Management of National Nutrition Programme.pptx

National Nutrition
Program
Presented By:
Babita Shrestha
MPH II sem (PHSM)
School of Health and Allied Sciences, Pokhara University
2/4/2024 Babita Shrestha, MPH(PHSM) 1

Background
• The National Nutrition Programme is priority programme of the government.
It aims to achieve the nutrition well-being of all people so that they can
maintain a healthy life and contribute to the country’s socioeconomic
development.
• Nutrition section under FWD is responsible for management of national
nutrition program.
• Nutrition interventions are cost effective investments for attaining many of
the SDGs.
• In alignment with national and international declarations & policies, GoN is
committed to ensure adequate food, health and nutrition for every citizen.
• The Constitution of Nepal (2015) ensures the right to food, health and
nutrition to all citizens.

Burden
• Globally, 149.2 million children under the age of 5 years of age are stunted
(too short for their age) and 45.4 million are wasted (underweight for their
height).
• Around 45% of deaths among children under 5 years of age are linked to
undernutrition. These mostly occur in low- and middle-income countries.
• WHO estimates that 40% of children less than 5 years of age and 37% of
pregnant women worldwide are anaemic.
• Malnutrition is a significant public health problem in Nepal.
• From 1996 to 2022 (NDHS), the national prevalence of stunting among
children under five years declined from 57% (severe) to 25% (moderate)
while wasting among the same age group dropped from 15% (severe) to 8%
(moderate).

National Nutritional Program
Goal:
• Its goal is to achieve nutritional well‐being of all people to maintain a healthy
life to contribute in the socio‐economic development of the country, through
improved nutrition program implementation in collaboration with relevant
sectors.

Objectives (1)
Specific Objectives
• To reduce protein-energy malnutrition in children under 5 years of age and
women of reproductive age
• To improve maternal nutrition.
• To reduce the prevalence of anaemia among adolescent girls, women and
children.
• To eliminate iodine deficiency disorders and vitamin A deficiency and sustain
elimination.

Objectives (2)
• To reduce the infestation of intestinal worms among children and pregnant
women.
• To reduce the prevalence of low birth weight.
• To improve household food security to ensure that all people can have
adequate access, availability and use of food needed for a healthy life.
• To promote the practice of good dietary habits to improve the nutritional
status of all people.
• To prevent and control infectious diseases to improve nutritional status and
reduce child mortality.

Objectives (3)
• To control lifestyle related diseases including CHD, hypertension, tobacco,
cancer and diabetes
• To improve the health and nutritional status of school children
• To reduce the critical risk of malnutrition during very difficult life
circumstances
• To strengthen the health system for analysing, monitoring and evaluating the
nutrition situation
• To accelerate BCC and nutrition education at community levels
• To align health sector programmes on nutrition with the Multi-Sectoral
Nutrition Initiative.

SDGs Targets 2016-2030
Goal 2 — End hunger, achieve food security and improved nutrition and
promote sustainable agriculture
• By 2030, end hunger and ensure access by all people, particularly among the
poor & vulnerable and infants.
• By 2030, end all forms of malnutrition, including achieving, by 2025, the
internationally agreed targets on stunting and wasting in <5 of age, and
address the nutritional needs of adolescent girls, pregnant, lactating women
and older persons;
• By 2030, double the agricultural productivity and incomes of small-scale food
producers, in particular women, indigenous peoples, family farmers,
pastoralists and fishers

Global Nutrition Target by 2025 (WHA)
• Reduce the global number of <5 children who are stunted by 40%
• Reduce anaemia in women of reproductive age by 50%
• Reduce low birth weight by 30%
• Zero increase in childhood overweight
• Increase the rate of EBF in the first six months up to at least 50%
• Reduce and maintain childhood wasting to less than 5%

National Nutritional Status & Targets

Overall Strategies of National
Nutrition Programme
Promotion of a food based-
approach
Food fortification
Supplementation of foods
Promotion of public health
measures.
Overall strategies
for improving
nutrition

Nation Wide Implemented Nutrition Program
S.N Programs
1 Maternal, infant and young child Health Nutrition (MCHN)
2 Growth Monitoring and Promotion (GMP)
3 Infant and young child feeding (IYCF)
4 Control and Prevention of Iron Deficiency Anemia
5 Control and Preventions of Vitamin A Deficiency Disorders
6 Control and Prevention of Iodine Deficiency Disorders
7 Control of Intestinal Helminths Infestations
8 Flour fortification with micro- nutrients/roller mill fortification
9 School Health and Nutrition Program (Adolescent IFA distribution)
10 Promotion of food based dietary guideline
2/4/2024 12

