld s u si n g a d eq u at el y io d iz ed s al t 82 N M IC S 20 14 > 90 N D H S, N M IC S H ea lt h % o f a d o le sc en t g ir ls (1 0 19 y ea rs ) w h o re ce iv ed w ee kl y IF A t ab le t su p p le m en ts 5 50 H M IS H ea lt h % o f c h ild re n a g ed 6 2 3 m o n th s w h o re ce iv ed m ic ro n u tr ie n t p o w d er (M N P) 5 H M IS 20 H M IS H ea lt h % o f c h ild re n w h o re ce iv ed O RS an d z in c d u ri n g d ia rr h o ea 18 N M IC S 20 14 50 N D H S, N M IC S H ea lt h O u tp u t 1. 4: Im p ro ve d m an ag em en t o f se ve re a n d m o d er at e ac u te m al n u tr it io n N o. o f l o ca l g o ve rn m en ts w it h in te gr at ed m an ag em en t o f a cu te m al nu tr iti on (I M A M ) p ro g ra m m e 35 d is tr ic ts 52 0 lo ca l g o ve rn m en ts H M IS H ea lt h Pe rc en ta g e o f c h ild re n a g ed 6 5 9 m o n th s id en ti fie d w it h s ev er e ac u te m al n u tr it io n (S A M ) a g ai n st to ta l e st im at io n o f S A M N A > 90 N D H S H ea lt h % o f c h ild re n a g ed 6 5 9 m o n th s w it h a cu te m al n u tr it io n t re at ed am o n g id en ti fie d c as es 70 90 H M IS H ea lt h N o. o f l o ca l g o ve rn m en t b o d ie s w it h IM N C I p ro g ra m m e im p le m en te d 55 d is tr ic ts 75 3 lo ca l g o ve rn m en ts H M IS H ea lt h O u tp u t 1. 5: En h an ce d p re p ar ed n es s fo r n u tr it io n in em er g en cy re sp o n se s N o. o f l o ca l g o ve rn m en ts w it h n u tr it io n e m er g en cy p re p ar ed n es s an d re sp o n se o r co n ti n g en cy p la n 50 50 0 lo ca l g o ve rn m en ts C o n ti n g en cy p la n s an d p re p ar ed n es s p la n H ea lt h O u tp u t 1. 6: C ap ac it y b u ilt o f n u tr it io n s p ec ifi c se ct o rs N o. o f c ap ac it y d ev el o p m en t m ea su re s re co m m en d ed in th e ca p ac it y d ev el o p m en t p la n im p le m en te d b y n u tr it io n s p ec ifi c se ct o r N A > 90 H M IS H ea lt h M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 58 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 N U T R IT IO N S EN S IT IV E O U T P U T S O u tc o m e 2: Im p ro ve d a cc es s to a n d t h e eq u it ab le u se o f n u tr it io n s en si ti ve s er vi ce s an d im p ro ve d h ea lt h y h ab it s an d p ra ct ic es A g ri cu lt u re a n d li ve st o ck O u tp u t 2. 1: In cr ea se d a va ila b ili ty an d c o n su m p ti o n o f sa fe a n d n u tr it io u s fo o d s % o f p ro d u ct io n a n d p ro d u ct iv it y o f c ro p s an d li ve st o ck : 1. C er ea ls : a re a (1 ,0 00 h a) 33 06 34 05 33 71 33 03 32 70 31 88 A n n u al re p o rt o f M o A D A g ri cu lt u re 2. C er ea ls : p ro d u ct io n (1 ,0 00 to n n es ) 86 14 95 15 97 50 94 14 96 97 99 87 A g ri cu lt u re 3. P u ls es : a re a (1 ,0 00 h a) 34 2 34 9 35 3 35 6 36 0 36 3 A g ri cu lt u re 4. P u ls es : p ro d u ct io n (1 ,0 00 to n n es ) 31 6 32 9 33 5 34 2 34 9 35 6 A g ri cu lt u re 5. V eg et ab le s: a re a (1 ,0 00 h a) 28 0 31 5 32 8 34 1 35 4 36 9 A g ri cu lt u re 6. V eg et ab le s : p ro d uc tio n (1 ,0 00 to nn es ) 38 19 44 13 46 78 49 59 52 56 55 72 A g ri cu lt u re 7. P o ta to es : a re a (1 ,0 00 h a) 19 0 21 0 21 8 22 7 23 6 24 6 A g ri cu lt u re 8. P o ta to : p ro d u ct io n (1 ,0 00 to n n es ) 25 51 29 76 32 14 34 71 37 49 40 49 A g ri cu lt u re 9. F is h : p ro d u ct io n (1 ,0 00 to n n es ) 48 57 60 63 66 69 A g ri cu lt u re 10 . F ru it s: p ro d u ct io n (1 ,0 00 to n n es ) 99 2 (2 01 4) 11 81 12 52 13 27 14 07 14 92 A g ri cu lt u re Ye ar ro u n d ir ri g at io n (% ) 18 (2 01 0) 22 25 30 35 45 A D S an nu al re po rt s A g ri cu lt u re Pe r c ap it a fo od g ra in p ro d u ct io n (k g ) 34 1 (2 01 4) 38 1 39 1 40 1 41 1 42 2 SD G p ro gr es s re po rt A g ri cu lt u re D ec re as ed in ci d en ce o f s ub st an d ar d fo od in th e m ar ke t ( % ) 12 D FT Q C 11 10 9 8 7 A n n u al re p o rt o f D FT Q C A g ri cu lt u re an d L iv es to ck H o u se h o ld s w it h m in im u m d ie ta ry d iv er si ty (% ) 10 .5 A H SI II 20 14 /1 5 13 15 18 20 23 A n n u al h o u se h o ld su rv ey (C B S) A g ri cu lt u re an d L iv es to ck % o f p ro d u ct io n a n d p ro d u ct iv it y o f c ro p s an d li ve st o ck : M ilk (1 ,0 00 to n n es ) 1, 95 4 20 31 22 96 25 94 27 76 29 42 A n n u al re p o rt o f M o LD Li ve st o ck M ea t (1 ,0 00 to n n es ) 33 2 34 4 37 9 41 7 43 8 46 0 Li ve st o ck Eg g s (1 ,0 00 to n n es ) 13 5 13 5 14 5 15 7 16 8 17 8 Li ve st o ck M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 59 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 O u tp u t 2. 2: In cr ea se d p h ys ic al a n d ec o n o m ic a cc es s to d iv er se t yp es o f f o o d s Im p ro ve d a cc es s to u p d at ed ag ri cu lt u re m ar ke ti n g in fo rm at io n A B PM D D re p o rt Pu b lis h a g ri cu lt u re m ar ke ti n g in fo rm at io n b u lle ti n 1 1 1 1 1 1 A g ri cu lt u re U p d at e w eb si te a n d a p p re la te d to a g ri cu lt u re m ar ke ti n g in fo rm at io n s ys te m 1 1 1 1 1 1 A g ri cu lt u re H o u se h o ld s ra is in g li ve st o ck N A W at er , S u p p ly a n d S an it at io n O u tp u t 2. 3: In cr ea se d a cc es s to sa fe d ri n ki n g w at er % h o u se h o ld s u si n g im p ro ve d d ri n ki n g w at er fa ci lit ie s 93 .3 N M IP 2 01 7 95 98 10 0 10 0 10 0 N M IP D W SS W at er Su p p ly a n d Sa n it at io n % h o u se h o ld s w it h p ip ed w at er su p p ly in d w el lin g y ar d 26 N M IP 2 01 7 25 32 40 45 50 N M IP D W SS W at er Su p p ly a n d Sa n it at io n % h o u se h o ld s ad o p te d w at er tr ea tm en t o p ti o n 22 .4 N M IC S 20 14 30 52 .1 5 58 .1 64 .0 5 70 N M IC S W at er Su p p ly a n d Sa n it at io n % h o u se h o ld s w it h E sc h er ic h ia co li (E . c o li) r is k le ve l i n h o u se h o ld w at er o f ≥ 1 c o lo n y fo rm in g u n it (c fu )/ 10 0m l 82 .2 N M IP 2 01 7 60 50 30 20 10 N M IP D W SS W at er Su p p ly a n d Sa n it at io n O u tp u t 2. 4: In cr ea se d a cc es s to sa fe a n d s u st ai n ab le sa n it at io n s er vi ce s % h o u se h o ld s h av in g to ile ts (s an it at io n c o ve ra g e) 87 .2 7 N M IP D W SS 20 16 98 99 10 0 10 0 10 0 N M IP /D W SS W at er Su p p ly a n d Sa n it at io n % o f c h ild re n a g ed 0 –2 y ea rs w h o se la st s to o ls w er e d is p o se d o f s af el y (u se o f t o ile t, o r f ae ce s d is p o se d in to ile t) 48 N M IC S 20 14 52 56 62 66 70 N M IC S W at er Su p p ly a n d Sa n it at io n N u m b er o f d is tr ic ts d ec la re d o p en d ef ec at io n fr ee (O D F) 42 d is tr ic ts N M IP 2 01 7 65 77 (7 53 lo ca l go ve rn m en ts) 77 (7 53 lo ca l g o ve rn m en ts ) 77 (7 53 lo ca l g o ve rn m en ts ) 77 (7 53 lo ca l g o ve rn m en ts ) N M IP D W SS W at er Su p p ly a n d Sa n it at io n M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 60 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 O u tp u t 2. 5: Im p ro ve d k n o w le d g e o f c h ild re n , a n d m o th er s an d ca re ta ke rs o f u n d er 5 ye ar o ld s o n h ea lt h an d h yg ie n e % o f m o th er s an d c ar et ak er s o f u n d er 5 y ea r o ld c h ild re n (h o u se h o ld s) w it h k n o w le d g e o f h an d w as h in g b ef o re e at in g 92 .2 N M IC S 20 14 95 96 97 98 10 0 N M IC S W at er Su p p ly a n d Sa n it at io n % o f m o th er s an d c ar et ak er s o f u n d er 5 y ea r o ld c h ild re n (h o u se h o ld s) w it h k n o w le d g e o f h an d w as h in g b ef o re p re p ar in g fo o d 22 .2 N M IC S 20 14 30 40 50 60 70 N M IC S W at er Su p p ly a n d Sa n it at io n % o f m ot h er s an d c ar et ak er s of u n d er 5 y ea r ol d s (h ou se h ol d s) w it h k n ow le d g e of h an d w as h in g b ef or e b re as tf ee d in g o r f ee d in g b ab ie s 6 N M IC S 20 14 20 30 40 50 60 N M IC S W at er Su p p ly a n d Sa n it at io n % o f m o th er a n d c ar et ak er s o f u n d er 5 y ea r o ld s (h o u se h o ld s) w it h k n o w le d g e o f h an d w as h in g af te r d ef ec at io n a n d u ri n at in g 86 .6 N M IC S 20 14 88 90 93 96 99 N M IC S W at er Su p p ly a n d Sa n it at io n % o f m o th er s an d c ar et ak er s o f u n d er 5 y ea r o ld s (h o u se h o ld s) w it h k n o w le d g e o f h an d w as h in g af te r c le an in g c h ild re n’ s b o tt o m s 5. 5 N M IC S 20 14 15 20 50 70 90 N M IC S W at er Su p p ly a n d Sa n it at io n % o f m o th er s an d c ar et ak er s o f u n d er 5 y ea r o ld s (h o u se h o ld s) w it h k n o w le d g e o f h an d w as h in g af te r c le an in g to ile ts a n d p o tt ie s (a ft er m an ag in g w as te ) 7. 7 N M IC S 20 14 20 30 45 60 75 N M IC S W at er Su p p ly a n d Sa n it at io n % o f p eo p le w h o w as h ra w fo o d , ve g et ab le s, c o ve rs c o o ke d fo o d an d s u ffi ci en tl y h ea t st al e fo o d b ef o re e at in g N A So ci al P ro te ct io n O u tp u t 2. 6: Ta rg et ed g ro u p s h av e ac ce ss to re so u rc es an d o p p o rt u n it ie s th at m ak e th em s el f re lia n t N o. o f w o m en g ro u p c o o p er at iv es re ce iv ed g ra n ts a n d c re d it 41 1 88 90 10 0 11 0 12 0 A n n u al re p o rt o f D ep t o f W o m en an d C h ild re n (D W C ) W o m en , C h ild re n a n d So ci al W el fa re N o. o f c o m m u n it y le ve l a w ar en es s p ro g ra m m es h el d o n re d u ci n g ch ild m ar ri ag e 90 0 1, 00 0 1, 05 0 11 25 1, 20 0 A n n u al re p o rt o f D W C W o m en , C h ild re n a n d So ci al W el fa re N o. o f w o m en g ro u p , c o m m it te e, co o p er at iv e m em b er s w it h es ta b lis h ed s el f en tr ep re n eu rs h ip (s ta rt u p g ra n ts ) 49 ,3 85 15 ,0 00 12 ,0 00 10 ,0 00 15 ,0 00 17 ,0 00 A n n u al ec o n o m ic su rv ey W o m en , C h ild re n a n d So ci al W el fa re M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 61 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 N o. o f l o ca l g o ve rn m en ts p ro vi d in g c h ild g ra n ts to c h ild re n u n d er 5 y ea rs o ld 20 3 20 3 29 9 32 3 34 7 37 2 R ep o rt o f D ep t o f C iv il R eg is tr at io n (D o C R) Lo ca l G o ve rn an ce se ct o r M at er n al H ea lt h a n d W o m en E m p o w er m en t O u tp u t 2. 