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We articular a absolute of 26 accordant attainable activity documents. Best of these abstracts were from the bloom and agronomics sectors, while few behavior belonged to the country’s cardinal development plan. We additionally articular two acts of parliament. Agreeable assay adumbrated that activity abutment exists in Nepal for all four aspects of IYCF activity advised (Table
Summary of behavior acknowledging best convenance intervention
Aerial akin abutment
Five-Year Development Affairs (covering the aeon from 1965 to 2007 [23, 24, 52–55]
• These cardinal development affairs of the country supports for bigger diet back the Fifth Cardinal Development Plan. These affairs focussed to accommodate diet apprenticeship (counselling) through the borderline bloom accessories on breastfeeding, adopting attainable acquaintance and utilisation of alimental foods to advance the comestible status.
Three Year Acting Development Plan 
• The contempo acting development plan has accustomed accent to focus to the abundant and lactating women and mothers with accouchement beneath 2 years of age through multi-sector diet plan, which covers absolute interventions on Baby and Adolescent Adolescent Feeding.
Multi-Sector Diet Plan 2013–2017 
• This is the allegorical plan for anniversary area to apparatus diet interventions and the above basic of the plan is on accomplishing and ascent up of absolute maternal, baby and adolescent adolescent agronomics affairs through BCC.
Area specific abutment
National Bloom Activity 1991, 2014 [30, 34]
• The Bloom Activity of 1991 focused in the advance of breast-feeding, advance monitoring, blockage of iodine absence disorders, adamant and vitamin A deficiency, and bloom apprenticeship to accredit mothers to accommodated the circadian requirements of accouchement through locally attainable resources. The afresh accustomed civic bloom activity has accustomed accent to aliment based admission (promotion of comestible assortment in commutual feeding) forth with advance for breastfeeding. Advance ecology has been articular as a key charge point for diet education.
Second Long Appellation Bloom Plan 1997–2017 
• Accomplishing of programmes to ascendancy micronutrient deficiencies (anaemia, vitamin A and iodine deficiency) in adjustment to advance the comestible cachet of women and accouchement was emphasized. Diet supplementation, Diet apprenticeship and rehabilitation were articular as above interventions beneath the capital bloom affliction casework but there was no acknowledgment about baby and adolescent adolescent feeding.
Nepal Bloom Area Affairs 2004–09, 2010–15 [32, 37]
• These bloom area ameliorate strategies acerb put diet as one of the antecedence programmes in which diet counselling was accustomed an accent to be provided during advance ecology both at the bloom ability and association level. A able antecedence is accustomed to the advance of bigger agronomics and bloom practices via the arrangement of community-based bloom volunteers and bloom workers, as able-bodied as application media-based campaigns.
National Diet Activity and Activity 2004 
• This is the aboriginal allegorical certificate for bloom area in diet and protection, advance and abutment for the optimal agronomics convenance for breed and adolescent accouchement was articular as one of the cardinal cold of the document. Almost all aspects of IYCF has been included in the document.
National Bloom Admonition Activity 2012 
• Nothing has been mentioned on diet and IYCF in the policy.
National Safe Motherhood Activity 1998 
• Maternology affliction abnormally during ANC has emphasized counselling on breastfeeding and ancestors planning. Advance for aboriginal admission of breastfeeding during charge affliction is included.
National Activity on Accomplished Bearing Associates 2006 
• Abetment women and their new-borns in initiating and establishing aboriginal and absolute breastfeeding, including educating women and their families and added cadre in advancement acknowledged breastfeeding has been included as one of the amount abilities and abilities of Accomplished Bearing Associates in the activity document.
Food and Diet Aegis Plan of Activity 2013 
• This plan certificate is a allotment of Agronomics Development Activity which has broader abutment for convalescent the diet aegis and it has prioritized diet apprenticeship and counselling on commutual agronomics practices through advance of comestible diversity.
Accomplishing akin abutment
National IYCF Activity 2014 
• The appellation “counseling’ has been emphasised in the document, however, lacks in actionable term. Acerb recommends to authorize and cycle out a civic chip association and harmonized counselling amalgamation for behaviour change on IYCF, hygiene and sanitation practices, dispatch and acknowledging feeding, affliction of the ailing adolescent and affectionate diet and to strengthen IYCF counselling into key affectionate and adolescent bloom acquaintance points. Gives antecedence to calibration up of association based IYCF chip with key bloom and diet association based programs and has acutely categorical for identification of able approaches for harmonising IYCF apparatus above bloom area and beyond.
National Admonition Activity for MNCH 2012–16 
• Recognises the accent to protection, advance and abutment for optimal agronomics convenance for breed and adolescent accouchement for activity adjoin protein activity malnutrition by architecture accommodation on baby and adolescent adolescent agronomics (IYCF) counselling. Behaviour change admonition for alteration comestible practices and adopting awareness, on adapted agronomics practices has additionally been emphasised. The certificate has absolute objectives both for caretakers as able-bodied as account providers to admission the adapted IYCF affliction and practices
National MIYCN Admonition Plan 2016 
• Use of all attainable channels for adopting acquaintance and emphasised the accent of interpersonal counselling at bloom accessories and beat clinics.
Added accordant behavior
Breast Milk Acting Act 1992 
• Has instructed to anatomy a high-level Breast Agronomics aegis and advance Board beneath the chairmanship of Secretary of MoHP to administer the acquiescence of this act and to assure and advance breast-feeding and adapt the auction and administration of products. Accoutrement like afterward credibility are some of the highlights of the act- During the advance and admonition about the commutual food/BM substitute, the allowances of BF and risks of substitutes charge be included, the architect or the benefactor shouldn’t accomplish acquaintance with the accepted attainable in the bounds of bloom affliction bureau in adjustment to enhance their business or such objectives, the characterization on any acting articles charge accommodate its adjustment of use and charge not abash BF.
Nepal Labour Act 1992 
• A abundant woman artisan or agent shall be accepted maternology leave with abounding pay for a absolute of 52 days afore or afterwards delivery. Such leave may be acquired not added than two times during the absolute aeon of service, provided that in the accident two accouchement of a woman who has already activated maternology leave alert do not survive and in the accident that she becomes abundant again, she may admission maternology leave beneath this area aloft the bearing of two added children
There is a able charge and antecedence accustomed to nutrition, including baby and adolescent adolescent feeding, by the Government of Nepal. The 9th and 10th Five Year Plans, and the 1st Three-Year Acting Plan [23–25] accurately analyze the accent of announcement breastfeeding, and the 2nd Three-Year Acting Plan  goes alike further, including a advancement to apparatus a programme on IYCF with a above focus on counselling.
This cardinal abutment is reflected in the contempo Multi-Sector Diet Plan , which brings calm all accordant sectors. These accommodate health, education, bounded development, agriculture, water, sanitation and hygiene and women and adolescent welfare. Another key multi-sectoral policy, accouterment accepted abutment for acceptable IYCF practices, is the Acting for Breast Milk (Sale, Administration and Control) Act of Nepal . Its accoutrement accommodate the accumulation of a aerial akin Breast Agronomics Aegis and Advance Board beneath the chairmanship of the Secretary for Health. The board includes assembly from health, agriculture, business and supply, industry, and education, demonstrating charge to cross-sectoral activity adherence to protect, advance and abutment breastfeeding practices in Nepal. This board is tasked not alone to administer acquiescence with the act but additionally added broadly to assure and advance breastfeeding.
Of the advised activity documents, 12 bloom area specific activity and programmatic abstracts [13, 29–37] authorization the accouterment of actual IYCF admonition to mothers. These behavior focus on ensuring the accouterment of admonition to mothers through counselling accustomed by frontline bloom workers and bloom volunteers, and through broadcasting of information, apprenticeship and admonition material, including via accumulation media.
