Over the years, nutrition is increasingly being considered a key development agenda around the world. Some international, regional and national initiatives have been effective in addressing poor nutrition among children and women in developing countries. In this context, Scaling Up Nutrition (SUN) is a unique global movement founded on the principle that all people have a right to food and good nutrition. It primarily aims to unite all relevant stakeholders from governments, civil society, the United Nations, donors, businesses and researchers in a participatory and inclusive approach to improve nutrition.As a matter of fact, poor nutrition in the first 1,000 days of children's lives can have irreversible consequences. For millions of children, it means they are stunted, forever. Despite several efforts of government and external development partners, there are still challenges to improve the nutrition status of children who are poor, socially disadvantaged and marginalized in the communities.
According to the Nepal Demographic and Health Survey of 2011, 41 percent of children were stunted. Furthermore, 11 percent were still "wasted". Given these indicators, much is to be done to improve access to nutrition services for poor, vulnerable and socially marginalized people. In this context, the multi-sector nutrition plan (2013-2017) is a landmark progress in terms of a new initiative by bringing all relevant development sectors to harness nutrition sensitive interventions in their plans and programs.
Towards this end, Nepal as one of the SUN countries has expressed its commitments to prioritize nutrition and food security as a national development agenda. This is because a vast majority of young children suffer from some form of malnutrition with devastating consequences on health, education, economic development, resilience and security. More importantly, investing in nutrition can significantly help break the cycle of poverty.
Since 2011, Nepal has been actively participating in the annual global gathering of SUN to share the experiences, progresses and challenges faced in the area of multi-sector approach to nutrition. As always, one of the important objectives of this high level meeting is to enhance mutual accountability within the movement particularly with all constituents, countries, networks, secretariat and other stakeholders, and more importantly envisioning the movement beyond 2015.
In recent years, multi-sector approach to nutrition is increasingly receiving recognition in tackling the malnutrition in most of the developing countries. Agriculture sector has a key role to play as it can substantially contribute to nutritious food by harnessing a range of interventions which promote nutrition-sensitive agriculture.
Similarly, community-based water and sanitation activities will help improve access to water supply and sanitation services that eventually reduces infections and incidence of diseases. Furthermore, the role of education, health, local government, women development will be instrumental in better harvesting nutrition in order to reduce child mortality and morbidity.
After the launch of multi-sectoral nutrition plan at national and district levels in 2012, few important activities such as capacity development and advocacy have already started. The district level multi-sector planning process with costing of interventions has been completed to address the needs of multi-sector approach in tackling growing challenges of malnutrition in the country.
More importantly, the implementation process of multi-sector nutrition plan has a long way to go as it requires tremendous support from partners for capacity development of stakeholders at central, district and village levels. Moreover, there are emerging needs to promote utilization of locally available nutritious foods by overcoming the existing socio-economic and cultural barriers in a more pragmatic approach.
Much has been talked about the relevance of multi-sector approach to nutrition. However, due to several practical issues around coordination and resource mobilization, the implementation of multi-sector nutrition plan has not gained the steady momentum yet. Moreover, after the devastating earthquake in April, millions of children have been more vulnerable and they need immediate health and nutrition services for their survival. Therefore, in the changing context, multi-sector nutrition plan needs to realistically address nutrition issues in emergencies.
Lack of proper coordination and mutual understanding among sectoral ministries and several partners has further complicated the implementation process in terms of prioritizing adequate resources for nutrition. Apart from this, utilization of available budget from both government and partners has been delayed due to lack of clear implementation guidelines at district and village levels.
Though the government has recognized the importance of multi-sector approach to nutrition, integrating nutrition-sensitive interventions in sectoral plans has always been a slow process. Unfortunately, the existing nutrition governance is still weak in terms of multi-sector coordination and resource mobilization, and this will have adverse impacts on the effective implementation of multi-sector nutrition plan at large.
Multi-sector coordination committees for nutrition and food security are mostly inactive in the districts where there is no support from partners. Clearly, there are emerging needs to enhance local ownership and sustainability of these committees for effective coordination and implementation of multi-sector nutrition plan at district and village levels.
The role of nutrition and food security secretariat at National Planning Commission (NPC) is important in terms of creating a space for all actors to play their role in supporting government efforts to alleviate under-nutrition. More efforts are needed to involve academia, private sectors and civil society organizations in this important process of multi-sector approach to nutrition. In recent years, the institutional capacity and continuity of the secretariat have been a crucial issue for both the NPC and partners as this has largely relied on external resources.
In addition, there is an encouraging progress of civil society engagement in the country. The alliance of civil society organizations for nutrition has been established and is fully functional in order to enhance social advocacy for multi-sectoral approach to nutrition at all levels. This will definitely help create demands in the communities so that nutrition services are more responsive to local needs and priorities.
Realizing all practical challenges and opportunities, national nutrition policies and strategies should be pro-poor and gender-sensitive in order to meet the needs of health and nutrition services for poor women and children. Therefore, policymakers and planners now need to realistically rethink the scalability of nutrition-sensitive interventions in an inclusive approach to ensure better nutritional impacts.
The author is a PhD research fellow in public health with Chulalongkorn University, Thailand
talk2jhabindra@gmail.com
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