7: N u tr it io n c o m p o n en t in co rp o ra te d in w o m en , a d o le sc en t g ir ls a n d c h ild d ev el o p m en t tr ai n in g p ac ka g es N o. o f t ra in in g p ac ka g es w it h h ea lt h a n d n u tr it io n m o d u le in te g ra te d 2 3 2 1 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re O u tp u t 2: 8: W o m en , c h ild re n an d o u t o f s ch o o l ad o le sc en t g ir ls re ac h ed w it h h ea lt h an d n u tr it io n c ar e p ra ct ic es N o. o f o u t o f sc h o o l a d o le sc en t g ir ls re ac h ed w it h h ea lt h an d n u tr it io n c ar e p ra ct ic es in fo rm at io n t h ro u g h li fe s ki lls tr ai n in g N A 3, 70 0 3, 75 0 3, 80 0 3, 82 5 3, 90 0 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re N o. o f w o m en g ro u p , c o m m it te e, co o p er at iv e m em b er s re ac h ed w it h h ea lt h a n d n u tr it io n c ar e in fo rm at io n t h ro u g h w o m en so ci al a n d e co n o m ic d ev el o p m en t tr ai n in g N A 15 ,0 00 12 ,0 00 10 ,0 00 15 ,0 00 17 ,0 00 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re O u tp u t 2. 9: C h ild c ar e h o m es co m p ly w it h m in im u m st an d ar d s o f n u tr it io n ca re N o. o f c h ild c ar e h o m es t h at co m p ly w it h m in im u m n u tr it io n ca re s er vi ce s 10 3 47 25 30 35 40 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re O u tp u t 2. 10 : C o m m u n it ie s em p o w er ed to p re ve n t h ar m fu l p ra ct ic es N o. o f c o m m u n it ie s an d ru ra l m u n ic ip al it ie s d ec la re d ch h au p ad i f re e 15 V D C s (d ec la re d a s m en st ru al se cl u si o n s h ed [c hh au pa di go th ] f re e) 6 7 8 9 10 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 62 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 Ea rl y C h ild h o o d D ev el o p m en t an d C la ss ro o m E d u ca ti o n O u tp u t 2. 11 : En h an ce d e n ro lm en t o f c h ild re n in b as ic ed u ca ti o n N u m b er o f c h ild re n in b as ic ed u ca ti o n re ce iv in g m id d ay m ea ls 61 2, 00 0 st u d en t 61 2, 00 0 61 2, 00 0 61 2, 00 0 61 2, 00 0 61 2, 00 0 EM IS Ed u ca ti o n O u tp u t 2. 12 : In cr ea se d a d o le sc en t g ir ls ’ a w ar en es s an d im p ro ve d b eh av io u r o n n u tr it io n N u m b er o f s ch o o ls u si n g n u tr it io n s en si ti ve li te ra cy m at er ia ls A n n u al re p o rt o f D ep ar tm en t o f Ed u ca ti o n (D o E) Ed u ca ti o n H ea lt h a n d F am ily P la n n in g S er vi ce s O u tp u t 2. 13 : En h an ce d a cc es s to h ea lt h a n d re p ro d u ct iv e h ea lt h se rv ic es Pr o p o rt io n o f w o m en (1 5 49 ye ar s) u si n g a n y co n tr ac ep ti ve m et h o d 53 N D H S 20 16 60 N D H S H ea lt h % o f c h ild re n re ce iv in g c o m p le te im m u n iz at io n w it h in o n e ye ar 78 N D H S 20 16 ≥ 9 0 N D H S, N M IC S H ea lt h En ab lin g e n vi ro n m en t o u tp u ts O u tc o m e 3: I m p ro ve d p o lic ie s, p la n s an d m u lt i se ct o ra l co o rd in at io n a t fe d er al , p ro vi n ci al a n d l o ca l g o ve rn m en t le ve ls t o e n h an ce t h e n u tr it io n s ta tu s o f al l p o p u la ti o n g ro u p s O u tp u t 3. 1: M SN P II in cl u d ed in lo ca l, p ro vi n ci al a n d fe d er al g o ve rn m en t p o lic ie s an d p la n s N o. o f s ec to ra l m in is tr ie s’ p la n s th at in cl u d e n u tr it io n a n d fo o d se cu ri ty in li n e w it h M SN P II 7 7 7 7 7 7 A W PB o f Se ct o ra l M in is tr ie s N PC , S ec to ra l M in is tr ie s N o. o f p ro vi n ci al g o ve rn m en t’s p la n s in cl u d in g n u tr it io n a n d fo o d se cu ri ty in li n e w it h M SN P II N o t ap p lic ab le 7 7 7 7 7 A W PB o f p ro vi n ce g o ve rn m en t N PC , S ec to ra l M in is tr ie s N o. o f l o ca l g o ve rn m en ts in co rp o ra te d n u tr it io n re la te d ta rg et s an d in d ic at o rs in t h ei r p la n s an d p ro g ra m m es 30 d is tr ic ts (s el ec te d w ar d s o f 19 4 lo ca l g o ve rn m en ts ) 30 8 (3 0 d is tr ic ts ) 30 8 (3 0 d is tr ic ts ) 33 2 (3 3 d is tr ic ts 35 6 (3 7 d is tr ic ts ) 38 1 (3 9 d is tr ic ts ) A W PB s o f l o ca l g o ve rn m en ts Lo ca l G o ve rn an ce N o. o f p ro vi n ce s w it h M SN P II in st it u ti o n al a rr an g em en t se t u p an d fu n ct io n al N o t ap p lic ab le 5 6 7 7 7 M ee ti n g m in u te s Lo ca l G o ve rn an ce N o. o f p ro vi n ce s al lo ca te d re so u rc es a s re q u ir ed fo r M SN P II N o t ap p lic ab le 7 7 7 7 7 A n n u al b u d g et s an d p la n s at p ro vi n ce Lo ca l G o ve rn an ce N o. o f l o ca l g o ve rn m en ts al lo ca te d re so u rc es a s re q u ir ed fo r M SN P II N o t ap p lic ab le 30 8 30 8 33 2 35 6 38 1 A n n u al b u d g et s an d p la n s o f l o ca l g o ve rn m en ts Lo ca l G o ve rn an ce M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 63 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 O u tp u t 3. 2: M SN P g o ve rn an ce m ec h an is m in st it u te d an d s tr en g th en ed a t fe d er al , p ro vi n ci al , a n d lo ca l l ev el s N o. o f m ee ti n g s o f H ig h L ev el N u tr it io n a n d F o o d S ec u ri ty St ee ri n g C o m m it te e co n d u ct ed a ye ar a t fe d er al le ve l 1 2 2 2 2 2 M ee ti n g m in u te s N PC N o. o f q u ar te rl y N u tr it io n a n d Fo o d S ec u ri ty C o o rd in at io n C o m m it te e m ee ti n g s co n d u ct ed at fe d er al le ve l 1 4 4 4 4 4 M ee ti n g m in u te s N PC N u tr it io n a n d fo o d s ec u ri ty st ee ri n g c o m m it te es fo rm ed a t p ro vi n ce le ve l N o t ap p lic ab le 7 M ee ti n g m in u te s N PC , L o ca l g o ve rn an ce N o. p ro vi n ce s h o ld in g n u tr it io n an d fo o d s ec u ri ty s te er in g co m m it te e m ee ti n g s tw ic e a ye ar N o t ap p lic ab le 7 7 7 7 7 M ee ti n g m in u te s N PC , L o ca l g o ve rn an ce N o. p ro vi n ce s fo rm in g n u tr it io n an d fo o d s ec u ri ty c o o rd in at io n co m m it te es N o t ap p lic ab le 7 M ee ti n g m in u te s N PC , L o ca l g o ve rn an ce N o. o f p ro vi n ce s co n d u ct ed n u tr it io n a n d fo o d s ec u ri ty co o rd in at io n c o m m it te e m ee ti n g s q u ar te rl y N o t ap p lic ab le 7 7 7 7 7 M ee ti n g m in u te s N PC , L o ca l g o ve rn an ce M SN P II fo ca l p o in t/ u n it id en ti fie d in a ll re le va n t se ct o rs a t p ro vi n ce le ve l N o t ap p lic ab le 7 7 7 7 7 D ec is io n le tt er fo r M SN P fo ca l p o in t/ u n it Lo ca l G o ve rn an ce N o. o f l o ca l u n it s (d is tr ic ts a n d lo ca l g o ve rn m en ts ) w it h M SN P in st it u ti o n al a rr an g em en ts 30 d is tr ic ts (3 08 lo ca l g o ve rn m en ts ) 30 8 lo ca l g o ve rn m en ts (3 0 d is tr ic ts ) 30 8 (3 0 d is tr ic ts 33 2 (3 3 d is tr ic ts ) 35 6 (3 7 d is tr ic ts ) 38 1 (3 9 d is tr ic ts ) M ee ti n g m in u te s Lo ca l G o ve rn an ce N o. o f l o ca l g o ve rn m en ts co n d u ct ed n u tr it io n a n d fo o d se cu ri ty s te er in g c o m m it te e m ee ti n g a t le as t tw ic e a ye ar 30 d is tr ic ts (3 08 lo ca l g o ve rn m en ts ) 30 8 (3 0 d is tr ic ts ) 30 8 (3 0 di st ric ts ) 33 2 (3 3 d is tr ic ts ) 35 6 (3 7 d is tr ic ts ) 38 1 (3 9 d is tr ic ts ) 30 d is tr ic ts (3 08 lo ca l g o ve rn m en ts ) Lo ca l G o ve rn an ce N o. o f l o ca l g o ve rn m en ts a ss ig n ed a co o rd in at o r ( fr o m e xi st in g s ta ff o r o u ts o u rc ed ) t o o ve rs ee M SN P II in te rv en ti o n s 30 d is tr ic ts (3 08 lo ca l g o ve rn m en ts ) 30 8 (3 0 d is tr ic ts ) 30 8 (3 0 d is tr ic ts ) 33 2 (3 3 d is tr ic ts ) 35 6 (3 7 d is tr ic ts ) 38 1 (3 9 d is tr ic ts ) Le tt er s Lo ca l G o ve rn an ce N o. o f w ar d s w it h w ar d le ve l n u tr it io n a n d fo o d s ec u ri ty st ee ri n g c o m m it te es 2, 74 9 2, 74 9 27 49 2, 94 1 3, 13 3 3, 51 4 M ee ti n g m in u te s Lo ca l G o ve rn m en t M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 64 R es u lt s In d ic at o rs B as el in e Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o r 20 18 20 19 20 20 20 21 20 22 N o. w ar d s co nd uc te d w ar d le ve l nu tr iti on a nd fo od s ec ur ity s te er in g co m m itt ee a t l ea st tw ic e a ye ar 2, 74 9 2, 74 9 2, 74 9 2, 94 1 3, 13 3 3, 51 4 M ee ti n g m in u te s Lo ca l G o ve rn m en t O u tp u t 3. 3: M SN P in st it u ti o n al m ec h an is m s fu n ct io n al a t fe d er al g o ve rn m en t le ve l N at io n al N u tr it io n a n d F o o d Se cu ri ty S ec re ta ri at (N N FS S) in st it u ti o n al iz ed a n d fu n ct io n al at N PC 1 1 1 1 1 1 F N PC O rg an iz at io n a n d m an ag em en t su rv ey fo r N N FS S co m p le te d a n d ap p ro ve d b y N PC B o ar d 0 1 N PC o rg an o g ra m N PC N u m b er o f s an ct io n ed s ta ff p o si ti o n s fil le d a t N N FS S 1 (F u lfi lle d fr o m e xt er n al so u rc es ) 1 C o n tr ac t le tt er s N PC O u tp u t 3. 4: Fu n ct io n al u p d at ed in fo rm at io n s ys te m ac ro ss a ll M SN P II se ct o rs M SN P II M & E fr am ew o rk d ev el o p ed o r u p d at ed fo r a ll se ct o rs a n d im p le m en te d a t fe d er al , p ro vi n ci al a n d lo ca l l ev el s 1 1 1 1 1 1 M & E fr am ew o rk fo r M SN P II N PC , s ec to rs , Lo ca l G o ve rn an ce W eb b as ed re p o rt in g s ys te m lin ke d w it h M SN P II M & E p la n a t al l l ev el s 7 se ct o rs 7 7 7 7 7 N PC ’s w eb b as ed s ys te m N PC & s ec to rs N N FS S p o rt al u p d at ed e ac h q u ar te r 4 4 4 4 4 4 N N FS S p o rt al N PC N o. o f s ec to ra l r ep o rt s u p d at ed o n N N FS S p o rt al a s p er M & E p la n ea ch q u ar te r 0 4 4 4 4 4 N N FS S p o rt al N PC , a ll se ct o rs O u tp u t 3. 5: En h an ce d c ap ac it y o f fe d er al , p ro vi n ci al a n d lo ca l l ev el g o ve rn m en t to p la n a n d im p le m en t n u tr it io n p ro g ra m m es N at io n al C ap ac it y D ev el o p m en t M as te r P la n fo r i m p le m en ta ti o n o f M SN P II d ev el o p ed 0 1 1 1 1 1 C ap ac it y d ev el o p m en t p la n N PC , a ll se ct o rs M SN P II C ap ac it y D ev el o p m en t M as te r P la n im p le m en te d a t fe d er al le ve l 0 1 1 1 1 1 Se ct o ra l t ra in in g re p o rt s N PC , a ll se ct o rs M SN P II C ap ac it y D ev el o p m en t M as te r P la n im p le m en te d a t p ro vi n ci al le ve l 0 7 7 7 7 7 Se ct o ra l t ra in in g re p o rt s N PC , a ll se ct o rs M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 65 K ey a ct iv iti es K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 O U TP U T 1 N u tr it io n s en si ti ve a ct iv it ie s O u tp u t 1. 1: E n h an ce d n u tr it io n s ta tu s o f W R A in cl u d in g a d o le sc en ts 1. 1. 1 O rg an iz e an d im p le m en t fu lly n o u ri sh ed vi lla g es /w ar d s in cl u d in g G o ld en 1 00 0 D ay s co m m u n ic at io n c am p ai g n V ill ag e N A 30 0 vi lla g es A n n u al re p o rt s o f D o H S H ea lt h 1. 1. 2 R ev it al iz e Sc h o o l H ea lt h a n d N u tr it io n Pr o g ra m m e in cl u d in g p ro m o ti o n o f h ea lt h y d ie ta ry h ab it s an d p h ys ic al a ct iv it y Lo ca l g o ve rn m en ts 77 d is tr ic ts 35 0 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 1. 3 R ai se a w ar en es s an d s er vi ce s fo r h ea lt h y ti m in g a n d s p ac in g o f p re g n an cy . Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 1. 4 C o n d u ct b ar ri er a n al ys is fo r i n cr ea si n g A N C s er vi ce u ti liz at io n Pr o vi n ce N A 7 (1 in e ac h p ro vi n ce ) A n n u al re p o rt s o f D o H S H ea lt h 1. 1. 5 In te g ra te a n d e xp an d a d o le sc en t fr ie n d ly h ea lt h a n d n u tr it io n s er vi ce s Lo ca l g o ve rn m en ts N A 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h O u tp u t 1. 2: Im p ro ve d m at er n al , i n fa n t an d y o u n g c h ild n u tr it io n a n d c ar e p ra ct ic es 1. 2. 1 C o n d u ct m at er n al , i n fa n t an d y o u n g ch ild n u tr it io n (M IY C N ) c o u n se lli n g o n a ll h ea lt h s ec to r p la tf o rm s vi z. h ea lt h m o th er ’s g ro u p m ee ti n g s, im m u n iz at io n , A N C , P N C , g ro w th m o n it o ri n g (G M P) , P H C O R C , I M N C I an d O PD Lo ca l g o ve rn m en ts N A 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 2. 2 C o n d u ct re g u la r g ro w th m o n it o ri n g co u n se lli n g a t PH C O R C s an d h ea lt h fa ci lit ie s Lo ca l g o ve rn m en ts N A 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt o f D o H S H ea lt h 1. 2. 3 D is se m in at e IE C a n d B C C m at er ia ls in lin e w it h F o o d B as ed D ie ta ry G u id el in es th ro u g h h ea lt h fa ci lit ie s, F C H Vs to co m m u n it ie s an d h o u se h o ld s re g u la rl y. Lo ca l g o ve rn m en ts N A 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt o f D o H S H ea lt h 1. 2. 4 C o n d u ct fo o d p re p ar at io n a n d c o o ki n g d em o n st ra ti o n s to p re p ar e lo ca l n u tr it io u s fo o d s (e .g . n u tr it io u s flo u r/ p o rr id g e (li to ), ja u lo a n d k h ic h ad i u si n g lo ca l f o o d st u ff s Lo ca l g o ve rn m en ts N A 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt o f D o H S H ea lt h M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 66 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 1. 2. 5 En g ag e m ed ia fo r d o cu m en ta ti o n a n d d is se m in at io n o f M IY C N p ro g ra m m e Ev en t N A 7 (1 in a ll 7) A n n u al re p o rt o f D o H S H ea lt h 1. 2. 6 R ai se a w ar en es s o n n u tr it io n in cl u d in g es se n ti al n ew b o rn c ar e Lo ca l g o ve rn m en ts N A 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt o f D o H S H ea lt h O u tp u t 1. 3: Im p ro ve d M IY C m ic ro n u tr ie n t st at u s 1. 3. 1 M ai n ta in a n d s u st ai n ro u ti n e d is tr ib u ti o n o f V it am in A c ap su le s an d d ew o rm in g t ab le ts to c h ild re n u n d er 5 Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt o f D o H S H ea lt h 1. 3. 2 In cr ea se c o ve ra g e an d c o m p lia n ce o f i ro n fo lic a ci d a n d d ew o rm in g a m o n g p re g n an t an d p o st p ar tu m w o m en Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt o f D o H S H ea lt h 1. 3. 3 Sc al e u p h o m e fo o d fo rt ifi ca ti o n w it h m u lt ip le m ic ro n u tr ie n t p o w d er (M N P) in ta rg et ed a re as Lo ca l g o ve rn m en ts 30 d is tr ic ts 34 d is tr ic ts 45 d is tr ic ts 55 d is tr ic ts 75 3 lo ca l g o ve rn m en ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 3. 4 R ai se a w ar en es s to p ro m o te h o u se h o ld u se o f t w o c h ild l o g o io d iz ed s al t Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 3. 5 R ai se a w ar en es s to p ro m o te c o n su m p ti o n o f n at io n al ro lle r m ill fo rt ifi ed fl o u r a n d r ic e Lo ca l g o ve rn m en ts N A 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h a n d ag ri cu lt u re 1. 3. 6 In it ia te r ic e fo rt ifi ca ti o n in g o ve rn m en t (N FC ) a n d s el ec te d b ig r ic e p ro d u ci n g m ill s R o lle r m ill s N A 1 2 2 2 A n n u al re p o rt s o f D FT Q C A g ri cu lt u re , h ea lt h , su p p lie s 1. 3. 7 C o n d u ct re se ar ch to im p ro ve u se o f i ro n fo lic a ci d (I FA ) s u p p le m en ta ti o n Pr o vi n ce 7 A n n u al re p o rt s 1. 3. 8 C o n d u ct b ar ri er a n al ys is o n lo w c o ve ra g e/ co m p lia n ce o f M N P Ev en t p er p ro vi n ce N A 7 (1 in a ll 7 p ro vi n ce ) A n n u al re p o rt s o f D o H S H ea lt h 1. 3. 9 Pr o cu re a n d s u p p ly n u tr it io n c o m m o d it ie s fo r r eg u la r a n d e m er g en cy p ro g ra m s (V A C , I FA , d ew o rm in g t ab le ts , M N Ps , R U TF , t h er ap eu ti c m ilk , R eS o M al ) Pe rc en ta g e 10 0 10 0 A n n u al re p o rt s o f D o H S H ea lt h M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 67 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 1. 3. 10 S ca le u p fo rt ifi ed s u p er c er ea l fl o u r d is tr ib u ti o n in s el ec te d d is tr ic ts w it h h ig h p re va le n ce o f a cu te m al n u tr it io n to p re g n an t an d la ct at in g w o m en a n d 6 2 3 m o n th s ch ild re n u n d er M C H N p ro g ra m m e D is tr ic ts 6 6 6 8 9 9 A n n u al re p o rt s o f D o H S H ea lt h O u tp u t 1. 4: Im p ro ve d m an ag em en t o f s ev er e an d m o d er at e ac u te m al n u tr it io n 1. 4. 1 Ex p an d a n d e st ab lis h O TC a n d IT C c en tr es fo r m an ag em en t o f s ev er e ac u te m al n u tr it io n in c h ild re n u n d er 5 y ea rs Lo ca l g o ve rn m en ts 32 d is tr ic ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 4. 2 Sc al e u p n u tr it io n re h ab ili ta ti o n h o m es (N RH ) i n 5 0+ b ed h o sp it al s Lo ca l g o ve rn m en ts 43 h o sp it al s 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 4. 3 C o n d u ct p er io d ic n u tr it io n a ss es sm en ts an d c o u n se lli n g a t co m m u n it y le ve l Lo ca l g o ve rn m en ts N A 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 4. 4 C o n d u ct b ar ri er a n al ys is o n s er vi ce s re la te d to S A M m an ag em en t Pr o vi n ce N A 7 p ro vi n ce A n n u al re p o rt s o f D o H S H ea lt h 1. 4. 5 Sc al e u p a n d s tr en g th en IM N C I p ro g ra m m e Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h 1. 4. 6 Es ta b lis h a n d s tr en g th en n u tr it io n in fo rm at io n a n d s u rv ei lla n ce s ys te m in n o rm al an d h u m an it ar ia n s it u at io n s Pr o vi n ce 2 d is tr ic ts 7 p ro vi n ce s A n n u al re p o rt s o f D o H S H ea lt h O u tp u t 1. 5: E n h an ce d p re p ar ed n es s fo r n u tr it io n in e m er g en cy r es p o n se s 1. 5. 1 Es ta b lis h lo ca l n u tr it io n c lu st er s an d co n d u ct q u ar te rl y co o rd in at io n m ee ti n g a t lo ca l l ev el s Pr o vi n ce 77 d is tr ic ts 7 p ro vi n ce s A n n u al re p o rt s o f D o H S H ea lt h 1. 5. 2 U p d at e an d d ev el o p n u tr it io n in em er g en cy p re p ar ed n es s fo r r es p o n se a n d co n ti n g en cy p la n n in g a t lo ca l l ev el s Pr o vi n ce s an d lo ca l g o ve rn m en ts 77 d is tr ic ts 7 p ro vi n ce s an d 3 72 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h O u tp u t 1. 6: B u ilt c ap ac it y o f n u tr it io n s p ec ifi c se ct o r 1. 6. 1 C o n d u ct re fr es h er t ra in in g to h ea lt h w o rk er s an d F C H Vs a t al l l ev el s o n M IY C N p ac ka g e Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 A n n u al re p o rt s o f D o H S H ea lt h 1. 6. 2 O rg an iz e b as ic t ra in in g o n M IY C N p ac ka g e to n ew ly re cr u it ed n u tr it io n s u p er vi so rs a n d n u tr it io n o ffi ce rs Lo ca l g o ve rn m en ts N A 75 3 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 68 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 1. 6. 3 O rg an iz e n u tr it io n c h am p io n le ad er sh ip d ev el o p m en t ev en ts Pr o vi n ce N A 7 p ro vi n ce s A n n u al re p o rt s o f D o H S H ea lt h 1. 6. 4 C o n d u ct ro u ti n e d at a q u al it y as se ss m en t (R D Q A ) u si n g n u tr it io n p ro g ra m m e re la te d H M IS to o ls Lo ca l g o ve rn m en ts N A 37 2 lo ca l g o ve rn m en ts A n n u al re p o rt s o f D o H S H ea lt h K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 O U TP U T 2 A g ri cu lt u re a n d L iv es to ck O u tp u t 2. 1: In cr ea se d a va ila b ili ty a n d c o n su m p ti o n o f s af e an d n u tr it io u s fo o d 2. 1. 1 M ak e av ai la b le a g ri cu lt u re a n d li ve st o ck in p u ts (i .e . s ee d s, fe rt ili ze rs , b re ed s) a t h o u se h o ld a n d c o m m u n it y le ve ls Im p ro ve d s ee d s (in cr ea se b y 10 % ) ( in 1 ,0 00 to n n es ) 1, 00 0 to n n es 9, 54 0 (2 01 4) 12 ,6 98 13 ,9 68 15 ,3 64 16 ,9 01 18 ,5 91 M o A D ’s an n u al re p o rt s A g ri cu lt u re Fe rt ili ze rs (i n cr ea se u se b y 5% a n n u al ly ) ( in 1, 00 0 to n n es ) 1, 00 0 to n n es 29 8, 67 7 (2 01 4) 34 5, 75 6 36 3, 04 4 38 1, 19 6 40 0, 25 6 42 0, 26 9 M o A D ’s an n u al re p o rt s A g ri cu lt u re B re ed s (n o. o f a rt ifi ci al in se m in at io n s) B re ed s 45 0, 00 0 50 0, 00 0 52 5, 00 0 55 0, 00 0 60 0, 00 0 65 0, 00 0 M o A D ’s an n u al re p o rt s Li ve st o ck 2. 1. 2 Pr o vi d e te ch n ic al s u p p o rt (t ra in in g , d em o n st ra ti o n ) t o p ro m o te p ro d u ct io n o f f ru it s, ve g et ab le s, n u tr it io u s ro o ts , c er ea ls a n d p u ls es to in cr ea se c o n su m p ti o n o f d iv er si fie d fo o d s in h o u se h o ld s A g ri cu lt u re C er ea ls (1 ,0 00 to n n es ) 1, 00 0 to n n es 8, 61 4 (2 01 4) 9, 51 5 9, 70 5 9, 41 4 9, 69 7 9, 98 7 M o A D ’s an n u al re p o rt s Pu ls es (1 ,0 00 to n n es ) 1, 00 0 to n n es 31 6 (2 01 4) 32 9 33 5 34 2 34 9 35 6 Fr u it s (1 ,0 00 to n n es ) 1, 00 0 to n n es 99 2 (2 01 4) 11 81 1, 25 2 1, 32 7 1, 40 7 1, 49 2 Ve g et ab le s (1 ,0 00 to n n es ) 1, 00 0 to n n es 3, 81 9 (2 01 4) 44 13 4, 67 8 4, 95 9 5, 25 6 5, 57 2 Po ta to (1 ,0 00 to n n es ) 1, 00 0 to n n es 19 0 21 0 21 8 22 7 23 6 24 6 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 69 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 2. 