Scale up Program
2/4/2024 13
S.N Program
1. Comprehensive Nutrition Specific Interventions (CNSI)
2. Integrated Infant and Young Child Feeding and Multiple Micronutrient
Powder (Balvita) Community promotion program
3. Integrated Management of acute malnutrition(IMAM)
4. Maternal and child health nutritional program
5. Maternal Baby Friendly Hospital Initiative (MBFHI)

1. Control of Protein Energy
Malnutrition (PEM)
Strategies
• Promote breastfeeding within one hour of birth & avoid pre-lacteal feeding.
• Promote exclusive breastfeeding for first six month.
• Timely introduction of appropriate complementary feeding (at 6 months).
• Ensure continuation of breastfeeding for at least 2 years.
• Strengthen the capacity of health workers and medical professionals for
nutrition and breastfeeding management and counselling.
• Improve skills and knowledge of health workers on growth monitoring.
• Strengthen the system of growth monitoring and its supervision and
monitoring.
• Promote the use of appropriate locally available complementary foods.

1. Control of Protein Energy
Malnutrition (PEM)
• Increase awareness on the importance of appropriate and
adequate nutrition for children and pregnant and lactating
mothers.
• Strengthen the knowledge and skill of health personnel on the
dietary and clinical management of severely malnourished
children.
• Distribute fortified foods to pregnant and lactating women and
children aged 6 to 23 months in food deficient areas.
• Improve maternal and adolescent nutrition & decrease LBW.
• Strengthen nutrition education and nutrition counselling.

Average no. of growth monitoring
visits per child (0–23 months)

% of 0–6 month babies registered for growth monitoring
who were exclusively breastfed for their first six months

2. Prevention and Control of Iron
Deficiency Anaemia (IDA)
• MoHP has been providing supplementary IFA to pregnant and post-partum
women since 1998 to reduce maternal anaemia.
• The protocol is to provide 60 mg elemental iron and 400 microgram folic acid
to pregnant women for 225(180+45) days from their second trimester.
• In 2003, the Intensification of Maternal and Neonatal Micronutrient
Programme (IMNMP) began IFA supplementation through female community
health volunteers (FCHVs).
• IMNMP covered all 75 districts by 2014.

Strategies
• Advocate to policy makers to promote dietary diversity.
• Iron folic acid supplementation for pregnant and post-partum mothers.
• Iron fortification of wheat flour at roller mills.
• Multiple micronutrient supplementation for 6-23 months children.
• Create awareness of importance of iron in nutrition, promote consumption of
iron rich foods and promote diverse daily diets.
• Control parasitic infestation among nutritionally vulnerable groups through
deworming pregnant women and children aged 12-23 months.

% of women who received a 180 day supply
of iron folic acid during pregnancy

3. Prevention and Control of Iodine
Deficiency Disorders (IDDs)
• MoHP adopted a policy of universal iodization edible salt in 1973.
• The mandate of iodization and distribution is given to Salt Trading
Corporation.
• The GoN uses the Two-Child- Logo to certify adequately iodized salt.
• MoH is responsible for promoting iodized salt.
• DoHS has been implementing a social marketing campaign of this salt to
improve awareness of its use in households.

• Sustain the universal iodization of salt.
• Strengthen implementation of the Iodized Salt Act, 2055 to ensure that all
edible salt is iodized.
• The social marketing of certified two-child logo iodized salt.
• Ensure the systematic monitoring of iodized salt.
• Increase the accessibility & market share of iodized salt with the two-child
logo.
• Create awareness about the importance of using iodized salt to control IDDs
through social marketing campaign.
Strategies

% of households using iodized salt
(1998-2016)

4. Prevention and Control of Vitamin
A Deficiency (VADDs)
• The government initiated the National Vitamin A Programme in 1993 to
improve the vitamin A status of children aged 6-59 months and reduce child
mortality.
• It initially covered 8 districts and was scaled up nationwide by 2002.
• FCHVs distribute the capsules to the targeted children twice a year through a
campaign-style activity.

Strategies
• The biannual supplementation of high dose vitamin A to 6-59 month through FCHVs
• Post-partum vitamin A supplementation within 42 days of delivery.
• Strengthen implementation of vitamin A treatment protocol including
supplementation during severe malnutrition, persistent diarrhoea, measles and
xerophthalmia.
• Nutrition education to promote dietary diversification and consumption of vitamin A
rich foods.
• Ensuring the availability of vitamin A capsules at health facilities.
• Increase awareness on importance of vitamin A supplementation.
• Advocate for increased home production, consumption and preservation of vitamin
A rich foods.
• Promote the consumption of vitamin A rich foods and a balanced diet through
nutrition education.

