For Addressing Malnutrition in Punjab · Punjab. This figure shows more food insecurity in Punjab...

GOVERNMENT OF Punjab

Multi-sector Nutrition Strategy

For Addressing Malnutrition in Punjab

Table of Contents Executive Summery ........................................................................................................................... 76

1 CHAPTER 1: INTRODUCTION & BACKGROUND .......................................................................... 1211

1.1 Introduction ....................................................................................................................... 1211

1.2 Situation Analysis (nutrition related) National level ............................................................ 1312

1.3 Causality framework .......................................................................................................... 1413

1.4 Punjab profile .................................................................................................................... 1615

1.5 Rationale for Multi-Sectoral Strategy ................................................................................. 1615

1.6 Development Process of Nutrition Strategy ........................................................................ 1817

2 CHAPTER 2: OVERVIEW OF THE STRATEGY ................................................................................. 2019

2.1 Objectives .......................................................................................................................... 2019

2.1.1 Strategic Objectives .................................................................................................... 2019

2.1.2 Specific Objectives/Expected outcomes ...................................................................... 2119

2.2 Conceptual framework ....................................................................................................... 2322

2.2.1 Strategic direction ...................................................................................................... 2422

2.2.2 Guiding principles ....................................................................................................... 2524

2.2.3 Intervention Framework ............................................................................................. 2624

3 CHAPTER 3: SECTORAL PERSPECTIVE – STRATEGIC SECTORAL PLANS ......................................... 2726

3.1 PLANNING AND DEVELOPMENT (P&D) ................................................................................... 2726

3.1.1 Overview of the sector ................................................................................................... 2726

3.1.1.1 Potential role in nutrition improvement, engagement and role within the multisectoral

framework ..................................................................................................................................... 2726

3.2 HEALTH SECTOR ..................................................................................................................... 2827


3.2.1.1 Lady Health Workers (LHW) ........................................................................................ 2827

3.2.1.2 MNCH program: ......................................................................................................... 2827

3.2.1.3 School Health & Nutrition Program:............................................................................ 2827

3.2.2 Potential role in nutrition improvement ......................................................................... 2928

3.2.2.1 Causal Pathway of Malnutrition .................................................................................. 2928

3.2.2.2 Care for Mothers and Children ................................................................................... 3029

3.2.3 Objectives ...................................................................................................................... 3130

3.2.4 Intervention framework ................................................................................................. 3231

3.2.4.1 Strategy 1: Mainstreaming Nutrition in Health ............................................................ 3231

3.2.4.2 Strategy 2: Equitable access to Nutrition services to poor and marginalized people .... 3332

3.2.4.3 Strategy 3: Strengthening capacity of Provincial and local governments on nutrition to

provide basic services in an inclusive and equitable manner ...................................................... 3635

3.3 WASH .................................................................................................................................... 3736


3.3.1.1 Public Health & engineering department (PHED) ....................................................... 3736

3.3.1.2 Achievements of Public Health & Engineering Department ......................................... 3836

3.3.2 Potential role in nutrition improvement, engagement and role within the multisectoral

framework ..................................................................................................................................... 3837

3.3.4 Intervention framework ................................................................................................. 4039

3.3.4.1 Strategy 1: Equitable access to safe & clean water ...................................................... 4039

3.3.4.2 Strategy 2: Promote best practices & behavioral change regarding hygiene practices . 4341

3.3.4.3 Strategy 3: Equitable access to Total Sanitation Services ............................................. 4543

3.3.4.4 Strategy 4: Development and implementation of Policies and Strategies .................... 4847

3.4 FOOD ................................................................................................................................. 4947


3.4.2 Punjab Food Department ........................................................................................... 5048

3.4.2.1 Potential role in nutrition improvement, engagement and role within the Multisectoral

framework ..................................................................................................................................... 5048

3.4.2.2 Food Security ............................................................................................................. 5048

3.4.3 Overall Sectoral objectives .................................................................................................... 5250

3.4.3.1 Nutrition specific objectives: related to nutrition specific strategic plan ........................ 5250

3.4.4 Punjab Food Authority ................................................................................................... 5250

3.4.4.1 Potential role in nutrition improvement: .................................................................... 5250

3.4.5 Overall Objectives ...................................................................................................... 5351

3.4.5.1 Nutrition specific objectives: related to the Nutrition Specific Strategic Plan ............. 5351

3.4.6 Intervention framework ............................................................................................. 5351

3.5 SOCIAL PROTECTION .............................................................................................................. 5957


Implementation of U.N. Conventions ratified by Government of Pakistan .............................. 6058

3.5.2 Potential role in nutrition improvement, engagement and role within the multisectoral

framework ..................................................................................................................................... 6158

3.5.3 Food Insecurity and Vulnerability ............................................................................... 6260

3.5.4 Women Empowerment .............................................................................................. 6360

3.5.6 Intervention Framework ................................................................................................ 6461

3.5.6.1 Strategy 1: Strengthen social protection sector to scale-up nutrition-sensitive

interventions ............................................................................................................................. 6461

3.5.6.2 Strategy 2: Improving the economic access to address nutritional needs through poverty

alleviation and social protection ................................................................................................ 6764

3.5.6.3 Strategy 3: Promote nutrition awareness for healthy & safe dietary practices ............ 6866

3.6 AGRICULTURE ........................................................................................................................ 7067

3.6.1 Crop Sector .................................................................................................................... 7067

3.6.1.1 Overview of the sector ................................................................................................... 7067

3.6.1.1.1 Live Stock & Diary Development .............................................................................. 7168

3.6.1.1.2 The Fisheries ........................................................................................................... 7168

3.6.1.2 Contribution in GDP, Poverty Alleviation, Women empowerment- Workforce ............ 7168

3.6.1.3 Potential role in nutrition improvement ......................................................................... 7269

3.6.1.2.1 Casual Pathway of Malnutrition and the Agriculture Sector .................................... 7270

3.6.1.3 Food Security Resources ............................................................................................. 7370

3.6.1.3.1 Food Diversity and caloric Intake situation .............................................................. 7572

3.6.1.4 Overall sectoral objectives .............................................................................................. 7673

3.6.1.4.1 Nutrition specific objectives .................................................................................... 7673

3.6.1.5 Intervention framework ................................................................................................. 7673

3.6.1.5.1 Strategy 1: Mainstreaming Nutrition in Agriculture ................................................. 7673

3.6.1.5.2 Strategy 2: Increase Productivity in nutritious food (by developing and promoting high

yielding varieties of grains & pulses) .......................................................................................... 7875

3.6.1.5.3 Strategy 3: Equitable access to vegetables and fruits .............................................. 8077

3.6.1.5.4 Strategy 4: Addressing Malnutrition through bio-fortification ............................... 8279

3.6.1.5.5 Strategy 5: Scaling up of Kitchen gardening ............................................................. 8380

3.6.1.5.6 Strategy 6: Increase accessibility of animal protein sources at household level ....... 8481

3.6.2 LIVESTOCK AND DAIRY SECTOR ...................................................................................... 8582

3.6.2.1 Overview of the Sector ............................................................................................... 8582

3.6.2.2 Livestock & Diary and Nutrition Connect .................................................................... 8683

3.6.2.3 Nutrition sepecific objectives of sector: ...................................................................... 8784

3.6.2.4 Intervention Frame work ............................................................................................ 8784

3.6.2.4.2 Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical

access to livestock-based products ............................................................................................ 8986

3.6.2.4.3 Strategy 3: Increase accessibility of animal protein sources at household level

especially for vulnerable community .......................................................................................... 9188

3.6.3 FISHERIES AND AQUACULTURE SECTOR.......................................................................... 9289

3.6.3.1 Overview of the Sector ............................................................................................... 9289

3.6.3.3 Overall Objective of the sector: .................................................................................. 9591

3.6.3.4 Intervention Matrix .................................................................................................... 9592

3.7 EDUCATION SECTOR (PUNJAB) ............................................................................................... 9996


3.7.2 Potential role in nutrition improvement ................................................................... 10097

3.7.3 Nutrition specific objectives of the Education Sector ................................................ 10198

3.7.4 Intervention Matrix .................................................................................................. 10299

4 CHAPTER 4: IMPLEMENTATION OF THE STRATEGY / OPERATIONALIZATION .......................... 109106

4.1 Implementation Model .................................................................................................. 109106

4.2 Organizational Structure ................................................................................................ 110107

4.2.1 Provincial ............................................................................................................... 111107

4.2.2 District.................................................................................................................... 113109

4.2.3 Community ............................................................................................................. 114110

4.3 Harmonization and Synergy ........................................................................................... 115112

4.4 Capacity Building ............................................................................................................ 116113

4.5 Communication Strategy ................................................................................................ 117113

4.6 Monitoring, Evaluation and Accountability ..................................................................... 117113

4.6.1 Measuring the progress: result based monitoring framework ................................. 118114

4.7 Research and development ............................................................................................ 120116

4.8 Public private partnership/Bussiness Network ............................................................... 123119

4.9 Financial framework/ resource management ................................................................. 123119

4.9.1 Financial Management ........................................................................................... 123119

4.9.2 Establishment of Joint Funding Pool ....................................................................... 124120

4.9.3 Funds Flow ............................................................................................................. 124120

LIST OF FIGURES

Figure 1.1: Causal pathway of Malnutrition, ......................................................................................... 154

Figure 1.2: Sectors involved in reducing the burden of malnutrition & food insecurity ......................... 187

Figure 1.3: process of developing Multisectoral plan in the Province ................................................... 198

Figure 3.4: Sources of Drinking water in Punjab ................................................................................. 4130

Figure 3.5: Percentage of house hold with availability of water & soap .............................................. 4332

Figure 3.6: Integrated Total Sanitation Model .................................................................................... 4634

Figure3.7: Statistics about type of Toilets used in Punjab ................................................................... 4735

Figure 3.8: Relevance of food security & Stunting .............................................................................. 5139

Figure 3.9: Social Protection at a glance Source: adapted from de Janvry (pers. comm.) .................. 6250

Figure 3.10: Food entitlement gaps & social protection instruments.................................................. 6452

Figure 3.11: Food Security Situation -Punjab ...................................................................................... 7362

Figure 3.12: Figure 3: Relationship between Maternal education and Child Stunting (Source: NNS 2011)

........................................................................................................................................................ 10190

LIST OF TABLES

Table 3.1: MTDF Targets and MDGs ................................................................................................... 3837

Table 3.2: Food security resources and poverty in Pakistani provinces, 2009 – 2011 .......................... 7572

Table 3.3: Area & Production of Pulses 2011-2012 and 2012-2013 .................................................... 7876

Table 3.4: National Production, consumption & gap of major pulses 2012-2013 ............................... 7976

Table 3.5: Table Protein Quality Comparison of Fish Protein with other animal Proteins .................... 9390

Table 3.6: Aquaculture practices ........................................................................................................ 9490

Table 3.7: Consumption of Fish in Various Provinces of Pakistan (KGs per capita per annum) ............ 9895

Executive Summery Punjab is the most populous province and play imperative role in the economy of Pakistan. The

economy of Punjab is predominantly based on the agricultural sector along with significant contribution

of industry. In spite of the major contribution (about 68%) to the annual food grain production in

Pakistan, the food security and malnutrition indicators in Punjab exhibit meager condition. Pakistan

National Nutrition Survey (2011) reported 58% household food insecurity in Pakistan and 59.5% in

Punjab. This figure shows more food insecurity in Punjab as compared to national average and is very

interesting as Punjab is a hub for agricultural production.

On the account of Nutritional Profile of Punjab, 34% of children are underweight, 42% stunted and 13%

of children were wasted in under five years of age. It was also estimated that about half the children

(49%) aged 0–5 months were exclusively breastfed (MICS, 2007–08). Furthermore, micronutrient

deficiencies in Punjab also indicate an alarming situation. Vitamin A deficiency, that reduces immune

function and impaired eyesight, influences 41.8% of women and 51.0% of children. Moderate and

severe anemia, resulting in part from iron deficiency, and reducing the flow of oxygen from the

lungs to the rest of the body, affects 49.3% of pregnant women in the province and 60.3% of children.

Overall, there seems no major difference and improvement in nutrition indicators compared to national

averages.

