Nepal Nutrition Programs Guide: Vitamin A, Iron-Folic Acid & More

Nepal's public nutrition programs are coordinated by the Family Welfare Division (FWD) of the Department of Health Services (DoHS) under the Ministry of Health and Population (MoHP), with wider planning led by the National Planning Commission (NPC). Most services are free of charge at government health facilities, and the frontline delivery agent is the Female Community Health Volunteer (FCHV) - a network of tens of thousands of trained local women in every ward. FCHVs distribute supplements, counsel mothers, register pregnancies and refer sick or malnourished children.

Services reach families through several channels: routine health-facility visits (antenatal care, immunization, sick-child visits), monthly FCHV meetings and mothers' groups, Primary Health Care Outreach Clinics, and twice-yearly national campaigns. Records are kept on the child health card, nutrition registers and FCHV registers, so a mother should keep her child's health card and her own antenatal card safe to track doses received.

The programs described below fall into two groups. 'Nutrition-specific' interventions directly address nutrition - Vitamin A, IFA tablets, deworming, micronutrient powder, treatment of acute malnutrition and salt iodization. 'Nutrition-sensitive' actions tackle underlying causes through agriculture, water and sanitation, education and social protection, and are brought together under the Multi-Sector Nutrition Plan (MSNP).

The National Vitamin A Programme (NVAP) began in 1993 in eight districts with support from UNICEF and USAID, and scaled up nationwide. It provides high-dose vitamin A capsules to children aged 6-59 months twice a year to prevent night blindness, strengthen immunity and reduce child deaths. The Nepali Technical Assistance Group (NTAG) provides technical support, while the Family Welfare Division leads implementation. The program is widely cited as a global public-health success, with coverage consistently above 85 percent and reported campaign coverage exceeding 90 percent.

Dosing depends on age: 100,000 International Units (IU) for infants aged 6-11 months and 200,000 IU for children aged 12-59 months. The capsules are given during two national campaigns each year, traditionally the first week of Baisakh (around April) and the first week of Kartik (around October-November). FCHVs administer the capsules ward by ward, so families do not usually need to travel to a facility during campaign days.

Eligibility is simply the child's age - all children 6-59 months are entitled, regardless of income or ethnicity. A child who misses a campaign can often receive a dose at the nearest health facility. Because supplementation reaches roughly 2.5-2.7 million children each round, mothers are encouraged to bring their under-five children to the FCHV or the ward distribution point on the announced dates.

Nepal integrates child deworming with the Vitamin A campaign so that both are delivered on the same days. Children aged 12-59 months receive a deworming tablet (albendazole) twice a year to reduce intestinal worm infestation, which contributes to anaemia and poor growth. Combining the two interventions keeps coverage high and simplifies the visit for caregivers.

Eligibility for the child deworming tablet starts at 12 months (younger infants receive only Vitamin A). As with Vitamin A, distribution is by FCHVs in every ward during the biannual campaigns, and children who miss the campaign can usually be dewormed at a health facility. Keeping the child health card up to date helps health workers confirm when the last dose was given.

Anaemia in pregnancy remains common in Nepal, so the government provides iron-folic-acid (IFA) tablets free to all pregnant and recently delivered women. The national Iron Intensification Programme (IIP) started in 2003 and reached all districts by 2014. The policy is a daily tablet containing 60 mg of elemental iron and 400 micrograms (mcg) of folic acid, beginning in the second trimester of pregnancy and continuing until 45 days after delivery.

In total a woman should receive about 180 tablets during pregnancy and 45 tablets in the postpartum period. Tablets are given through antenatal care (ANC) visits at health facilities and topped up by FCHVs at monthly mothers'-group meetings, who also counsel women on how to take the tablets and manage mild side effects such as nausea or dark stools. Taking IFA with vitamin-C-rich food and avoiding tea or coffee around the same time improves absorption.

Pregnant women are also given a single deworming tablet (albendazole) after the first trimester as part of the anaemia-control package. To access IFA, a woman should register her pregnancy early and attend the recommended antenatal visits; the tablets, the deworming dose and the counselling are all free.