Coverage of vitamin A supplementation
to children aged 6-11 months

Coverage of vitamin A supplementation to
children aged 12-59 months by distribution
round

5. Prevention & Control of Parasitic Infestations
• FWD is implementing biannual deworming tablets distribution to the
children aged 12-59 months aiming to reduce childhood anaemia with
control or parasitic infestation through public health measures.
• This activity is integrated with biannual Vitamin A supplementation to the
children aged 6-59 months.
• Deworming was initiated in few districts during the year 2000 and with
gradual scaling-up, the program was successfully implemented nationwide by
the year 2010.

Coverage of Deworming Tablets distribution to
the Children aged 12-59 months

6. Low Birth Weight (LBW)
• Reduce maternal malnutrition by preventing PEM, VADs, IDDs and IDA.
• Reduce the workloads of pregnant women.
• Increase awareness on risks of smoking & alcohol to pregnant women.
• Increase awareness on risks of early pregnancy on infant & maternal health.
• Promote activities for nutrition monitoring and counselling at antenatal
clinics

% of newborns with LBW among total
delivery by HWs

7. Household Food Security
• Promote kitchen garden and agricultural skills.
• Promote the raising of poultry, fish and livestock for household consumption.
• Inform community people how to store and preserve food.
• Improve technical knowledge of food processing and preservation.
• Promote women’s involvement in income generation activities.

8. Improved Dietary Practices
• Conduct studies to clarify the problems of culturally-related dietary habits
• Promote nutrition education and advocate for good diets and dietary habits.
• Develop and strengthen programmes for behaviour change to improve
dietary habits.
• Strengthen nutritional education and advocacy activities to eliminate food
taboos that affect nutritional status.
• Promote the household food security programme

9. Infectious Disease Prevention and
Control
• Promote knowledge, attitudes and practices that will prevent infectious
diseases.
• Ensure access to appropriate health services.
• Improve nutritional status to increase resistance against infectious disease
• Improve safe water supplies, sanitation and housing conditions.
• Improve food hygiene.

10. School Health and Nutrition
Programme
• The School Health and Nutrition Strategy (SHNS) was developed jointly in
2006 by MOHP and MOE to address the high burden of diseases in school age
children.
• With gradual scaling-up, the program has covered all 77 districts by FY
2073/074.
• The improved use of SHNS services, improved access to safe drinking water
and sanitation, skill-based health education, community support and an
improved policy environment are the core elements of the programme.

Strategies
• Build capacity of policy and working level stakeholders.
• The biannual distribution of deworming tablets to grade 1 to 10 school
children.
• Celebrate School Health and Nutrition (SHN) week in each June to raise
awareness on malnutrition at the community level through school children
and health workers.
• Distribute first aid kits to public schools.
• Introduce child-to-child and child-to-parent nutrition promotion approaches.

11. Integrated Management of Acute
Malnutrition (IMAM)
• The IMAM Programme (previously CBMAM) manage Severe Acute
Malnutrition (SAM) in children aged 0-59 months through inpatient
and outpatient services at facility and community level.
• IMAM aims to integrate nutrition support across health, early
childhood development, WASH and social protection sectors for
the continued rehabilitation of cases and to widen malnutrition
prevention programme and services.
• The programme also acts as a bridge between emergency and
development nutrition interventions.

Strategies
• Build capacity of health workers on managing acute malnutrition and of other
community workers on screening and the referral of cases.
• Establish and implement the key strategies of IMAM program: community
mobilization, inpatient therapeutic care, outpatient therapeutic care and
management of MAM.
• Implement the IMAM programme based on maximum coverage & access,
timeliness of service provision, appropriate care and care as long as it is
needed.
• Integrate the management of acute malnutrition across sectors to ensure that
treatment is linked to support for rehabilitating cases and to wider
malnutrition prevention programme and services.

Strategies
• Support and promote IYCF, WASH, early childhood development, social
protection and child health and care along with the management of acute
malnutrition.
• The supportive supervision and monitoring of IMAM programme activities.
• Harmonize the community and facility-based management of acute
malnutrition.
• Strengthen the coordination and capacity of nutrition rehabilitation homes.
• The SPHERE standards of effectiveness of IMAM Program:
• recovery rate >75 percent, defaulter rate <15 percent and death rate <10
percent

12. Nutrition in Emergencies (NiE)
• Emergency such as natural disasters (earthquake, flood, drought, etc.), conflicts
or any other cause occurs affecting the overall health, nutrition, and livelihoods
of all the population, NiE services is provided to the affected areas.
• NiE interventions focus on the pregnant and lactating women (PLWs) and
under five children as they are nutritionally most vulnerable during any
emergency.

NiE flows five building blocks of nutrition
interventions
1. Promotion, protection and support to breast feeding of infant and young
2. Promotion of proper complementary feeding to the infant and young
3. Management of moderate acute malnutrition (MAM) among the children
aged 6-59 months and among PLWs through targeted supplementary
feeding program (TSFP).
4. Management of severe acute malnutrition among the children aged 6-59
months through therapeutic feeding.
5. Intensification of Micronutrient supplementation for children and women
including MNP and vitamin A for children aged 6-59 months, IFA for
pregnant and postnatal women.

Strategies
• Develop adequate capacity and predictable leadership in the nutrition sector
for managing humanitarian responses.
• Formulate an emergency nutrition in emergency preparedness and response
contingency plans.
• Establish and strengthen stronger partnerships and coordination
mechanisms between government, UN and non-UN agencies.
• Agencies to respond in emergencies through the activated nutrition cluster.

13. Lifestyle Related Diseases
• Create awareness among adults about the importance of maintaining good
dietary habits.
• Develop the capacity for nutritional counselling at health facilities.
• Create awareness among adolescents and adults about the importance of
controlling smoking and body weight.
• Create awareness to increase physical activity and improve stress
management.

14. Nutrition Rehabilitation Homes
(NRH)
• The first NRH was established in 1998 in Kathmandu aiming to reduction of
child mortality caused by malnutrition through inpatient rehabilitation of
acute malnutrition among the children.
• The NRH not only treat and manage acute malnutrition with inpatient service,
but also provide nutrition education and counselling to the guardians of
admitted children on good nutrition and health care of their children.
• NRH restore severely malnourished children to good health while educating
their mothers about nutrition and child care.
• This program is very effective which involves the mothers in the process for
built-in sustainability to bring back children’s optimal health.

Nutritional Rehabilitation Home Admission and
discharge status of nutrition rehabilitation homes,
2078/79

15. Integrated Infant and Young Child Feeding and
Micro-Nutrient Powder (baal-vita) Community
Promotion Programme
• The promotion of MNPs is linked with improving complementary feeding.
• Mothers and caregivers are counselled to introduce complementary foods at
six months of age, on age-appropriate feeding frequency, on improving
dietary quality of complementary foods by making them nutrient and calorie
dense, as well as on hand washing with soap before feeding.
• Mothers and caregivers are trained to prepare ‘poshilojaulo’ (pulses, rice and
green vegetables cooked in oil) and ‘lito’ (mixture of blended and roasted
cereal and legume flours).

Percentage of children aged 6-23 months
who received 3 cycle Baal vita (MNP)

16. Adolescent Girls Iron Folic Acid
Supplementation
• From FY 2072/073, the SHN Program has initiated Weekly Iron Folic Acid
(IFA) supplementation to the adolescent girls aged 10-19 years.
• Under this component, all the adolescent girls aged 10-19 years are
supplemented with weekly Iron Folic Acid biannually in Shrawan (Shrwan-
Asoj) and Magh (Magh-Chiatra) rounds.
• IFA distribution to adolescent girls in school Iron-Folic Acid (IFA)
supplementation programs since the FY 2072/73 as a public health
intervention to prevent iron deficiency anemia.

IFA distribution to adolescent girls
in school
• The program is targeted at girls aged 10-19 years old, and is usually provided
through schools for school going adolescent girls and from health facilities for
out of school adolescent girls.
• Adolescent Girls take total of 26 tablet of iron per year.

The Baby-Friendly Hospital Initiative
(BFHI)
• The Baby-friendly Hospital Initiative (BFHI) is a global effort launched by
WHO and UNICEF to implement practices that protect, promote and support
breastfeeding.
• It was launched in 199.
• The global BFHI materials have been revised, updated and expanded for
integrated care. The materials reflect new research and experience, reinforce
the International Code of Marketing of Breast-milk Substitutes, support
mothers who are not breastfeeding, provide modules on HIV and infant
feeding and mother-friendly care, and give more guidance for monitoring and
reassessment.