Planning & Development Department Punjab, while realizing its role in tackling the grave issue of

malnutrition in Punjab, constituted a Steering Committee (SC) with representation of relevant sectors

including government departments and international development partners. This committee was given

the mandate to develop Nutrition Policy Guiding Notes (NPGN), Punjab. The Steering Committee

constituted a Technical Working Group (TWG) in August 2012 and the TWG subsequently notified six

sectoral technical groups namely Agriculture Sector, Food Sector, Health Sector, Education Sector, Social

Protection Sector and WASH Sector. The sectoral groups were comprised of representatives of relevant

Government departments, development partners, academia and civil society. These sectoral groups,

through meetings and consultative process, developed their respective nutrition policy guidance notes.

These notes were refined through a series of meetings at the provincial and national level and were

then approved by Steering Committee in its meeting held on 07-02-2014. The same consultative

process has been adopted for the development of this strategy with the support of two consultants

supported by UNICEF.

The objectives of the multi-sector nutrition strategy are to

Improve the food security indicators to reduce the chronic malnutrition by increasing the

awareness, equitable access to safe and nutritious food including water

Minimize malnutrition associated damage to human capital and economic growth

Reduce acute malnutrition in order to address its long lasting effects

Strategy has identified following outcomes to be achieved by the program in order to attain the main

objectives of the proposed strategy.

1: Policies, plans and multi-sector coordination planned & implaced at provincial and local levels

Development and establishment of protocols for the implementation of proposed multi sectoral

nutrition interventions from provincial to the local level is the focus of this outcome. The strategy will

provide the well-constructed & comprehensive infrastructure for implementation along with reporting,

monitoring and evaluation in order to make the approach ready to practice.

1. The multi-sectoral strategy will specifically focus on enhancing coordination in order to define the

coordination mechanism among participating sectors, donors, and other implementing partners

2. Capacity building of all sectors on implementation and monitoring of progress towards scaling up

nutrition through the multi-sector approach, by defining a core set of multi-sector monitoring and

evaluation indicators

3. Strategy will identify technical as well as funding gaps in the government capacity and provide the

single platform for all partners and donors to chip in to their priority areas to maximize the

coverage, avoid any duplication and support the provincial government.

2: Well-coordinated sectoral plans to maximize the impact of nutrition ‘specific’ and nutrition

‘sensitive’ interventions leading to improved nutritional status of targeted population

This outcome of the strategy will maintain and strengthen the already existing key nutrition ‘specific’

interventions by health department, including, nutrition specific activities performed during biannual

MCH weeks celebrated across the province. Like Vitamin A supplementation and de-worming for all

children aged 6-59 and 12-59 months, respectively; Iron Folic Acid (IFA) supplementation and education

campaign on maternal and child nutrition specially designed for these weeks. Some other routine

activities of health department include the use of zinc in the management of diarrhea together with ORS

and universal salt iodisation. It will also further strengthen and expand Community Infant and Young

Child Feeding (IYCF) program. In addition, a modified model of the CMAM program with the major

addition of maternal nutrition and use of micronutrient supplementation for the treatment of MAM

children & PLWs will be scaled up with initial focus in high risk districts. It also supports strategies with

respect to flour & oil fortification.

Furthermore, the outcome will contribute through the education sector to improve and scale up core

nutrition ‘sensitive’ interventions with particular focus on enhancing adolescent girls’ education, life

skills and nutritional status through its School Health and Nutrition Program. The core interventions

include:

Ensure equitable access to education, with particular focus on increasing enrollment and

retention of the girl child

Introduction of Nutrition, Health & Hygiene education modules in schools and education

curriculum

Improve knowledge regarding nutrition among teachers, parents/caregiver's children and

adolescents engaged in schooling

To support the health department in malnutrition screening among children and adolescents

and improve nutritional status among school going children through appropriate referrals,

health & nutrition education and promotion activities

Introduction and promotion of Nutrition as a professional track for post-graduate education and

employment

The outcome will contribute to reduce incidence of infections – with a focus on reducing diarrheal

diseases and ARI among young children, mothers and adolescent girls. It aims to attain this by

Increasing access of “improved” or non-surface water

Enhancing Rural Population Coverage (Barani, Brackish and Contaminated Areas)

Improving quality control of water (by providing Water Testing Facilities and through provision

of Water Filtration Plants)

Enhancing sanitation, environmental sustainability and open defecation free (ODF) environment

Functionalizing Rural Water Supply Schemes and replacing old water supply pipe lines for

eradication of gastroenteritis in 15 cities of Punjab

Increasing public awareness about water safety, safe hygiene practices, and water conservation

Finally, the outcome through the agriculture sector will aim to

Mainstreaming nutrition in agriculture

Enhance productivity of grains and pulses (increase availability of nutritious foods)

Address malnutrition through bio-fortification

Promote kitchen gardening at household level (Equitable access to vegetables and fruits)

Create awareness on the importance of food diversification and healthy dietary practices

prioritize development of zinc rich wheat variety

Empower Women labor involved in Agriculture sector

3: Capacity building of provincial as well as local government on nutrition to provide basic services in

an inclusive and equitable manner

This outcome aims to strengthen nutrition related capacities of all involved sectors in multi-sectoral

approach as well as all implementing partners to integrate proposed set of interventions in provincial

and district level planning and monitoring. The multi-sectoral approach will strengthen the capacity of

all involved sectors and other stakeholders at all levels through cross-sectoral (between sectors) and

inter-sectoral (within sectors) coordination depending upon nutrition-sensitive or nutrition-specific

intervention. Capacities will be developed at three levels: the first level will be the policy making level

that also includes the political participation/ownership. The second level will be the implementing

institutions/ sector from province to union council level (such as Fields Assistant, School Health Nutrition

Supersvisors, Teachers, etc.). Lastly, the third level will include the individuals who will be implementing

these activities. Leadership is proposed from the nutrition cell at PSPU under the P&D department at

provincial level to ensure that capacity is built on all levels with increased ownership and commitment.

Effective and coordinated implementation of the proposed strategy is imperative in realization of the

objectives of the strategy. The implementation is proposed to be done in partnership between all

responsible departments. Implementation of this strategy will be mainly through three distinct ways;

1) adjustments in already implemented or existing programmes by making them more nutrition

sensitive.

2) seeking funds and implementing nutrition sensitive interventions by developing PC-1s against

approved interventions in this strategy using their own resources.

3) seeking funds through Nutrition Cell from the pool of resources allocated for implementation of

nutrition strategy for nutrition specific and high priority nutrition sensitive interventions. The

implementation model will vary from intervention to intervention for effective implementation.

There are interventions in all sectors, which are department specific and therefore the implementing

department will take lead in its planning and implementation within the sector. Some interventions are

multi-institutional within each sector and some are multisectoral, and their effective implementation

requires coordinated implementation frame-work from all involved departments and/or sectors.

1 CHAPTER 1: INTRODUCTION & BACKGROUND

1.1 Introduction

Malnutrition and food insecurity are the most serious health concerns throughout the world and the

significant contributors in child morbidity & mortality. These indices instigate a preventable

embarrassment to global society and induce serious political, economic, and social consequences1. In

developing countries, nearly one-third of children are undernourished (underweight or stunted), and

more than 30% people are enduring different kinds of micronutrient deficiency that undermine

economic growth and perpetuates poverty. Although, numerous efforts were directed to tackle

malnutrition over past few decades, but consequential successes have not been observed, even at

times, with the application of well-tested approaches or strategies. The ineffectiveness is quite evident

from unsatisfactory progress towards achieving MDG to halve the global hunger by 2015 (Target 1.C).

Stunting, wasting, and intrauterine growth retardation presents the most overwhelming concerns

affecting the children, and cause 2.2 million deaths of children (under 5 years). Overall, nutrition-related

factors result in 35% of child deaths and 11% of the total global disease burden2. Change in dietary

habits and inequitable access to food, services and nutritional information are also the contributing

factors for malnutrition. Excess intake, attributable to change in dietary pattern, proliferate the

prevalence of over-weight and obesity. According to WHO report more than 1.4 billion adults (over 20

years) were overweight worldwide in 2008, among those 500 million (200 million men and 300 million

women) found were obese. Poor nutritional status and high prevalence of malnutrition are mainly

attributable to various factors like food insecurity, poverty, lack of knowledge/information, poor dietary

habits (imbalance diet intake), poor maternal and child health, as well as deficiency of micronutrients

(especially iodine & zinc) in soil.

The health and nutrition status indicators of Pakistan are even worse compared to countries having

lower Gross National Product and lower per capita income. According to the Pakistan’s National

Nutrition Survey 2011, various malnutrition indicators like stunting, wasting, and micronutrient

deficiencies are endemic in Pakistan. Although, some of the nutrition indicators for Punjab are slightly

better compared to other provinces, yet the situation is more than worse, as a whole and demand for

effective and targeted strategic actions to tackle the issues immediately. In order to combat the severe

threats posed by malnutrition and achieving the commitments towards MDGs, Government of the

1 Scrimshaw, N.S. (1986). Fed Proc., 45(10), 2421-2426. 2 Blacketal., (2008). The Lancet. 371 (9608):243-260.

Punjab along with international development partners keenly developed “Nutrition Policy Guidance

Notes (NPGN), Punjab”. The core of the policy is to adopt a Multi-Sectoral approach for effectively

tackling the grave and persistent issue of malnutrition. This nutrition strategy is based on the (NPGN)

and focuses on various nutrition specific / sensitive strategic actions to be implemented by various

involved sectors targeted to improving nutrition indicators of masses in Punjab.

1.2 Situation Analysis (nutrition related) National level

The Government of Pakistan, in the recent past, has shown its commitment to reinforce nutritional and

health status, especially by improving the nutrition indicators and women empowerment and to make

quick progress towards achieving MDGs. Various programs and projects are in the pipeline to improve

nutrition and food adequacy for a healthy and productive life. Pakistan has also joined the Scaling-Up

Nutrition (SUN), which reiterates its commitment to a healthy nation. Pakistan is now confronting

transecting challenges to feed increasing population, where people are already suffering from nutrient

deficiencies and do not have factual access to adequate micronutrients, protein and energy in their

diet3,4. Despite the inadequate dietary intake and overburden of malnutrition, current indices revealed

that in Pakistan about 33.9% mothers fall in the overweight range (according to BMI>24.9 kg/m2) and

about 14.1% are categorized as underweight (BMI<18.5 kg/m2) because of imbalanced diet and change

in dietary pattern3. However, positive signs have been witnessed as Economic Survey of Pakistan (2013),

indicates that per capita food intake and protein availability has increased in the last two years (from

2410 Kcal/day to in 2450 Kcal/day and 71.5 g/day to 72.5g/day, respectively).

The Pakistani community largely consumes cereals based diet as staple food that contributes to 62% of

total energy. However, the food consumption pattern as well as food diversification is not according to

the Food Guide Pyramid and instigates various nutrition related maladies. Attributable to lifestyle

modifications, inadequate access due to seasonal variation, unorganized market facilities, improper food

supply chain and escalating poverty, the fruits, vegetables, fish and meat consumption are inadequate

as compared to actual requirements. However, the per capita milk consumption is significantly higher in

comparison to other Asian countries. According to National Nutrition Survey 2011, prevalence of

micronutrient deficiencies in women were; iron deficiency anemia (37.0%), anemia (51.0%), zinc

deficiency (47.6%), vitamin A deficiency (46.0%), and vitamin D deficiency (68.9%). While, the

prevalence of micronutrient deficiencies in non-pregnant women were; anemia 50.4%, iron deficiency

3 NNS, 2011 [National Nutrition Survey Pakistan] Government of Pakistan.

4 Economic Survey of Pakistan, 2013

anemia 26.8%, vitamin A deficiency 42.1%, zinc deficiency 41.3% and vitamin D deficiency 66.8%. The

micronutrient deficiencies in children (<5 years of age) are also widely prevalent; iron deficiency 43.8%,

anemia 61.9%, zinc deficiency 39.2%, vitamin A deficiency 54.0%, and vitamin D deficiency 40.0%.

Moreover, the indicators of stunting (43.7%) and wasting (15.1%) have deteriorated in 20115compared

to 20016 stunting 37% and wasting 13%. The high level of food insecurity (58%) has also led Govt to

establish Ministry of National Food Security and Research at the federal level to improve the food

security situation in Pakistan, which is one of the major underlying causes for malnutrition in the

country.