1. 3 In cr ea se p ro d u ct io n a n d p ro m o te co n su m p ti o n o f f re sh fr u it s an d g re en le af y ve g et ab le s R ef er to c . an d d . o f ac ti vi ty 2 .1 .2 M o A D ’s an n u al re p o rt s A g ri cu lt u re 2. 1. 4 B u ild c ap ac it y o f l iv es to ck fa rm er s an d en tr ep re n eu rs to in cr ea se m ilk , m ea t an d e g g p ro d u ct io n Pe rs o n 13 ,0 00 15 ,0 00 17 ,0 00 19 ,0 00 22 ,0 00 25 ,0 00 A n n u al re p o rt s o f M o LD Li ve st o ck 2. 1. 5 Te ch n ic al s u p p o rt fo r m ic ro a n d a lt er n at iv e sm al l i rr ig at io n to p ro d u ce d iv er si fie d a n d m ic ro n u tr ie n t ri ch fo o d s % o f c ro p la n d in y ea r r o u n d ir ri g at io n 18 (2 01 0) 22 25 30 35 45 A D S A g ri cu lt u re 2. 1. 6 Su p p o rt fo o d p ro d u ci n g in d u st ri es to ad o p t g o o d m an u fa ct u ri n g p ra ct ic es a n d re la te d s ys te m s In d u st ry N A 10 10 10 10 10 R ep o rt s o f D FT Q C A g ri cu lt u re a n d Li ve st o ck 2. 1. 7 Tr ai n a g ri cu lt u re a n d li ve st o ck e xt en si o n o ffi ce rs a n d s ta ff o n fo o d s af et y, fo o d p ro ce ss in g an d n u tr it io n Ev en t N A 10 0 10 0 10 0 10 0 10 0 R ep o rt s o f D FT Q C A g ri cu lt u re a n d Li ve st o ck 2. 1. 8 Tr ai n fa rm er s o n fo o d s af et y, fo o d p ro ce ss in g a n d n u tr it io n Pe rs o n N A 1, 00 0 1, 00 0 1, 00 0 1, 00 0 1, 00 0 R ep o rt s o f D o A & D o LS A g ri cu lt u re a n d Li ve st o ck .9 S tu d y an d im p ro ve lo ca l f o o d re ci p es Ev en t N A 5 5 5 5 5 R ep o rt s o f D FT Q C A g ri cu lt u re a n d Li ve st o ck 2. 1. 10 U p d at e an d d is se m in at e fo o d co m p o si ti o n t ab le s a) A n al ys e fo o d s am p le s b ) D at a co m p ila ti o n a n d p u b lic at io n o f u p d at ed fo o d c o m p o si ti o n t ab le Pi ec e Ex is ti n g 30 0 30 0 30 0 30 0 30 0 R ep o rt s o f D FT Q C A g ri cu lt u re a n d Li ve st o ck 2. 1. 11 D is se m in at e fo o d b as ed d ie ta ry g u id el in es to lo ca l g o ve rn m en ts Pi ec e N A 30 0 30 0 30 0 30 0 30 0 R ep o rt s o f D FT Q C A g ri cu lt u re a n d Li ve st o ck 2. 1. 12 D ev el o p a n d m u lt ip ly B C C m at er ia ls in cl u d in g a u d io v is u al s o n fo o d s af et y, fo o d p ro ce ss in g a n d n u tr it io n Pi ec e N A 5 5 5 5 5 R ep o rt s o f D FT Q C A g ri cu lt u re a n d Li ve st o ck O u tp u t 2. 2: In cr ea se d p h ys ic al a n d e co n o m ic a cc es s to d iv er si fi ed fo o d 2. 2. 1 En h an ce a cc es s an d u ti liz at io n o f a n im al so u rc e fo o d s a) O p en m ar ke t es ta b lis h m en ts N o. o f m ar ke ts 3 5 6 7 7 7 A n n u al re p o rt s o f M o LD Li ve st o ck b ) C h ill in g v at d is tr ib u ti o n N u m b er 20 40 60 70 10 0 11 0 c) A w ar en es s p ro g ra m m es to u se s af e an im al p ro d u ct s (e ve n ts ) Ev en t 20 40 50 70 90 12 0 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 70 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 2. 2. 2 Pr o m o te a n d s u p p o rt p ro d u ct io n a n d co n su m p ti o n o f fi sh in cl u d in g s u p p o rt to es ta b lis h c o m m u n it y p o n d s fo r p ro d u ct io n a n d lo ca l c o n su m p ti o n 1, 00 0 to n n es 48 57 60 63 66 69 A n n u al re p o rt s o f M o A D A g ri cu lt u re W at er S u p p ly a n d S an it at io n O u tp u t 2. 3: In cr ea se d a cc es s to s af e d ri n ki n g w at er 2. 3. 1 C o n st ru ct a n d re p ai r w at er s u p p ly s ch em es in c o m m u n it ie s an d in st it u ti o n s th ro u g h w at er sa fe ty p la n s an d p ro je ct s Pe rc en ta g e 6 10 0 D W SS W at er S u p p ly an d S an it at io n 2. 3. 1 Pr o m o te a lt er n at iv e an d in n o va ti ve te ch n o lo g ie s fo r s u p p ly w at er Pe rc en ta g e 0. 4 2. 5 N M IP D W SS W at er S u p p ly an d S an it at io n 2. 3. 3 Pr o m o te h o u se h o ld w at er t re at m en t o p ti o n s Pe rc en ta g e N A 25 N M IP D W SS W at er S u p p ly an d S an it at io n O u tp u t 2. 4: In cr ea se d a cc es s to s af e an d s u st ai n ab le s an it at io n s er vi ce s 2. 4. 1 R ai se c o m m u n it y aw ar en es s o n co n st ru ct io n , m ai n te n an ce a n d h yg ie n ic u se o f i m p ro ve d h o u se h o ld to ile ts in cl u d in g s af e d is p o sa l o f c h ild fa ec es Pe rc en ta g e N A 10 0 N M IP D W SS W at er S u p p ly an d S an it at io n 2. 4. 2 Su p p o rt a n d s tr en g th en W A SH co o rd in at io n c o m m it te es a n d lo ca l g o ve rn m en t to a cc el er at e O D F ca m p ai g n s. Pe rc en ta g e 10 0 N M IP D W SS W at er S u p p ly an d S an it at io n 2. 4. 3 Su p p o rt c o n st ru ct io n a n d m an ag em en t o f c h ild , g en d er a n d d iff er en tl y ab le d fr ie n d ly to ile ts in cl u d in g m en st ru al h yg ie n e m an ag em en t fa ci lit ie s at in st it u ti o n s Pe rc en ta g e N A 20 35 W A SH S ec to r D ev el o p m en t Pl an W at er S u p p ly an d S an it at io n 22 .4 .4 S af e an d h yg en ic fo o d s af et y p ra ct ic es su ch a s co ve ri n g s to n e m ix tu re , d ry in g u te n si ls e tc Pe rc en ta g e N A 20 35 W A SH S ec to r D ev el o p m en t Pl an W at er S u p p ly an d S an it at io n O u tp u t 2. 5: P ro m o te d h yg ie n e b eh av io u r p ra ct ic es a n d it s m an ag em en t 2. 5. 1 C o n st ru ct , e st ab lis h a n d p ro m o te u se r fr ie n d ly h an d w as h in g fa ci lit ie s in h o u se h o ld s an d in st it u ti o n s Pe rc en ta g e N A 10 0 D W SS W at er S u p p ly an d S an it at io n 2. 5. 2 R ai se a w ar en es s o n h an d w as h in g a t cr it ic al t im es in c o m m u n it ie s, s ch o o l c h ild re n an d h ea lt h w o rk er s N A D at a fr o m D o E an d D o H S W at er S u p p ly an d S an it at io n 2. 5. 3 R ai se a w ar en es s o n m en st ru al h yg ie n e m an ag em en t in c o m m u n it ie s an d s ch o o ls Pe rc en ta g e N A 10 0 D W SS W at er S u p p ly an d S an it at io n 2. 5. 4 R ai se a w ar en es s ab o u t fo o d h yg ie n e in co m m u n it ie s N A D W SS W at er S u p p ly an d S an it at io n M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 71 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 So ci al P ro te ct io n O u tp u t 2. 6: T ar g et ed g ro u p s h av e ac ce ss t o r es o u rc es a n d o p p o rt u n it ie s th at a re e ss en ti al fo r m ak in g t h em s el f re lia n t. 2. 6. 1 Su p p o rt c o m m u n it y se ed b an ks Se ed b an k 15 (2 01 6) 17 19 21 23 25 A n n u al re p o rt o f M o A D A g ri cu lt u re 2. 6. 2 Su p p o rt w o m en a n d d is ad va n ta g ed g ro u p s to p ro d u ce a n d c o n su m e an im al liv es to ck p ro d u ct s D is tr ic t N A 20 25 30 32 35 A n n u al re p o rt o f M o LD Li ve st o ck 2. 6. 3 Pr o vi d e st ar t u p e n tr ep re n eu rs h ip g ra n ts to w o m en c o o p er at iv es fo r s o ci al a n d e co n o m ic em p o w er m en t (N PR 1 50 ,0 00 to 4 50 ,0 00 ) W o m en co o p er at iv e 41 1 88 90 10 0 11 0 12 0 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re 2. 6. 4 Pr o vi d e st ar t u p e n tr ep re n eu rs h ip g ra n ts to w o m en g ro u p m em b er s fo r s o ci al a n d ec o n o m ic e m p o w er m en t (N PR 3 50 0– 75 00 ) M em b er s o f w o m en co o p er at iv es 49 ,3 85 15 ,0 00 12 ,0 00 10 ,0 00 15 ,0 00 17 ,0 00 D ra ft 7 3/ 74 A n n u al Ec o n o m ic Su rv ey W o m en , C h ild re n a n d So ci al W el fa re 2. 6. 5 Tr ai n in g a n d o ri en ta ti o n s fo r i n co m e g en er at io n a n d b u si n es s p ro m o ti o n (v eg et ab le & fr u it p ro d u ct io n , a n im al h u sb an d ry , l iv es to ck , ta ilo ri n g , e tc .) Pe rs o n s/ n o. o f tr ai n in g s 16 3, 95 9 1, 50 0 1, 60 0 1, 75 0 1, 90 0 2, 00 0 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re 2. 6. 6 Li n k th e d is tr ib u ti o n o f c h ild p ro te ct io n g ra n ts to n u tr it io n in a ll d is tr ic ts Lo ca l g o ve rn m en ts 20 3 lo ca l go ve rn m en ts 20 3 29 9 32 3 34 7 37 2 R ep o rt s o f D o C R Lo ca l G o ve rn an ce 2. 6. 7 In cl u d e n u tr it io n a s a m aj o r o b je ct iv e o f so ci al p ro te ct io n p ro g ra m m es Lo ca l g o ve rn m en ts 20 3 lo ca l go ve rn m en ts 20 3 29 9 32 3 34 7 37 2 R ep o rt s o f D o C R Lo ca l G o ve rn an ce M at er n al H ea lt h a n d W o m en E m p o w er m en t O u tp u t 2. 7: N u tr it io n c o m p o n en t in co rp o ra te d in w o m en , a d o le sc en t g ir ls a n d c h ild d ev el o p m en t tr ai n in g p ac ka g es 2. 7. 1 In te g ra te n u tr it io n m o d u le s in t ra in in g p ac ka g es in cl u d in g g en d er b as ed v io le n ce p re ve n ti o n a n d re sp o n se t ra in in g , l ea d er sh ip , co m m u n it y p ro te ct io n , b u si n es s d ev el o p m en t an d li fe s ki lls t ra in in g M o d u le 2 3 2 1 0 0 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 72 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 O u tp u t 2. 8: W o m en , c h ild re n a n d o u t o f s ch o o l a d o le sc en t g ir ls r ea ch ed w it h h ea lt h a n d n u tr it io n c ar e p ra ct ic es 2. 8. 1 O rg an iz e tr ai n in g s fo r w o m en c o o p er at iv es an d c h ild c lu b s o n n u tr it io n s en si ti ve s er vi ce s: A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re Le ad er sh ip t ra in in g Pe rs o n 37 ,6 32 3, 76 0 3, 80 0 3, 82 5 3, 85 0 3, 90 0 G en d er b as ed v io le n ce p re ve n ti o n a n d re sp o n se t ra in in g C o o p er at iv e 36 40 42 45 50 C o m m u n it y p ro te ct io n t ra in in g C o o p er at iv e 32 40 42 45 50 B u si n es s d ev el o p m en t tr ai n in g s Pe rs o n 48 ,3 00 28 ,3 00 38 ,2 00 51 ,6 00 62 ,0 00 73 ,0 00 R ep ro d u ct iv e h ea lt h t ra in in g Pe rs o n 12 1, 51 3 19 80 2, 00 0 2, 05 0 2, 15 0 2, 20 0 G en d er d ev el o p m en t tr ai n in g (c o d ev el o p m en t) Pe rs o n 2, 85 0 2, 90 0 2, 95 0 3, 00 0 3, 10 0 3, 20 0 2. 8. 