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Integration and Coordination in Nepal

Despite worldwide efforts to reach the Millennium Development Goal target of halving the proportion of people who suffer from hunger by 2015, 165 million children remain stunted and 870 million people are chronically undernourished. The 2013 Lancet Series on Maternal and Child Nutrition points to a growing consensus that combating the global burden of malnutrition will require collaboration across development sectors.

Recognizing the potential gains that can be made through better coordination, USAID’s Bureau for Food Security and Bureau of Global Health commissioned the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project to lead a series of practical and program-driven Agriculture and Nutrition Global Learning and Evidence Exchange (AgN-GLEE) events in Uganda, Guatemala, and Thailand between December 2012 and March 2013.

To inform the agendas of the AgN-GLEEs, SPRING conducted a landscape analysis. Its purpose was to review and synthesize current Feed the Future investments being made by USAID, extracting key data and patterns from project documents and telephone interviews with USAID Missions. In addition to completing landscape analysis reports for each of the 19 Feed the Future countries, SPRING also conducted several field studies. These qualitative exercises were designed to gather, analyze, and summarize one or more practical activities being carried out by either a USAID Mission or a Feed the Future implementing partner that demonstrated potential for supporting nutritional outcomes within the country’s Feed the Future defined zone of influence.

This field note highlights the work of the Nepal Mission to coordinate programming within the Feed the Future zone of influence to leverage greater results in improving nutritional outcomes among the region’s population, particularly pregnant and lactating women and children under two years of age.


The overall goal of the Nepal Multi-Year Feed the Future Strategy is to reduce hunger and poverty among smallholder farm families, with special attention to the nutrition of pregnant and lactating women and children under two years of age. The Mission is pursuing implementation through three different components: 1) agricultural production, 2) nutrition behaviors, and 3) entrepreneurial literacy training. The agriculture and nutrition components are combined in the Knowledge-based Integrated Sustainable Agriculture and Nutrition (KISAN) activity, awarded in February 2013. The entrepreneurial literacy training component will be implemented as a separate, co-located project, which is expected to be awarded to a local organization in early 2014. While both projects will target poor and malnourished populations, the entrepreneurial literacy training program will work explicitly with a subset of women, youth, disadvantaged caste groups, and ethnic and religious minorities chosen from among the KISAN beneficiaries.

In agriculture, KISAN plans to use private-sector service providers, agribusinesses, government extension agents, and lead farmers as “change agents,” promoting conservation agriculture packages, soil and water management techniques, and community production of climate-adapted seeds. Existing USAID-funded economic growth activities such as Nepal Economic, Agriculture, and Trade Activity (NEAT, 2011–13) and phase four of the Hill Maize Research Program (HMRP, 2010–14) also share programmatic links with KISAN, leveraging prior investments in market infrastructure, microfinance, agricultural policy, improved inputs, and farmers groups. Also, regional initiatives including a Nutrition Cooperative Innovative Laboratory (CIL, 2010–15) and a lentil, maize, and rice development initiative (Cereal Systems Initiative South Asia, 2012–15) coordinate operational research, monitoring and evaluation, and dissemination of improved inputs with KISAN.

For its nutrition interventions, KISAN directly incorporates community programming from Suaahara (2011–16), a major USAID-funded nutrition activity developed shortly before the Feed the Future rollout. Materials and social and behavior change communication (SBCC) techniques researched and created for Suaahara are being adopted by Nepalese female community health volunteers, health workers, mothers’ groups, and Peace Corps Volunteers. The approach in KISAN promotes essential nutrition and hygiene actions (ENHA), household gardening, and improved knowledge on diet, while addressing sociocultural norms that impact food consumption and food purchase patterns. Along with the programmatic links, the Mission adjusted Suaahara and KISAN’s geographic coverage based on its Feed the Future strategy to avoid geographic duplication and achieve greater impact in reducing undernutrition.

Targeting and Geography

Nepal’s Feed the Future zone of influence covers 20 districts in the West, Mid-West, and Far-West Regions. These districts were selected according to poverty and hunger indices, sales of household assets due to food insecurity, male and youth migration, prevalence of female-headed households, high prevalence of undernutrition and diarrhea among children, infrastructure, and potential for returns on investment. Approximately 160,000 vulnerable smallholder households are targeted for improved horticulture, lentil, rice, maize, and livestock production. These value chains were selected based on a combination of Government of Nepal priority, nutrition content, market potential, and suitability for smallholder production. In total, KISAN is projected to reach one million individual beneficiaries with its agriculture and nutrition programming.