1.3 Causality framework

Malnutrition is the outcome and manifestation of either unavailability or lesser availability of one or

more vital nutrients to the body, especially when they require the most. They are many key factors,

which cause this nutrients’ insecurity, depending upon the situation. The key factors which might

instigate the hunger and food insecurity include rapid population growth, climate change, calamities,

low food productivity, incompetent supply chain, post- and pre-harvest losses, frequent food price

hikes, food and water safety issues, untrained and low quality human resource in the food supply chain,

inequitable access to health services and knowledge,7

Among these, climate change is persistently posing serious threats and is influencing agricultural

production and food chain. Frequent floods in Pakistan have impacted large segment of the population

and have left many more vulnerable. Similarly, the death toll is in hundreds due to recent drought in

THAR which caused serious food and water insecurity in large geographical area. The victims are also

prone to even relatively smaller shocks in future, as they lose their assets including livestock and

backyard poultry. Although, irrigated agriculture is essential to meet the food demand and reduce the

hunger and food insecurity by increasing the food production for vulnerable community, yet frequent

calamities and disease outbreaks in one part of the world also impact big time in adjacent countries and

several regions are faced with various concerns that intimidate the sustainability



7 Beddington et al., 2012. Agriculture & Food Security, 1(10), 1-9. doi:10.1186/2048-7010-1-10

Figure 1.1: Causal pathway of Malnutrition8,9

The undernourishment (macro nutrient deficiencies & hidden hunger) may cause intrauterine growth

and mental retardation; low birth weight; poor health/ high burden of morbidity; reduced physical and

mental performance; and ultimately constrain community and national development. There are more

different concerns that associated with malnutrition prevalence and the food insecurity situation in the

different parts of the world, especially in developing countries, where the whole resources are not

utilized or somewhere lack of resources create hurdles.

8 Sources: UNICEF, 1990 9 Benson & Shekar, 2006. Washington, DC: World Bank.

1.4 Punjab profile

Punjab is the most populous province and play imperative role in the economy of Pakistan. The

economy of Punjab is predominantly based on the agricultural sector along with significant contribution

of industry. In spite of the major contribution (about 68%) to the annual food grain production in

Pakistan, the food security and malnutrition indicators in Punjab exhibit meager condition. In this

province, devastating burden of under-nutrition remains a substantial health concern and induce

enduring adverse consequences. The overburden of malnutrition also instigates the maternal and child

morbidity as well as elevated mortality rates. The infant mortality rate in Punjab is 82 per 1000 live

births, while the child mortality rate (under 5 years) is 104 per 1000 live births (MICS Punjab, 2011). It is

estimated that about 92% of the population in the province have access to improved drinking water

sources; whereas 58% of the population has access to proper sanitation facility (Health Department,

Punjab 2014). Pakistan National Nutrition Survey (2011) reported 58% household food insecurity in

Pakistan and 59.5% in Punjab. This figure, showing more food insecurity in Punjab compared to a

national average, is very interesting as Punjab is a hub for agricultural production. This also reveals that

the producers, especially small holders, they are food insecure due to poverty driven lesser access to

food. In spite of this situation, there is also an increasing trend of obesity, especially in women and NNS,

2011 revealed that 29.9% women are either overweight or obese, while lower percentage is

underweight (17.7%). This situation again reveals the increasing trends towards un-balanced dietary

patterns.

On the account of Nutritional Profile of Punjab, 34% of children underweight, 42% stunted and 13% of

children were wasted in under five years of age. It was also estimated that about half the children (49%)

aged 0–5 months were exclusively breastfed (MICS, 2007–08). Furthermore, micronutrient deficiencies

in Punjab also indicate an alarming situation. Vitamin A deficiency, that reduces immune function and

impaired eyesight, influences 41.8% of women and 51.0% of children. Moderate and severe anemia,

resulting in part from iron deficiency, and reducing the flow of oxygen from the lungs to the rest of

the body, affects 49.3% of pregnant women in the province and 60.3% of children. Overall, there seems

no major difference and improvement in nutrition indicators compared to national averages.

1.5 Rationale for Multi-Sectoral Strategy

Food insecurity and malnutrition induce considerable economic cost comprising reduced lifetime

productivity, expanding poverty, slowing down economic development, lowering the quality of human

resource and resource deprivation10. Vulnerable community (chronically hungry and/or severely

malnourished) requires immediate assistance to rescue. Although, most of the world’s vulnerable

communities facing hunger by some means rely on agriculture and related fields like fisheries and

livestock for their survival, however, some other concerns like lack of knowledge, inadequate access to

food, insufficient health and hygiene facilities also associated with their vulnerability.

World Health Organization (WHO) Assembly emphasized on nutritious and healthy foods and lifestyles

in 2012-13 to decrease non-communicable diseases (NCDs) burden in entire world. The endeavors to

reduce malnutrition burden and food insecurity for economic and human development in Pakistan

requires involving agriculture (crop, livestock, & fisheries), food (safety, handling, storage &

preservation) water, sanitation & hygiene (WASH), social welfare, women development, health as well

as education sectors. These sectors along with some others have also been identified at global level and

scaling-up nutrition, movement also revolves around multi-sectoral approaches to tackling malnutrition

across the globe. Moreover, coordination and close collaboration between various sectoral players like

government, development partners, academia and civil society is also the need of the hour for

addressing immediate, underlying and basic causes of malnutrition having roots across the sectors.

Consequently, improvement in nutrition indicators at reasonable pace will only be possible through

multi-sectoral approach by involving relevant sectors that have substantial potential for declining

chronic malnutrition in the province. WHO particularly gives emphasis on the long term sustainable

contribution of “Agriculture and Food Sectors”. The consensus report further elaborated that along with

ensuring food security throughout the world; both sectors must ensure the adequate access to safe and

good quality foods. Multisectoral experience in nutrition from countries like Nepal, Thailand, Peru and

Brazil confirm that such a centrally-placed coordination mechanism is imperative for ‘planning

multisectorally, implementing sectorally, and reviewing sectorally as well as multisectorally’.

10 (FAO, 2012) http://www.fao.org/docrep/016/i3027e/i3027e00.htm

http://www.fao.org/docrep/016/i3027e/i3027e00.htm

Figure 1.2: Sectors involved in reducing the burden of malnutrition & food insecurity

1.6 Development Process of Nutrition Strategy

Planning & Development Department Punjab, while realizing its role in tackling the grave issue of

malnutrition in Punjab, constituted a Steering Committee (SC) with representation of relevant sectors

including government departments and international development partners. This committee was given

the mandate to develop Nutrition Policy Guiding Notes (NPGN), and provide strategic advice on

developing nutrition strategies and operational plans of Punjab. The steering committee was also

mandated to facilitate the resource generation and budgetary allocations from Punjab Government and

development partners. The Steering Committee constituted a Technical Working Group (TWG) in August

2012 and the TWG subsequently notified six sectoral technical groups namely Agriculture Sector, Food

Sector, Health Sector, Education Sector, Social Protection Sector and WASH Sector. The sectoral groups

were comprised of representatives of relevant Government departments, development partners,

academia and civil society. These sectoral groups, through meetings and consultative process,

developed their respective nutrition policy guidance notes. These notes were refined through a series of

meetings at the provincial and national level and were then approved by Steering Committee in its

Malnutrition &

Food Insecurity

Agriculture Crop,

Livestock, Fisheries

Food

Health

Water, Sanitation & Hygiene

Education

Social Protection

INGOs& Other

development Partners

meeting held on 07-02-2014. The same consultative process has been adopted for the development of

this strategy with the support of two consultants supported by UNICEF.

Recognizing the complexity of the issue of malnutrition for economic and human development and for

efforts to achieve the Millennium Development Goals, the Government of Punjab and its partners have

decided to undertake a Multisectoral nutrition plan to address the issue involving all key sectors which,

collectively, have considerable potential for reducing malnutrition in the province.

The following picture illustrates the process of developing Multisectoral plan in the Province.

Figure 1.3: process of developing Multisectoral plan in the Province

In a nutshell targeted, well-coordinated and integrated multisectoral approach is the core of this

strategy, which aims to develop ownership in involved sectors to realize their role in reducing the

burden of malnutrition from the province of the Punjab. If implemented in letter and spirit, this multi-

sector nutrition strategy is believed to be appropriately responding to impending crises of malnutrition

from the province.

Multi-sectoral strategy

Sector-specific Working Groups

Development of Policy Guideline notes

P & D Steering Committee

D-10 Meetings (Planning Commission of Pakistan)

2 CHAPTER 2: OVERVIEW OF THE STRATEGY

A casual pathway to malnutrition provokes the need of the multisectoral approach because of its

effectiveness to combat the overwhelming burden of malnutrition. Keeping in view the threatening

situation of nutrition indicators in Punjab, the Govt. of Punjab has decided to initiate a multisectoral

strategy in order to intervene the causes of under nutrition from underlying causes to immediate ones.

Multisectoral approach will be comprehensive, valuable and most effective way to adopt the both

nutrition specific and nutrition sensitive interventions, involving all related sectors with their poteintial

role. This strategy is going to define the implementation and coordination (both horizontal and vertical)

mechanisms at all levels within the sectors in collaboration with development partners. Multisectoral

strategy is mainly focused on single work plan with common objective of all sectors and partners, thus

making it convenient for partners to chip in at their priority area and will help to maximize the coverage

& avoid any duplication. The effective implementation of multisectoral strategic intervention will

certainly play a key role in reducing ever-escalating burden of malnutrition mainly and will also be

helpful in improving the food-security indicators.

2.1 Objectives

2.1.1 Strategic Objectives

The objectives of the multi-sector nutrition strategy are to

Improve the food security indicators to reduce the chronic malnutrition by increasing the

awareness, equitable access to safe and nutritious food including water

Minimize malnutrition associated damage to human capital and economic growth

Reduce acute malnutrition in order to address its long lasting effects

These objectives will be achieved by considering both nutrition specific as well as nutrition sensitive

interventions equally important. Nutrition specific interventions will be implemented largely through

the health sector, and nutrition sensitive interventions mostly by other sectors including education,

agriculture, WASH and social protection, in well-coordinated manner with developing-partners and

government will add into the impact of the strategy.

2.1.2 Specific Objectives/Expected outcomes

The multi sectoral strategy is designed in a way that every sectoral plan will work effectively at all levels

from provincial to local in order to achieve a common goal of reduction in acute as well chronic

malnutrition and other nutrition associated maladies. Each sector, health, education, agriculture, social

work, WASH & local government will implement their assigned plans in multi-sector coordinated

manner and will be monitored and evaluated sectorally as well as multisectorally. Following outcomes

are defined to be achieved by the program in order to attain the main objectives of the proposed

strategy. Expected results/ specific objectives

1: Policies, plans and multi-sector coordination planned & implaced at provincial and local levels

Development and establishment of protocols for the implementation of proposed multi sectoral

nutrition interventions from provincial to the local level is the focus of this outcome. The strategy will

provide the well-constructed & comprehensive infrastructure for implementation along with reporting,

monitoring and evaluation in order to make the approach ready to practice.

1. The multi-sectoral strategy will specifically focus on enhancing coordination in order to define

the coordination mechanism among participating sectors, donors, and other implementing

partners

2. Capacity building of all sectors on implementation and monitoring of progress towards scaling up

nutrition through the multi-sector approach, by defining a core set of multi-sector monitoring and

evaluation indicators

3. Strategy will identify technical as well as funding gaps in the government capacity and provide the

single platform for all partners and donors to chip in to their priority areas to maximize the

coverage, avoid any duplication and support the provincial government.

2: Well-coordinated sectoral plans to maximize the impact of nutrition ‘specific’ and nutrition

‘sensitive’ interventions leading to improved nutritional status of targeted population

This outcome of the strategy will maintain and strengthen the already existing key nutrition ‘specific’

interventions by health department, including, nutrition specific activities performed during biannual

MCH weeks celebrated across the province. Like Vitamin A supplementation and de-worming for all

children aged 6-59 and 12-59 months, respectively; Iron Folic Acid (IFA) supplementation and education

campaign on maternal and child nutrition specially designed for these weeks. Some other routine

activities of health department include the use of zinc in the management of diarrhea together with ORS

and universal salt iodisation. It will also further strengthen and expand Community Infant and Young

Child Feeding (IYCF) program. In addition, a modified model of the CMAM program with the major

addition of maternal nutrition and use of micronutrient supplementation for the treatment of MAM

children & PLWs will be scaled up with initial focus in high risk districts. It also supports strategies with

respect to wheat flour & oil/ghee fortification.