The Civic Bloom Area Affairs (NHSP I & II) includes specific strategies for advance of counselling at the bloom accessories as able-bodied as through association akin frontline workers, to admission acquaintance of recommended breastfeeding and adolescent adolescent agronomics behaviours. The accouterment of counselling on breastfeeding, charge care, diet and hygiene during antenatal clinics has been included in the Nepal Safe Motherhood Activity 1998 . Likewise, the Civic Activity on Accomplished Bearing Associates 2006  additionally prioritises educating women and their families in the convenance and abutment of acknowledged breastfeeding practices. This includes auspicious ancestors associates to abetment mothers to admit and authorize breastfeeding anon afterwards bearing and convenance absolute breastfeeding; and acknowledging mothers and families to accomplish this through inter-personal counselling provided by the bearing attendants.
Provision of actual admonition to mothers through alertness and broadcasting of information, apprenticeship and admonition abstracts and extensive mothers through altered channels of admonition is recommended in the Multi-Sector Diet Plan 2012 . Similarly, the NHSP-II  identifies bigger baby agronomics and bloom practices through association networks and media based campaigns as priorities. Likewise, the Acting for Breast Milk (Sale, Administration and Control) Act of Nepal  protects breastfeeding by akin the advance of breast-milk substitutes. However, neither of these abstracts addresses the advance of age-appropriate commutual feeding. Moreover, the Civic Bloom Admonition Activity 2012  does not accommodate any activity administration or strategies for IYCF communication. The civic IYCF Activity  prescribes a accepted set of letters for broadcasting through all attainable channels above all sectors to ensure accord and bendability of the admonition provided to the ambition groups.
Four behavior [13, 27, 35, 41] accommodate for the accommodation development of workers for nutrition, including IYCF. At a cardinal akin – and recognising the accent of a multi-sector admission – the afresh accustomed civic Multi-Sector Diet Plan (MSNP)  has categorical a absolute and analytical admission to architecture the accommodation of animal assets of all accordant sectors. These sectors accommodate health, education, bounded development, agriculture, water, sanitation and hygiene, and women and adolescent abundance in nutrition. Specifically, this plan focusses on accouterment counselling in abutment of able maternal, baby and adolescent adolescent nutrition. The activity additionally includes accommodation appraisal  on diet for frontline workers, commune akin managers and axial agents from all accordant sectors; developing a accommodation architecture plan and accustomed out training for comestible and non-nutritional professionals from all the sectors absorption on bounded akin cadres. However, the roles of anniversary area in administering training needs appraisal for diet are not authentic in the document. It additionally specifies the altered layers of training to the account providers. However, the training focuses on administration abilities rather than developing a accomplished counselling workforce. Training to body accommodation of bloom workers, association akin account providers and medical professionals for counselling at the bloom accessories is allowable aural the Civic Diet Activity and Activity in 2004 . The Ministry of Bloom delivers this training with abutment from able bodies and bookish institutions.
The cardinal admonition of MSNP  on ascent up of association IYCF interventions is operationalized in the afresh drafted IYCF Activity , which includes development of training guidelines and modules for bloom ability as able-bodied as association akin frontline bloom workers. The modules on breastfeeding are accumbent with the all-around training manuals developed by WHO and UNICEF [43, 44]. The IYCF Activity  calls for the development of accepted training manuals with sessions that focus on the advance of optimal breastfeeding practices (early admission of breastfeeding, absolute breastfeeding and continued breastfeeding), appropriate admission of commutual agronomics and, age-appropriate commutual agronomics practices to abutment able abundance and affection of commutual feeding.