The Baby-Friendly Hospital Initiative
(BFHI)
• Tribhuvan University Teaching Hospital, Paropakar Maternity & Women’s
Hospital, Patan Hospital, Bhaktapur Hospital, Hetauda Hospital, BP Koirala
Institute of Health Science, and Koshi Zonal Hospital are among the seven
hospitals.
• Because of the stagnant neonatal mortality rate and declining IYCF practices, an
assessment was conducted in all 7 BFHI hospitals 99 Family Welfare DoHS,
Annual Report 2078/79 (2021/22) in 2011.
• The study yielded some intriguing results that all BFHI-certified hospitals were
found to be failing to complete all ten steps of BFHI activities.

NDHS findings, 2022

Status of Nutrition Related Indicators
2/4/2024 53

2/4/2024 54
Fig: Trend of exclusive breastfeeding practices as per NDHS reports
Status of Nutrition Related Indicators

42
48 46
33
0
10
20
30
40
50
60
NDHS- 2006 NDHS- 2011 NDHS- 2016 NDHS- 2022
Trend of Anemia Prevalence in Pregnant
Women(%)
Trend of Anemia Prevalence in Pregnant Women(%)
2/4/2024 55

Policy Initiatives
• The National Nutrition Policy and Strategy 2004: Provides the strategic and
programmatic directions in the health sector.
• Multi Sectoral Nutrition Plan I (MSNP I 2013-2017): Provides a broader policy
framework within and beyond the health sector.
• Multi Sectoral Nutrition Plan II (2018-2022): Aims to reduce all forms of
malnutrition i.e; under nutrition and over nutrition prevailed among pregnant and
lactating women, children under 5 years of age and adolescents
• The National Health Policy, 2076: Highlights improved nutrition via the use and
promotion of quality and nutritious foods generated locally to fight malnutrition.
• The Nutrition Technical Committee was established in FWD in 2011 to support
multi-sectoral coordination for developing nutrition programmes.
• FWD is planning to establish a National Nutrition Centre for implementing MSNP
in the health sector.

Ministry of
Health and
Population
Maternal Infant and
Young Child feeding,
Micronutrient,
Management of SAM,
Treatment of Infection
Ministry of
Education
• Nutrition in
formal/informal
curriculums,
• Improved
awareness, Life-
skills and improved
meals to
Adolescent,
• Parenting
education
Ministry of Federal
Affairs and Local
Development
Linking social protection
and nutrition, Improved
Coordination and
resource mobilization
Ministry of Agriculture Development
Availability of Nutrient dense foods, income
generation, consumption of Nutrient dense/ animal
source foods and Reduced workload of women
National Planning Commission
Multi-sector resources, Nutritional information
management, Nutrition capacity Enhancing
Ministry of Urban
Development
Sanitation facilities/ODF,
Hand washing,
Safe drinking water at
point of Use
Multi-Sector Nutrition Plan Framework
Ministry of Women and Children
Nutrition Awareness among Women and
Adolescent
Mobilization of Women Group, Saving Credit
Groups for Nutrition, Participation in Planning
at local Levels
Child growth
failure/ death
Low Birthweight
baby
Low weight &
height in teenagers
Early pregnancy
Small adult
woman
Small adult man
The intergenerational transmission of growth
failure: When to intervene in the life cycle

Responsibilities of Nutrition Section
• Supporting the MoHP to prepare national policy related to nutrition, strategy,
guidelines, criteria, and protocols.
• Promoting nutrition related survey/research work.
• Multi-sectoral coordinating for nutrition promotion.
• Analysing nutritional status and technical assistance in provincial and local
level policy building.
• To facilitate the construction and implementation of national level programs
related to nutrition.
• Coordinate and work on technological issues with the state, local level and
stakeholders.

SN Post Level Group Sub group N
o
1. Senior Nutrition
Officer
9/10th Health Health Inspection 1
2. Nutrition Officer 7/8th Health Health Inspection 1
3. Senior/Community
Health Nursing
Officer
7/8th Health Community/Public
Health Nursing
1
4. Health Assistant 5/6/7th Health Health Inspection 1

Coordination and Collaboration
Management Division (HMIS &
Logistic Management
Section),National planning
commission (NPC), NHTC, NHEICC;
other sectors (Agriculture,
Education, Social development);
NPC; EDPs (including UNICEF),
PHDs, Hospitals, PHC facilities and
local governments etc.

