菀菀 ..................................................................................... .................................................................................... Field Article By Pradiumna Dahal, Anirudra Sharma and Stanley Chitekwe Pradiumna Dahal is a nutrition specialist with UNICEF Nepal and has more than 15 years’ experience in public health, nutrition and food security. Having helped formulate major nutrition policies, plans and strategies in Nepal, he is one of the core experts supporting the National Planning Commission of the Government of Nepal to develop the Multi-Sector Nutrition Plan (MSNP). He is actively engaged in scaling up nutrition in Nepal. Anirudra Sharma has worked as a nutrition specialist with UNICEF for 17 years, including as emergency nutrition cluster coordinator for the last six years. He has more than three decades experience with the Government of Nepal, Save the Children and UNICEF. His scope of work has included formulation of national nutrition and health policies, plans and strategy; national programme design on integrated management of acute malnutrition (IMAM); and disaster risk reduction. He is a core expert team member supporting the National Planning Commission in the MSNP development. Stanley Chitekwe is the Chief of Nutrition for UNICEF Nepal. He has worked for more than 17 years with UNICEF in Africa and now in South Asia. His vision is to treat acute malnutrition and eradicate stunting. He is a mentor to many young professionals. His focus is on evidence-based, cost- effective programme delivery and using innovations. The authors would like to acknowledge the National Planning Commission, Ministry of Health and other sector ministries of the MSNP (Education; Women, Children and Social Welfare; Agriculture, Livestock and Birds; Water and Sanitation; and Federal Affairs and Local Development). The authors also sincerely thank the European Union for their generous support to UNICEF for scaling up MSNP in Nepal, as well as the contributions from other UN agencies and nutrition stakeholders, mainly USAID/Suaahara and World Bank, in rolling out the MSNP in Nepal. An interview (podcast) with Stanley Chitekwe, by Charulatha Banerjee, ENNs regional KM specialist based in India, is available on the ENN MediaHub, www.ennonline.net/mediahub A journey to multi-sector nutrition programing in Nepal: evolution, processes and way forward Multi-sector policy development Multi-sector thinking on nutrition program- ming in Nepal began back in 1978 with the frst National Nutrition Strategy, followed in 1986 by the Second Nutrition Strategy. ese were jointly known as Pokhara Dec- laration I and II (see Figure 1). Subsequently, the Joint Nutrition Support Programme (JNSP) (1989-1992) was the frst attempt at multi-sector programming for nutrition. However, due to poor engagement of sectors while formulating the programme and hence poor ownership, the JNSP had limited suc- cess. e 2004 National Nutrition Policy proved to be the frst effective response. Developed by the health sector, it was im- mediately implemented through its annual work plan and budget, with key indicators included in the Health Management Infor- mation System (HMIS) and monitored. In 2009, the Nutrition Assessment and Gap Analysis (NAGA) identifed strengths, weaknesses and gaps in nutrition programing. Primary determinants of undernutrition identifed in the NAGA included inadequate food availability, access and affordability; poor food and care-related behaviours; in- adequate food quality/nutrient density; and high prevalence of infection, which reduces food absorption and utilisation (see Figure 2). ese refected the need for a multi- sector approach. Recommendations from NAGA were endorsed by the National Plan- ning Commission (NPC) in 2011 and a Memorandum of Understanding was for- mally signed between NPC and UNICEF to develop a Multi-Sector Nutrition Plan (MSNP) in Nepal (see Figure 3). MSNP development and rollout In May 2011, Nepal joined the Scaling Up Nutrition (SUN) Movement, the fh country to join and an ‘early riser’. is refected and reinforced the political space and mo- mentum for nutrition in Nepal. In the same year, two national committees on Nutrition and on Food Security were merged into one, the High Level Nutrition and Food Se- curity Steering Committee, chaired by the Location: Nepal What we know: Multi-sector policies and plans are an increasing feature of country efforts to tackle undernutrition. What this article adds: In 2012, Nepal developed a Multi-Sector Nutrition Plan (MSNP I), a reflection of 30 years of policy evolution. Rollout included restructure and development of national and district/village level coordination and steering committees, technical working groups and pilots in selected districts. Subsequent scale-up was informed by lessons learned. Since MSNP I, resourcing for nutrition-sensitive programming has significantly increased. Stunting prevalence has fallen from 57% (2001) to 37% (2014); an annual rate of reduction of 3.3%. A 2014 report described a participatory and inclusive MSNP development process, enabled by high-level champions. Recommendations to address identified challenges included urgent improvement in nutrition capacity at district and sub-district levels and continued targeted advocacy; actions have been taken. Moving ahead, there is a need to map interventions and their coverage, stakeholders and resources at district level, identifying gaps; and to develop budget codes for nutrition to facilitate tracking on spend. The six-step process of development for MSNP II (2018-2022) is underway, led by the National Planning Commission, Government of Nepal together with UNICEF. Launch of roll-out of implementation of MSNP in one of the districts, Kapilvastu, in Western Terai of Nepal