Navigating structural barriers to the implementation of agriculture-nutrition programs in Nepal

Nutrition-sensitive agriculture programs hold substantial promise for improving access to nutritious food in contexts like rural Nepal. Yet, implementing such programs in geographically and culturally diverse settings can be challenging. To better understand the contextual factors that influence the ability of program participants to benefit from agriculture-nutrition interventions, we qualitatively examined the implementation of Helen Keller International’s Homestead Food Production program (HFP) in far-western Nepal. Data collection consisted of shadowing program staff for three months, interviewing program participants (n = 31) and staff (n = 10), and conducting three focus-group discussions with female community health volunteers (n = 28). An integrated food and nutrition system framework guided thematic analysis. Participants demonstrated high levels of knowledge about the program’s nutrition messages and expressed interest in and motivation to engage in the HFP program. However, access to water, land, and time determined the extent to which their full participation in the program was feasible. Factors within the biophysical and sociocultural environments interacted to influence access to these crucial resources. Some program participants and staff provided examples of ways in which they overcame these contextual constraints. These included investing in micro-irrigation equipment, arranging land-sharing agreements, and demonstrating more equitable gender norms. Successfully implementing nutrition-sensitive agriculture requires addressing context-specific structural barriers, particularly when aiming to benefit the most vulnerable. Long-term solutions to the barriers faced by the most marginalized households will require broad structural changes. However, problem-solving strategies used by program participants and staff also point towards immediate actions that programs can take to expand the potential for marginalized households to fully participate.