Programme management
Provincial level: Policy, planning and program coordination section
Local level: Health section of municipality/rural municipality
Service Delivery Points
• Federal Hospitals
• Provincial Hospitals
• Local Hospitals
• Primary Health Care Facilities
• PHC ORC and FCHVs: baal- vita, iron folic acid, vitamin A
• Nutritional rehabilitation home
• Community Based Organizations

Logistic Management
• Logistic management section of management division of Department of
Health Services is responsible for logistics management for national nutrition
program in coordination with nutrition section of family welfare division.
• Provincial logistic management centers responsible for logistics management
for national nutrition health program at provincial level.
• Fund is provided to local government for procurement of essential nutritional
related commodities at local level.
Financial Management
• Government of Nepal
• External Development Partners, SUAAHARA
• World Health Organization (WHO)
• WFO
• UNICEF etc.

Review, Monitoring and Evaluation
• 25 input, process, output, outcome and impact indicators for programme
review, monitoring and evaluation.
• Onsite supervision and programme monitoring visits.
• Half yearly performance review at local, provincial and federal level.
• Annual performance review and micro planning local, provincial and federal
level.
• Joint Annual Review (JAR)
• Policy Reviews and Special Studies.

Leadership/Governance
Policy Documents
• Nepal Integrated Management of Acute Malnutrition (IMAM) Guideline: 2017
• Multi-sector Nutrition Plan I (2013-2017)
• Multi-sector Nutrition Plan II (2018-2022)
• Multi-sector Nutrition Plan III (2023-2030)
• Multi-sector Nutrition Plan National Infant Young Child Feeding Strategy 2073
• Food and Nutrition Security Plan of Action, Nepal 2016
• Nepal Health Sector Strategy (2016-2020)
• National Health Policy 2076
• Sustainable Development Goals 2016-2030
• Nepal health sector strategy 2077
• Nepal health sector strategic plan (2023-2030)

Directing
Leadership: Nutrition Section of Family Welfare Division .
Controlling: Recording Reporting
HMIS 2.3: Child Nutrition Register
HMIS 2.5: IMAM Child Health Card
HMIS 2.6: IMAM Register
HMIS 2.7: IMAM Register – Hospital
HMIS 9.2: PHC ORC Monthly Reporting
HMIS 9.3: PHCC, HP, UHC, CHU Monthly Reporting

HMIS l Module 5 l Nutrition
HMIS 2.1: बाल स्वास्थ्य कार्डमा पोषण सम्बन्धी
परिमार्डन भएका विषयिस्तुहरु
बाल स्वास्थ्य
कार्डमा पोषण
सम्बन्धी क
ु नै
पवन परिमार्डन
नभएको

HMIS 2.3: Nutrition Register मा
बालबाललकाले २३ मलिना पुरा हुँदाको समयमा कलि पटक वृद्धि अनुगमन
गरेको िो भन्ने अनुगमन गने मिल थलपएको
िाल प्रयोग भैरिेको पररमालजिि
HMIS 2.31: २ बर्ि मूनीका बालबाललकाको पोर्ण रलजष्टर

HMIS 2.32 मा
HMIS २.३२
फािाममा
क
ु नै पवन
परिमार्डन
नभएको

HMIS 2.33 मा
HMIS २.३३
क
नभएको

२.३४: वकशोिी लवित आइिन फोवलक एवसर्
वितिण अवभलेखको सािाांश फािाम

HMIS 4.2: वकशोिी लवित आइिन फोवलक एवसर् वितिण
अवभलेख
FCHV Register

HMIS 2.5: शीघ्र क
ु पोषणको
एकीक
ृ त व्यिस्थापन कायडक्रम
दताड कार्ड
• लवित तौलको महल हटाइएको
• कार्ड को वशिमा स्वास्थ्य सांस्था ि पावलकाको नाम लेख्ने स्थान
खुलाइएको
िाल प्रयोग भैरिेको पररमालजिि

HMIS 2.6: शीघ्र क
ु पोषणको
एकीक
ृ त व्यिस्थापन िवर्ष्टि
िाल
प्रयोग
भै
र
िे
क
ो
पररमालजि
ि

HMIS 2.7: मेवर्कल र्वटलतार्न्य
शीघ्र क
ु पोषणको एकीक
ृ त व्यिस्थापन
िवर्ष्टि – अस्पताल
HMIS २.7
क
नभएको