Furthermore, the outcome will contribute through the education sector to improve and scale up core

nutrition ‘sensitive’ interventions with particular focus on enhancing adolescent girls’ education, life

skills and nutritional status through its School Health and Nutrition Program. The core interventions

include:

Ensure equitable access to education, with particular focus on increasing enrollment and


Introduction of Nutrition, Health & Hygiene education modules in schools and education

curriculum

Improve knowledge regarding nutrition among teachers, parents/caregiver's children and


To support the health department in malnutrition screening among children and adolescents

and improve nutritional status among school going children through appropriate referrals,

health & nutrition education and promotion activities

Introduction and promotion of Nutrition as a professional track for post-graduate education and

employment

The outcome will contribute to reduce incidence of infections – with a focus on reducing diarrheal

diseases and ARI among young children, mothers and adolescent girls. It aims to attain this by

Increasing access of “improved” or non-surface water

Enhancing Rural Population Coverage (Barani, Brackish and Contaminated Areas)

Improving quality control of water (by providing Water Testing Facilities and through provision

of Water Filtration Plants)

Enhancing sanitation, environmental sustainability and open defecation free (ODF) environment

Functionalizing Rural Water Supply Schemes and to replace old water supply pipe lines for

eradication of gastroenteritis in 15 cities of Punjab

Increasing public awareness about water safety, safe hygiene practices, and water conservation

Finally, the outcome through the agriculture sector will aim to


Enhance productivity of grains and pulses (increase availability of nutritious foods)

Address malnutrition through bio-fortification


Create awareness on the importance of food diversification and healthy dietary practices

prioritize development of zinc rich wheat variety

Empowering Women labor involved in Agriculture sector

3: Capacity building of provincial as well as local government on nutrition to provide basic services in

an inclusive and equitable manner

This outcome aims to strengthen nutrition related capacities of all involved sectors in multi-sectoral

approach as well as all implementing partners to integrate proposed set of interventions in provincial

and district level planning and monitoring. The multi-sectoral approach will strengthen the capacity of

all involved sectors and other stakeholders at all levels through cross-sectoral (between sectors) and

inter-sectoral (within sectors) coordination depending upon nutrition-sensitive or nutrition-specific

intervention. Capacities will be developed at three levels: the first level will be the policy making level

that also includes the political participation/ownership. The second level will be the implementing

institutions/ sector from province to union council level (such as Fields Assistant, School Health Nutrition

Supersvisors, Teachers, etc.). Lastly, the third level will include the individuals who will be implementing

these activities. Leadership is proposed from the nutrition cell at PSPU under the P&D department at

provincial level to ensure that capacity is built on all levels with increased ownership and commitment.

2.2 Conceptual framework

The therapeutic approach to treat malnutrition are complex and vary in different situations. Inadequate

access to basic human requirements such as lack of safe drinking water, poor hygiene conditions (and its

associated diseases such as diarrhea, infectious disease, parasites), drought or any emergencies leading

to a collapse of social networks, then it comes social beliefs and taboos (due to lack of knowledge)

affecting food and specially nutrient intake. These are few highlighted causes which can determine the

nutritional status of a community, household or individual. Any strategy aiming to treat or prevent

malnutrition needs to identify clearly the direct and underlying causes of malnutrition in the country or

province specific context. The conceptual framework of malnutrition adopted by UNICEF in 2000

proposes a multi-sectoral analysis of malnutrition causes, which can guide for further assessments,

project design, their implementation, monitoring and evaluation.

2.2.1 Strategic direction

Key strategic directions for multi-sector nutrition plan will be following:

2.2.1.1 Scaling up of nutrition specific interventions of proven effectiveness

Most of the sectors i.e. agriculture, Food, education, wash, social protection and specially Department

of health Punjab has already identified and started working on nutrition specific interventions in the

province. The strategy will provide direction towards scaling up of already identified & proposed cost

effective interventions of proven effectiveness by sectors in an equitable and coordinated manner. The

multi sectoral nutrition strategy will serve as the basis for the implementation of all sectoral plans as a

government’s plan to improve the nutrition indicators.

2.2.1.2 Identification and implementation of sector specific nutrition sensitive interventions

(Multisectoral approach: plan multisectorally, implement sectorally)

The strategy will identify nutrition sensitive interventions with major focus on sectors other than health

and will provide the single platform for intersectoral planning. The strategy will focus on “plan

multisectorally-implement sectorally & then monitor and evaluate sectorally as well as multi sectorally”.

2.2.1.3 Target groups

This strategy will be addressing the most vulnerable segments of the society in equitable manner. Target

group for the proposed interventions will be adolescent, all married females with special focus to

pregnant & lactating mothers, and all children of less than 5 years of age.

2.2.1.4 1000 days plus model

In order to focus on the window of opportunity when stunting occurs, from conception to two years of

age, strategy is designed with 1000 days plus model to catch the problem even before conception.

Adolescent & maternal component of interventions is thus mainly considered in order to prevent the

issue even before it occurs.

2.2.1.4.1 Women empowerment / Women Focused Approach (As SUN countries pursue goals in a

way that empowers women at every level.)

The strategy will be women & child friendly design. In order to maximize the participation of most

disadvantaged segment of the society women focused approach will be introduced. Capacity of women

already working with different sectors will be improved through trainings that leads to their

empowerment. The strategy will also ensure the participation of women & most disadvantaged in the

decision making process at all levels through mainstreaming their participation from provincial to local

level.

2.2.1.5 Over nutrition (Childhood obesity, adolescent health)

Over nutrition, especially childhood obesity is very much associated with lifestyle and eating patterns.

The strategy will also add the behavior change related to unwanted weight gain and over consumption

of refined & processed foods.

2.2.2 Guiding principles

Key guiding principles of the strategy will be as following :

2.2.2.1 The fundamental right to be free from hunger

Every child born has a fundamental right to be free from hunger, thus the Multisectoral approach will be

designed in a way to ensure the availability safe, enough & nutritionally adequate food to every child at

all times.

2.2.2.2 Gender empowerment

Gender balance and women empowerment will be guiding principle of the strategy in order to ensure

equitable access of nutrition services. Women being more vulnerable towards malnutrition will be

addressed through women focused approach of the strategy.

2.2.2.3 Geographical convergence

Equitable geographical coverage with special focus to far flung and disadvantaged area will be very

important principal for the implementation of proposed Multisectoral strategy.

2.2.2.4 Evidenced based interventions

All the interventions that will be proposed to be scaled up should be necessarily evidence based. So

strategy will propose to pick internationally proven intervention relevant to the local context, then

should be piloted and will only recommend to be scaled up once evidence is being generated.

2.2.2.5 Equity in distribution

The poorest of the poor will be the real target of the strategy. Equity in distribution of all nutrition

related interventions will take up the most marginalized segment of the society in the account. And

provide the services very much according to need based, e.g. malnourished children about food secure

household will be provided with counseling of right choice not the food supplementation.

2.2.3 Intervention Framework

Figure 2.1: Intervention Framework [Source: Adapted from (Black et al., 2013) by A. Dorward]

3 CHAPTER 3: SECTORAL PERSPECTIVE – STRATEGIC SECTORAL PLANS

3.1 PLANNING AND DEVELOPMENT (P&D)

3.1.1 Overview of the sector

The Planning and Development Department (P&D), Government of Punjab, is the principal planning

organization at the provincial level. It coordinates and monitors development programs and activities of

various departments of the provincial government. The department also prepares the overall medium

term framework of development activities in the province. The medium term development framework

lays down the development activities to be carried out in various sectors of the provincial economy. In

this manner the Planning & Development department is one of the main actors in the growth of the

economic potential of the province. Bureau of Statistics Punjab, Agency for Barani Areas Development

(ABAD) & Directorate General Monitoring & Evaluation are attached departments of P & D Punjab.

The mandate of the P&D department includes, provision of technical support and coordination to

various Government departments in their planning activities. The P&D department is also the main

government agency working with foreign donors in the province.

The main objectives of the Planning and development department are:

Assessment of the material and human resources of the province

Formulation of long and short term plans.

Recommendations concerning, prevailing economic conditions, economic policies or measures.

Examination of such economic problems as may be referred to it for advice.

Coordination of all economic activities in the provincial government.

3.1.1.1 Potential role in nutrition improvement, engagement and role within the multisectoral

framework

Considering the domain of Planning & Development Department Punjab and multisectoral strategy, P&D

has a central role in planning, implementation, coordination and M&E. The planning role of P&D has

been discussed in first chapter (1.6 Development Process of Nutrition Strategy) and the detailed

description is documented in Chapter 04 of this strategy.

3.2 HEALTH SECTOR


Health Department is the key with the fundamental responsibility for ensuring the health of the entire

population of the province. The Health Department delivers preventive as well as curative health care

services of Primary Health Care level to Tertiary level. The infrastructure in the province consists of

2,461 Basic Health Units (BHUs), 293 Rural Health Centers (RHCs), 88 Tehsil Headquarters Hospitals

(THQs), 34 District Headquarter Hospitals (DHQs) and23 Teaching/ tertiary Care Hospitals.

Keeping in consideration the key role of the health sector in addressing malnutrition, the Punjab health

department has already started implementing an RMNCH & Nutrition program in an integrated manner

through its vertical programs i-e LHW Program & MNCH program.

3.2.1.1 Lady Health Workers (LHW)

The Lady health worker program is operating in all 36 districts of Punjab with 47000 thousand LHWs

working in the community. After the floods of 2010 LHW program remained main implementer of the

CMAM & nutrition programs in the flood affected districts of Punjab. More than 15000 LHWs are fully

trained in basic nutrition and IYCF.

Moreover the community component of the nutrition program is also responsible of LHWs. It includes,

screening, referral and follow up of identifying malnourished cases in the community. Provision of iron,

folic acid tablet to all females of child bearing age, micronutrient supplements for suspected cases of

MAM children, & BCC with special focus to nutrition is added to LHWs routine jds now.

3.2.1.2 MNCH program:

Community midwives are engaged in community based nutrition related programs like MCH week, and

special weeks like breast feeding weeks. All CMWs will be trained on IYCF & basic nutrition under the

RMNCH & Nutrition program.

3.2.1.3 School Health & Nutrition Program:

Total 1,754 School and Nutrition, Health Specialists (SH&NS) are appointed at a Basic Health Unit level.

The School Health and Nutrition Specialist (SH&NS) visits every primary and middle school in the

catchment area, preferably once in a month for delivering lectures on health education and health

lifestyle. The SH&NS also carries out screening of students for eye, ENT, dental, skin and general physical

problems. The trained school teachers also assist in these activities.

3.2.2 Potential role in nutrition improvement

The combination of inefficient health services and burden of malnutrition has been identified

impediments in achieving MDGs. High levels of malnutrition are consistent with high rates of infant and

maternal mortality. The infant mortality rate in Punjab is 81 per 1000 live births, higher than the

national average. At the same time, relation between health especially infectious disease and

malnutrition cannot be ignored. In a well-nourished child, a common infectious disease is usually a

passing illness. While for an already malnourished child the same disease can precipitate, life-long

disabilities such as Vitamin A deficiency can cause even blindness. Similarly rapid sequence of infections

can leads towards malnutrition.

A slow sequence of disease accompanied with malnutrition & poor health services leads to stunting,

wasting, and affects mental development, decisively handicapping the affected millions that do not die.

The survivors remain with difficulties in terms of cognitive and physical development. Their handicap

though invisible, marks lifelong effects, leaving them less productive throughout their life.

The Malnutrition–Health complex is drain on human resource. One condition aggravates the other.

Infections lead to malnutrition and malnutrition may exacerbate infections increasing the duration,

severity, morbidity, and mortality. Malnutrition, health and poverty are closely linked with each other;

already poor people who are also malnourished and unhealthy and vice versa. It is envisaged that health

status improvements will enable individuals to avail more choices/opportunities that can help in

improving quality of their lives like attaining education, competing for better employment opportunities

and contributing towards their families and society’s betterment, hence enjoying their life.

