Nutrition International’s work in Nepal

Nutrition International, formerly the Micronutrient Initiative, began working in Nepal in 1998. With support from the Government of Canada and in close collaboration with Nepal’s Ministry of Health and Population (MoHP), Nutrition International focused efforts on key priority interventions to improve nutrition and health of the most vulnerable – especially women and children – to help them survive and thrive.

From the outset, Nutrition International has been an active partner of the Nepalese government in its formulation of health and nutrition policies.

Nutrition International Nepal provided micronutrient supplementation and food fortification inputs to the Multi-sectoral Five-year Nutrition plan to reduce malnutrition led by the National Planning Commission. In addition, Nutrition International supported the development of the First and Second Five-Year Plans of Action to control anaemia in women and children.

Boosting immune systems

From 1999 – 2012 Nutrition International provided 100% of Nepal’s requirement of vitamin A capsules to support the national vitamin A supplementation (VAS) program through the Government of Canada’s In-Kind-Assistance donation program.  Since 2013, Nutrition International provided 50% of Nepal’s needs of high-dose (200,000IU) vitamin A capsules.

As a member of Nepal’s National Steering Committee for VAS, Nutrition International provided technical expertise to finalize specifications of these high-dose vitamin A capsules for young children (6–59 months) to support in-country procurement. Nutrition International also supported the implementation of pilot projects testing the feasibility of providing VAS to newborns and strategies to deliver VAS to children at 6 months of age, which resulted in the Nepal government scaling-up the strategy in a phased manner.

In 2015, Nutrition International provided technical and financial support (through UNICEF) to the MoPH to scale-up VAS to reach infants aged 6-8 months through multiple delivery channels in seven districts

Treating childhood diarrhoea

Beginning in 2009, Nutrition International supported the government to address childhood diarrhoea with zinc and oral rehydration salts (ORS) as a simple and affordable treatment. This included a two-year pilot project to demonstrate suitable program strategies to increase the use of zinc and ORS as a treatment for childhood diarrhoea. At the policy level, Nutrition International supported the Nepali Technical Assistance Group (NTAG) to incorporate zinc and ORS in the micronutrient survey.

Other results included:

  • Nutrition International reviewed Nepal’s policy, strategy and program for treating childhood diarrhoea, identifying gaps and providing recommendations to strengthen the program.
  • Nutrition International supported the Department of Health Services (GoN) in training public sector health service providers and pharmacists; strengthening supply chain mechanisms; and monitoring and reporting systems.
    • The program was scaled up to 12 districts and, in 2014 and 2015, nearly 320,000 episodes of diarrhea were treated with both zinc and low osmolarity-ORS through public sector providers.
  • Nutrition International trained 12,200 health workers and FCHVs on service delivery, supply chain, record keeping; and 260 pharmacists on the use of zinc; ensuring they had relevant communication material to counsel caregivers.
  • To improve recording and reporting in the Health Management Information System (HMIS), Nutrition International assisted the government to implement modified tools for recording information on childhood diarrhoea, while continuing to provide supportive supervision to health workers.
Micronutrient support for better health

Since 2013, Nutrition International supported a pilot project to improve the delivery of key micronutrient interventions including: VAS for children (6-59 months), iron and folic acid (IFA) supplementation for pregnant women, and zinc and LO-ORS for children (2-59 months) suffering from diarrhoea. The focus of the pilot was to strengthen four key building blocks of the health system: service delivery; supply chain; recording and reporting; and local health governance.

Reducing impact of anaemia for pregnant women

The 1998 Nepal National Micronutrient Survey (NNMS) funded by Nutrition International, revealed anemia as a severe public health concern.

With Nutrition International and UNICEF as primary external donor partners, the Government of Nepal launched the Iron Intensification Project (IIP) in 2003 in five districts and, over subsequent nine years, scaled-up the program to cover 74 of 75 districts.

Since then, Nutrition International supported Nepal’s iron and folic acid (IFA) supplementation for pregnant women, through the Intensification of Maternal and Neonatal Micronutrient Program (IMNMP). Nutrition International’s technical and financial support to Nepal’s Child Health Division focused on sustaining the achievements, and the strengthening and scaling-up of the IMNMP.

Consequently, coverage of any IFA supplements among pregnant women increased from 58% in 2006 to 80% in 2011 as per NDHS 2011.

It is estimated that more than 80% (600,000) pregnant women nationally have received IFA tablets with Nutrition International’s support every year since 2013. At the district level, Nutrition International helped streamline stocks and devise strategies to expand reach.

Nutrition International provided technical assistance to HMIS Section/Management Division to streamline national recording and reporting of IFA supplementation. With Nutrition International support, 9,000 health workers and FCHVs, received refresher training for appropriate and effective counseling in 2013 and 2014.

Reducing risks of iodine deficiency disorders

Nutrition International provided technical and financial support for conducting the Nepal Iodine Deficiency Disorder

(IDD) Status Survey in 2005. The survey revealed that the use of adequately iodized salt was lowest in eastern and central Terai districts; in response, Nutrition International provided funding support, through UNICEF, to implement a community-based iodized salt social marketing campaign in 9 districts of East and Central Terai in 2008 and 2009. As a result, the proportion of households using the ‘two-child’ logo salt packets (the mark to identify adequate iodine content) increased from 23% to over 70% after the intervention. This significantly helped increase the national coverage of adequately iodized salt from 58% in 2005 to 80% in 2011 (NDHS).

Fortifying staple foods for better health

Nutrition International’s collaboration with the Nepali Government over 8 years  led to the enactment of mandatory fortification legislation in 2011, requiring large-scale roller mills to fortify wheat flour with IFA and vitamin A, to reduce iron deficiency anaemia in women. Subsequently. around 75% of roller mills in Nepal joined the program.

Nutrition International supported both the roller mills and the small-scale fortification at the village level. In 2014, this resulted in approximately 62,000 metric tonnes of fortified wheat flour to be produced via 20 roller mills.

  • Approximately 689,000 women of reproductive age are estimated to have gained access to fortified wheat flour.

Since 2009, Nutrition International supported small-scale fortification projects in the Lalitpur district. Nutrition International continued to support fortification efforts in Nepal through regular testing for quality, training on quality assurance, and extending technical and financial support to the Department of Food Technology and Quality Control for orientating food inspectors and analysts on the flour fortification program and its monitoring.

Future Forward

Nutrition International plans to support UNICEF in undertaking the Nepal National Micronutrient Status Survey (NNMSS), which is currently underway and will be completed by June 2017. The NNMSS will assess micronutrient status among representative populations in Nepal, including the status of vitamins A and B12, iron, folic acid, iodine, zinc and the condition of anemia among vulnerable populations in Nepal. It is expected that the results from this survey will inform the health and nutrition programming in Nepal in the coming years.