२.८: पोषण पुनस्थाडपना गृह िवर्ष्टि

HMIS 4.1: गाउँघि क्लिवनक िवर्ष्टि
• HMIS 4.1 गाउँघि क्लिवनक िवर्ष्टिको “4.14: २ बषड मुवनका बालबावलकाको िृक्लि अनुगमन सेिा”
फािाममा क
ु नै प्रमुख परिमार्डन नभएको
• गाउँघि क्लिवनक सांचालन हुने स्थानको लावग महल मात्र थवपएको

HMIS 4.3: िावष्टिय वभटावमन “ए” कायडक्रम िवर्ष्टि
• HMIS 4.3 िावष्टिय वभटावमन “ए” कायडक्रम िवर्ष्टिमा क
ु नै पवन परिमार्डन नभएको

HMIS 9.2: समुदाय स्ति स्वास्थ्य कायडक्रमको
मावसक प्रवतिेदनः खोप तथा गाउँघि क्लिवनक
HMIS 9.2 प्रवतिेदनको पोषण खण्डमा क
ु नै पवन परिमार्डन नभएको

HMIS Nutrition Indicators (25)
Code Indicator Numerator Denominator
Multipl
ier
A GROWTH MONITORING
7.1 % of newborns with low birth weight
(<2.5kg)
Number of newborns who were weighed
less than 2.5 kg
Number of live births at
health facilities and home
who were weighed
100
7.2 % of children aged 0-12 months
registered for growth monitoring
Number of aged 0-12 months registered
for growth monitoring
Estimated number of
children age 0-12 months
100
7.3 Average number of visits among children
aged 0-24 months registered for growth
monitoringᵃ
Sum of number of visits among children
aged 0-24 months registered for growth
monitoring
Number of registered visits
for children age 0-24
months registered for
growth monitoring
100
7.4 % of children aged 0-24 months
registered for growth monitoring who
were underweight
Number of children aged 0-24 months
were underweight
Number of children age 0-24
months registered for
growth monitoring
100

B INFANT AND YOUNG CHILD FEEDING
7.5 % of newborns who initiated
breastfeeding within 1 hour of birth
Number newborns who initiated
breastfeeding within 1 hour of birth
Number of recorded live
births
100
7.6 % of children aged 0- 6 months
registered for growth monitoring, who
were exclusively breastfed for the first
six months
Number of children aged 0- 6
monthsand registered for growth
monitoring who were exclusively
breastfed for first 6 months
Number of children age 6-
11 months
100
7.7 % of children aged 6–8 months
received solid, semi-solid or soft foods
received solid, semi-solid or soft foods
Number of children age 6-
11 months
100

C MICRO-NUTRIENTS AND ANTIHELMINTHICS
7.8 % of children aged 6-59 months, who
received Vitamin A supplements
who received Vitamin A supplementation
Estimated number of
children aged 6-59 months
100
7.9 % of children aged 12-59 months who
received antihelminthics
who received antihelminthics
Estimated number of
children aged 12-59 months
100
received Baal Vita (MNP)
Number of children aged 6-23 months,
who received Baal Vita (MNP)
Estimated number of
100
received all 3 cycles of Baal Vita (MNP)
Number of children aged 6-23 months,
who received all 3 cycles of Baal Vita
(MNP)
Estimated number of
100
7.12 % of adolescents girls aged 10-19 years
who received iron supplementation for
13 weeks
Number of adolescents girls aged 10-19
years who received iron supplementation
for 13 weeks
Estimated number of
adolescent girls aged 10-19
years
100

D MANAGEMENT OF ACUTE MALNUTRION (MAM)
7.13 Number of cases admitted at outpatient therapeutic
centers (OTPs)
7.14 % of cases admitted at OTPs with moderate acute
malnutrition (MAM)
Number of cases admitted at OTPs with MAM Number of cases admitted at OTPs 100
7.15 % of cases admitted at OTPs with MAM who
recovered
Number of cases admitted at OTPs with MAM who
recovered
Number of cases admitted at OTPs
with MAM
100
7.16 % of cases admitted at OTPs with MAM who died Number of cases admitted at OTPs with MAM who died Number of cases admitted at OTPs
with MAM
100
7.17 % of cases admitted at OTPs with severe acute
malnutrition (SAM)
Number of cases admitted at OTPs with SAM Number of cases admitted at OTPs 100
7.18 % of cases admitted at OTPs with SAM who recovered Number of cases admitted at OTPs with SAM who
recovered
Number of cases admitted at OTPs
with SAM
100
7.19 % of cases admitted at OTPs with SAM who died Number of cases admitted at OTPs with SAM who died Number of cases admitted at OTPs
with SAM
100
7.20 Number of SAM cases admitted at nutrition
rehabilitation homes (NRHs)
7.21 % of cases admitted at NRHs with SAM who
recovered
Number cases admitted at NRHs with SAM who
recovered
Number of cases admitted at NRHs
with SAM
100
7.22 % of SAM cases at NRHs who died Number of cases admitted at NRHs with SAM who died Number of cases admitted at NRHs
with SAM
100