Improved health behaviors and ensured access to primary health care package including the nutrition as

an important component of primary health care services will not only reduce the suffering at individual

level but will also reduce the cost of treatment. In the end, investment in treatment of complicated

cases will be decreased and would allow planning for the development projects. It is difficult to put

these benefits in figures, but their significance cannot be overlooked.

3.2.2.1 Causal Pathway of Malnutrition

Casual pathway for Malnutrition clearly shows linkages between health and nutrition. As poor health

and insufficient health, surfaces are the main contributor towards increasing the malnutrition Burdon.

Figure 3.1: Health sector specific area of interventions mapped on the causal pathway of malnutrition

3.2.2.2 Care for Mothers and Children

Adequate nutrition influences the health status of women and children to a great extent. The

prevalence of anemia is significantly high amongst pregnant women; this coupled with low caloric intake

during pregnancy has a negative impact on the growth of the fetus, resulting in nearly 28% of births

being low weight. Women and children in Punjab also suffer from high rates of deficiencies in essential

vitamins and minerals. The MMR for Punjab (227 per 100,000 live births11) is lower as compared to

other regions of the country; however, it is still high when compared with neighboring countries of

South Asia. The High TFR and MMR in the province are also indicative of the fact that the experience of

pregnancy and other reproductive health related aspects among women in Punjab predispose them to a

high risk of morbidity and mortality.

This data reflect the abysmal conditions of Nutrition among the more vulnerable segments of the

population that include the women and children of the province. This snapshot of Nutritional status

indicates that Punjab is far from achieving the health related MDG targets. Such nutrition indicators on

the part of the provincial health department also warrant a comprehensive and effective plan of action

on a war footing, to improve the existing deplorable health & nutrition conditions and indicators for the

women and children. Moreover the nutrition indicators could be improved only by adopting integrated

primary health care approach as all indicators are interlinked with each other. Health sector alone may

not be able to achieve MDGs but its prime importance and role in multi-sectoral approach cannot be

overlooked Nutrition Specific

3.2.3 Objectives Following are nutrition Specific Strategic objectives of health sectors By the end of 2020:

To develop Policy framework to create an enabling environment for mainstreaming Nutrition in

Sector & improving multi-Sectoral coordination mechanisms by the year 2015

To develop nutrition communication strategy and development of IEC material for other sectors

by December, 2015

To reduce 50% micronutrient deficiencies among maternal Infant & young Child (MIYC)

micronutrient status (Vitamin A, Iodine, Iron) improved from an existing baseline (NNS 2011) by

2020

TO 20% reduced in prevalence of stunting among children under -5 Years

To reduce acute malnutrition from 15% to 9% by 2020

To 50% reduce prevalence of underweight among children under-5 Years

To 50% reduce low birth weight babies (<2,500 grams)

To train 80% of Health Care providers on Nutrition

11 The Pakistan Demographic and Health Survey 2006-07

3.2.4 Intervention framework

3.2.4.1 Strategy 1: Mainstreaming Nutrition in Health

Integration of nutrition services into routine healthcare system is being experimented globally, although

the patterns of integration and the issues related to the integration process. Mainstreaming nutrition in

regular channels of the Directorate General of Health Services can address the malnutrition issues

directly.

Apart from current initiatives, routine health system of the province lacks nutrition lens. Proposal for

integrated services is a way forward not only to continue existing interventions through an integrated

approach, but also to expand their scope and introduce new nutrition interventions. Currently the

department of health is initiating integrated nutrition services approach into primary health care as well

as a tertiary health care system through a PC1 in selected target districts with the aim to expand into all

over the province. However, in order to harmonize the system in all over the province following

strategies are recommended to be initiated on war footing basis.

INTERVENTION MATRIX

Strategy Objective Strategy Action(s)

Nature of

Intervention Impact on

Nutrition

Nu

trit

ion

sen

siti

ve

Nu

trit

ion

spec

ific

To develop Policy

framework to

create an enabling

environment for

mainstreaming

Nutrition in Sector

& improving

multi-Sectoral

coordination

mechanisms by

the year 2015

1.1 Develop and promulgate rules for implementation of Breast feeding Act 2009

√ -- Development,

promulgate and

implementation

of nutrition

sensitive

policies will

ultimately lead

to uptake of

nutrition

indicators

1.2 Policy decision to integrate nutrition as part of EPHS and revision of JDs of HCPs & SHNS accordingly

√ --

1.3 To take up with PFA and other stakeholders regarding development of, mandatory legislation on wheat flour fortification with iron and folic acid, salt iodization

√ --

1.4 Policy to institutionalize Gender Sensitive and pro poor approach in all health plans ( PC1s)

√ --

1.5 Advocacy with BISP to convert its cash transfer scheme into

√ --

conditional cash transfer

To develop nutrition communication strategy and development of IEC material for other sectors by December , 2015

1.6 Develop consensus among stakeholders of each sector in communication framework by December, 2014

√ --

Impact on lives of women and children by sensitizing them to adopt positive health behavior

1.7 Develop linkages and provide support to other sectors in implementation of communication strategy and training of their staff.

√ --

1.8 Create awareness among the community on use of nutritious food, healthy dietary habits, hygiene and health

√ --

3.2.4.2 Strategy 2: Equitable access to Nutrition services to poor and marginalized people

Nutrition Program Punjab is currently working in seven target districts of Punjab (D.G. Khan, RajanPur,

Muzaffargarh, Layyah, Mianwali, Rahim Yar Khan, Bhakkar). The Punjab Nutrition Program is modified

version of CMAM (Community based treatment of acute malnutrition) as SAM (Severe Acute

Malnourished children) are treated by provision of RUTF (Ready to use therapeutic food).

To address micronutrient deficiencies, MMS (multi-micro nutrient supplementation) is proposed

intervention to be provided to MAM children and PLWs, in addition to nutritional counseling. Currently

the high default rate in the OTP (Outpatient therapeutic program) is a challenge in the treatment of SAM

children. Extended health house is another intervention proposed to reduce the default rate & maximize

the SAM treatment coverage. In extended health houses, SAM child will be provided follow-up visits

services. SAM child is expected to visit the facility after every 7 days, while in this approach LHW will

examine and provide RUTF at home during follow up visits and child will visit the facility after every 14

days.

Community Health workers (SHNS, LHWs, CMWs) are proposed to be trained on IYCF & Basic Nutrition

in order to provide all communities based services to address malnutrition that include, Screening,

Referral, Follow-up, support in breastfeeding, all components of IYCF & nutrition counseling. Health care

providers are also proposed to be trained on facility level treatment protocols of malnutrition in

addition to the same IYCF & Basic Nutrition.

INTERVENTION MATRIX

Strategic Objective Strategy Action(s)

Nature of


Nutrition

Nu

trit

ion

sen

siti

ve

Nu

trit

ion

spec

ific

80% of children

with SAM

accessing services

on Severe Acute

Malnutrition

(SAM)

management as

per National

guidelines,

especially in the

most affected

districts by 2020

2.1 Establish nutrition treatment centers

(OTPs) for SAM children from 80 to 930

by the year 2017 -- √

Early detection

and treatment of

wasting will

ultimately reduce

stunting.

2.2 Establish nutrition treatment centers (SC) for SAM children with complication from 8 to 36 by the year 2017

-- √

Maternal Infant &

young Child

(MIYC)

micronutrient

status (Vitamin A,

Iodine, Iron)

improved by 50%

from existing

baseline (NNS

2011) by 2020

2.3 Enforcement mechanism of salt iodization developed and implemented by 2015

√ --

By addressing Micronutrient deficiencies stunting can be prevented.

2.4 Ensure quality of iodized salt by strengthening and up gradation of existing lab system by 2015

√ --

2.5 Advocate with PFA for effective implementation regarding fortification of oil & Ghee with vit A & D by 2014

√ --

2.6 Assessment of existing mechanism of provision of Vit A biannually with NIDs by 2014

√ --

2.7 Increase in coverage of Vit A from 73% to 95% during NIDs by 2016

-- √

2.8 Conduct research to assess absorption and storage of iron. √ --

2.9 Research on compliance on uptake of iron √ --

2.10 Provision of iron folic acid to PLW and adolescent girls through community health workers

-- √

2.11 Exploring & establishing protocols for nutrition screening of adolescent girl -- √

2.112.12 Promote and provide deworming tablets to children and adolescent girls.

-- √

2.122.13 Provision of iron syrup and tablets in all health facilities -- √

2.132.14 Ensure develop and enforce of flour fortification law by 2014 √ --

2.142.15 Demand Generation of fortified foods through Lady Health Workers

√

Reduction in low birth weight babies by 50% of existing baseline (NNS 2011) by 2020 by Improving maternal health

2.152.16 Promote healthy timing and spacing of pregnancy √ --

Low birth weight babies are more prone towards malnutrition and infections

2.162.17 Increase coverage of ANC by health care providers √ --

2.172.18 Provision of calcium and vitamin D supplements to PLW -- √

2.182.19 Counseling of pregnant women to take one extra meal and food diversity in accordance with the food pyramid

√ --

Reduce prevalence of stunting among children of under five years from 39% to 27% ( 2% reduction annually by 2020

2.192.20 Increase in early initiation within one hour from 15% to 60%. -- √

Reduction in stunting is the main goal of the nutrition strategy to decrease malnutrition.

2.202.21 Increase exclusive breastfeeding from 22% to 50% -- √

2.212.22 Increase the number of children fed in accordance with all three IYCF practices (breast milk consumption, timely introduction of solid foods, food diversity, frequency and consistency of weaning food.)

-- √

2.222.23 %age of mothers aware of at least two benefits of exclusive breastfeeding.

√ --

2.232.24 Percentage of mothers aware of all components of IYCF practices.

√ --

2.242.25 %age of mothers able to identify at least two signs of childhood illness (e.g. Pneumonia)

√ --

Reduction in acute malnutrition from

2.252.26 Increase in coverage of fully immunized children from 34.6% to 90%. √ --

Timely identification and

15% to 9% by 2020 2.262.27 Establishment of nutrition treatment sites at 30% BHUs and all RHCs of Province

-- √ treatment of wasting/acute malnutrition prevent stunting. 2.272.28 Establishment of

Stabilization Centers (SCs) in all DHQs & Teaching Hospitals.

-- √

2.282.29 Increase in percentage of identifying SAM children enrolled for treatment at nutrition site.

-- √

2.292.30 Increase percentage of registered children successfully treated for severe acute malnutrition, according to national guideline protocols.

√ --

2.302.31 Provision of MMS sachet to 60% of identified MAM children. -- √

2.312.32 Increase in percentage of children suffering from diarrhea treated with ORS & Zinc.

-- √

2.322.33 Develop facility for local production of RUTF for MAM children.nutritional products like RUTF, and supplementray food at local level

√

2.34 Explore and establish appropriate protocols for the treatment of MAM keeping the local context in mind.

-- √

3.2.4.3 Strategy 3: Strengthening capacity of Provincial and local governments on

nutrition to provide basic services in an inclusive and equitable manner

The above described nutrition services are quite new to the department of health, and there is an

intense need to build capacity of the existing system as well as health care providers for quality

provision of nutrition services. The Punjab Policy guidance note on Nutrition shows that there is a strong

association between factors such as poverty and women’s education and malnutrition. Special efforts

are thus needed to reach the poorest households and the communication for behavior change needs to

be designed in a way to effectively communicate with illiterate and less educated mothers.

INTERVENTION MATRIX

Strategic Objective Strategy Action(s) Nature of

Intervention

Impact on

Nutrition

Nu

trit

ion

sen

siti

ve

Nu

trit

ion

spec

ific

80% of Health

Care providers

trained on

Nutrition

3.1 Development of training modules for

different cadres √ -- Well-trained

professionals

can identify

malnutrition

timely and

provide quality

services in order

to minimize the

complications.

