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Scaling Up Nutrition

Tackling malnutrition in South Asia: regional efforts scale up through "Learning Exchange"


Tackling malnutrition in South Asia: regional efforts scale up through "Learning Exchange"
Photo: Critical discussions on decentralisation led by Devendra Raj Singh during the SUN CSN Asia Learning Exchange

Reflections from Sylvia Szabo and Devendra Raj Singh from the SUN CSN Asia "Learning Exchange" in Nepal.

"The South Asia region suffers from one of the highest malnutrition rates, with the continuing challenge of chronic and acute malnutrition and an increasing obesity burden. Most recent UNICEF estimates indicate that in South Asia more than 34 per cent of children under 5 are stunted and in fact two out of five stunted children in the world live in this region. As has been extensively evidenced, malnutrition not only has significant negative effects in terms of physical and cognitive development of individuals, but it translates into a loss of countries’ GDP and slower pace of overall human development. "

Given these critical challenges, the Scaling up for Nutrition (SUN) Civil Society Network convened a regional Learning Exchange (LE), which took place in Kathmandu, Nepal between 17 and 20 July 2017. Civil Society Alliance for Nutrition Nepal (CSANN) hosted the event.

Nepal is the fifth country to join the SUN movement and has also implemented its Multi-Sector Nutrition Plan (MSNP, 2013-2017), which is landmark progress in terms of bringing together relevant sectors to combat malnutrition.

The SUN Civil Society LE provided a platform for civil society organisations to share their experiences and learn from peers. Participants included both advocacy specialists and technical experts in nutrition from over 9 countries in the region including Bangladesh, Cambodia, Indonesia, Laos, the Philippines, Myanmar, Kyrgyzstan, Pakistan and Nepal.

The first half day of the event started with a formal opening session with chief guest Dr. Kiran Regmi, Secretary, Ministry of Health, Nepal and high-level guests from government and nongovernment sectors.

This was followed by workshops, in which participants explored key thematic issues, including:
1) decentralisation of civil society networks
2) citizen engagement and bottom up nutrition advocacy through public hearings
3) effective nutrition budget advocacy
4) the implementation and monitoring of the The International Code of Marketing of Breastmilk Substitutes (the Code).

A field visit was also organised to further enhance learning. During the event, cases of evidence based advocacy approaches, success stories and achievements of civil society in the area of nutrition from different countries were discussed, especially on the above-mentioned topics.

During the decentralisation session, civil society decentralisation process, structures and operation were discussed. In addition, the roles of decentralised CSA, CSOs needs assessment tools, capacity building interventions and challenges faced by CSA were shared by local alliances from Nepal.

Nepal is the first country among SUN CSAs in Asia to expand it decentralised structure at sub-national level. The MSNP of Nepal provided a formal space for civil society representation with the central and sub-central level structure nutrition and food security committee.

Case studies were presented from two of the most disadvantaged districts in Nepal; Kapilvastu and Achham. According to Mr. Ramendra Singh Rawal, district CSA Chairperson, Kapilvastu: “As a result of our joint effort regarding advocacy in favour of nutrition budget increment, the local government, has increased the nutrition budget by 7 times, as compared to previous last two fiscal year budget. Also, local media being one of the district CSA member, nutrition issues within the district have been highly talked both in local print and visual media resulted in getting attention from multiple sector that has never happened before the establishment of local CSA”.

Similarly, the citizens’ engagement session included discussion of innovative approaches to participatory policy formulation and provided participants with the opportunity to practice their public engagement skills. This approach was also identified as one of the most effective methods for tracking the commitments of government and non-government. Nepal has successfully applied this approach in tracking the effectiveness of the MSNP implementation at district and village development committee level.

Experts from Nepal also presented the experience of an “ombudsperson model”, which is applied in Nawalparasi district. Although the term “ombudsperson” may not be new in Nepal, its practice, however, is relatively fresh. Governments, donors, civil society and private sector are increasingly recognising the importance of accountability to strengthen transparent governance. In this regard, the ombudsperson model is considered a fair and neutral mechanism to oversee functioning of the various agencies.

The session on BMS was arguably the liveliest one and allowed participants to develop ideas around how to tackle conflicts of interest, deal with often low penalties and discuss BMS issues in a post disaster context. In addition to many ideas generated during session, concrete solutions were also suggested. For example, regarding monitoring of the Code, participants identified, amongst others, the following priority needs:
• focusing on advocacy and increasing public perception, because there is consumer demand;
• educating the BMS companies;
• finding loopholes that BMS companies are utilising, find evidence and close these loopholes;
• utilising mass media for awareness raising;
• gaining a greater understanding of what is being promoted;
• educating employers to promote breastfeeding friendly environment.

Finally, CSOs shared their practical experiences in effective evidence-based nutrition budget advocacy. The budget advocacy session aimed to; increase CSO knowledge of nutrition budget advocacy, strengthen budget advocacy skills and identify key advocacy tactics within each stage of the budget cycle. Finally, the participants were able to learn about specific budget analysis and advocacy experiences from colleagues in Nepal and Pakistan. Some of the key challenges identified were accessing data as well as t the methodology surrounding nutrition sensitive interventions, both in terms of how these are categorised and weighted within budgets.

Key priorities identified during the LE included an increased focus on generation of evidence and knowledge sharing, sharing of best practices, and developing joint advocacy messages and policy inputs for key regional initiatives. Participants also identified the most important global and regional events, such as the Roundtable Event on Government Action for Nutrition organised by the South Asia Food and Nutrition Security Initiative (SAFANSI), the World Food Day and the World Breastfeeding Week. For all these regional initiatives and events, a coordinated action will be required and a workplan has already been put in place to effectively plan and deliver change.

Sylvia Szabo, PhD is Nutrition Policy and Advocacy Adviser at Save the Children and a Visiting Academic at the University of Southampton, United Kingdom. Devendra Raj Singh is Assistant Professor at Purbanchal University, Nepal and a member of the Executive Committee of CSANN.

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