Health Programs in Nepal - with Respect to Feed the Future

Integration Strategy

The Nepal Multi-Year Feed the Future Strategy links agriculture, nutrition, and education as a complete package to increase the economic resilience and health of vulnerable populations. The flagship KISAN activity is embedded within the strategy, and both focus heavily on nutritious horticultural crops for sale and consumption. Community-level agriculture and nutrition “change agents” are targeted for capacity development and for direct involvement in Feed the Future activities. Steps taken to create and support Nepal’s integration strategy, described below, demonstrate a strong focus on facilitating and institutionalizing Mission, activity, and government-level coordination.

Mission Coordination

  • Forging interoffice collaboration. The Nepal Mission began with separate Feed the Future activity concept notes among the Health and Family Planning (HFP) and Social, Environmental and Economic Development (SEED) teams, but restructured its planning process midstream to create a single integrated request for proposal (RFP). During the RFP development process, a four-day intensive interoffice meeting was critical in defining a shared budget, activity goals, and operational decisions, with strong input from the Feed the Future team leader, and agriculture, food security, and nutrition specialists. The Mission director and technical office directors provided input and meaningfully engaged in this collaborative work.
  • Budgeting for impact. The HFP and SEED offices shared, discussed, and revised sample budgets when creating the KISAN RFP. These served as key practical documents for Feed the Future planning, particularly when defining realistic and cost-effective district coverage for nutrition interventions. Based on previous experience in Nepal, achieving nutrition results requires specific activities and consistent, long-term messaging to completely “saturate” an entire area, compared to targeted agricultural activities that have been proven to “diffuse” from one village to another.
  • Balancing coverage and programming. The budget deliberations resulted in a two-tier approach to nutrition interventions, targeting most KISAN districts with “High Nutrition Intense’” activities (i.e., total coverage) as described in the RFP, and “Low Nutrition Intense” districts covering select communities within each district. Prevalence of stunting, wasting, underweight, and diarrhea will help determine High versus Low Nutrition Intense districts. In implementation, the Mission is collaborating with the newly awarded World Bank Global Agriculture Food Security Program (GAFSP) to provide additional nutrition coverage in eleven shared districts. The Mission is concentrating its High Nutrition Intense activity in nine districts that will not benefit from the GAFSP program activity.
  • Sustaining Feed the Future coordination in the Mission. An interoffice food security working group was created in mid-2009. This group was chaired by the deputy Mission director during the Feed the Future strategy preparation and formulation phase, and received input from the Program and Project Development (PPD) Office and US embassy representatives. SEED and HFP technical team members continue to meet weekly during Feed the Future implementation to discuss and triage implementation hurdles and bottlenecks.
  • Linking Feed the Future with other Mission initiatives. In May 2013, the contracting officer representative and agreement officer representative (COR/AOR) of the Mission’s major health, nutrition, governance and climate change activities established a Mission-level COR/AOR working group to facilitate discussions of implementation activities and link opportunities for synergistic action and results.

Activity Coordination

  • Evaluating implementers on integration. Implementers were evaluated based on past performance with integrated agriculture-nutrition programming in their project proposal, in order to be considered for the Feed the Future contract. The KISAN RFP included specific language to this effect, including judging the offeror on their “clear understanding of the problems related to each of the components” [agriculture, nutrition, literacy].
  • Incorporating and aligning materials. The Suaahara activity provided Feed the Future with recently developed nutrition and water sanitation and hygiene (WASH) materials, as well as interventions that are already aligned with the government’s Multisectoral Nutrition Action Plan (2013–17) and Water and Sanitation Master Plan (2011–15). The Nepal Mission recognizes the value of capitalizing on these widely accepted materials and adapting them to the local context where needed.
  • Mandating and sustaining coordination among implementers. The KISAN RFP contractually obligates implementers to coordinate with specific regional and USAID-led agricultural or nutrition initiatives. The Mission also helped create an activity coordination mechanism in April 2013, which brings together implementing partners in monthly meetings that facilitate harmonization of activities, stimulate joint activities, and help align approaches with national policy and planning processes. Meeting minutes are shared with Mission staff members, who participate based on the agenda and meeting location.