3.2 Trainings of Provincial master trainers √ --

3.3 Trainings of Community health workers and health care providers on Nutrition

√ --

3.3 WASH


By 1978 Public Health Engineering Department (PHED) was finally evolved and then placed under the

umbrella of H&PP. However, very soon this sector was also renamed called “Housing Physical &

Environmental Planning” (HP & EP) in 1978 plus attached this was “Environmental Protection Agency”

(EPA). In 1996, EPA was detached and HP& EP was given another name “Housing, Urban Development &

Public Health Engineering Department (HUD & PHED)” and consist of the following sectors: Punjab

Housing and Town Planning Agency (PHATA); Public Health Engineering Department (PHED); Lahore

Development Authority (LDA); Rawalpindi Development Authority (RDA); Gujranwala Development

Authority (GDA); Faisalabad Development Authority (FDA); Multan Development Authority (MDA);

Water and Sanitation Agency, Lahore; Water and Sanitation Agency, Rawalpindi; Water and

Sanitation Agency, Gujranwala; Water and Sanitation Agency, Faisalabad; Water and Sanitation

Agency, Multan; Traffic Engineering and Transport Planning Agency (TEPA), Lahore; Parks & Horticulture

Authority (PHA), Lahore; Parks & Horticulture Agency (PHA), Faisalabad; Parks & Horticulture Authority

(PHA), Multan; Improvement Trusts (Murree & Sargodha).

3.3.1.1 Public Health & engineering department (PHED)

The main objective of “PHED” is to improve quality of life of the people of Punjab through the provision

of “Safe Drinking Water” in areas like Brackish, Barani (Fig. 1) and areas where ground water is polluted

or contaminated or else inappropriate for drinking purposes. Similarly PHED aimed to provide clean

atmosphere “Pollution Free Environment” through improving Sewerage / Drainage Schemes and

Construction of Sewage Treatment Plants to meet MDGs).

3.3.1.2 Achievements of Public Health & Engineering Department

Govt. of Punjab sectoral policy aimed to achieve MDGs within due time to provide safe Water

Supply & Sanitation facilities as appropriate. PHED have allocated and provided enough

financial resources asunder.

Description Population Coverage (%)

Projected Year of Reaching MDG

MDG’s Targets

2015 in % 2006-

07 2007-

08 2008-

09 2009-

10 2010-

11 2011-

12

Urban Water Supply

66.2 71.9 75.5 83 85 87 2009-10 80

Rural Water Supply

30.8 32.7 36.1 38 45 48 2020-21 65

Urban Sewerage/ Drainage

68.5 72.0 76.0 79 83 85 2010-11 82

Rural Sewerage/ Drainage

41.3 43.8 48.6 50 53 56 2015-16 70

3.3.2 Potential role in nutrition improvement, engagement and role within the

multisectoral framework

The one of the main objectives of the sector is achieving MDG7, which is broadly defined by UN,

covering environmental policy, preservation of biodiversity, access to water and sanitation and urban

development. The target to measure MDG7 is” Halve, by 2015, the proportion of the population without

sustainable access to safe drinking water and basic sanitation”.

Progress in provision of safe drinking water and sustainable sanitation services is imperative as these

conditions have a direct impact on targets in other MDGs goals. The effectiveness of preventive health

measures and risk of communicable and waterborne diseases is dependent on the quality water and

sanitation services provided to the population. Enrolment rates are also affected by the lack of water

and sanitation facilities in schools, thereby having a major impact on the achievement of education

indicators as well.

Poor environment (unsafe drinking water and poor sanitation and hygiene, or WASH), the underlying

determinants of malnutrition, often lead to increases in diarrheal disease, a leading cause of child death

in Pakistan, which decreases the absorption of nutrients consumed. Accordingly, even when food

consumption is sufficient, such bacterial, infection can lead to malnutrition in children12. Additionally,

open defecation, improper sanitation facilities and unsanitary waste disposal contaminate food in the

household as well as food production.

While a large majority of households in Punjab utilizes piped water or water from a tube well or bore

well for drinking, (88.9%), it is important to note that there are numerous opportunities for pathogens

to make their way into the water prior to ingestion, during water collection, transport, storage and/or

transfer to drinking vessels. The Punjab Municipal Water Act has been drafted and should reduce the

misuse of ground water. Nearly 22% (PLSM 2011) of households do not have access to hygienic sanitary

facilities. In addition, while hand washing after defecation and before the preparation of a meal (99.0%

and 97.4%, respectively) is substantially higher than that in many developing countries, soap is available

only in an estimated 77% of Punjabi households. The likelihood of women being free of anemia in

Punjab is twice as high where toilet facilities are available at home (73% vs. 36 %.)

Figure 3.2: Linkages with Nutrition Indicators

12 WHO, 2008

Odds of stunting at 24 months of age increase by a factor of 1.05 with each episode of diarrhoea (Lancet 2008, data pooled from 9 studies)

Improvements in sanitation were associated with increases in height ranging from 0.8cm to 1.9cm (Esrey 1996, multi-country analysis, sample size almost 17.000)

Children with worst conditions for water source, water storage and sanitation were 1·0 cm shorter in stature (Lancet 2004, Peru)

“The total number of deaths caused directly and indirectly by malnutrition induced by unsafe water, inadequate sanitation and insufficient hygiene is 860,000 deaths per year in children

under five years of age” (WHO 2008)

Figure 3.3: WHO pathway linking WASH & malnutrition

3.3.3 Overall Sectoral objectives

To increase access of to “improved drinking water” or non-surface water: MDG 7

To enhance Rural Population Coverage (Barani, Brackish and Contaminated Areas)

Improving quality control of water (by providing Water Testing Facilities and through provision of Water Filtration Plants)

To enhance sanitation, environmental sustainability and open defecation free (ODF) environment

To make dysfunctionally Rural Water Supply Schemes functional and to replace old water supply pipelines for eradication of gastroenteritis in 15 cities of Punjab

Increase public awareness about water safety, safe hygiene practices, and water conservation


3.3.4.1 Strategy 1: Equitable access to safe & clean water

Background/Rationale: While recognizing that access to safe drinking water is the basic human right of

every citizen and that it is the responsibility of the state to ensure its provision to all citizens, Provincial

government is committed to provision of adequate quantity of safe drinking water to the entire

population at an affordable cost and in an equitable, efficient and sustainable manner.

While Government of Punjab (GoPb) to fulfill its commitments and responsibilities in achieving MDGs

has developed and approved Punjab Drinking Water Policy in May 2011. Inadequate and unsafe water,

poor sanitation, and unsafe hygiene practices are the main causes of diarrhea, which results in at least

1.9 million under-5 child deaths annually.

Around 80% of all diseases are attributed to water and sanitation related causes. Inadequate disposal of

human excreta and personal hygiene are associated with a range of diseases including polio, diarrheal

diseases, jaundice, typhoid, malaria, dengue viral fever and cholera. Sanitation is both a public and a

private good, and that individual hygiene behavior can affect the whole community if your neighbors

defecate in the open, then your children risk excreta-related diseases even when the members of your

own household use a sanitary toilet, wash their hands, and practice good hygiene. Factors related to

water, sanitation and hygiene affect children’s right to education in many ways. In an atmosphere of

poor health, children are unable to fulfill their education potential for example; 400 million school-aged

children a year are infected by intestinal worms, which, research shows, sap their learning abilities.

Figure 3.4: Sources of Drinking water in Punjab source from where they put

INTERVENTION MATRIX

Strategy Objective

Strategy Action(s)

Nature of Intervention Impact on

nutrition Nutrition Sensitive

Nutrition Specific

To increase the access to water in Punjab by 2020and reduce

1.1 Provide drinking water under Changa Paani Programme through early implementation and completion of project in all districts

√ --

Access to safe drinking water will ultimately reduce the risk

the arduous labour of women in carrying it in all vulnerable communities by 2020

of Punjab by 2020 (Implementation level) depends upon approval and avaibility of resouces

of water-borne diseases and lead to uptake of nutrition indicators

1.2 Provide clean drinking water by installing filtration plants under Saaf Paani Programme through early implementation and completion of project by 2020 (Implementation level) consultation with saaf pani company

√ --

1.3 Provide hand pumps in areas where the provision of tap water facility is currently not feasible (Implementation Level) subject to provision of fincial resouces

√ --

1.4 Rehabilitation of dysfunctional rural water supply schemes 172 (2015)schemes are arpproved and rest are subjected to approval and finicial (Implementation Level)

√ --

1.5 Ensure availability of safe drinking water by installation of small water filtration plants in schools (Implementation Level) mandare of school dept

-- √

To increase access to clean/safe drinking water in all vulnerable communities punjab by 2020

1.6 Ensure scaling and sustain functioning of installed water filtration plants saaf pani company

√ -- Access to safe drinking water will ultimately reduce the risk of water-borne diseases and lead to uptake of nutrition indicators

1.7 Initiate water treatment projects with special awareness campaign at household and community level by distribution of chlorinating tablets etc. subject to availability to functional resources or (initiate a project)

√ --

1.8 Establish water quality testing facilities and regular sampling of water from various water projects starting from water source to household level water qualiy testing lab (mobility) strengthing of water quality labs and ensuring regular provision of water testing servicing

√ --

1.9 Introduce community based effective monitoring mechanism comprising elected UC representatives, school council

√ --

Formatted: Adjust space between Latin and Asian text,Adjust space between Asian text and numbers

Formatted: Indent: Left: 0"



members and CBOs for provision of safe drinking water mechanism under process

1.10 Plan and introduce proper operation and maintenance mechanism for keeping the facilities functional

√ --

To reduce misuse and depletion of ground water

1.11 Increase water conservation with increased and improved water storage capacity

√ --

1.12 Launch a campaign for awareness to reduce water wastage and misuse

√ --

3.3.4.2 Strategy 2: Promote best practices & behavioral change regarding hygiene

practices

Background/Rationale: Wash is an important prerequisite for ensuring the right to basic education with

a water-related disease. Hand washing practices reduce the risk of infectious diseases associated with

microbial infections. Hand washing practices with soap are the single most important factor in

preventing the spread of pathogens and antibiotic resistance in healthcare settings.

Figure 3.5: Percentage of house hold with availability of water & soap13

Proposed hygiene promotion actions should aim to encourage healthy behavior changes among target

13 MICS 2011

76.8

19.4

2.5

0

10

20

30

40

50

60

70

80

90

Water + Soap Available Only Water AvailableBoth Water + Soap not available

Per

cen

t H

ou

seh

old

communities. Interventions will follow a community driven approach to hygiene promotion and focus on

personal hygiene promotion relating to hand washing (at critical times), latrine usage, water transport,

storage, and consumption as well as infrastructure maintenance and management related to latrines

and water points. The community workers should equip with basic skills on community participation,

awareness raising methodologies and basic prevention and control of water and sanitation related

infections. Likely training topics will include personal hygiene, latrine use & maintenance, hand washing,

safe water use, diarrheal disease prevention and management, ORS, and malaria prevention and

treatment.

Hygiene promotion should aim to motivate beneficiaries to use latrines by explaining the health benefits

they are going to gain through such practices and in connection to other healthy behaviors and

maintaining clean latrines. Messages need to be delivered in a way that they can be readily understood

by target group and language, design of IEC materials for illiterate people, gender considerations,

cultural norms etc.

INTERVENTION MATRIX

Strategy Objective

Strategy Action(s)



Nutrition Specific

To Launch campaign and awareness programs to promote hygiene practices

2.1 Conduct awareness campaigns an community sessions through integration approach by community workers like SH&NS, LHW, CMW, agriculture field assistant, school teachers, civil society, union council, CBOs, KHATTEEB of local MASAJIDS (AUQAF Dept.) and local media (Policy Level)

√ --

Access to educational materials and awareness about sanitation and hygiene practices (especially among females) will ultimately reduce the health risk

2.2 Celebrate the Mother & Child Week, Global Hand Washing Day, World Toilet Day and World Water Day, Anti-Dengue Day to promote hygiene practices (Implementation Level)

√ --

2.3 Develop IEC material on nutrition containing guidelines of health and hygiene practices (Policy Level)

√ --

2.4 Creative inclusion of sanitation, hygiene and preventive approaches adressing malnutrition in school curriculum in coordination with the School Education Department and Punjab Curriculum Authority (Policy Level)

√ --

3.3.4.3 Strategy 3: Equitable access to Total Sanitation Services

Background/Rationale: UN declared that access to proper sanitation services is a basic human right to

improve public health and quality of life. It is widely recognized and documented that lack of access to

this essential basic service is associated with adverse impact on public health and environment. The

Millennium Development Goal 7 (MDG-7) assigns the signatory nations to extend access to improved

basic sanitation to at least half of the un-served population by 2015 and to 100% population by 2025.

