Improving Early Childhood Nutrition and Maternal Health in Nepal

Young children's undernutrition has a long-term impact on both a child's and a community's ability to develop and thrive. The World Bank estimates the annual economic cost of undernutrition at 2 to 3 percent of gross domestic product (World Bank 2018c). Good nutrition in a child's first 1,000 days lays an essential foundation for their future growth and learning. Using a community-driven development approach and with funds from the World Bank and other donors, the five-year project provided ongoing support for 100-Day Challenges (formerly Rapid Results Nutrition Initiatives (RRNIs)) to be implemented across multiple locations in Nepal. These initiatives helped communities identify and change key nutrition-related behaviors and water and sanitation challenges that have a detrimental effect on child growth and development within the nation's poorest rural communities.

This project was the first of its kind in the long history of collaboration between the World Bank and the RE!NSTITUTE. For the first time, the RE!NSTITUTE approach was used as the core method of design and delivery for a large-scale five-year project, rather than being brought in to ‘connect the last mile' in projects that have met challenges in implementation.

Some of the early project results include:

In Bhimeshwor 8, the ward had a goal to be open defecation-free (ODF) in 100 Days. The goal was achieved by constructing nine latrines for disadvantaged households, providing latrine cleaning kits across the community to support latrine maintenance, and a weekly door-to-door campaign to educate households on the importance of latrine sanitation.

In Bhimeshwor 4, the entire Thulagaon community (the poorest and most remote community in the ward) will be open defecation-free (ODF) within 100 Days. The team successfully reached their goal to end open defecation by constructing eleven latrines in marginalized households and weekly door-to-door household visits.
Jhangajholi-Ratamata 3’s goal was that every pregnant woman will eat one egg a day and two servings of green vegetables in the month of August. The team successfully built four community chicken coops to provide daily eggs to 18 pregnant women and 17 children between the ages of 6-24 months.

In Jhangajholi-Ratamata 1, the goal was that all children from the age of 6-12 months will eat ½ an egg daily, and all children from the age 12-24 months will eat 1 egg daily in the month of August. The team successfully built a community chicken coop to provide a weekly supply of eggs to eight children under 24 months old and three pregnant women during the 100 Days.

In the longer term, a World Bank impact evaluation revealed “improved nutritional status of children under two years of age as a result of the RRNIs. The impact evaluation shows that between 2014 and 2017, stunted growth decreased from 38 percent to 33 percent, wasting from 21 percent to 16 percent, and underweight from 32 percent to 15 percent. The project’s high achievements in water, sanitation, and hygiene, and to a lesser extent in adequate dietary practices, plausibly contributed to reducing the prevalence of enteric infections, as shown by the impact evaluation. Child infections and diseases are known to be associated with reduction in food intake, intestinal malabsorption, and endogenous nutrient loss.” To find out more about the sustainability and long-term impact of the effort, see the report here

• Government of Nepal 
• World Bank 
• Lifeline Nepal

• Egg a Day
• Engaging Communities  
• Video: Nutrition in Nepal