2 Li fe s ki ll d ev el o p m en t p ro g ra m m es fo r o u t o f sc h o o l a d o le sc en t g ir ls : M en st ru al h yg ie n e tr ai n in g Pe rs o n 24 0 50 0 70 0 90 0 1, 00 0 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re K n o w le d g e an d a w ar en es s ra is in g in it ia ti ve s fo r a d o le sc en t g ir ls (v u ln er ab le d is tr ic ts fo r g en d er b as ed v io le n ce a n d g ir l t ra ffi ck in g ) Pe rs o n 3, 70 0 3, 85 0 4, 00 0 4, 20 0 4, 50 0 A n n u al re p o rt s o f D W C G en er al li fe s ki ll d ev el o p m en t tr ai n in g Pe rs o n , 5, 12 0 2, 80 0 3, 00 0 3, 20 0 3, 30 0 3, 50 0 A n n u al re p o rt s o f D W C O rg an iz e tr ai n in g to c h ild c lu b s an d v ill ag e ch ild p ro te ct io n c o m m it te es ( V C PC ) o n n u tr it io n c ar e A n n u al re p o rt s o f D W C O u tp u t 2. 9: C h ild c ar e h o m es c o m p ly w it h m in im u m s ta n d ar d s o f n u tr it io n c ar e se rv ic es . 2. 9. 1 M o n it o r c h ild c ar e h o m es c o m p lia n ce w it h m in im u m s ta n d ar d s o f p ro vi si o n o f n u tr it io n se n si ti ve s er vi ce s C h ild C ar e H o m e 10 3 47 25 35 40 45 A n n u al re p o rt s o f D W C W o m en , C h ild re n a n d So ci al W el fa re C h ild C ar e H o m e 10 3 10 3 10 0 10 5 11 0 12 0 A n n u al re p o rt o f D W C 2. 9. 2 Pr o m o te n u tr it io n s en si ti ve s er vi ce s at ch ild c ar e h o m es C h ild C ar e H o m e N A 50 10 0 10 0 10 0 10 0 A n n u al re p o rt s o f D W C 2. 9. 3 In te g ra te n u tr it io n c o m p o n en t in c h ild p ro te ct io n c as e m an ag em en t tr ai n in g a n d se rv ic es Tr ai n in g Pa ck ag e N A 1 A n n u al re p o rt s o f D W C 2. 9. 4 D ep ri ve d (B ip an n a) in fa n t n u tr it io n p ro g ra m m e (N PR 5 0, 00 0 g ra n t fo r w o m en co o p er at iv es ) C o o p er at iv e 36 40 50 55 60 70 A n n u al re p o rt s o f D W C M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 73 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 O u tp u t 2. 10 : C o m m u n it ie s em p o w er ed t o p re ve n t h ar m fu l p ra ct ic es 2. 10 .1 R u n b eh av io u r c h an g e co m m u n ic at io n ac ti vi ti es to e n d h ar m fu l t ra d it io n al p ra ct ic es Ev en t N A 90 0 1, 00 0 1, 15 0 1, 20 0 1, 50 0 A n n u al re p o rt o f D W C W o m en , C h ild re n a n d So ci al W el fa re 2. 10 .2 R u n c am p ai g n s to p re ve n t m ar ri ag e u n ti l ag e 20 (3 50 a d o le sc en ts , 3 90 s ta ke h o ld er s, 8 40 d h am i jh ak ri in 3 9 in te ra ct io n p ro g ra m m es ) Ev en t 5, 00 0 27 50 3, 00 0 3, 20 0 3, 50 0 4, 00 0 A n n u al re p o rt o f D W C 2. 10 .3 P ro g ra m m es to s h ift s o ci al n o rm s an d h ar m fu l p ra ct ic es o n fo o d t ab o o s th at p re ve n t m en st ru al h yg ie n e, a d eq u at e n u tr it io n fo r ad o le sc en ts , e tc . Ev en t 30 0 30 0 40 0 45 0 50 0 55 0 A n n u al re p o rt o f D W C Ea rl y C h ild h o o d D ev el o p m en t an d C la ss ro o m E d u ca ti o n O u tp u t 2. 11 E n h an ce d e n ro lm en t o f c h ild re n in b as ic e d u ca ti o n . 2. 11 .1 R u n w el co m e to s ch o o l c am p ai g n s fo r b as ic e d u ca ti o n Sc h o o l 29 ,2 07 29 ,3 07 29 ,4 07 29 ,5 07 29 ,6 07 29 ,7 07 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 11 .2 P ro vi d e ad eq u at e re so u rc es to a ll sc h o o ls to h av e EC ED /P PE Sc h o o l 25 ,0 00 25 ,5 00 26 ,0 00 27 ,0 00 28 ,0 00 29 ,0 00 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 11 .3 P ro vi d e d iv er si fie d a n d n u tr it io u s m id d ay m ea ls to c h ild re n in b as ic e d u ca ti o n St u d en t 61 2, 00 0 61 2, 00 0 61 2, 00 0 61 2, 00 0 61 2, 00 0 61 2, 00 0 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 11 .4 E C ED fa ci lit at o rs , c o m m u n it y le ar n in g ce n tr es (C LC ) f ac ili ta to rs , f o ca l t ea ch er a n d h ea lt h te ac h er s an d fo o d m an ag em en t co m m it te es in c o o rd in at io n w it h F C H Vs e n g ag e p ar en ts to im p ro ve t h ei r k n o w le d g e o f h ea lt h , h yg ie n e an d n u tr it io n D is tr ic t 12 12 12 12 12 12 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 11 .5 N u tr it io n m o n it o ri n g o f b as ic e d u ca ti o n st u d en ts D is tr ic t 12 57 57 57 57 57 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 11 .6 B u ild n u tr it io n c ap ac it y o f E C D fa ci lit at o rs , C LC fa ci lit at o rs , h ea lt h te ac h er s an d fo o d m an ag em en t co m m it te e in s ch o o ls D is tr ic t 12 12 12 12 12 12 A n n u al re p o rt s o f D o E Ed u ca ti o n O u tp u t 2. 12 : I n cr ea se d a d o le sc en t g ir ls ’ a w ar en es s an d b eh av io u rs in n u tr it io n 2. 12 .1 R u n c am p ai g n s to in cr ea se g ir ls ’ en ro lm en t in s ch o o ls in t ar g et ed a re as Sc h o o l 29 ,2 07 29 ,3 07 29 ,4 07 29 ,5 07 29 ,6 07 29 ,7 07 EM IS Ed u ca ti o n 2. 12 .2 C re at e p ri o ri ty m in im u m e n ab lin g co n d it io n s (c la ss ro o m s, te ac h er s, te xt b o o ks , W A SH , b o o k co rn er s) in s ch o o ls Sc h o o l N A A ll sc h o o ls A ll sc h o o ls A ll sc h o o ls A ll sc h o o ls A ll sc h o o ls EM IS Ed u ca ti o n 2. 12 .3 B u ild s ep ar at e fu n ct io n al to ile ts w it h g ro u p h an d w as h fa ci lit ie s, e sp ec ia lly fo r g ir ls in sc h o o ls Sc h o o l 67 72 77 82 87 92 EM IS Ed u ca ti o n M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 74 K ey a ct iv it ie s U n it Si tu at io n in 2 01 7 Ta rg et M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 2. 12 .4 P ro vi d e sa fe d ri n ki n g w at er in s ch o o ls Sc h o o l 80 85 90 95 10 0 10 0 EM IS Ed u ca ti o n 2. 12 .5 P ro m o te h ea lt h y b eh av io u r t h ro u g h sk ill s b as ed h ea lt h e d u ca ti o n in s ch o o ls Sc h o o l N A 35 ,2 22 35 ,3 00 35 ,4 00 35 ,5 00 35 ,6 00 EM IS Ed u ca ti o n 2. 12 .6 R ev is e h ea lt h a n d n u tr it io n c u rr ic u lu m C la ss N A C la ss 1 3 C la ss es 4 5 C la ss es 6 8 C la ss es 9 1 0 C la ss es 1 1 12 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 12 .7 E st ab lis h fo o d m an ag em en t co m m it te es in a ll sc h o o ls p ro vi d in g m id d ay m ea ls D is tr ic t 12 57 57 57 57 57 A n n u al re p o rt s o f D o E Ed u ca ti o n 2. 12 .8 D ev el o p a s et o f e d u ca ti o n al t ra in in g p ac ka g es o n d is as te r r is k re d u ct io n (D RR ) f o r st u d en ts , t ea ch er s an d s ch o o l m an ag em en t co m m it te es Tr ai n in g p ac ka g e N A 1 A n n u al re p o rt s o f D o E Ed u ca ti o n H ea lt h a n d F am ily P la n n in g S er vi ce s O u tp u t 2. 13 P ro m o te a cc es s to h ea lt h a n d r ep ro d u ct iv e h ea lt h s er vi ce s. 2. 13 .1 P ro vi d e re p ro d u ct iv e h ea lt h in fo rm at io n se rv ic es in s ch o o ls a n d h ea lt h fa ci lit ie s fo r b o ys an d g ir ls Pu b lic s ch o o l 77 d is tr ic ts > 75 % o f p u b lic sc h o o ls A n n u al re p o rt s o f D o H S H ea lt h 2. 13 .2 P ro vi d e kn o w le d g e o n im p o rt an ce o f d el ay ed fi rs t p re g n an cy a ft er m ar ri ag e Pu b lic s ch o o l 77 d is tr ic ts > 75 % o f p u b lic sc h o o ls A n n u al re p o rt s o f D o H S H ea lt h 2. 13 .3 P ro vi d e in fo rm at io n to s ch o o l s tu d en ts o n b en efi ts o f u se o f f am ily p la n n in g m et h o d s Pu b lic s ch o o l 77 d is tr ic ts > 75 % o f p u b lic sc h o o ls A n n u al re p o rt s o f D o H S H ea lt h 2. 13 .4 B eh av io u r c h an g e co m m u n ic at io n fo r in cr ea si n g u p ta ke o f r o u ti n e m ea sl es a n d ru b el la im m u n iz at io n Lo ca l g o ve rn m en ts 77 d is tr ic ts 75 3 A n n u al re p o rt s o f D o H S H ea lt h M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 75 K ey a ct iv it ie s U n it Si tu at io n in 20 17 Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 O U TP U T 3 En ab lin g e n vi ro n m en t ac ti vi ti es O u tp u t 3. 1: M SN P in cl u d ed in lo ca l, p ro vi n ci al a n d fe d er al g o ve rn m en t’s p o lic ie s an d p la n s. 3. 1. 1 In co rp o ra te M SN P II in fe d er al p la n s an d p o lic es Se ct o ra l p o lic ie s an d p la n s N PC , S ec to rs a) D ev el o p a n d u p d at e se ct o ra l p o lic ie s, lo n g te rm p la n s an d s tr at eg ie s at fe d er al le ve l M in is tr y 7 7 7 7 7 7 Se ct o ra l p o lic ie s an d p la n s N PC , S ec to rs b ) D ir ec ti ve s fr o m N PC to s ec to rs a t fe d er al le ve l t o in co rp o ra te n u tr it io n s p ec ifi c an d se n si ti ve a ct iv it ie s in A W PB s in li n e w it h M SN P II Ev en t 1 1 1 1 1 1 D ir ec ti ve s N PC c) E n su re n u tr it io n s p ec ifi c an d s en si ti ve ac ti vi ti es a re in co rp o ra te d in a n n u al w o rk p la n s an d b u d g et s o f a ll se ct o rs a t fe d er al le ve l in li n e w it h M SN P II M in is tr y 7 7 7 7 7 7 A W PB s o f se ct o rs N PC 3. 1. 2 In co rp o ra te M SN P II in p ro vi n ci al le ve l p la n s an d p o lic ie s a) A d vo ca cy w o rk sh o p o n M SN P II in a ll p ro vi n ce s Ev en t N A 7 7 7 7 7 W o rk sh o p R ep o rt s N PC b ) S en d c ir cu la r t o a ll p ro vi n ci al g o ve rn m en ts to in co rp o ra te n u tr it io n in t h ei r r el ev an t p o lic ie s, lo n g t er m p la n s an d s tr at eg ie s in li n e w it h M SN P Ev en t N A 1 1 1 1 1 Po lic es a n d p la n s o f p ro vi n ce s N PC , L o ca l G o ve rn an ce , Fi n an ce c) C o o rd in at e an d fa ci lit at e w it h lo ca l g o ve rn m en t se ct o r a t fe d er al le ve l ( M o FA LD ) to d ev el o p M SN P II p o lic y, lo n g t er m p la n a n d st ra te g y at lo ca l l ev el s Ev en t N A 2 2 2 2 2 C o o rd in at io n m ee ti n g s N PC 3. 1. 3 In co rp o ra te M SN P II in lo ca l g o ve rn m en t p la n s an d p la n n in g p ro ce ss es Lo ca l g o ve rn m en ts 28 d is tr ic ts (1 94 lo ca l g o ve rn m en ts ) 20 3 29 9 32 3 34 7 37 2 A W PB s o f l o ca l g o ve rn m en ts Lo ca l G o ve rn an ce se ct o r 3. 1. 4 O rg an iz e jo in t an n u al re vi ew m ee ti n g s am o n g M SN P II se ct o r m in is tr ie s at fe d er al le ve l Ev en t 0 1 1 1 1 1 R ep o rt s o f r ev ie w m ee ti n g N PC 3. 1. 5 A d vo ca cy m ee ti n g s fo r i n cr ea si n g n u tr it io n b u d g et (a t le as t 3. 