E SCHOOL HEALTH AND NUTRITION
7.23 % of public schools that received a first
aid kit box
Number of public schools that received
a first aid kit box
Number of public schools 100
7.24 % of students in grade 1-10 who
received anthelminthic
Number of students in grade 1-10 who
received anthelminthic
Number of students in
grade 1-10
100
F FOOD SUPPLEMENT
7.25 % of children aged 6-23 months who
received monthly food supplements
who received monthly food
supplements
Estimated number of
100

Strength
• Priority one health programme of MoHP, GoN
• Significantly contributed to reducing the prevalence of malnutrition,
addressing nutrient deficiencies, and promoting overall health and well-
being.
• Separate act and regulation.
• Collaboration between government agencies, non-governmental
organizations, healthcare providers.
• Strengthen the School Health and Nutrition Program.
• Integrate nutrition in universal health coverage.

Weaknesses
• Procurement and supply of nutrition commodities (RUTF, MNP, IFA) is not
timely
• Inadequate HRH
• Recording and reporting of nutrition program indicators within HMIS is
inconsistent, incomplete, untimely, and unreliable for data centric planning.
• Lack of accountability frameworks.
• Emerging issues of the triple burden of malnutrition (undernutrition,
overweight/obesity, and micronutrient deficiencies).

Opportunities
• Different supporting partners including WHO and UNICEF.
• Improve multi sector coordination and collaboration and incorporation of the
private sector.
• Willingness of communities to programme.
• Private sector involvement in programme.
• Fund increment by government for nutrition.
• Scaling up of nutrition friendly health facility concept to all health facilities.

Threats
• High prevalence of malnutrition and their impacts in the programme.
• Geographical constraints.
• Delayed release of budget specially by partners.
• Ownership and coordination at all level.
• Deep-rooted misconceptions, taboos and harmful socio-cultural practices
related to food and nutrition

Challenges
• Challenge to managing more than dozen nutrition specific programmes.
• Competing programme interest and priorities among stockholders.
• Information management through HMIS is a big problem.
• Challenges in programme monitoring and evaluation due to program
comlexicity
• Mobilization of health workers and FCHVs
• Needed training/orientation to HWs & volunteers to develop skills for each
components of programme.

Challenges (2)
• Lack of focal person with assigned responsibility of nutrition at district and
local level.
• Lack of human resources at provincial and local level program
• Complexity in coordination and collaboration with other sectors and external
development partners
• Donor dependent programmes challenges in sustainability of specific
programme components.
• GMP, IMAM, MNP and Adolescent IFA are key nutrition specific interventions.
The coverage, compliance and quality of service is found to be poor.
• Deep-rooted misconceptions, taboos and harmful socio-cultural practices
related to food and nutrition.

Way Forward
• Intensify Social Behavior Change Communication for recommended nutrition
practices.
• Promote digital technologies, manage food supply, and provide tax subsidies for
domestic farmers.
• Develop specific policies to tackle the widespread availability of fast food and junk
foods.
• Enhance food inspection, monitoring, evaluation, and research for evidence-based
policies.
• Integrate with the education sector to address nutrition issues in adolescents.
• Expand nutrition-friendly health facility concepts.
• Equip all health facilities to manage various forms of malnutrition and promote
proper nutrition behaviors.

References
• Nepal Integrated Management of Acute Malnutrition (IMAM) Guideline: 2017
• Multi-sector Nutrition Plan II(2018-2022)
• Multi-sector Nutrition Plan (2013-2017)
• National Infant Young Child Feeding Strategy 2073
• Food and Nutrition Security Plan of Action, Nepal 2016
• SUAAHARA II Good Nutrition Program (USAID-supported) (April 2016-March
2021).
• Bhandari, T.R., Chhetri, M., 2013. Nutritional status of under five year children
and factors associated in Kapilvastu District, Nepal. J Nutri Health Food Sci 1,
2–6.
• Bhusal, U.P., 2022. Poor and non-poor gap in under-five child nutrition: a case
from Nepal using Blinder-Oaxaca decomposition approach. BMC Health Serv.
Res. 22, 1245. https://doi.org/10.1186/s12913-022-08643-6

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