Impact of the Suaahara Program in Nepal

This blog was originally published by the EVERY ONE Campaign. Written by Pallavi Dhakal.

Save the Children, under the guidance of the Government of Nepal, leads a consortium of seven partners on the Suaahara program. The USAID-funded Suaahara is a five year (2011-2016) program aiming to reduce national stunting through the concentration of activities in 41 of the most vulnerable districts of Nepal.

Suaahara meaning “good nutrition” in Nepali is a uniquely designed, multi-sector community-based nutrition program focused on reducing undernutrition among women and children during the critical 1000 days (period from conception to a child’s second birthday) and their families. According to the global recommendations Government of Nepal has prioritized 1,000 days as primary targets to improve nutrition.

Malnutrition remains a serious obstacle to child survival, growth and development in Nepal – 41 % children under five are stunted, 11% are wasted and 29% are underweight. Diarrhea and other morbidity conditions related to poor sanitation and hygiene continue to be major cause of childhood malnutrition including illness and death.

The Suaahara program is focused at the household level to address multiple causes of malnutrition and is in line with the National Multi-Sector Nutrition Plan of Action. It uses integrated approach (nutrition specific intervention, agriculture, Water, Sanitation and Hygiene (WASH), and health service promotion) to tackle malnutrition at the household level. It focuses on changing behavior by promoting actions and practices that are easily doable (e.g., adding animal protein such as egg or a piece of liver to porridge to make it nutritious, maintaining properly-managed backyard poultry and/or vegetable garden for access to nutritious food, washing hands with soap prior to preparing food and feeding, using toilet and boiling drinking water, going for regular ante-natal checkups and more).

Transformation of a young mother from knowing little to becoming a role model

When Rita Tilija from Myagdi district in the west attended the training by USAID-funded Suaahara program for the first time, she was already three months pregnant. “I was surprised to learn that children needed to be exclusively breastfed for six months without even giving water,” says Rita.

Photo: Pallavi Dhakal/Save the Children

The integrated nutrition program, Suaahara, trained Rita to recognize the importance of yellow and green vegetables and diverse diet, proper hygiene and sanitation, regular health check-ups and imparted valuable skills on homestead farming and poultry management. She also received five young chicks and diverse vegetables seeds to start farming at home. “I didn’t know anything about agriculture and today I am teaching mothers how to make raise beds to improve cultivation and increase their access to nutritious vegetables at home,” smiles Rita.

Delivering better health

35-year-old Malla Devi Joshi was already in labour when she arrived at the Deulekh Primary Health Center in Bajhang. Auxiliary nurse midwife (ANM) Shyamkala Panthee rushed to meet Malla and escorted her to the delivery room. Soon thereafter, Malla gave birth to her fourth child— the first to be born in a health facility.

Photo: Rachel Machefsky/Suaahara, JHUCCP

Women come from far and wide to the Deulekh Primary Health Center. Before Suaahara began organizing Health Mothers’ Group meetings for pregnant women and new mothers in Bajhang District, many women did not understand the importance of delivering in a health facility, and instead delivered at home. Suaahara also contributed to improving the quality of services provided in the health center by training the auxiliary nurse midwives (ANMs), like Shyamkala, on skilled birth attendance, as well as on nutrition and family planning counseling. The Health Post In-Charge, Hem Raj Bhatta says, “There has been a huge increase in the number of institutional deliveries and antenatal checkups made by women in this community over the past few years The number of patients we see has grown from 20 -30 in one day to 50 -60 in one day.”

Transforming community’s nutritional behaviour

In the remote Kaluketi village of the far-west corner of Bajhang district in Nepal, the Joshi family – traditionally forbidden to eat eggs or meat – is going against their custom for the health of their family. Suaahara works to improve nutrition and health status through an integrated approach that includes communication activities to change behavior such as Bahun individuals’ abstinence from consuming animal source foods rich in nutrients.

“Before we became involved in the Suaahara Program,” Deepak Raj Joshi says, “we never even heard the sound of chickens.” Today, Deepak Raj and his wife, Dhan Laxmi, own seven large chickens. They feed their 17-month-old son, Parshuram, eggs and meat frequently. Dhan Laxmi Devi, who breastfeeds Parshuram in addition to giving him nutritious solid foods, also regularly eats eggs and meat.

Almost immediately, the Joshis saw the benefits of their unpopular decision. Deepak says, “Our second baby looks bigger and healthier than our first did.” Dhan Laxmi adds, “He is also smarter and has never suffered from a serious illness.”

Photo: Rachel Machefsky/Suaahara, JHUCCP

Impact and accolades

Dr. Patrick Webb, Dean for academic affairs of the Friedman School of Nutrition Science and Policy at Tufts University called Suaahara “the most cutting-edge nutrition program in the world”. He says, “As a global nutrition community, we now know the critical importance of integrated projects to achieve maximum effectiveness. Suaahara does this, and that is why it’s showing impressive initial results.”

Since its beginning in 2011, Suaahara has already increased the prevalence of exclusive breastfeeding of children under six months of age by 18 percentage points – from 46 percent to 64 percent. At the same time, the prevalence of children 6-23 months receiving a minimum acceptable diet has improved from 36 percent to 54 percent in the project’s initial 25 districts.

The USAID-funded Suaahara program is a consortium led by Save the Children, with Helen Keller International, JHPIEGO, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Nepal Water for Health, Nutrition Promotion and Consultancy Services and Nepali Technical Assistance Group.

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