Sanitation is one of the significant hygienic means of promoting health through prevention of human

contact with the hazards of wastes. “The Pakistan Approach for Total Sanitation (PATS) is towards

achieving and sustaining an open defecation free environment both in rural and urban context with

clear emphasis towards behavior change and social mobilization enhancing the demand side of

sanitation. The approach endorses the use of a number of branded total sanitation models, having a key

role of communities, which include:”

Community Led Total Sanitation

School Led Total Sanitation

Component Sharing

Sanitation Marketing

Disaster Response

The literature review revealed that every model has proved its own success in different context. The

above models may be adopted by the provincial and local governments in accordance to suitability of

their local context. The integrated approach of “Total Sanitation” which is comprised of sanitation

demand creation interventions, sustaining demand through supply side interventions, health hygiene

promotion intervention, and drainage & water treatment interventions of “Component Sharing Model.”

Figure 3.6: Integrated Total Sanitation Model sources

This integrated approach will have the chance to produce sustained results. Before the implementation

strategy of “Integrated Model” is delineated, the existing situation is analyzed.

Integrated Total Sanitation Model

Demand Creation

Interventions for ODF

Communities

CLTF, SLTS

Attaining 100 % Adequate

Drainage, Waste water

treatment and solid waste

collection disposal through

Component Sharing

Participatory Health &

Hygiene Promotion

Promotion

Sustaining the Demand

through Supply Side

Interventions

Sanitation Marketing

1. Launching a behavior

change communication

campaign based on

baseline information

regarding Knowledge

Attitude and Practices &

Formative Research

findings

2. Finalization and

triggering of PRA tools for

mobilizing communities

through Community

Activists/ sanitation

Ambassadors(Adapting a

cascading model)

1. Technical training of

masons

2. Construction of low cost

environment friendly

latrines for demonstration

of technical solutions

3. Piloting concept of

sanitation mart

Trainings of sanitation

entrepreneur and sanitation

enterprises

4. Facilitation to develop

linkages with the

microfinance institutions

5. Incentivizing outcomes

1. IEC material on active

health and hygiene key

massages

2. Mass Media/

Communication Campaign

3. IEC campaigns

promoting low-cost

appropriate and informed

sanitation solutions

1. Waste water disposal in

a hygienic way including

small sewerage treatment

units, oxidation ponds etc

2. Underground/ covered

drainage system

3. Solid waste collection

and disposal system

Figure3.7: Statistics about type of Toilets used in Punjab source

The above picture shows overall provincial status of toilets used in Province. Further break up of data,

into rural & urban and district wise status shows big differential. According to Multiple Indicator Survey

(MICS), Punjab (2011), 32% of the rural population defecates in open environment, which puts a

significant challenge for Government of Punjab to create an open defecation free environment in the

Province.

LG&CDD has the legal role and mandate of community development in order to improve water supply,

sanitation, hygiene including rural communities, which are more vulnerable and are excluded so far

water, sanitation, and hygiene services are concerned.

Further analysis of MICS 2011 reveals that 61.8% people of Rajanpur, 51.2% of Muzaffargarh, 50.3% of

DG Khan, 48.4% of Chinniot and 44.2% of Jhang defecates in open environment as compared to

provincial average which is 22%.

INTERVENTION MATRIX

Strategy Strategy Action(s) Nutrition Level Impact on

Objective Nutrition Sensitive

Nutrition Specific

nutrition

To decrease ODF 23 22% to 10% in province of Punjab by 2020 23-18% 2015

3.1 Scaling up PATS in Punjab to have ODF villages Conduct pilot project of PATS in high risks districts (Rajanpur, Muzaffargarh, DG Khan, Chinniot and Jhang) by 2015 RYK, Layyah, Chakwal, Vehari, Bahawalpur, DGK (PATS project are running )

√ --

Clean environment will be helpful in decreasing health risk factors and reduce the malnutrition burden

Installation of sewerage treatment units by 2020

3.2 Install small scale sewerage treatment units especially with prioritization in those large villages (Implementation Level) resources

√ --

Installation of solid waste management plants by 2020

3.3 Improve solid waste management schemes and mechanism through establishment of solid waste management plants in all over the Punjab to treat agriculture, sewerage and domestic solid waste (Implementation Level) local govt

√ --

3.4 Install composting plants in large cities to manufacture compost fertilizers from this waste (Implementation Level)local govt

√ --

To ensure availability of facilities of quality hygiene and sanitation practices at 100% schools by 2019 (especially in girls school)

3.5 Provide WASH facilities, like soap and toilets, in schools in collaboration with School Education Department (Policy Level) Schoold dept

√ --

3.3.4.4 Strategy 4: Development and implementation of Policies and Strategies

Background/Rationale: Government of Punjab (GoPb) to fulfill its commitments and responsibilities in

achieving MDGs has developed and approved Punjab Drinking Water Policy in May 2011. Recognizing

the significance of sanitation, GoPb is formulating Sanitation Policy for the province. The Policy may

provide a broad framework and policy guidelines to provincial institutions, District Governments and

Tehsil Municipal Administrations in order to improve sanitation coverage and services in the province.

The Policy document may envisage a structure for addressing the institutional, administrative, legal,

regulatory, fiscal, social & environmental issues and challenges faced by the sector actors.

INTERVENTION MATRIX

Strategy Objective

Strategy Action(s) Nutrition Level

Impact on nutrition

Nutrition Sensitive

Nutrition Specific

Formulation of nutrition and gender sensitive policies & strategies of WASH sector

4.1 Approval and dissemination of Punjab Drinking Water Strategy by 2015 (Policy Level)inprocess draft complter

√ --

Sanitation and hygiene will ultimately reduce the risk of water-borne diseases and lead to uptake of nutrition indicators

4.2 Approval and dissemination Punjab Sanitation Policy and Strategy by 2015 (Policy Level)CM approved and move to canbient division

√ --

4.3 Approval and dissemination Behavior Change Communication Strategy by 2015 (Policy Level) draft completed and comments are incorporating

√ --

4.4 Approval, dissemination & implementation of Punjab Municipal Water Act 2013 (Policy Level)inprocess of approval move to CM

√ --

3.4 FOOD


Punjab economy is mainly agricultural and province is playing a leading role in agricultural production. It

contributes about 68% to the annual food grain production in the country. 51 million acres of land are

cultivated and another 9.05 million acres land is lying as cultivable waste in different parts of the

province (Govt. Punjab). Although, Punjab is predominantly an agricultural province yet 60%14 of its

14 NNS-Pak 2011

households are food insecure (higher than the countrywide figure of 58 %). Of these, 18% are classified

as food “insecure with hunger,” and 11.5% are food insecure with severe hunger.

The number of surplus food producing districts in Punjab decreased from 21 to 14, while the food deficit

districts increased from 7 to 14 between the years 2003-04 to 2008-09. During the same time period,

the number of districts with “low” to “extremely low” access to food increased from 35% to 53%15 .Part

of this deterioration in Punjab has been the result of an economic and industrial crisis relating to power

shortages, increased production costs and non-significant growth in household income.

3.4.2 Punjab Food Department

This department was initially developed to distribute important food items, but current government

decided to limit its function to procuring what at support price and supply to the flour mills at subsidized

rates and subsidy may be withdrawn gradually within the next few years. Unfortunately, price of ATTA

became a very sensitive issue and rulers could not gather the political will to withdraw subsidy.

3.4.2.1 Potential role in nutrition improvement, engagement and role within the Multisectoral

framework

Food Department is safeguarding the interests of growers through purchase of wheat on support price

fixed by the Government, maintenance of strategic reserves as well as improving the quality of life of

citizens of Punjab by providing them quality and nutritious flour at reasonable price. Under the Food

Stuff (Control) Act, 1958, Food Department is responsible for regulating the business of food grains,

which include purchases, storage, sales, transfer, and milling. Furthermore, Food Department is

responsible for procurement of wheat for issuance to the mills, to act as government agents to provide a

wheat purchase window to the farmers at support price.

3.4.2.2 Food Security

The concept of food security has emerged and expanded over time to integrate a wide range of food-

related issues and reflects the complexity of the role of food in human society (Cook, 2006). The Rome

Declaration on World Food Security in 1996 defined food security as a situation where ‘All people at all

times, have physical and economic access to sufficient, safe and nutritious foods to meet their dietary

needs and food preferences for an active healthy life’ (World Food Summit, 1996).

15 SDPL et al,2009

Food insecurity, the limited or uncertain availability of or access to nutritionally adequate and safe foods

throughout the year, is associated with malnutrition as a key underlying determinant of overall food

intake in the household, depicted in a causal framework of malnutrition. Food insecurity may also be a

more sensitive measure of food issues experienced by low-income families than household income

alone, especially the psychological and social ramifications of a lack of food.16

Wheat is the staple diet of Pakistan. There is major link b/w poverty and consumption pattern of wheat.

The poorest of the poor obtain the highest proportion of energy and nutrients from the wheat as flour

based CHAPPATI is the major food item or, at times, the only food item of their daily meals. Therefore,

focusing on the production of wheat, its proper storage, ensuring its nutrient quality and controlling

price will certainly help in improving food security, especially in population, which is food insecure with

severe hunger. The production of food including wheat rests with Agriculture sector, i.e. Agriculture,

Livestock and Fisheries Departments, however, the food after harvesting, picking, catching, slaughtering

etc. comes under the domain of Food Department. The Food Department is therefore key provincial

department to ensure safe, wholesome, good quality and nutritious food at a reasonable price in

consumer table, thus having a major role in food security in the province. This strategic plan has taken

care of this significant issue to address malnutrition. Additionally, the micronutrient fortification of food

products like flour, edible oil, ghee and salt, and targeted food subsidies will be the key interventions of

this sector, helping to tackle the ever-escalating burden of malnutrition.

Figure 3.8: Relevance of food security & Stunting17

16 Frangillio, 1999 17 Nutrition Policy Guidance Notes, Punjab 2013

3.4.3 Overall Sectoral objectives

The objective of the Food Sector Plan:

Improved quality of common mans diet by providing them quality wheat flour (staple diet) at

affordable prices ( with special focus to maximum utilization of micronutrients)

Ensure the food security in Punjab province to maximum population

3.4.3.1 Nutrition specific objectives: related to nutrition specific strategic plan

Ensure food security related to wheat and wheat products

Transportation of wheat from surplus to deficit regions

Provision of quality of wheat by protecting it from insect pests and other hazards

Targeted food support programs

Fortification of wheat flour with micronutrients

3.4.4 Punjab Food Authority

The Government of Punjab has taken an initiative to establish Punjab Food Authority under the "Punjab

Food Authority Act 2011" to ensure availability of safe and wholesome food for human consumption.

The basic purpose is to lay out standards for food articles and to regulate their manufacturing, storage,

distribution, sale and import. Its main function include formulation of standards, procedures, processes,

and guidelines in relation to any aspect of food including food business, food labeling, food additives,

and specify appropriate enforcement systems; Specify procedures and guidelines for setting up and

accreditation of food laboratories; Formulate method of sampling, analysis of samples and reporting of

results; Specify licensing, prohibition orders, recall procedures, improvement notices or prosecution;

Provide scientific advice and technical support to the Government in matters related to food; Collect

and analyze relevant scientific and technical data relating to food; Establish a system of network of food

operators and consumers to facilitate food safety and quality control; Organize training programmes in

food safety and standards; Promote general awareness as to food safety and standards; Levy fee for

registration, licensing and other services; certify food for export.

3.4.4.1 Potential role in nutrition improvement:

Ensuring food safety and quality

Collect and analyze relevant scientific and technical data relating to food safety

Standardization including legislation on mandatory fortification of food products i.e. edible oil,

ghee, flour and salt.

