INSTITUTIONAL STRUCTURE AND NON- GOVERNMENT PARTNERSHIP FOR NUTRITION PROGRAMS Manav Bhattarai, Abeyah A. Al-Omair and Chhitij Bashyal Abstract A multi sector effort is essential to improve the nutritional status of children and women. For effective and efficient implementation of multi sector interventions, each sector should be well positioned to deliver the required services. With the aim to understand the bottlenecks to effective implementation of nutrition operations in Nepal and provide strategies and recommendations to overcome these challenges, researchers from the World Bank conducted a qualitative study in 2016/17 entitled: “Study of Operational Strategies to Reduce Malnutrition in Nepal”. This research brief highlights various institutional structures and non-government partnership arrangements that contribute to effective implementation of nutrition related activities. Institutional Structure and Non-Government Partnership for Nutrition Programs In Nepal, addressing malnutrition has traditionally projects and other ministerial jobs in addition to been viewed as the responsibility of health sector implementing the SHD project. only. However more recently, other sectors have This bifurcation of roles and responsibilities created recognized that they have a role to play. It is tension as staff were pulled in different directions. important for all sectors that work on nutrition related tasks to take stock of their institutional Human Resource with Adequate Capacity structures and human resources to ensure effective Although addressing malnutrition has now been implementation. recognized as multi sector agenda and different ministries have come to understand their roles, A Dedicated Project/Program Management Unit success depends on the capacity of individual Substantial evidence points to the need for agencies to deliver their tasks. establishing a dedicated program/project management unit (PMU) for nutrition specific or The MOH is continuing to oversee its nutrition specific sensitive interventions. For instance, the Ministry of interventions with staff who are equipped with Health (MOH) has a Nutrition Section under the Child adequate capacity. The nutrition specific services are Health Division with dedicated staff who have the delivered through its health facilities including sole responsibility of executing nutrition hospitals, primary health care centers and health interventions as per their mandate. This section posts. Female Community Heath Volunteers (FCHVs) effectively designs, implements and monitors are also actively involved. Although the MOH is fairly- activities based on an annual work plan and budget. well equipped to deliver such services, its capacity is The Agriculture and Food Security Project (AFSP) enhanced by the technical and financial support of under the Ministry of Agriculture Development donors such as UNICEF, USAID, UNFPA and World (MOAD) also has a central PMU manned and Food Program (WFP). supported by adequate staff to implement project activities. New ministries which have recently recognized their roles in combatting malnutrition should ensure that In other cases, for example under the Sunaula Hazar they have adequate capacity to implement their Din (SHD) project which was implemented by the share of work. For example, to better deliver food Ministry of Federal Affairs and Local Development security and nutrition interventions under the AFSP, (MOFALD), the PMU staff were involved in other the MOAD sought technical assistance from various 1-2 supporting structures including the Nepal Agriculture quite low to win the contract and later they could not Research Council, the Department of Food perform very well. Technology and Quality Control, and the Food and Agriculture Organization. Policy Lessons: On the other hand, the SHD Project by MOFALD • Establish a dedicated Implementing Unit suffered implementation challenges at the local level with adequate human resource who have because of inadequate human resources. MOFALD responsibility for implementing the being a new ministry to implement the standalone nutrition project had to rely on the capacity of the nutritional interventions which will ensure Village Development Committees (VDCs) for project focus and prevent distractions from other management at the local level, even though: (i) ministerial work. activities under the SHD Project were very different from other activities that VDCs had experience with • Non-government partnerships play an implementing and supervising; (ii) VDCs did not have important role and nutrition adequate knowledge about the complex nature of projects/programs should build in such malnutrition; and (iii) VDC members were already opportunities. quite busy and otherwise occupied. It is important that relevant ministries work towards • Given the possibility of non-performance creating the required human resource positions to by the hired non-government partners (be implement nutrition related interventions. it NGOs or private firms), their Simultaneously, until such provisions are available, accountability can be ensured by paying for services should be procured through non- verified results. government partnerships. Non-Government Partnerships Non-government partners can play a critical role in Full report: “Study of Operational Strategies to strengthening public service delivery of nutrition Reduce malnutrition in Nepal”. Website: interventions. They can either be an International/ Non-Governmental Organization (I/NGO), a technical http://documents.worldbank.org/curated/en/47445 firm or a United Nations’ organization. They can be 1508933829359/Study-of-operational-strategies-to- hired through the government’s budget or be part of reduce-malnutrition-in-Nepal technical assistance provided by Development Partners. The findings, interpretations and conclusions expressed in this paper are entirely those of the Non-government partnerships can provide technical author(s) and should not be attributed in any manner expertise related to nutrition specific and sensitive to the World Bank. The World Bank does not interventions, human resource deployment, guarantee the accuracy of the data included in this supervision and monitoring and information work. management. If a non-government partnership is deemed necessary, then it should be recruited early Financial support for this work was provided by the in the process. Government of Japan through the Japan Trust Fund for Scaling Up Nutrition. Evidence from the field suggests that some NGOs were not performing their assigned tasks in various government and donor run projects. They were not paying salaries to their staff and obliging with their duties. It appeared in some cases that NGOs had bid 2-2