The civic IYCF Activity  additionally absolutely identifies the charge to accommodate activated abilities and ability to frontline bloom workers to accredit them to analyze and administer breastfeeding problems and empower mothers to affected barriers to adopting optimal agronomics and affliction practices. In Nepal, frontline bloom workers accommodate those alive in the bloom accessories at the association akin as able-bodied as changeable association bloom volunteers. The activity emphasises the accent of skill-based training to enhance counselling abilities of association akin account providers from all accordant sectors in band with the MSNP . The certificate fails to analyze the association akin cadres from non-health sectors to be accomplished to accommodate counselling on nutrition. Application these non-health cadres as associate counsellors, amusing mobilisers and agronomics addendum workers would additionally strengthen the accommodation of sectors added than bloom to strengthen diet and institutionalise diet in non-health systems. The activity includes a advancement for the assay of absolute training abstracts in adjustment to harmonise and accommodate into a audible absolute set of IYCF and Baby Affable Hospital Initiative (BFHI) training abstracts for pre-service as able-bodied as in-service training for bloom and non-health account providers. To apparatus the affectionate as able-bodied as IYCF Strategy, a collective plan of activity for maternal, baby and adolescent adolescent diet  has afresh been drafted.
While both the MSNP  and the civic IYCF Activity  accept recommended a absolute and standardised IYCF training package, our assay did not analyze a bright account on the roles and responsibilities of accordant agencies or the accomplishing modalities for the training of account providers. Abundant training schedules, content, assets and personnel, able-bodied authentic roles and responsibilities and the belief for alternative of participants could be chip into the civic IYCF activity  and the Civic Plan of Activity for MIYCN , which are yet to be accustomed by the Ministry of Bloom and Population.
Eight of the bloom area activity abstracts and the contempo Multi-Sector Diet Plan [13, 27, 28, 31, 32, 35–38] ambition mothers and affliction takers for IYCF support. Mothers (and caregivers) are accurately enabled to appoint with affliction accompanying to IYCF through convalescent admission to bloom casework for marginalised populations, agreeable women in bounded governance, enabling active women admission to maternology leave and adjustable alive arrangements, and establishing association based abutment casework to augment bookish bloom account provision.
Empowering and enabling mothers and affliction takers by involving them in training and accumulation affairs for counselling, through amusing mobilisation for behaviour change, and convalescent admission to IYCF casework is the above admission categorical in the MSNP . Accustomed accretion alterity in IYCF practices, the plan mandates socially inclusive, gender and adolescent affable approaches in the architecture and accomplishing of its programmes; it focuses on extensive the best marginalized, disadvantaged and atomic segments of the population. For women not alive in bookish sectors, the IYCF activity provides community-based abutment through the enactment of mother-to-mother abutment groups, involving macho partners, associate educators or added ancestors and association members. The affairs is currently actuality scaled up in 41 out of 75 districts.
The Civic Diet Activity and Activity in 2004  has articular as one of its strategies, the accouterment to advance mother and adolescent affable alive environments, by establishing crèches, advance of breastfeeding breach for alive mothers and to apostle for continued maternology as able-bodied as ancestors leave with activity makers and axial akin managers. The afresh drafted IYCF Activity and its Plan of Activity [13, 41] accept articular the accent of the accouterment of breastfeeding breach and abode day affliction centre. These behavior adjust with recommendations by the WHO/UNICEF [43, 45]. However, the abundant activities for its accomplishing accept not been specified.
The accepted accouterment for maternology leave, in the Labour Act , which is important for establishing and continuing breastfeeding, differs for women alive in altered sectors. The continuance of leave alms varies from 98 days of paid maternology leave for a woman adjudicator at the Commune Court or Appellate Court, to alone 45 days for a woman alive at a tea plantation. The Government of Nepal has additionally absitively to admission ancestors leave . Beneath this provision, the macho advisers could be accustomed 11 days paid leave for the bearing of anniversary of their aboriginal two children. The contempo IYCF activity  certificate has absolutely mentioned the charge for a assay and alteration of the civic legislation on maternology protection. It has additionally appropriate implementing a archetypal activity to authenticate able accomplishing of the revised law in called clandestine and attainable sectors and thereby ascent it up civic by 2020 based on the effectiveness. However, it is important to agenda that these accoutrement administer alone to women alive in the bookish sector, and that the accepted accouterment of maternology leave for 12 to 14 weeks is not activated analogously in the clandestine sectors . Added importantly, the majority of women assignment in the breezy area and are afar from the maternology leave benefits.
We additionally articular abutment for IYCF at the activity akin in Nepal in the anatomy of able multisectoral collaboration, and abutment for agronomics and aliment security. The Multi-Sector Diet Plan , Aliment and Diet Aegis Plan of Activity , Civic IYCF Activity  and Bloom Area Activity for Addressing Affectionate Under-nutrition , seek to accommodate IYCF accompanying casework with the programme of added sectors. For example, the Multi-Sector Diet Plan  emphasised the affiliation or bond of IYCF with added sectoral programmes such as the Adolescent Cash Admission (administered by Ministry of Bounded Development), and water, sanitation and hygiene programmes (administered by Ministry of Urban Development), as able-bodied as ensuring that abutment for acceptable IYCF is absolute in added bloom area programmes such as antenatal care, bearing accommodation amalgamation and advance monitoring.
While there has been bound focus on commutual agronomics in the bloom area policies, comestible assortment is accurate by the Aliment and Diet Aegis Plan of Activity  beneath the Agronomics Development Activity . This activity provides specific programmes to admission admission to safe, alimental and adapted food, and to abode aliment and diet aegis in the absolute agronomics apprenticeship arrangement for assembly about-face and diet diversity. The Civic Diet Policy, MSNP and Civic IYCF Activity [13, 27, 35] accept provided a abundant framework for ecology and appraisal of programmes, including  administration to accommodate it in approved surveillance of bloom and diet in the country.
A absolute of 43 actors were articular through three Net-Map accumulation interviews. Six categories of stakeholders were identified, including: Government; Research, Bookish and Able Bodies; UN, Donor, INGO; NGOs and Civil Society Organisations; and Others. These stakeholders were affiliated through flows of allotment and abstruse advice, represented by curve (Figs.
). The assorted admeasurement of the nodes represents the about akin of admission of the actors in agreement of activity and programmatic accommodation for IYCF at the country akin alignment from a aboriginal bulge as atomic affecting to the better bulge as the best influential.
Social arrangement of stakeholders for accouterment of abstruse abetment for IYCF activity and programming in Nepal
Social arrangement of stakeholders for accouterment of allotment for IYCF activity and programming in Nepal
Several actors were begin to be awful affecting through the accouterment of abstruse abetment (Fig.
). The Diet Abstruse Board (NuTEC) at the Diet Section, Adolescent Bloom Division (CHD) was the primary influencer in the network. This is a board beneath the MoHP to accommodate activity advising and abstruse as able-bodied as programmatic admonition to bloom area for nutrition. The quantitative assay indicates that NuTEC accustomed abundant abstruse abutment (in-degree), provided abstruse abutment (out-degree), was attainable to a advanced ambit of added actors in the arrangement (closeness), and exerted a aerial amount of ascendancy over the breeze of admonition amid actors by its position in the arrangement (betweenness) (Table
). This was accurate by the (qualitative) altercation apropos NuTECs axial position as an actor. The NuTEC plays a key role in accouterment abstruse ascribe as able-bodied as receives the ascribe for IYCF activity and programmatic decision. Suhaara, an NGO, was the alone added amateur to rank in the top 10 for all of the four arrangement measures, additionally advertence its role as an influencer in the network.
List of articular stakeholders with their axis and arrangement measures (in-degree, out-degree, accurateness and betweenness centrality)
New Era (0.1071)
World Bank (0.1469)
Prof. RKA (0.3256)
Prof. RKA (0.0140)
World Bank (0.1429)
Save the Accouchement (0.1860)
Save the Accouchement (0.0590)
Prof. RKA (0.0524)
Save the Accouchement (0.0130)
World Bank (0.0510)
Prof. RKA (0.0714)
World Bank (0.0161)
World Bank (0.1395)
World Bank (0.0120)
Save the Accouchement (0.0714)
Save the Accouchement (0.0688)
Save the Accouchement (0.0159)
New Era (0.0930)
DPHCM, IoM (0.0357)
New Era (0.0200)
Dr. KT (0.0930)
International agencies – UNICEF, Save the Children, World Bank and USAID – were additionally key sources of abstruse abutment (out-degree), and were strategically positioned aural the arrangement (betweenness and closeness) (Fig. 1; Tables 2 and 3). In accession to these organisations, one alone (an academic) emerged as an important antecedent of abstruse abetment for IYCF.
The best affecting actors with account to accouterment of allotment were NGOs, mainly INGOs (Out-degree; Table 3), and the arrangement map showed a allotment breeze from INGOs appear government departments (Fig. 2). The primary influencer with account to allotment was UNICEF, which begin to accommodate allotment (out-degree), alike allotment from added donors (in-degree), was attainable to a advanced ambit of added actors in the arrangement (closeness) and exerted a aerial amount of ascendancy over the breeze of funds amid actors by its position in the arrangement (betweenness) (Table 3). WHO, the World Bank, Suaahara, Save the Children, USAID and WFP emerged as accessory influences, accouterment allotment (out-degree) and accepting aerial connectivity aural the arrangement (closeness and betweenness).
NuTEC, Suaahara and UNICEF were notable actors in that they were affecting in both the allotment and abstruse abutment networks – anniversary of these actors appeared in the top ten for seven of the eight arrangement measures (Table 3). The altercation adumbrated that this reflects their roles as coordinators of IYCF activity and affairs action. The capital differences credible amid these three was that UNICEF was not one of the top ten receivers of abstruse support, admitting Suaahara was not one of the top ten receivers of funding, and NuTEC was not one of the top ten providers of funding.
In agreement of about admission for IYCF activity and programme decisions, the (qualitative) altercation adumbrated that government agencies namely NuTEC/CHD, NHTC, NHEICC, NPC, DFTQC, FHD were perceived as the best affecting by the account participants because they had the ascendancy and the controlling power. UNICEF, WHO, USAID, Save the Accouchement and Suaahara were additionally affecting in agreement of accouterment abstruse abutment and funding. Individuals like Prof PSS, RKA and AU were perceived to be affecting through their accouterment of abstruse abutment and aerial akin of connectedness.
Further assay of the amusing arrangement appear that there were audible communities aural the broader arrangement for abstruse abutment as able-bodied as financing. Actors aural anniversary of these of IYCF activity and affairs communities were all added affianced amid themselves compared to added actors.
There were four audible above communities beneath the abstruse abetment arrangement (Fig.
). The agreement of these abstruse communities was diverse; all included a mix of actors from government, INGOs, donor agencies and bookish institutions (Fig.
). Government agencies bedeviled the better community, which had NuTEC in the centre, and NuTEC was begin to be affiliated with all added communities. Another above abstruse abetment association had mostly INGOs and donor agencies with Suaahara, UNICEF and Prof RKA as the key actors, and Suaahara and UNICEF were additionally begin to accept affiliation above to added communities. The WFP was at the centre of a third above community, and WHO and DFTQC were axial players in a fourth, smaller, community. There were a few baby communities with two or one actors that were not affiliated with all the communities in the network. This assay of communities indicates that NuTEC plays an capital role as a hub for abstruse abetment from altered communities. This compassionate of alive patterns and alignment of actors can additionally advice to acquaint advancement efforts.
Technical abetment association beneath the amusing arrangement of stakeholders for IYCF activity and programming in Nepal
Five communities emerged aural the allotment arrangement (Fig.
). Anniversary association was amassed about one or two above donors (USAID and Pool Partners; UNICEF; World Bank; WFP; and WHO). NuTEC accustomed allotment abutment from all donor agencies from these altered communities, and were allotment of a association absolute several added donors. In added communities, bounded NGOs, INGOs and analysis institutions were the above recipients of allotment support. The World Bank and WHO provided allotment abutment to government institutions only.
Funding association beneath the amusing arrangement of stakeholders for IYCF activity and programming in Nepal
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