Dr. Kenda Cunningham Sr. Advisor, Monitoring, Evaluation and Research, Suaahara II

1. Health and nutrition services during Covid 19 in Nepal:
interruptions and restoration
Dr. Kenda Cunningham
Sr. Advisor, Monitoring, Evaluation and Research, Suaahara II

2. MIYCN in Covid19 Context Rapid Assessment
Suaahara II
Objective To assess health and nutrition services and practices during the COVID-19 context in 389 of
Nepal’s 753 municipalities
Design Cross-sectional surveys; 3-4 rounds; random selection at each level
Remote, electronic data collection by Suaahara II field staff
Sampling 1st phase (January 2021, about 6 months
after 1st lock-down ended):
• 42 districts
• 20 wards per district
• 6020 Mothers (7 per ward)
• 851 Health facilities/posts (1 per ward)
• 860 FCHVs (1 per ward)
2nd phase (July 2021, less than 1 month
after 2nd lock-down ended):
• 389 municipalities (all in the 42 districts)
• All wards of each district
• 23,471 Mothers (7 per ward)
• 772 Health facilities (2 per municipality)
• 3,353 FCHVs (1 per ward)
Ethics Nepal Health Research Council
Notes Practices are self-reported; observations were not possible; referencing the 3 months prior to the
survey (April-June 2021)
Note: National lockdowns: 1) March 26, 2020-June 10, 2020 and April 28, 2021-June 18, 2021

3. Suaahara II & MIYCN Rapid Assessment sites

4. Child health and nutrition service participation (%)
96
83
73
73 73 70
0
10
20
30
40
50
60
70
80
90
100
Immunization Growth Monitoring and Promotion Vitamin A
Jan. 2021
Mother [N = 6020]
July 2021
Mother [N = 23471]

5. Child health and nutrition service availability (%)
44 40
8
23
46
54 57
49
0
20
40
60
80
100
Deworming
for child
Diarrhoea ARI/
Pneumonia
Postnatal,
newborn
care
Jan. 2021
FCHV (N = 860)
July 2021
FCHV (N = 3353)
67
49
35
43
46
54 57
49
0
20
40
60
80
100
Deworming
for child
Diarrhoea ARI/
Pneumonia
Postnatal,
newborn
care
Jan. 2021
HW (N = 851)
July 2021
HW (N = 772)

6. Barriers to providing health and nutrition services (%)
77
27
39
24
5
11
31 30
44
20
4
9
0
10
20
30
40
50
60
70
80
90
100
Mobility
restriction
(service
provider or
mother/
client)
Fear of
COVID-19
(service
provider)
Fear of
COVID-19
(mother/
client)
Lack of PPE Suffering
from COVID-
19 (service
provider)
Lack of H&N
commodities
Jan. 2021
FCHV (N = 860)
July 2021
FCHV (N = 3353)
26
35
41 38
14
31
20
29
41
15 16 19
0
10
20
30
40
50
60
70
80
90
100
Mobility
restriction
(service
provider or
mother/
client)
Fear of
COVID-19
(service
provider)
Fear of
COVID-19
(mother/
client)
Lack of PPE Suffering from
COVID-19
(service
provider)
Lack of H&N
commodities
Jan. 2021
HW (N = 851)
July 2021
HW (N = 772)

7. COVID-19 program participation and prevention counseling (%)
43
71
86
0
10
20
30
40
50
60
70
80
90
100
Participated in discussion session, orientation or awareness on
COVID-19
Mother [N = 23471] FCHV (N = 3353)
51 50
0
10
20
30
40
50
60
70
80
90
100
COVID-19 prevention counseling
Chart Title
FCHV (N = 3353) HW (N=772)

8. Key take-aways
• Monitor: Ongoing investments in data collection (and USE) are needed to
know which services are most at risk and in turn, provide support
• Adapt: Interventions and research adaptations are needed regularly and
quickly based on evolving contexts; technology and innovation will be vital
• Recognize workload: Service providers are taking on covid-19 responsibilities
(e.g. trainings; risk communication; counseling, when their time availability
was already minimal
• Respond to barriers: Both demand and supply barriers to service provision
must be addresses for delivery of services to resume and continue
• Focus: equity and service quality are additional priority areas for research and
implementation efforts

9. This presentation is made possible by the generous support of the American people through the United States Agency for International Development
(USAID). The content of this plan is produced by Helen Keller International, Suaahara II Program and do not necessarily reflect the views of USAID or
the United States Government.
Suaahara II
would like to
thank the
Government
of Nepal for
their
leadership.