WFP Regional Bureau for Asia and the Pacific - 2016 SPRs RBB 2016 SPRs by country | Page 544

Standard Project Report 2016
Lessons Learned and Story Worth Telling
LESSONS LEARNED
The earthquake emergency response led the way for the Government to undertake relevant changes to the state
bodies that managed the activities. The formation of the National Reconstruction Authority was one of the results of
these changes. In the approval process of the PRRO and the joint planning with the Government, WFP was not fully
aware of the changed mandates of each government agency in the post-earthquake scenario, which in turn led to
more time spent on obtaining the clearances from the applicable state agencies in the approval process.
In terms of the significance to public health, the nutrition status in Gorkha, Sindhupalchowk and Dolakha districts
remained poor and moderately severe even after the initial emergency nutrition response, as revealed by a Nutrition
Survey conducted by Save the Children in May 2016. It was also observed that among the wasted children
(WH <-2SD), 42.9 percent were also stunted, while 82.1 percent were underweight on top of wasting. As children
who suffer from multiple types of undernutrition face an increased risk of mortality compared with children having
one type of undernutrition, any child survival and nutrition interventions needed to essentially focus more on children
suffering from multiple types of undernutrition. The study further suggested that integration of nutrition counselling
with food-security-and-livelihood support packages for earthquake-affected poor families might increase the overall
impact with regard to nutritional outcomes. This was based on the review of the results of complementary feeding
practices.
The implementation of the treatment of moderate acute malnutrition (MAM) programme should be continued
through the health posts for children suffering from both severe and moderate acute malnutrition. Since
under-nutrition in Nepal is very much linked to the lean agricultural season the harvest, and post-harvest situation in
these districts, it will be important to look at trends of under-nutrition during different times of the year and the
evolution throughout the years. WFP’s experience indicated that analysis of barriers for MAM treatment coverage
needs to be carried out in order to identify and remove key barriers that hinder systematic screening, registration,
admissions, treatment and the referral mechanism. At the same time, it was found to be necessary to further
reinforce growth-monitoring and promotion activities at the health posts, focusing on identifying growth failure and
promoting age appropriate infant-and-young-child-feeding (IYCF) practices. It would also be equally important to
conduct an assessment of locally available foods to develop context-specific information, education and
communication materials for IYCF practices for children aged 6-23 and 24-59 months.
STORY WORTH TELLING
Carrying her six month old baby Karan on her back, Bhagwati trudged on through the narrow trails leading to the
local health post in the Namdu Village Development Committee area in Dolakha district. She recalled her last visit to
the health post in May 2016 to get medicine for Karan for fever and to make him start eating again. But the health
staff had told her a different story. It had been a shock to learn that Karan was malnourished after all the trouble she
took to ensure that he had at least a little food every day. "I had never imagined that my baby would be
malnourished. I did not even know what it meant. I thought I was feeding him right, but he would cry more often,
wouldn't eat anything solid, and wanted only to drink my milk."
Thinking back later, Bhagwathi realized that malnourishment was the reason for Karan’s strange behavior that she
could not understand at the time. She had noticed the change in Karan for several weeks. He was cranky and
inactive and would refuse to eat solid food and only drink mother's milk. At the health post, Karan
weighed six kilograms, had a mid-upper arm circumference (MUAC) of 12.3 cm, and was immediately identified as
being moderately malnourished. The nutrition assistant explained what it meant to Bhagwathi and gave her 14
packets of Plumpy Sup, telling her clearly how much she will receive and how to give the correct amount to her
baby.
At first, Karan refused to eat the Plumpy'Sup, spitting it out as soon as the paste entered his mouth. But Bhagwati
did not give up and managed to feed him most of the food. Gradually Karan got used to the taste after being fed
every day. In the first follow-up visit in June 2016, Karan's weight had increased to seven kilograms, and this
encouraged Bhagwati to try harder to feed the full ration to Karan. It was not so difficult now to feed him the full
packet each day, and she also made it part of her daily routine to give him lentil soup, rice porridge and fruits as
best as she could along with the Plumpy'Sup.
Each day Bhagwati saw small improvements in her son. "These days, he doesn't cry a lot, he plays with his toys
and eats well. I feel very glad."
In early July 2016, Karan’s MUAC measured at 12.5 cm, and he had gained weight by half a kilo. Bhagwati heaved
a sigh of ardent relief when the health staff told her that Karan was slowly emerging out of the "yellow" category and
into the healthier "green" zone in the MUAC tape.
Nepal, State of (NP)
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