5% o f t o ta l) at fe d er al a n d p ro vi n ce le ve ls a) A d vo ca cy m ee ti n g s w it h p ar lia m en ta ri an a t fe d er al a n d p ro vi n ce le ve ls Ev en t 0 8 8 8 8 8 M ee ti n g re p o rt s N PC , s ec to rs b ) A d vo ca cy m ee ti n g s w it h m in is tr y o f fin an ce a t fe d er al a n d p ro vi n ce le ve ls Ev en t 0 2 2 2 2 2 M ee ti n g re p o rt s N PC , s ec to rs M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 76 K ey a ct iv it ie s U n it Si tu at io n in 20 17 Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 c) A d vo ca cy m ee ti n g s w it h g ro u p s, ed u ca ti o n al in st it u te s, p ri va te s ec to r a n d in d u st ri es Ev en t 0 2 2 2 2 2 M ee ti n g re p o rt s N PC d ) A d vo ca cy m ee ti n g s w it h c iv il so ci et y o rg an iz at io n s an d N G O s Ev en t 1 2 2 2 2 2 M ee ti n g re p o rt s N PC 3. 1. 6 D ev el o p n u tr it io n b u d g et c o d e Ev en t 0 1 R ed b o o k N PC , M o F O u tp u t 3. 2: M SN P g o ve rn an ce m ec h an is m s tr en g th en ed a t fe d er al , p ro vi n ci al a n d lo ca l l ev el 3. 2. 1 O rg an is e H ig h L ev el N u tr it io n a n d F o o d Se cu ri ty S te er in g C o m m it te e (H LN FS S) m ee ti n g s tw ic e a ye ar Ev en t 2 2 2 2 2 2 M ee ti n g m in u te s N PC 3. 2. 2 O rg an is e N at io n al N u tr it io n a n d F o o d Se cu ri ty C o o rd in at io n C o m m it te e m ee ti n g s q u ar te rl y Ev en t 4 4 4 4 4 4 M ee ti n g m in u te s N PC 3. 2. 3 Se n d c ir cu la r a n d fa ci lit at e fo rm at io n o f n u tr it io n a n d fo o d s ec u ri ty s te er in g c o m m it te e in p ro vi n ce s Ev en t N A 7 M ee ti n g m in u te s N PC 3. 2. 4 Fo rm n u tr it io n a n d fo o d s ec u ri ty s te er in g co m m it te es a t p ro vi n ce le ve l Pr o vi n ce N A 7 M ee ti n g m in u te s N PC , L o ca l G o ve rn an ce 3. 2. 5 O rg an is e n u tr it io n a n d fo o d s ec u ri ty st ee ri n g c o m m it te e m ee ti n g s tw ic e a ye ar a t p ro vi n ce le ve l Ev en t N A 14 14 14 14 14 M ee ti n g m in u te s N PC , L o ca l G o ve rn an ce 3. 2. 8 A p p o in t n u tr it io n fo ca l p er so n s fo r a ll se ct o ra l m in is tr ie s at p ro vi n ce le ve l Pr o vi n ce N A 7 D ec is io n le tt er s Lo ca l G o ve rn an ce 3. 2. 9 O rg an is e th em at ic te ch n ic al w o rk in g g ro u p ( TW G ) m ee ti n g s at fe d er al le ve l q u ar te rl y. Th em at ic g ro u p s: a) C ap ac it y B u ild in g b ) A d vo ca cy a n d c o m m u n ic at io n c) M & E Ev en t 3 TW G s 12 12 12 12 12 M ee ti n g m in u te s N PC 3. 2. 10 F o rm n u tr it io n a n d fo o d s te er in g co m m it te es a t lo ca l g o ve rn m en ts le ve l a n d m ee t re g u la rl y Lo ca l g o ve rn m en ts 30 d is tr ic t 20 3 29 9 32 3 34 7 37 2 R ep o rt s fr o m lo ca l g o ve rn m en ts Lo ca l G o ve rn an ce 3. 2. 11 F o rm n u tr it io n a n d fo o d s te er in g co m m it te e an d re g u la r m ee ti n g s at w ar d le ve l in M SN P lo ca l g o ve rn m en ts W ar d s V D C le ve l 0 91 4 13 50 14 50 16 00 R ep o rt fr o m lo ca l g o ve rn m en ts Lo ca l G o ve rn an ce 3. 2. 12 F ac ili ta te to a ss ig n c o o rd in at o rs (e xi st in g st aff o r o u ts o u rc ed ) a t lo ca l g o ve rn m en ts to o ve rs ee M SN P II in te rv en ti o n s Lo ca l g o ve rn m en ts 30 d is tr ic t 20 3 29 9 32 3 34 7 37 2 R ep o rt s fr o m lo ca l g o ve rn m en ts Lo ca l G o ve rn an ce M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 77 K ey a ct iv it ie s U n it Si tu at io n in 20 17 Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 O u tp u t 3. 3 M SN P in st it u ti o n al m ec h an is m s fu n ct io n al a t fe d er al g o ve rn m en t le ve l 3. 3. 1 St re n g th en N at io n al N u tr it io n a n d F o o d Se cu ri ty S ec re ta ri at a t N PC Ev en t 1 1 1 1 1 1 N N FS S N PC 3. 3. 2 C ar ry o u t o rg an iz at io n a n d m an ag em en t su rv ey o n in cl u d in g N N FS S w it h in N PC Ev en t 0 1 O & M s u rv ey re p o rt N PC 3. 3. 3 Fa ci lit at e en d o rs em en t o f t h e O & M s u rv ey re p o rt Ev en t 0 1 N PC o rg an o g ra m N PC 3. 3. 4 R ec ru it s ta ff fo r N FS S as p er a p p ro ve d o rg an o g ra m Ev en t 0 0 1 1 1 1 A n n u al re p o rt s N PC O u tp u t 3. 4: F u n ct io n al u p d at ed in fo rm at io n s ys te m a cr o ss t h e se ct o rs . 3. 4. 1 U p d at e M SN P in fo rm at io n p o rt al a n d m ak e it fu n ct io n al Ev en t 1 1 1 1 1 1 A cc es s to u p d at ed M SN P p o rt al N PC 3. 4. 2 Li n k an d u p d at e n u tr it io n in fo rm at io n a t ce n tr al le ve l ( H M IS , E M IS , W A SH , a g ri cu lt u re , liv es to ck a n d lo ca l g o ve rn an ce ) Ev en t 1 1 1 1 1 1 Li n ka g e o f n u tr it io n in fo rm at io n w it h a ll se ct o rs N PC A ll se ct o rs 3. 4. 3 Pr o vi d e tr ai n in g o n w eb b as ed M SN P re p o rt in g s ys te m a t fe d er al a n d p ro vi n ce le ve l Ev en t 0 1 U se o f w eb b as ed M SN P re p o rt in g sy st em N PC 3. 4. 4 D o cu m en t an d d is se m in at e g o o d p ra ct ic es , l es so n s le ar n ed a n d c as e st u d ie s Ev en t 1 1 1 1 1 1 R ep o rt Lo ca l G o ve rn an ce 3. 4. 5 D ev el o p a n d re vi ew m o n it o ri n g a n d ev al u at io n fr am ew o rk fo r a ll M SN P se ct o rs a t fe d er al le ve l Ev en t 1 1 1 1 1 1 M SN P II M & E fr am ew o rk N PC , s ec to rs 3. 4. 6 D ev el o p a n d re vi ew m o n it o ri n g a n d ev al u at io n fr am ew o rk fo r a ll M SN P se ct o rs a t p ro vi n ce le ve l Pr o vi n ce N A 7 7 7 7 7 M SN P II M & E fr am ew o rk N PC , s ec to rs 3. 4. 7 D ev el o p m o n it o ri n g a n d e va lu at io n fr am ew o rk fo r a ll M SN P se ct o rs a t lo ca l l ev el Lo ca l g o ve rn m en ts 30 d is tr ic ts 20 3 29 9 32 3 34 7 37 2 M SN P II M & E fr am ew o rk N PC , l o ca l g o ve rn an ce , se ct o rs O u tp u t 3. 5: E n h an ce d c ap ac it y o f f ed er al , p ro vi n ce a n d lo ca l l ev el g o ve rn m en t to p la n a n d im p le m en t n u tr it io n p ro g ra m 3. 5. 1 D ev el o p n at io n al c ap ac it y b u ild in g m as te r p la n fo r M SN P II Ev en t 0 1 C ap ac it y d ev el o p m en t m as te r p la n d o cu m en t N PC , S ec to rs 3. 5. 2 Im p le m en t ca p ac it y d ev el o p m en t m as te r p la n a t al l l ev el s. a) D ev el o p t ra in in g p ac ka g e Ev en t 0 1 Tr ai n in g p ac ka g e N PC , s ec to rs M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 78 K ey a ct iv it ie s U n it Si tu at io n in 20 17 Ta rg et s M ea n s o f ve ri fi ca ti o n R es p o n si b le se ct o rs 20 18 20 19 20 20 20 21 20 22 b ) C o n d u ct m as te r t ra in in g o f t ra in er s (M To T ) o n M SN P II Ev en t 1 1 1 1 1 M To T re p o rt N PC 3. 5. 2 (c o n ti n u ed ): C ap ac it y d ev el o p m en t m ea su re s fr o m s ec to rs A g ri cu lt u re a n d L iv es to ck D ev el o p m en t C ap ac it y d ev el o p m en t tr ai n in g , i n te ra ct io n s, ex p o su re v is it s: a) C en tr al le ve l — 1 0 p er so n s b ) P ro vi n ci al le ve l — 3 5 p er so n s c) L o ca l l ev el — 1 ,4 88 (a g ri cu lt u re a n d liv es to ck s ec to r h u m an re so u rc es ) Pe rs o n N A 1, 52 3 1, 52 3 1, 52 3 Tr ai n in g re p o rt s A g ri cu lt u re an d L iv es to ck Se ct o r d ) C o n d u ct t ra in in g a n d d em o n st ra ti o n s o n im p ro ve d re ci p es Ev en t N A 7 7 7 7 7 Tr ai n in g re p o rt s A g ri cu lt u re an d L iv es to ck Se ct o r e) E st ab lis h a n d s tr en g th en fo o d p ro ce ss in g , fo o d s af et y an d n u tr it io n re g u la ti o n a n d ex te n si o n s er vi ce s at lo ca l l ev el Lo ca l g o ve rn m en ts N A 75 3 75 3 75 3 75 3 75 3 A n n u al re p o rt o f M o A D A g ri cu lt u re an d L iv es to ck Se ct o r Lo ca l G o ve rn an ce a) B u ild c ap ac it y fo r i n s er vi ce n u tr it io n sp ec ifi c an d n u tr it io n s en si ti ve t ra in in g to n u tr it io n s ta ke h o ld er s at fe d er al , p ro vi n ci al , vi lla g e co u n ci l, lo ca l g o ve rn m en t an d co m m u n it y le ve ls Lo ca l g o ve rn m en ts 30 D is tr ic ts 1 fe d er al , 5 p ro vi n ce , 20 3 Lo ca l g o ve rn m en ts 1 fe d er al , 5 p ro vi n ce , 29 9 Lo ca l g o ve rn m en ts 1 fe d er al , 7 p ro vi n ce , 32 3 Lo ca l g o ve rn m en ts 1 fe d er al , 7 p ro vi n ce , 34 7 Lo ca l g o ve rn m en ts 1 fe d er al , 7 p ro vi n ce , 37 2 Lo ca l g o ve rn m en ts Pe ri o d ic re p o rt o f l o ca l g o ve rn m en ts Lo ca l G o ve rn an ce b ) D ev el o p in te g ra te d p ac ka g e fo r G o ld en 1 00 0 d ay s h o u se h o ld s — o ri en ta ti o n , t ra in in g Ev en t N A 1 N PC , L o ca l G o ve rn an ce c) S en si ti ze s ta ke h o ld er s o n M SN P II Pe rs o n N /A 4, 50 0 8, 97 0 9, 78 0 10 ,5 00 11 ,4 00 Pe ri o d ic re p o rt s o f l o ca l g o ve rn m en ts Lo ca l G o ve rn an ce N P C a) P re p ar e M SN P II ca p ac it y d ev el o p m en t p la n Ev en t 0 1 C ap ac it y d ev el o p m en t m as te r p la n N PC , s ec to rs b ) P re p ar e ad vo ca cy a n d c o m m u n ic at io n st ra te g y Ev en t 1 1 St ra te g y d o cu m en t Se ct o rs c) T ra in M & E fo ca l p er so n o n in fo rm at io n sy st em Ev en t 1 1 1 1 1 Tr ai n in g R ep o rt N PC M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 7979 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 8080 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 81 MSNP (2013–17) Related Programmes and Projects Supported by Development Partners ANNEX 2: Nepal’s development partners implemented the following programmes and projects under MSNP (2013–17) with some of them carrying on into the MSNP-II period: Period Project Description October 2012 to March 2017 Sunaula Hazar Din (Golden Thousand Days) This project was funded by the World Bank and implemented by the Ministry of Federal Affairs and Local Development (MoFALD). Programmes were conducted in 15 districts to prevent malnutrition in the crucial first 1,000 days from conception until children’s second birthday (= 270 days + 365 days + 365 days = 1,000 days). 2011 to 2016 (Suaahara-1) 2016 to 2021 (Suaahara-2) Suaahara Project This integrated nutrition programme is implemented with USAID funding in partnership with stakeholders to improve the nutritional status of women and children in 40 districts. The project is a major initiative under MSNP (2013–17) and MSNP-II. The second phase is being rolled out in coordination with the National Planning Commission and relevant federal ministries; and will be rolled out in coordination with provincial planning units, provincial ministries and local governments once they are established. Its activities address the first thousand days from conception to two years of age focussing on infants and women and adolescent girls as the people mainly responsible for caring for infants. It integrates health, nutrition, WASH, agriculture and food security activities. 