Sustaining behavior change with local government engagement: Suaahara II, a success story for Nepal

Summary:

Suaahara II (SII) is a five-year USAID-funded multi-sector nutrition program, currently working in 389 of Nepal's 753 municipalities and serving over 1.5 million households. While many projects fail to adapt to the changing political scenario, SII's embrace of federalization and advocacy with the local governments has resulted in eight times more investment in nutrition than the central government used to invest prior federalization. As of October 2019, approximately ninety percent of our local government partners have started allocating budgets for SII programming and folded it into their governance, ensuring that our behavior change model will continue after the project ends. The presentation will describe: 1.How SII is successfully engaging local officials to source and allocate funds that not only sustain SII behavior change activities, but also scale up and broaden its scope during the project cycle itself; 2.How SII persuaded local governments to pay for underfunded human resources, i.e. project staff salaries; 3.How SII was able to continue oversight of the municipality's adoption of the SII approaches and priorities, as their own and translating them into a very local context. It's important to note that SII's success was all the more rare because of competing funding commitments for infrastructure projects which are thought more visible by the political leader-ship vis a vis behavior change programs. In the coming months, we foresee a dramatic increase in local government ownership of SII programming as these leaders share their success stories with their colleagues across Nepal.

Background/Objectives:

Suaahara II is a USAID-funded integrated nutrition program that aims to improve nutritional status of women and children in 1.5 million households of 42 of Nepal's 75 districts with an integrated agriculture, nutrition, health, family planning, and WASH package. The program is aligned with the Government of Nepal (GoN)'s Multisector Nutrition plan, and also works to improve nutrition governance and sustaining the achievements in 389 municipalities, more than half of Nepal's 753 local governments. SII's over 1,500 frontline workers try to provide interpersonal counseling to the 1000-day families and mobilize communities for sustained behavior change.

Description of Intervention and/or Methods/Design:

In year two of SII's five-year plan, Nepal was federalized; local governments were formed; and elections took place for the first time. As the new constitution had given the responsibility of health and nutrition to local elected officials, SII stepped up early in the process to orient the newly elected public officials on nutrition priorities and planning cycles. Each municipality was encouraged to chart its own goals in eradicating malnutrition free; ensuring full immunization; achieving cent percent institutional delivery; promoting food diversity; achieving food security, and availing safe water, etc. One SII staff was assigned to each municipality, who supported local officials on following up the plans and commitments, and in aligning their priorities with national obligations. We supported them on efficacy of programming, as well as prioritizing expenditures. We became trusted partners, which resulted in an increase in both allocation and percentage of municipality expenditure for nutrition initiatives.

Results/Lessons Learned:

Currently, 90% of the municipalities where we work in, allocate budget to sustain SII activities. They replicated our behavior change activities at the household and community levels by implementing or scaling up: 1.Key life events where milestones during the 1000-day period are celebrated to promote and remind key positive nutrition behaviors; 2.Allowances for female community health volunteers to conduct monthly mothers' group meetings; 3.Mobilization of peer facilitators to conduct nutrition counseling in underserved households; 4.Truly unprecedented is that some of the local governments contribute to overhead costs of SII frontline workers. By quickly adapting to new constitutional provisions, we had first move advantage over other development partners. We encouraged these local officials to champion health outcomes to their constituents, resulting in much deeper engagement levels than we've experienced, and it gave these individuals a sense of pride and increased ownership of our program.

Discussion/Implications for the Field:

The federalization forced us to come up with new strategies for local engagement. We created persona modeling of these local governing bodies to help us understand them better. To highlight their roles, we recognized them as Nutrition Ambassadors and employed staff to help them prioritize numerous interests, as this was all new to them. Where projects such as ours, normally work in the background, taking a back seat to more visible infrastructure projects, we proved to them that that by broadening SII, they were providing good governance, and truly serving their constituencies and by investing in nutrition, securing future generations.

Abstract submitted by:

Indra Dhoj Kshetri - Helen Keller International (HKI)
Kenda Cunningham - HKI
Pooja Pandey - HKI