For young children, Nepal distributes a multiple micronutrient powder branded 'Baal Vita' through the integrated Infant and Young Child Feeding (IYCF) program. Each sachet contains around 15 micronutrients - including iron, zinc, vitamin A, folic acid and iodine - and one sachet is mixed into the child's food once a day. The target group is children aged 6-23 months; families typically receive a batch of sachets to use over about two months, replenished at the health facility or by FCHVs.

Growth monitoring and promotion (GMP) is the routine tracking of a child's weight and length/height, plotted on the child health card, to catch faltering growth early. Children are weighed at immunization and sick-child visits and at outreach clinics, and caregivers receive counselling on breastfeeding and complementary feeding. GMP is the entry point that connects a struggling child to the right service - micronutrient powder, feeding advice, or referral for treatment of acute malnutrition.

Children identified with severe wasting are enrolled in the Integrated Management of Acute Malnutrition (IMAM) program, which Nepal began piloting in 2008/09 and has since expanded to many districts. Children without medical complications are treated as outpatients with ready-to-use therapeutic food, while those with complications are admitted to a health facility or a Nutrition Rehabilitation Home, where mothers are also taught to prepare nutritious meals.

To prevent iodine-deficiency disorders such as goitre and cretinism - historically severe in Nepal's hills and mountains - the government adopted a Universal Salt Iodization (USI) strategy in 1998. Only adequately iodized salt may be sold for human consumption, and the familiar 'two-child logo' (dui bacchako chhap) on packets signals refined, iodized salt. The Salt Trading Corporation is the main importer and distributor. Nepal has historically iodized at about 50 parts per million (ppm) at production, with a retail minimum around 30 ppm.

The legal backbone is the Iodized Salt (Production, Sale and Distribution) Act, first drafted in the late 1990s (2055 BS, 1999 AD). Following a Cabinet decision, enforcement was set to begin with the fiscal year starting 17 July 2025 (Shrawan 2082 BS), enabling the government to issue regulations and, in future, revise the iodine level - since studies now show a large share of Nepalis consume more iodine than they need.

For consumers the action point is simple: buy packaged salt carrying the two-child logo and the stated iodine content, store it in a dry, closed container away from heat, and add it near the end of cooking to preserve iodine. This program does not require registration - it works by regulating the salt supply so that iodized salt is what reaches every household.

The Multi-Sector Nutrition Plan (MSNP) is Nepal's national framework, led by the National Planning Commission, that coordinates nutrition work across many ministries - health, agriculture, water and sanitation, education, women and social welfare, and local governments. MSNP-I ran from 2013 to 2017 (2070-2074 BS), MSNP-II from 2018 to 2022 (2075-2079 BS), and MSNP-III covers 2023 to 2030. Its goal is to reduce stunting and other forms of malnutrition, especially in the critical 'first 1,000 days' from conception to a child's second birthday, by combining nutrition-specific and nutrition-sensitive actions and mainstreaming them into local governments' periodic and annual plans.

Maternal support in Nepal is delivered mainly through the Aama (Safe Motherhood) Programme rather than a standalone 'nutrition allowance'. Under Aama, institutional delivery is free, and women receive a transport incentive on delivering at a facility - reported at roughly NPR 1,500 in mountain districts, NPR 1,000 in hill districts and NPR 500 in Tarai districts - plus a small cash incentive (around NPR 400) for completing the recommended four antenatal care visits. These payments, alongside free ANC, IFA tablets and deworming, are designed to bring pregnant women into care where nutrition services are provided.

Amounts and specific package details under Aama and related schemes are periodically revised in the annual budget and by local governments, so mothers and FCHVs should confirm the current rates and any additional local nutrition allowances (such as postnatal nutrition support in some municipalities) with their nearest health facility or ward office. Because nutrition budgets are increasingly channelled through local levels under MSNP-III, provision can vary between palikas.