2013 to 2018 Agriculture and Food Security Project This World Bank funded project is being implemented by the Ministry of Agricultural Development and the Ministry of Livestock Development in coordination with the Ministry of Health in 18 districts. It aims to improve the nutritional status and food security of targeted groups by increasing the productivity of agriculture and livestock production and improving the availability of and access to nutritional food and nutrition-related behaviour. 2013 to 2016 KISAN: Knowledge based Integrated Sustainable Agriculture and Nutrition The KISAN project was implemented by the ministries of agricultural and livestock development and the health ministry with funding from USAID. It ran in 16 districts of the Mid-West and Far Western regions –the areas most severely affected by food insecurity, hunger and inadequate nutrition. The project improved food security and increased incomes through integrated agriculture activities and was implemented as part of USAID’s Feed the Future initiative. 2014–2019 SABAL: Sustainable Action for Resilience and Food Security This project is being implemented in 11 hill and mountain districts of the eastern and central regions with support from USAID. It is being implemented by the Ministry of Agricultural Development, the Ministry of Federal Affairs and Local Development, the Ministry of Health and local NGO partners. 2016–2019 Partnership for Improved Nutrition (Poshan Ko Laagi Haatemalo) With financial aid from the European Union channelled via UNICEF, and additional funding from UNICEF, this project is conducting nutrition specific programmes through the Ministry of Health and nutrition sensitive programmes through MoFALD in 28 districts in coordination with relevant ministries following MSNP (2013–17) guidelines. 2014-2017 Food for Education Supported by the World Food Programme and implemented by the Ministry of Education, this programme is improving the nutritional status of students in 10 hill and mountain districts of Far Western and Mid-Western Nepal. It aims to bring quantitative and qualitative improvements in primary education, increase school admission rates for girls, and achieve sustainable improvements in the food security of marginalized community, especially women and children. 2013–2016 Multi-partner Trust Fund Nepal received a Multi-partner Trust Fund grant from the SUN Movement Secretariat to expand the availability of nutrition-related services. The Civil Society Alliance of Nepal allocated funds to its members to run advocacy and capacity building activities that facilitated the implementation of MSNP (2013–17). 2013–2016 REACH: Renewed Efforts Against Child Hunger and Undernutrition The REACH project helped establish the National Nutrition and Food Security Secretariat in the initial phase of MSNP (2013–17) to coordinate capacity building at central and district levels. This project has also helped to manage information related to nutrition and food security by developing the Nepal Nutrition and Food Security Portal. 81 82 September 2012 Kathmandu Declaration of Commitments For an accelerated improvement in maternal and child nutrition in Nepal ANNEX 3: We, the Nepal Government, UN agencies, de velopment partners and members of civil soci ety and the private sector, meeting today, the 17 September 2012, in the National Nutrition and Food Security Coordination Meeting, whose ob jective is to achieve a national consensus on the scaling up of the multi-sector action plan for the reduction of chronic malnutrition in Nepal, Recognizing that chronic malnutrition is the main problem affecting the nutrition of Nepali children especially during the first 1,000 days of life (from conception up to two year of age) and that its reso lution requires a multi-sector approach, Concerned that malnutrition is responsible for more than a third of child mortality, and for derailing socio-economic development of the af fected families, communities, and ultimately the country, and impacting negatively on achieve ment of the all the Millennium Development Goals, Recalling and reaffirming the commitment dur ing the World Food Summit, held in Rome in 1996, to reduce the number of undernourished people by 50 per cent by the year 2015, Recognizing that poverty reduction is a Gov ernment priority and that there is a strong link between poverty reduction, food insecurity and nutrition and chronic malnutrition, Taking into account the opportunities that pres ent themselves, notably: the national political engagement, cost effective interventions based on scientific evidence, global initiatives on Scal ing Up of Nutrition (SUN) and Renewed Ef forts Against Child Hunger and Under-nutrition (REACH), with Nepal having made commit ment to be an ‘early riser’ SUN country under the leadership of His Excellency the Prime Minister of Nepal as a member of the SUN Lead Group, and to introduce REACH in the country with the in volvement of national and international partners, Recognizing that the right to adequate food and nutrition is a fundamental human right, We commit ourselves and strive to: • Contribute to the implementation of actions defined in multi-sector nutrition plan of ac tion for the improvement of maternal and child nutrition and the reduction of chronic malnutrition; • Develop advocacy, communication, and social mobilization actions to raise awareness of the various sectors and the general public, about the significant problem of chronic malnutri tion and actions needed to improve maternal and child nutrition, accessible to everyone, especially during the first 1,000 days of life, ensuring equity, and facilitating access to in formation, to promoting behaviour change, with a focus to reach the most marginalized, poorest segments of the population, and tak ing into account gender related factors; • Strengthen the institutional, organization and human resource capacity for the implementa tion of the plan at all levels and in different sectors linked to nutrition; • Support the inter-sector coordination body at all the key levels (national, district, and VDC) in all its dimension so that through functional coordination mechanisms are implemented and effective action to improve the nutri tional status of women and children, ensuring complementarity and strengthening synergies between the different actors; • Enhance the multi-sector nutrition informa tion, knowledge management, surveillance systems, monitoring and evaluation of prog Commitments For implementing MSNP M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 83 Mr. Deependra Bahadur Kshetry Hon. Vice Chair, National Planning Commission Mr. Krishna Hari Baskota Secretary, Ministry of Finance Mr. Balananda Paudel Secretary, Ministry of Women, Children, & Social Welfare Mr. Suresh Man Shrestha Secretary, Ministry of Education Dr. Praveen Mishra Secretary, Ministry of Health and Population Ms. Hanaa Singer, Representative UNICEF On Behalf of UN REACH Partners (FAO, UNICEF, WFP, WHO) Mr. Suraj Vaidya Chair, Federation of Nepalese Chambers of Commerce and Industries (FNCCI) Prof. Dr. Shiba Kumar Rai Hon. Member, National Planning Commission, Country SUN Focal Point - Nepal Dr. Ganesh Raj Joshi Secretary, Ministry of Agriculture Development Mr. Kishor Thapa Secretary, Ministry of Urban Development Mr. Sheetal Babu Regmi Secretary, Ministry of Federal Affairs and Local Development Mr. Robert Piper UN Resident Coordinator Dr. Lin Aung, WHO Representative Chair, External Development Partners-Health Mr. Deepak Raj Sapkota, Country Director, Karuna Foundation As a Chair, Association of International NGOs in Nepal ress with links to existing early warning sys tems; and • Mobilize support nationally and internation ally to ensure the large-scale implementation of interventions and nutrition programs to address both the immediate, underlying and basic social and economic determinants of maternal and under-nutrition. We, the Nepal Government, UN agencies, de velopment partners and members of civil society and the private sector, by this we approve the contents of this “Declaration of Commitment for an Accelerated Improvement in Maternal and Child Nutrition in Nepal.” Kathmandu, September 2012 (For) (For) (For) (AI) (For) (For) 84 CONTRiBUTORS TO MULTiSECTOR NUTRiTiON PLaN-ii (2018-2022) ANNEX 4: Officials from Government of Nepal S.N. Name Position Organization/ Institute 1 Dr. Min Bahadur Shrestha Hon’ble Vice- Chair National Planning Commission, Singhadurbar 2 Dr. Swarnim Wagle Hon’ble Vice- Chair National Planning Commission, Singhadurbar 3 Dr. Usha Jha Hon’ble Member National Planning Commission, Singhadurbar 4 Mr. Min Bahadur Shahi Hon’ble Member National Planning Commission, Singhadurbar 5 Prof. Dr. Geeta Bhakta Joshi Hon’ble Member National Planning Commission, Singhadurbar 6 Prof. Dr. Ramesh Kant Adhikari Expert Member, High Level Nutrition and Food Security Steering Committee National Planning Commission, Singhadurbar/KIST 7 Prof. Dr. Madhu Dixit Devkota Expert Member, High Level Nutrition and Food Security Steering Committee National Planning Commission, Singhadurbar/IOM 8 Mr. Chandra Kumar Ghimire Member Secretary National Planning Commission, Singhadurbar 9 Mr. Madhu Kumar Marasini Joint Secretary National Planning Commission, Singhadurbar 10 Mr. Radhakrishna Pradhan Joint Secretary National Planning Commission, Singhadurbar 11 Mr. Khomraj Koirala Joint Secretary National Planning Commission, Singhadurbar 12 Dr. Tritharaj Dhakal Joint Secretary National Planning Commission, Singhadurbar 13 Mr. Biju Kumar Shrestha Joint Secretary National Planning Commission, Singhadurbar 14 Dr. Kiran Rupakhetee Programme Director National Planning Commission, Singhadurbar 15 Mr. Prakash Prasad Kharel Programme Director National Planning Commission, Singhadurbar 16 Ms. Lila Kumari KC Programme Director National Planning Commission, Singhadurbar 17 Mr. Mahesh Kharel Programme Director National Planning Commission, Singhadurbar 18 Mr. Krishna Murari Neupane Programme Director National Planning Commission, Singhadurbar 19 Ms. Sita Devi Thapa Planning Officer National Planning Commission, Singhadurbar 20 Mr. Chudamani Aryal Planning Officer National Planning Commission, Singhadurbar 21 Ms. Sushila Kumari Panth Planning Officer National Planning Commission, Singhadurbar 22 Ms. Gita Ghimire Planning Officer National Planning Commission, Singhadurbar 23 Ms. Bandana Kumari KC Planning Officer National Planning Commission, Singhadurbar 24 Mr. Purushottam Nepal Joint Secretary MoFALD 25 Mr. Kedarnath Sharma Joint Secretary MoFALD 26 Mr. Bijaya Raj Subedi Under Secretary MoFALD 27 Mr. Dila Ram Panthi Under Secretary MoFALD 28 Mr. Janak Raj Sharma Section Officer MoFALD 29 Mr. Dhananjaya Poudyal Nutrition Expert MoFALD/G1000D 30 Mr. Manoj Pant M & E Officer MoFALD 31 Dr. Khem Pokharel MSNP Coordinator MoFALD//HERD 32 Mr. Indra Bhujel Information Manager MoFALD/HERD 33 Mr. Mahendra Prasad Shrestha Chief, PPICD Ministry of Health and Population 34 Dr. Bikash Lamichhane Director Child Health Division, DoHS, MoHP 35 Ms. Yashoda Aryal PHA, PPICD Ministry of Health and Population 36 Mr. Giri Raj Subedi Chief, Nutrition Section Child Health Division, DoHS, MoHP 37 Mr. Raj Kumar Pokharel Chief, Nutrition Section Child Health Division, DoHS, MoHP M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 85 38 Mr. Kapil Timalsena Chief, Planning Section Child Health Division, DoHS, MoHP 39 Mr. Sharad Kumar Sr.Demo-Graph Family Health Division, DoHS, MoHP 40 Mr. Harihar Sharma Sr Public Health Officer CHD, MoHP 41 Ms. Basundhara Sharma PHO Child Health Division, DoHS, MoHP 42 Mr. Shanker Pandey Sr. AHWO Child Health Division, DoHS, MoHP 43 Mr. Uttam Acharaya Technical Coordinator NUTEC Child Health Division, DoHS, MoHP 44 Mr. Mahesh Karki L.V.D. NHEICC, Ministry of Health and Population 45 Dr. Rashmina Manandhar MO NHEICC, Ministry of Health and Population 46 Mr. Kunja Prasad Joshi HEA NHEICC, Ministry of Health and Population 47 Ms. Rajani Gyawali Technical Coordinator NUTEC Child Health Division, DoHS, MoHP 48 Mr. Chetnath Sharma Deputy Director General Department of Education, Ministry of Education 49 Mr. Bedahari Dahal Deputy Director Department of Education, Ministry of Education 50 Mr. Bishnu Bhandari Deputy Director Food for Education, Ministry of Education 51 Mr. Chetnath Aryal Deputy Director Department of Education, Ministry of Education 52 Mr. Khem Nanda Bhushal Deputy Director Department of Education, Ministry of Education 53 Mr. Narendra Raj Paudel Under Secretary Ministry of Education 54 Mr. Nava Raj Khatiwada Under Secretary Ministry of Education 55 Mr. Anil Sharma Mishra Under Secretary Ministry of Education 56 Mr. Karan Bdr. Bhuwagi Under Secretary Ministry of Education 57 Mr Sunil K. Das Deputy Director General Department of Water Supply & Sanitation 58 Mr. Hari Prasad Timilsina SDE Ministry of Water Supply & Sanitation 59 Mr. Shekhar Khanal Engineer Ministry of Water Supply & Sanitation 60 Ms. Sushma Kafle Engineer Ministry of Water Supply & Sanitation 61 Mr. Kamal Adhikari Sociologist Department of Water Supply & Sanitation 62 Ms. Bishwa Maya Neupane WDO Ministry of Women, Children and Social Welfare 63 Ms. Shobha Kharel Women Development Officer Ministry of Women, Children and Social Welfare 64 Ms. Sabriti Poudel Section Officer Dept. of Women and Childern, MoWCSW 65 Dr. Y.K. Karki Joint Secretary Ministry of Agriculture Development 66 Dr. Sita Ram Aryal Director NARC, Ministry of Agriculture Development 67 Ms. Jyotsna Shrestha Food Research Officer Ministry of Agriculture Development 68 Mr. Kalash Ram Chaudhary Sr.Agri Economist Ministry of Agriculture Development 69 Mr. Jeevan Acharaya Hrt. Dev Officer Department of Agriculture Development 70 Mr. Santosh Kr. Singh Fisheries Dev. Officer Department of Agriculture Development 71 Mr. Kishor Bista Sr. Agri. Economist Department of Agriculture Development 72 Mr. Ram Krishna Regmi Statistcian Ministry of Agriculture Development 73 Mr. Kalash Ram Chaudhary Sr. Agri. Economist Ministry of Agriculture Development 74 Mr. Shiva Sundar Ghimire Sr.Agri Economist Department of Agriculture, Food Security Nutrition Section 75 Mr. Dinesh Bhattarai S.S.O Ministry of Agriculture Development 76 Mr. Purna Chandra Wasti Sr.Food Researcher Officer (SFRO) DFTQC, Ministry of Agriculture 77 Dr. K.P Premy Joint Secretary Ministry of Livestock Development 78 Dr. Barun k . Sharma Senior VET Officer Ministry of Livestock Development 79 Dr. Pradeep Bhattarai Sr. Live Stock Dev. Officer Ministry of Livestock Development 80 Mr. Rajeev Kumar Agri. Economist Ministry of Livestock Development 81 Mr. Jay Mangal Prasad SFO Ministry of Livestock Development 82 Dr. Tej Bahadur Rijal SLDO Dept of Livestock, Ministry of Livestock Development 83 Mr. Atmaram Pandey Former Secretary GoN 84 Ms. Savita Malla Advocacy & Communication Specialist NNFSS/NPC/UNICEF M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 86 85 Mr. Bishnu Paudel Program and Policy Specialist NNFSS/NPC/Suaahara 86 Mr. Min Raj Gyawali Nutrition Advisior NNFSS/NPC/UNICEF 87 Ms. Rohita Gauchan Thakali M & E Officer NNFSS/NPC/UNICEF 88 Ms. Manu Panthi Nutrition Officer NNFSS/NPC/UNICEF 89 Ms. Shikha Basnet M & E and Documentation Consultant NNFSS/NPC/UNICEF 90 Mr. Sagar Shrestha Adim & Finance NNFSS/NPC/UNICEF Contributors from Development Partners S.N. Name Position Organization/ Institute 1 H.E. Rensje Teerink Ambassador/Head of Delegation Delegation of the EU to Nepal 2 Mr. Andreas Roettger Head of the Programs Delegation of the EU to Nepal 3 Mr. Robert Hynderick Program Manager Delegation of the EU to Nepal 4 Mr. Mim Hamal Program Manager Delegation of the EU to Nepal 5 Mr. Tomoo Hozumi Country Representative UNICEF Nepal 6 Mr. Stanley Chitekwe Chief, Nutrition Section UNICEF Nepal 7 Mr. Pradiumna Dahal Nutrition Specialist UNICEF Nepal 8 Mr. Anirudra Sharma Nutrition Specialist UNICEF Nepal 9 Mr. Gyan Bahadur Bhujel Nutrition Officer UNICEF Nepal 10 Mr. Sanjay Rijal M&E Officer UNICEF Nepal 11 Mr. Naveen Paudyal Nutrition Officer UNICEF Nepal 12 Mr. Mukunda Nepal Communication Officer UNICEF Nepal 13 Mr. Yadav KC Information Management Officer UNICEF Nepal 14 Mr. Phulgendra Singh Nutrition Officer UNICEF Nepal 15 Mr. Rudra Khadka Nurtition Officer UNICEF Nepal 16 Mr. Prakash Chandra Joshi Nutrition Officer UNICEF Nepal 17 Ms. Meena Thapa H & N Officer UNICEF Nepal 18 Ms. Alisha Pradhan Consultant UNICEF Nepal 19 Mr. Babu Ram Acharaya Nutrition Officer UNICEF Nepal 20 Mr. Binod Nepal Program Associate UNICEF Nepal 21 Ms. Dibya Manadhar Consultant CHD, DOHS/UNICEF Nepal 22 Dr. Rajendra Kumar BC Consultant CHD, DOHS/UNICEF Nepal 23 Ms. Pragya Rimal Consultant CHD, DOHS/UNICEF Nepal 24 Mr. Sher Singh Dahit IMAM Officer CHD, DOHS/UNICEF Nepal 25 Ms. Sophiya Uprety Nutrition Officer UNICEF Nepal 26 Ms. Sumi Maskey Nutrition Officer UNICEF Nepal 27 Ms. Chahana Singh Rana Programme Officer UNICEF Nepal 28 Mr. Chandan Deo IMO UNICEF Nepal 29 Mr. Dipu Shakya ECD Specialist UNICEF Nepal 30 Mr. Ernest Lecomte Intern UNICEF Nepal 31 Mr. Kapil Ghimire Consultant UNICEF Nepal 32 Mr. Lokendra Shansher Thapa Logistic Officer UNICEF Nepal 33 Mr. Siddhi Shrestha WASH Specialist UNICEF Nepal 34 Ms. Satya Tamatta Progs. Assistance UNICEF Nepal 35 Ms. Sanju Bhattarai C4D UNICEF Nepal 36 Mr. Sudip Pokharel Consultant UNICEF Nepal 37 Mr. Ram Thapa Budget Asst. UNICEF Nepal 38 Ms. Shanda Steimer Director USAID 39 Mr. Debendra Adhikari Nutrition Specialist USAID 40 Dr. Shilu Adhikari MNCH Advisor USAID 41 Dr. Manav Bhattarai Health Specialist World Bank M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 87 42 Ms. Pooja Pandey Rana Deputy Chief of Party Suahaara II 43 Ms. Bishow Raman Neupane Sr. Manager Suahaara II 44 Mr. Harendra Chand M& E Co-ordinator Suahaara II 45 Ms. Bhim Kumari Pun Sr. Program Manager Suahaara II 46 Ms. Anita Shah Sr. Coordinator Suahaara II 47 Mr. Bishnu Pd. Dulal Data Analysis Suahaara II 48 Dr. Lonim Dixit National Professional Officer WHO 49 Mr. Paridhi Pathak Programme Associate FAO 50 Mr. Shrawan Adhikari Food Security Officer FAO 51 Mr. Tej Bahadur Subedi Programme Director AFSP/FAO 52 Mr. Kul Dip Ghimire Sr. Planning Officer AFSP/FAO 53 Mr. Amrit Gurung Sr. Program Associate for Nutrition WFP 54 Ms. Mamta Gurung Head of Education WFP 55 Mr. Puspa Shrestha NekSAP WFP 56 Mr. Richard Nwandetar Nutrition WFP 57 Mr.Nhukesh Maharjan Programme Associate WFP 58 Mr. Umesh Chaudhary Programme Policy WFP 59 Ms. Naomi Saville Nutrition Advisior WFP 60 Mr. Chandra Br. Thapa VAM Officer WFP 61 Mr. Sujay N Bhattacharaya Head Nutrition and Health ACF 62 Mr. Deepak Paudel HoD Save the Children 63 Ms. Nira Sharma Program Manager Save the Children 64 Dr. Jaganath Sharma Sr. Tech. Manager Health & Nutrition SABAL Program 65 Mr. Jeeban Ghimire Sr. Programme Coordinator SABAL Program 66 Mr. Santosh Ghimire Sr. Manager SABAL Program 67 Mr. Govinda Acharaya Goverance &Coordination Advisor PAHAL Program 68 Mr. Buddhi Devkota Quality Control Officer Pahal/ NTAG 69 Ms. Shanti Upadhyaya Nutrition Specialist Pahal/ Plan Nepal 70 Ms. Richa Uprety Communication Specialist Care Nepal 71 Ms. Asha Basnyet Deputy Country Director Helen Keller International 72 Ms. Dale Davis Country Director Helen Keller International 73 Mr. Madhukar Shrestha Consultant Helen Keller International 74 Ms. Sabina Hora IEC & Nutrition Specialist Helen Keller International 75 Dr. Sushil Baral Managing Director HERD International 76 Hom Nath Subedi Sr. Programme Manager HERD 77 Ms. Shophika Regmi Programme Manager HERD International 78 Mr. Deepak Joshi Sr.RM &E Officer HERD 79 Mr. Alok Shrestha National Facilitator HELVETAS 80 Mr. Sunil Shrestha Board Member CSANN 81 Ms. Prativa AC Communication Officer CSANN 82 Dr. Purushottam Mainali Nutrition Advisor KISAN 83 Mr. Kuber Adhikari National Health Coordinator World Vision 84 Mr. Pranab Rajbhandari Deputy Chief of Party HC3 85 Ms. Seema Luitel Programme Manger WHH Nepal 86 Ms. Nira Joshi Research Officer New Era 87 Prof. Dr. Uma Koirala Chairperson Civil Society Alliances for Nutrition 88 Dr. Marina Vaidya Shrestha Doctor Kathmandu Medical College M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 88 Bakrania S. 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M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 9090 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 91 M U LT I - S E C TO R N U T R I T I O N P L A N - I I l ( 2 0 1 8 – 2 0 2 2 ) 92 GOvERNMENT OF NEPaL NATIONAL PLANNING COMMISSION KaTHMaNDU www.nnfsp.gov.np