1. National Nutrition Situation, Policies, Priorities and Programs Dr. Shyam Raj Upreti Child Health Division Department of Health Services

2. NHSP II (Impact Indicators)

3. NHSP II OUTCOME INDICATORS TARGET 201020132015 % of diarrhea cases among under -5 children treated with zinc (and ORS) 7%25%40% % of children exclusively breastfed in the first 6 months 35%48%60% % Vit A coverage maintained for children aged 6 -59 months 90% % of low birth weight (or small) babies 32%27%25%

4. Changes in nutritional status of children under 5 years of age Source: NDHS 2011

5. Stunting by Sub-region Percent of children under age 5 who are too short for their age (based on WHO standards) Eastern terai 31% Central terai 41% Western mountain 60% Mid-western terai 44% Far-western hill 58% Eastern hill 46% Central hill 31% Western hill 36% Mid-western hill 52% Far-western terai 32% Western terai 40% Central mountain 46% Eastern mountain 45% 41%

6. Disparity by wealth quintile exists…. 65% reduction in richest quintile! 12% increase in poorest quintile! 14% reduction overall High Inequity Ref: DHS 2001 and 2006. Adapted from Ramu Bishwakarma. Social Inequalities in Child Nutrition in Nepal. August 2009 (Background paper for Nepal Nutrition Assessment and Gap Analysis, November 2009)

7. Sustained High Vitamin A Supplementation and De-worming to Children (Focus needed: 6-11 months - 55% and Urban below 80%)

8. Iodized salt social marketing campaign will be planned for expansion in a phase wise manner to the districts having low consumption of adequately iodized salt

9. NDHS 2011

10. % of children aged 6-59 months with anemia NDHS 2011 68.6%

11. IYCF practices among 6-23 months children

14. NDHS 2011 42%

15. National Nutrition Policy Overall Objective: To reduce child and maternal mortality through nutritional interventions Specific Objectives: Reduce general malnutrition among children and women, i.e. stunting, underweight, wasting, low BMI Reduce Iron Deficiency Anemia among children, children under age 2 year and pregnant women Maintain and sustain Iodine Deficiency Disorders and Vitamin A Deficiency control activities. Improve maternal nutrition Align with multi-sectoral nutrition initiative. Improve Nutrition related behavior change and communication Improve Monitoring of Nutrition related programs/activities

16. National Nutrition Strategy Protect, promote and support optimal feeding practice of children through IYCF scale up, increasing coverage of GM Expansion of Community Management of Acute Malnutrition linked to expansion of Nutrition Rehabilitation Homes Reduce IDA through – iron tablet supplementation to pregnant, adolescents – MNPs distribution liked to IYCF to children under 2 years – Deworming (Preschool, school and pregnant) and flour fortification Increase accessibility and Social Marketing of 2-Child Logo iodized packet salt Bi-annual mass supplementation of VA to under 5 years children Gradual expansion of the School Health and Nutrition activities in all districts BCC for changing dietary practices for improved maternal and child nutrition practices

17. Nutrition Interventions Nationwide 1.Growth Monitoring and counseling 2.Prevention and control of Iron Deficiency Anemia (IDA) 3.Prevention, Control and Treatment of Vitamin A deficiency (VAD) 4.Prevention of Iodine Deficiency Disorders (IDD) 5.Control of Parasitic Infestation by deworming 6.Emergency Nutrition At scale 1.Infant and Young Child Feeding (IYCF) 2.Community Management of Acute Malnutrition (CMAM) 3.Micronutrient Powder (MNP) distribution link with IYCF 4.School Health and Nutrition Program – 14 districts+15 district under process in this FY Piloting / small scale 1.Maternal and Child Health Care (MCHC) Program – 9 districts 2.Food supplementation 3.Vitamin A Supplementation to address the low coverage in 6-11 months children (Jumla, Chitwan & Kavre) 4.Piloting New Growth Chart (Rukum) 5.Multi-sectoral Nutrition Plan (MSNP) – (6 Districts: Bajura, Achham, Jumla, Nawalparasi, Kapilvastu & Parsa)

18. Nutrition ProblemCurrent Status General Malnutrition among children under 5 years of age (Macronutrients) Underweight - “On track” Stunting and Wasting – “Not on track”  Inequity in increasing Vitamin A DeficiencyNo longer a public health problem Iodine Deficiency Disorders “On track” (MDG Target-90%) (80% HHs Consuming adequately Iodized Salt) Iron Deficiency Anaemia “On track” Current Progress in Nutrition

19. New Initiatives Multi-sectoral Nutrition Plan has recently been approved by the Council of Ministers Strategy for IYCF, Maternal Nutrition and detailed Communication Plan for MIYCF is under development process Priorities programmes such as IYCF, MNP, CMAM and NRH are gradually being scaled up in different districts MCHC Programme review (national as well as regional) has been carried out.

20. Issues and Challenges  Sustained and predictable financing for scaling up priority programmes viz. IYCF, CMAM etc.  Institutional strengthening for nutrition and capacity building of HWs including management capacity at central level  Sluggish procurement process for commodities and services  Weak monitoring and supervision at all levels with poor use of available data  Good progress of micronutrient deficiency control program but maintenance and sustainability is a challenge  Implementation of nutrition activities through multi-sectoral approach

21. Future Priorities in Nutrition Sustained financing for program scale-up, i.e. Infant and Young Child Feeding Counseling (IYCF), Multiple Micronutrient Powders (MNPs) distribution linked with IYCF, Community Management of Acute Malnutrition (CMAM) Impact assessment of targeted food supplementation and cash grant Support to maintain and sustain micronutrients deficiency control programs (IDA, IDD, VAD) Institutional strengthening of nutrition program with institutional arrangements and capacity building of community health workers and volunteers in nutrition Technical and financial support to implement multi-sectoral nutrition interventions.

22. Thank you