Country Policy Analysis Nutrition Impact of Agriculture and Food Systems Nepal November 2013 UN System Standing Committee on Nutrition country study for the second International Conference on Nutrition 1 ACKNOWLEDGEMENTS The country assessment for nutrition sensitive agriculture in Nepal was led by Jessica Fanzo (Columbia University), Mr. Raj Kumar Pokharel (Child Health Division Nepal), and Danielle Andrews (UCLA School of Public Health) and supported by Dr. Senendra Upreti (Child Health Division, Nepal). The team received technical assistance and advisement from Mr. Ashok Butyral and Mr. Ramesh Bastola (WHO, Nepal). Lina Mahy and Marzella Wüstefeld (UNSCN, Switzerland) ensured overall coordination of the country case study. This report was possible thanks to the sponsorship by the German Government. TABLE OF CONTENTS Acknowledgements............................................................................................................................2 Abbreviations ....................................................................................................................................5 I. Executive Summary .........................................................................................................................6 II. Purpose of Study and Research ..................................................................................................... 13 III. Introduction ................................................................................................................................ 14 3.1 Background: Nutrition sensitive agriculture and food systems ................................................................. 14 3.2 Situation analysis ........................................................................................................................................................... 16 3.2.1 Nutrition situation ........................................................................................................................................................ 1 7 3.2.2 Dietary transition .......................................................................................................................................................... 21 3.2.3 Agriculture and food security situation .................................................. ........................................................... 23 3.3 National nutrition priorities ...................................................................................................................................... 32 IV. Methods ..................................................................................................................................... 33 4.1 Data collection and sources of information ........................................................................................................ 33 4.2 Data analysis .................................................................................................................................................................... 35 V. Findings ....................................................................................................................................... 36 5.1 Description of the relevant food and agriculture policies and plans ........................................................ 36 5.1.1 Description of the major food and agriculture Policies .................................................. ........................... 36 5.1.2 Secondary policies ........................................................................................................................................................ 4 8 5.2 Analysis of the nutrition-sensitivity of the policies and frameworks ...................................................... 52 5.2.1 Analysis of the major food and agriculture policies and plans .................................................. ............ 52 5.2.2 Analysis of secondary policies .................................................. .............................................................................. 61 5.3 Unintended consequences on nutrition outcomes ........................................................................................... 63 5.4 A Funding of and implementation of nutrition-sensitive agriculture and food plans ....................... 67 5.4.1 Funding .................................................. ............................................................................................................................. 67 5.4.2 Implementation and capacity.................................................................................................................................. 69 3 5.5 Policy processes and alignments ............................................................................................................................. 75 5.5.1 Cross sectoral coordination ..................................................................................................................................... 75 5.5.2 Sustainability ................................................................................................................................................................... 77 5.5.3 Use of terminology .................................................. ...................................................................................................... 7 7 5.6 Analysis of monitoring and evaluation approach in the policies ............................................................... 78 VI. Conclusions ................................................................................................................................. 81 6.1 Nutrition-sensitive analysis of nepal’s food and agriculture policies ...................................................... 81 6.2 Recommendations and knowledge gaps .............................................................................................................. 83 VIII. References ................................................................................................................................ 87 IX. Annexes ...................................................................................................................................... 91 Annex 1: Persons Interviewed and Focus Groups .................................................................................................. 91 Annex 2: Interview Guide ................................................................................................................................................... 93 Annex 3: Guiding Principles of Nutrition Sensitive Agriculture......................................................................... 96 Annex 4: On-going Programmes in Nepal ................................................................................................................... 9 8 Annex 5: Terms of Reference for Nepal case study ............................................................................................. 101 4 ABBREVIATIONS ADS Agriculture Development Strategy, Nepal CBS Central Bureau of Statistics, Nepal CMR Child Mortality Rate (under 5 years of age) DDC District Development Committee DHO District Health Offices DLS Department of Livestock Services DoA Department of Agriculture DoHS Department of Health Services FAO Food and Agriculture Organization of the United Nations FNSP Food and Nutrition Security Plan of Action, Nepal GoN Government of Nepal IFPRI International Food Policy Research Institute IIDS Institute for Integrated Development Studies IMR Infant Mortality Rate MoAD Ministry of Agriculture and Development, Nepal MoE Ministry of Education, Nepal MoFALD Ministry of Federal Affairs and Local Development MoF Ministry of Finance, Nepal MoHP Ministry of Health and Population, Nepal MoUD Ministry of Urban Development MSNP Multi-Sectoral Nutrition Plan, Nepal NAGA Nutrition Assessment and Gap Analysis, Nepal NARC Nepal Agriculture Research Council NDHS Nepal Demographic Health Survey NLSS Nepal Living Standards Survey NFSCC Nutrition and Food Security Coordination Committee MSNP Nepal Multi-Sectoral Nutrition Plan NPC National Planning Commission, Nepal UN United Nations UNICEF United Nations International Children’s Emergency Fund UNSCN United Nations Standing Committee on Nutrition USAID United States Agency for International Development WB World Bank WFP World Food Programme WHO World Health Organization 5 I. EXECUTIVE SUMMARY Nepal is on track to achieve its Millennium Development Goal (MDG) to reduce the prevalence of underweight children ages 6-59 months to 29% by 2015 (National Planning Commission, 2010a). Furthermore, Nepal has shown significant improvement in both its Infant Mortality Rate (IMR) and Under 5 Child Mortality Rate (CMR), which serve as indicators of the country’s overall health status. Additionally, the prevalence of childhood stunting decreased by 14% from the period 2001 to 2006 and further declined by 16% between the years of 2006 and 2011 (NDHS). Also, the percentage of underweight children declined by 9% between 2001 and 2006 and 26% between 2006 and 2011; however, despite significant improvement in recent years, Nepal’s rates of chronic undernutrition remain high in comparison to similar low-income developing nations. Currently, about 41% of children under five are stunted, and although the prevalence of child acute undernutrition or wasting decreased by 15% in the period 2006 to 2011, this measurement is still high by global standards and remains at a critical