The last National Nutrition Survey (NNS) carried out in 2011 puts the figure of stunted children at 44 per cent and since then the same figure is quoted for reference, despite the possibility of a significant change in this figure over the years.
Against this backdrop, the country has announced a nutrition emergency and different programmes at both national and provincial levels have been launched mostly with the support of international organisations to address this issue.
The fact remains that there is no national policy on nutrition despite the urgency of the issue. There are reports that a national nutrition policy has been worked out by the Planning Commission of Pakistan with the support of the United Nations and will be announced shortly. It is hoped that properly planned interventions will be made in different parts of the country in line with the recommendations made in the policy.
Nutrition is a part of the Pakistan Vision 2025 strategic planning document of the government of Pakistan that integrates nutrition programmes into the health system through the formulation of provincial planning commission documents.
A plan called the Pakistan Integrated Nutrition Strategy (PINS), supported by Unicef, was formulated as a strategic framework to guide provinces to define nutrition in their provincial post-devolution development agendas. Inter-sectoral nutrition policy guidance notes and strategies have been developed by all the four provinces under the guidelines of this strategy.
Punjab’s Multi Sectoral Nutrition Strategy (MSNS) incorporates eight participating sectors, including health, education, water and sanitation for health (WASH), social protection, agriculture, livestock, fisheries and food in order to address malnutrition. The rationale given here is that the objective cannot be achieved without the support and participation of these sectors because the reasons of malnutrition are multiple and related to awareness, hygiene, poverty, food security, etc.
Dr Fauzia Waqar, a health sector consultant who has worked on the upcoming national nutritional policy, says there is an urgent need to increase spending by the government on the health sector, which is hardly 0.6 per cent of the GDP. “Besides, there is a paradigm shift in policies on nutrition which are now based on the realisation that only health departments are not responsible to take care of this condition. Other departments must also be engaged for this purpose as many reasons are beyond the purview of the health ministry.”
She says programmes must be extended to the lowest level just as the government spends on primary and tertiary care health facilities to tackle malnutrition. “Other issues, such as water-borne diseases, infections, fortification of food, awareness about malnutrition also need to be taken care of and have been recommended in the upcoming policy,” she adds.
Meanwhile, a few initiatives have been taken to tackle this issue. For example, the federal government has allocated Rs100 million in public sector development programme for the National Initiative for SDGs/nutrition for the next three years. In Khyber Pakhtunkhwa, three programmes are being implemented; namely: Health Integrated Reforms Programme having nutrition as a component, Special Initiative for Sasta Atta/Ghee Package at a cost of Rs2.45 billion and Primary Education School Feeding Programme worth Rs97.6 million.
In Punjab, Health integrated Reforms Programme (Integrated Reproductive Maternal New Born & Child Health Nutrition Programme), costing Rs13 billion having nutrition as component with specific allocation of Rs4 billion, Stunting Prevention Nutrition programme for 11 southern districts of Punjab, costing Rs7 billion and Water, Sanitation and Hygiene (WASH) programme in 11 districts at the cost of Rs9 billion are in the implementation stage.
Similarly, in Balochistan, Nutrition Programme for Mother & Children has been initiated in seven districts at a cost of Rs15 billion. In addition to this, the Ministry of National Food Security and Research has succeeded to develop a bio-fortified wheat variety “Zincol 2016” to overcome the deficiency of zinc and iron in the affected populations.
Dr Muneeb, a nutritionist based in Lahore, tells TNS that the United Nations started its Scaling Up Nutrition (SUN) Movement in 2010 to overcome malnutrition in the world by adopting a multi-sectoral strategy. Pakistan joined the global SUN Movement in 2013 to overcome malnutrition issues in the country.
He says now a “Fill the Nutrient Gap” tool is being used to identify which interventions are most appropriate for a particular set of population and geographical area so that specialised solutions are suggested and implemented instead of general ones. “This means if a selected population of infants or expecting mothers lack a particular nutrient, efforts will be made to make up for it.”
A country-wide survey to collect information on the nutritional status of women and children, food security and household water quality is underway. It is being carried out under a joint collaboration among the Ministry of National Health Services, Regulations and Coordination, the Aga Khan University, and Unicef.
It will be for the first time under the 2018 National Nutrition Survey (NNS) that data will be collected at the district level rather than provincial level, providing targeted insights about the areas that face the greatest nutrition challenges, barriers to adequate food intake, and nutrition-related health status.
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Under this survey, field teams will also collect information on household income, gender empowerment, education levels, and breastfeeding practices which are known to have an impact on nutrition indicators. Findings from the survey are also expected to shed light on the impact of the 2011 decision to devolve responsibility for health from federal to provincial governments.
Anwar Hussain, Director, Local Councils Association of Punjab (LCAP), suggests that the task to tackle malnutrition must be handed over to local governments as these can operate even at the union council levels.