Photo credit: Gorakh Bista

If we already know how to prevent and treat malnutrition, why do millions of children still go without care?

Our team at the Eleanor Crook Foundation kept returning to that question five years ago, well before the recent cuts to foreign assistance made the fragility of donor-built programs impossible to ignore. ECF exists to end child deaths from malnutrition, and for years we pursued that mission the way most issue-based funders do: by funding research into technical questions. Could bundling interventions improve outcomes? How might we lower the cost of wasting treatment? The work mattered, and it strengthened a growing body of evidence about what works.

But evidence, we came to realize, was never the bottleneck. We knew how to treat malnutrition. What we were not doing was changing whether that care reached the children who needed it. The gap was in delivery.

So we changed course. We decided to stop behaving like a global grantmaker and start behaving like a long-term country partner. Not to run programs ourselves, but to walk alongside governments as they do the difficult work of turning proven interventions into routine public services. This approach, coined by the late Dr. Paul Farmer is: accompaniment. It means partnering with patience, embedding programs into a government's own systems, budgets, and routines instead of building a parallel structure that collapses the moment the funder leaves.

It is not the fastest route to scale. But we have come to believe it is the only one that lasts.

Since 2023, with support from Coefficient Giving, we have put that conviction to work in Nepal. We chose Nepal deliberately. It has a relatively strong health system anchored by trained community health workers, most women already receive antenatal care, and the government had previously financed RUTF from its own budget. These were early signs of the genuine ownership that accompaniment depends on. There, we are supporting the government's effort to scale two highly cost-effective lifesaving interventions: RUTF and prenatal vitamins (MMS). 

The Ministry of Health and Population has set the agenda at every step, and we have followed its lead. The early results have taught us lessons we believe reach well beyond Nepal, including a national scale-up roadmap now under government consideration that could reach pregnant women across the country by 2030.

In a new piece for the Stanford Social Innovation Review, we share those lessons in full: five principles for funders willing to trade quick wins for lasting ones, and a candid look at what staying the course actually takes.

Read the full article in the Stanford Social Innovation Review

Dr. Yashodhara Rana is the President of Programs at the Eleanor Crook Foundation. Sudip Pokhrel is ECF's Country Representative in Nepal. Danielle Porfido is Associate Director of Global Advocacy at ECF. The authors thank the ECF programs team and the foundation's grantees, especially Helen Keller Intl and Action Against Hunger in Nepal, along with Kimberly Cernak for her contributions to the original piece.