Creating an Integrated Nutrition Game-Plan: Technical Brief and Recommendations from Lao PDR

By: Deirdre McMahon, Global Nutrition Advisor, SNV 

Malnutrition isn’t the result of a simple cause-and-effect algorithm. It can’t be boiled down into an if-then statement. It’s the result of a complex web of underlying factors and interrelated causes. And in response to that complexity, reducing malnutrition requires convergent action from many different sectors and stakeholders. 

Based on the need for integrated action to improve nutrition, SNV applies a convergent approach to nutrition programming. For example in Lao PDR’s remote and ethnically diverse upland farming communities, SNV, with support from the Swiss Agency for Development and Cooperation (SDC) and in partnership with Agrisud International, works with local Government partners to improve family nutrition through the Enhancing Nutrition of Upland Farming Families (ENUFF) project. ENUFF brings together nutrition-sensitive agriculture, gender equity, positive social and behavior change (SBC), and water, sanitation, and hygiene (WASH) into one multisectoral nutrition program. 

ENUFF has gained valuable insights on realizing effective convergence of sectors and implementation across district, community, and household levels to improve nutrition. Drawing on this experience, the project has published ‘Converging for improved nutrition in Lao PDR’, a technical brief that provides key insights into the district level coordination and implementation of a multisectoral nutrition program and  defines strategies for improving nutrition through integrated programming. ‘Converging for improved nutrition in Lao PDR’ is available to download as a Full Brief or as a Summary. 

The brief details four strategic avenues to improve family nutrition in the Laotian uplands through integrated programming that ENUFF has identified based on the project’s implementation and findings from its baseline study: 

 1. Engage in nutrition and WASH social and behavior change communication (SBCC), which involves both women and men, especially in relation to children’s feeding and diets, dietary quality and diversity, improved hygienic practices, and use of improved sanitation facilities.  

2. Provide technical and organizational support to farms and small businesses to enhance local capacities to diversify food crop and small livestock production, and to process, store, market and generate income from food crop value chains. 

3. Promote, support, and engage in context-sensitive yet integrated initiatives, such as nutrition-sensitive home gardens and value chains, which cut across the health, agricultural, environmental, and business sectors and account for the multidimensionality of livelihoods and nutritional issues.

4. Support nutrition coordination committees, including recruiting the right coordinators, establishing mechanisms for accountability, decentralizing national level actions to the village level, and strengthening capacity at all levels including a process for learning and not just reporting. 

The need for improved nutrition in Lao PDR, particularly among women and children, is critical. Although the country has achieved impressive economic growth in recent years, its further progress is impeded by high malnutrition rates. The 2015 Lao Child Anthropometry Assessment Survey (LCAAS) reported that 36.5%, of children under five as  were stunted, with child malnutrition showing strong inequalities across regions and groups, particularly among communities living in remote upland areas where ENUFF is implemented. 

The underlying causes of this malnutrition are heavily influenced both by external factors, including food systems, the sanitation context, livelihood opportunities, and income generation, and by household dynamics and behaviors related to food production and purchase, care practices, and hygiene. Therefore, improving nutrition requires integrated action both among sectors (nutrition, health, education, agriculture, livelihoods, and women’s empowerment), and among governance and social strata (activities at the district, community, and household levels).  

By enacting these four strategies, ENUFF aims to improve households’ physical and economic access to nutritious foods through diversification of production and augmented livelihoods, while fostering inclusive, sustainable food systems and hygienic environments. The increased availability of nutritious foods and hygienic infrastructure will be accompanied with enhanced counselling at the household level of proper dietary needs, especially for children, men’s role in nutrition, proper hygiene practices, and the use of income increases for improved health and nutrition. These activities are coordinated and aligned across different sectors, and from the district to the household level. 

The desired key outcomes of this convergence of sectors and governance strata is to empower households with a set of options, decisions, and actions that together will lead to improved nutrition, in particular for women and children. When designing and implementing nutrition programming, the actions across sectors may or may not be joint, but at a minimum should be strategic and coordinated. By bringing sectors together in an integrated approach, we can address the complex and interrelated factors that comprise the root causes of malnutrition, and not just treat its symptoms.  

You can find more information about SNV and our work in nutrition on our website: