The health and nutrition indicators are improving in Nepal but still, malnutrition exists among women, children, and adolescents. The Multiple Indicator Cluster Survey (MICS) 2019 shows that 32 percent of under 5 children are stunted, 12 percent are wasted, and 22 percent are underweight. The Nepal Demographic and Health Survey (NDHS) 2016 shows that 53 percent of under 5 children and 43 percent of adolescent girls are anaemic. The Nepal National Micronutrient Status Survey (NNMSS) 2016 reported stunting among 32 percent of adolescent girls and boys. Overweight and obesity, which are considered to be an important cause of non-communicable diseases, are also on the rise in Nepal. According to the NNMSS, 4 percent of adolescent girls and 5 percent of adolescent boys between the ages of 10 and 19 are overweight. The Sustainable Development Goals aims to reduce stunting by less than 15 percent, wasting by less than 4 percent, underweight by less than 10 percent and anaemia by less than 10 percent by the year 2030.
There is an increasing recognition of the critical role of the private sector in effectively addressing many health and development issues including undernutrition. Engaging with private sector stakeholders to tackle food and nutrition security has become an important SDG delivery strategy. However, the challenges, impacts and solutions offered by this strategy vary, requiring therefore practical, evidence-based research and sounder multi-stakeholder, multi-sectoral partnerships. It is also important to fill knowledge gaps and develop smart, adaptive, inclusive and principled partnerships for policymaking and programming for private sector engagement towards food and nutrition security for all.
Not so many public-private partnerships to date have been explicitly established to achieve nutritional goals. It is therefore important to assess how the potential of the private sector can be unlocked to address food security and malnutrition worldwide through nutrition-sensitive interventions. Responsible market-based approaches are needed to provide sustained access to effective and affordable nutritious products and services at scale to entire populations. Appropriate consumer education and promotion of nutritious products will help caretakers make informed choices when providing nutrition, hygiene, and health to their families.
The new National Health Policy 2019 has also spelled out partnership with private sector and utilization of its resources for the development and expansion of health services. In the last decade, the country has seen a lot of investment in health from the private sector as reflected by an increase in the number of private health facilities. People increasingly visit private health facilities, as a first point of contact with the health system, which also provide basic medical consultation and services. The NDHS 2016 shows that 10% of children received care from the private sector. Hence, contribution of the private sector is critical to improve access to health services.
Despite the importance of private sector in nutrition related services, there are limited studies on the role playing by private sectors in providing nutrition services, as well as the capacity of private sector actors in providing such services. A rapid market scan of products would help us understand the landscape of nutrition products currently available for consumers. This study aims to increase our understanding on the scope and potential areas for expanding MCH nutrition specific activities through the private sector channel in selected areas of Karnali and Madhesh Province of Nepal.
Objective of the study
This report’s overall objective is to increase understanding of business initiatives aimed at reducing malnutrition, by mapping and assessing evidence and lessons learned, identifying good practices and opportunities for further engagement in nutrition, and making recommendations to promote and support sustainable business action on nutrition.
- To conduct a situation analysis of the current provision of MCH nutrition-specific services provided by the private sector including a market scan for the availability of nutrition products.
- To assess the readiness and capacity of the private sector health service providers for providing MCH nutrition-specific services in an integrated manner.
- To explore barriers and enablers for private sector engagement in MCH nutrition-specific services.
Study approach, method, and participants
The study will be a qualitative assessment with rapid market assessment of nutrition products in 10 different municipalities from Karnali and Madesh province of Nepal. The study methods include in-depth interview with private sector actors, as well as other relevant stakeholders, rapid market assessment, and observation of nutrition services and facilities available in private health facilities, which will be completed by review of available literature. The participants include owners and service providers of private sector pharmacies, clinics and poly clinics, small scale hospitals, and small and big food and grocery stores.
Study site/location and sample size
The study will be conducted in five municipalities each from Karnali and Madhesh province of Nepal. Municipaliteis will be selected purposively from Surkhet and Dailekh from Karnali and Sarlahi and Dhanusa from Madhesh province based on presence of PSI/N and Save the Children programs and field offices; availability of market centers; and geographical proximity. The municipalities will be a mix of urban and rural municipalities. The proposed samples as per the ToR has been summarized in Table 1 below.
Table 1. Samples from each of the two provinces
|SN||Samples||Karnali province||Madhesh province||Total||Remarks|
|1||Pharmacy with and without health provider||25||25||50||5 in each municipality|
|2||Clinic/Polyclinic/small hospital||15||15||30||3 in each municipality|
|3||Supermarkets/grocery stores||10||10||20||2 in each municipality|
|4||Small “kirana pasal”||15||15||30||3 in each municipality|
|5||Other relevant stakeholders (municipality representative, community people, mothers, private networks, supply chain actors, etc.)||15||15||30||3 from each municipality|
Project Duration: September to December 2022
Area: Dhanusha and Sarlahi Madhesh Provence and Surkhet and Dailesh, Karnali province.