Nepal’s reductions in maternal and child undernutrition since the mid-1990s have been remarkable, but the high burden persists. Among children under five years, 36% are stunted, 10% are wasted, and 27% are underweight. Additionally, 17% of women of reproductive age (WRA, 15-49 years) are underweight while 41% are anemic (Nepal DHS Survey, 2016). The Government of Nepal (GoN) is rolling out the second phase of their national Multi-Sector Nutrition Plan (MSNP), with support of external development partners (EDPs). Suaahara II (SII) is a USAID-funded multisectoral nutrition program, aligned with Nepal’s MSNP, and is being implemented in all communities of 42 of Nepal’s 77 districts from April 2016 to March 2021. SII’s overall aim is to reduce the prevalence of stunting, wasting, and underweight among children under five years of age and to reduce the prevalence of anemia among WRA and children 6-59 months of age. SII works across thematic areas including nutrition, health and family planning (FP), water, sanitation and hygiene (WASH), agricultural/homestead food production (HFP), and governance, using a gender equality and social inclusion (GESI) approach for all interventions.
SII has a large, rigorous monitoring, evaluation, and research system. Annual monitoring surveys, a key component of SII’s monitoring system, primarily serve to monitor progress over time related to key SII inputs, outputs, and outcomes in intervention areas. The first SII annual monitoring survey was conducted between June to September 2017 among a representative sample of households with a child under five years by New ERA, a local survey firm. At the household level, mothers were the primary survey respondents. A primary male (or female, if male unavailable) household decision maker, the youngest child’s grandmother, and an adolescent girl (10-19 years), if residing in the same household, were also interviewed. Data was also collected from Female Community Health Volunteers (FCHVs) and 1 key informant from each health facility in the sampled areas. The household surveys included questions related to exposure, knowledge and practices for each of the thematic areas mentioned above. Anthropometric status was assessed for all female respondents and children. FCHV and health facility surveys collected information on exposure to training, motivation, supervision, and work-related activities. In 2017, the final survey sample included 3,642 households.
New ERA also carried out the second and third surveys between July and September 2018 and 2019 respectively, again among a representative sample of households with a child under five years in the same sample clusters. In the 2018 and 2019 surveys, only mothers as the primary survey respondents and a primary male (or female, if no males available) household decision maker were interviewed. Other household members, health facility workers and FCHVs were not interviewed and at the household level, anthropometry information was not collected. The final survey sample was 3,648 households in both 2018 and 2019.
Some variation in survey modules and questions existed across the 2017, 2018, and 2019 tools, mostly due to adding questions of important for program staff as activities implementing changed and dropping questions not needed to measure on an annual basis. Key modules and questions, however, needed for calculation of indicators along SII’s primary pathways to impact remained unchanged. Trends in key indicators from 2017, 2018, and 2019 for all intervention areas - nutrition, health, FP, WASH, and agriculture - can be measured. To assess changes over time, comparison of results between years 1 and 2, years 1 and 3, and years 2 and 3 were done, with more significant p-values expected for the changes between years 1 and 3 due to a longer period of program exposure in the population. Changes in key indicators from 2017 to 2018 to 2019 are noted in Table 1.