Government Coordination

  • Reviewing proposals with government ministries. To ensure government buy-in and perspective, high-level officials from the Ministry of Health and Population and the Ministry of Agriculture Development participated in reviewing Feed the Future activity proposals and were involved in reviewing the KISAN work plan.
  • Tying national government policy to USAID activities. The Mission also supported establishing a GON-led National Nutrition and Food Security Steering Committee in November 2012. This committee coordinates policy dialogue and program planning and management among the health, agriculture, and development ministries at the national level. Subnational National Nutrition and Food Security Steering Committee coordination structures are also being rolled out to facilitate implementation coordination at the district and subdistrict levels between KISAN and Suahaara.
  • Creating a space for regional and district coordination. For coordination of activity-specific matters, the GON and Nepal Mission are establishing a KISAN Advisory Committee consisting of representatives from relevant Ministries, the Mission, implementing partners, the private sector and other stakeholders. For field-level work, KISAN will participate in actions carried out by the regional and district-level Ministry of Agriculture coordination bodies.


In creating, implementing, coordinating and evaluating the Feed the Future strategy, USAID/Nepal has confronted several critical challenges. Chief among these is the effectiveness of the Mission’s two-tier nutrition implementation, which is ultimately the result of budgeting and targeting constraints. To help overcome potential weaknesses in Low Nutrition Intense zones, the Mission is closely coordinating with the World Bank–supported GAFSP in Nepal. GAFSP has similar nutrition messaging and approaches to Suahaara and KISAN and is beinge implemented in 11 of the 20 KISAN districts. The GAFSP-KISAN coordination is a win-win solution for improving nutrition coverage but will also require robust evaluation mechanisms to facilitate attribution of impact at the community level. Similarly, the ability of KISAN to target the same households with agricultural and nutrition interventions, and to differentiate between their individual and synergistic impacts, will require a sophisticated approach.

In April 2013, the Nepal Mission appointed an interim Feed the Future team leader to lead the Mission’s complex nutrition integration strategy from design to implementation. As some of the mechanisms to ensure KISAN leverages interventions from related activities (such as Suaahara and the upcoming entrepreneurial literacy training program) are either just beginning or have not yet been fully implemented, the new leadership will need to ensure that key details in participant overlap, sharing of infrastructure and inputs, and monitoring and evaluation are properly defined along the way.

While the staffing transition has the potential to test the Mission’s established coordination mechanisms, the transition from KISAN’s design to implementation is emerging as the more significant challenge. The Mission has recognized the need to deepen engagement with primary agriculture and health ministries and broaden cooperation with other relevant development ministries and donor projects to ensure successful activity in the field. The challenge, however, is to achieve balance between coordination—internally at the Mission, and externally with implementing partners, government structures and other donor projects—and action for the benefit of the KISAN’s target beneficiaries.


When creating their Feed the Future strategy, USAID | Nepal staff members were encouraged to share and coordinate budgets and development approaches, targeting ideas and experience from prior activities. The Mission convened an intensive four-day internal workshop to advance these efforts, which could be replicated in other settings as a way to jump-start cross-office collaboration and share, discuss, and agree on key activity details. The resulting Feed the Future activity RFP (KISAN) took a prescriptive approach in defining how agriculture and nutrition activities were to be linked in the field, and the Mission is currently facilitating the creation of coordination mechanisms between the concerned activities. Assigning Feed the Future oversight to an internal cross-office working group is a necessary step to ensure implementation continues to be an integrated effort. The invitation of Ministry of Agriculture Development and Ministry of Health and Population representatives to participate in a Technical Review Committee is a novel approach to promote country buy-in for KISAN and for the idea of agriculture-nutrition integration. Also, the Mission’s complementary support for creating the National Nutrition and Food Security Steering Committee effectively provides the Nepal Mission with institutionalized agriculture-nutrition collaboration at Mission, activity, and government levels. Nepal’s combination of coordinated and strategic planning is providing a strong foundation to support KISAN’s rollout and position within the entire Feed the Future portfolio. As a result, the Mission is likely to see its internal efforts translated into positive beneficiary impacts.