3.4.5 Overall Objectives

To ensure availability of safe and wholesome food for human consumption

To enhance quality perspective of the food products

3.4.5.1 Nutrition specific objectives: related to the Nutrition Specific Strategic Plan

Take measures to enhance food safety and quality in the Province

Ensure that the food is safe for human consumption at all stages of food supply chain

Improving the hygienic system and environment of food production / processing

Action against food business operators selling, storing, marketing, etc. adulterated, injurious,

sub-standard, contaminated or unsafe food or food products

Ensuring the effective food control system, including the implementation of voluntary and

mandatory food fortification


Multi-sectoral efforts are required to eradicate malnutrition and improve health of citizens of the

province. Reduction in nutrient deficiency and malnutrition are likely to be multi-sectoral task, but

clarity on sectoral responsibilities is an essence. The proposed strategic actions by the food sector

involving the Food Department and Punjab Food Authority to address malnutrition through Multi-

Sectoral Nutrition Plan (MSNP) in Punjab is as under:

3.4.6.1 Strategy 1: Physical access to food throughout the year for all targeted groups

Background and Rationale: Food security emerged as a priority issue during the Food price hike in

2007–08 and most recently in 2012-13 and with the realization that global food prices likely to remain

either high and/or frequently fluctuate, with strong adverse implications on food security. There is a

major link b/w poverty and consumption pattern; the poorest of the poor obtain the highest proportion

of energy and nutrients from the wheat as wheat based chappati are the major food item or, at times,

the only food item of their daily meals. Therefore, focusing on the production of wheat, its proper

storage, ensuring its nutrient quality and controlling price will certainly help in improving food security,

especially in population, which is food insecure with severe hunger. Therefore, improving the storage

capacity and quality control mechanism of staple food (wheat) is of utmost importance, which is housed

with this sector i.e. Food Department

INTERVENTION MATRIX

Strategy

Objective Strategy Action(s)

Nutrition Level Impact on

nutrition Nutrition

Sensitive

Nutrition

Specific

Increase in storage capacity from existing level to 80% by 2020

1.1 Replace wheat storage from bag to silos storage (Policy level)

√ --

Access to food

throughout the

year will

improve the

food security

situation and

ultimately

reduce the

malnutrition

burden

Ensure access to

food throughout

the year

1.2 Explore avenues for Public and Private partnership to preserve and increase storage perishable commodities at their peak harvesting for year-long availability at affordable price (Policy level)

√ --

1.3 Improve Food supply chain and promote the applications of modern technology and engineering to reduce post-harvest losses

√ --

1.4 Introduce and promote cold supply chain to increase the safety of high risk food i.e meat

-- √

3.4.6.2 Strategy 2: Ensure and improve food quality from farm to fork

Background/Rationale: Wheat and other grains quality testing within due time is necessary because low

quality food/grains pose health threats and economic losses to the farmers as well as to the consumers.

Among present day challenge is to introduce a well-managed tracking system where a particular area

grain is diseased or nutritionally unsuitable should be withdrawn from the market or supply chain. In

this regard Interlinking/networking of different food analysis labs with each other is important and there

should be skill development of analyst such as yearly training and time-to-time awareness workshop

regarding field problem as well as how to eradicate them?

INTERVENTION MATRIX

Strategy



nutrition Nutrition

Sensitive

Nutrition

Specific

Strengthen lab

facilities to

ensure food

safety and

quality by 2016

2.1 Up-gradation of the existing lab facilities for testing of micro-nutrients in foodsflour, wheat quality & safety testing in regions, where the labs are already present but are with limited capacity or non-operational(Policy level)

√ --

Up-gradation & establishment of lab will be helpful in provision of safe and nutritious food and ultimately improve nutrition indicator

2.2 Establishing new lab testing facility in regions where there is need but there are no labs (policy level Level)

√ --

3.4.6.3 Strategy 3: Provision of safe food

Background and Rationale: Low quality food/grains pose health threats and economic losses to the

farmers as well as to the consumers. “A safe and nutritionally adequate diet is a basic individual right

and an essential condition for sustainable development, especially in developing countries” (Gro Harlem

Brundtland). Therefore, establishment of effective and integrated food control system throughout the

province is critical for ensuring food safety. For this purpose, scaling up of Punjab Food Authority to

whole of Punjab and its capacity development in terms of access to sophisticated lab facilities,

availability of trained manpower in food safety, improvement and harmonization of rules, standards and

regulation with international standards is of utmost important. Currently the domain of Punjab food

authority is only in Lahore and is likely to extend its network from Lahore to four other divisional

headquarters of Punjab i.e. Faisalabad, Gujranwala, Rawalpindi, and Multan in 2014. It is recommended

to extend its network in all 36 districts of Punjab province by 2020. Moreover, purposeful action will

need to be initiated to produce manpower capable of inspecting food and food premises by starting /

scaling-up of professional programs in food safety.

INTERVENTION MATRIX

Strategy



nutrition Nutrition

Sensitive

Nutrition

Specific

Strengthen and expansion of Punjab Food Authority to improve food safety

3.1 Phase-wise extending the

Punjab Food Authority to whole

of Punjab by 201720 (Policy

level)

√ --

Improvement in

food safety

increase

nutrition status

and reduce

disease burden 3.2 Establishing lab facilities at district level parallel with the extension of Punjab Food Authority for safety & quality testing of food products & testing facility of micro nutrient (Policy level)

√ --

Improve the food

safety

management

systems by

legislation,

promulgate and

implement

3.3 Improving the capacity of inspection services through revising and harmonizing the food rules with (Codex Alimentarious Commission(CAC), OIE, and IPPC) (implementation Level)

√ --

Provision of safe

food ultimately

lead to uptake of

nutrition

indicators

3.4 Continuous professional development, capacity enhancement, trainings and awareness campaigns for all involved in food supply chain starting from producers to consumer desk

√ --

Awareness to

food safety

will reduce

health risks and

ultimately lead

to uptake of

nutrition

indicators

3.5 Promoting and advising to get Food Safety Management Certification like HACCP, BRC, ISO-22000 etc. by food business operators, targeting specifically the large industries and high risk food processors for 3 years

√ --

Certification will

be beneficial in

food safety and

it will also

will reduce

health risks

3.6 Mandatory Food Safety Certification of large food industries in five years, medium size in 10 years, and all food business operation in 15 years

√ --

Certification will

effective in food

safety and it will

also

will reduce

health risks

3.7 Roadside should be upgraded to minimum hygine standards √ --

3.4.6.4 Strategy 4: Ensure Economic Access To Food

Background Rationale: Majority of the nation faces financial problem and hence pose with limited

access to the food. Targeting poor group and making subsidies on wheat flour/or-other grains would

have positive impact on decreasing malnutrition in the country. Similarly, production of wheat is not

much satisfactory to the extent it should be and need careful consideration. Although food production

on large scale is necessary however, where indicated or people with limited resources need home

livestock and garden production (home scale agribusiness). Monthly cash system like BISP, Zakat and

other Charity has to be properly in place for targeted groups particularly, women and children.

INTERVENTION MATRIX



nutrition Nutrition

Sensitive

Nutrition

Specific

Improve the economic access to food by subsidies and price control and regulation

4.1 Targeted and conditional food subsidies for poor instead of generic subsidies and may be linked with inflation rate by 2014(Policy level)

√ --

Access to food at

economical price

will improve the

food security

mechanism 4.2 Putting in place the price control and regulation mechanism especially for staple food (Policy level)

√ --

situation and

ultimately reduce

the malnutrition

burden

3.4.6.5 Strategy 5: Reduce micronutrient deficiency in adolescents girls, pregnant &

lactating mothers and children’s through fortification

Background/Rationale: Globally 79 countries have legislation to mandatory fortification at least one

major cereal grain. Of these, 78 countries fortify wheat flour, 12 countries fortify maize products, and 5

countries fortify rice. Currently 78 countries require fortification of wheat flour produced in industrial

mills. All the countries fortify wheat flour with at least iron and folic acid except Australia which does not

include iron, and Venezuela, the United Kingdom, and the Philippines which do not include folic acid.

Additionally, seven countries fortify at least half their industrially milled wheat flour through voluntary

efforts. We estimate that 31% of the world’s industrially milled wheat flour is fortified with at least iron

or folic acid through these mandatory and voluntary efforts.We define mandatory as legislation that has

the effect of requiring fortification of one or more type of grain with at least iron or folic acid. Most

countries permit fortification. Encouraging and advising on minimal, nutrient friendly and innovative

food processing techniques for qualitative and quantitative retention of vital nutrients.

INTERVENTION MATRIX



nutrition Nutrition

Sensitive

Nutrition

Specific

Develop Promulgate and implement, legislation regarding the fortification of food by 2014

5.1 Create awareness on benefits

for use of fortified flour, salt

and edible oil (Policy level)

√ -- Promulgation

and legislation

of fortification

eventually lead

to the uptake of

nutrition

indicators

5.2 Legislation of mandatory wheat

flour fortification with iron and

folic acid by 2014 for flour

milling industry and in five

years in flour grinding industry

(chakki flour) (policy level)

√ --

5.3 Develop supplu chain

mechanisim for micro feeders

and premix.

√ --

5.35.4 Start enforcement of

mandatory legislation after one

year of enactment.

√ --

5.45.5 Develop mechanism for pass

through of fortification cost to

consumer.

√ --

5.55.6 Establish market based,

sustainable, suppy chain

mechanism for premix and

microfeeders for flour millers.

√

5.7 Legislation on mandatory

universal salt iodization by

December 2016 4 (policy level)

5.6 (legislation target is 2014, implementation target is 2016)

√ --

5.75.8 Devise robust

implementation strategy to

ensure Vitamin A and Vitamin

D fortification in ghee and

oil(Implementation level)

-- √

3.5 SOCIAL PROTECTION 3.5.1 Overview of the sector

Social Welfare initiatives of the Punjab Government provide social welfare, protection and development

that may lead to improvement in quality of life. The base of “Social Welfare” in Pakistan is “Adl-o-Ehsan

and Haqooq-ul-ibad” that according to Islamic law stand affluent society and the state responsible for

the welfare of the people. Similarly, the constitution of Pakistan enforces the state to ablate misery and

sufferings of citizen living in the state irrespective of caste, gender, creed or race. The Secretary to

Department of Social Welfare & BAIT-UL-MAAL oversees all matters. BAIT-UL-MAAL committees have

Formatted: Font: Not Bold, Not Italic

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been established at the district level to assist the council in the distribution of funds to vulnerable and

needy families. To keep fairness in this sector, Punjab Social Service Board (Governor Punjab is the

president of the board) was established in 1970 to enhance efficiency and departmental coordination

within welfare/voluntary organizations (NGOs) in the private sector. The board provides financial and

technical assistance to the Voluntary Social Welfare Agencies (Registration & Control) ordinance, 1961.

Social Welfare & BAIT-UL-MAAL is chaired by “Deputy Director” at divisional level who controls and

monitors ongoing Social Welfare Programmes in the public and private sector. Each Deputy Director is

further assisted by Assistant Directors at District level and social welfare officers who are in control of

Projects at Tehsil/sub-Tehsil level. Social protraction has tremendous role in provision of financial

support for Health. Social Health Insurance provides shelter to insured people who cannot pay high

treatment costs during sickness. The concept has also been adapted to newly industrialized and

developing countries.

Social Protection Sector has key component departments including federal & provincial departments;

Social Welfare, Bait-ul-Maal, Zakat, Women Development & Benazir Income Support Programme.

Some of the functions being performed by this sector, which reflect the objectives of its component

departments

Promote sustainable socio economic development

Voluntary participation in community development programs for socio economic development

Reviews and propose amendments in the existing laws

Training & rehabilitation services for economically and socially oppressed and vulnerable groups

Training and rehabilitation of the disabled persons

Mass education, motivation and advocacy campaigns and NGO development for poor community

Social and economic welfare of women

Coordination of women development effort and gender mainstreaming

Implementation of National Plan of Action through cash transfers and women development

Implementation of U.N. Conventions ratified by Government of Pakistan

Provision of social & monitory assistance programs for poor, disabled, widows, orphans, the

indignant, the destitute and the sick

Provision of professional, medical and financial assistance to patients and addicts and their

families through professional social workers, hospitals, Health Welfare Committees (Zakat),

Patients Welfare Societies (NGOs) and District BAIT-UL-MAAL Committees

Welfare and poverty alleviation of poor segments of the society

Although all the departments included in social protection sector are working, may be in different ways,

to provide social & financial protection to the poor segment of Pakistan but still reach only to small

proportion of the >50 million poor. Furthermore, the protection being provided, although very

important, seems to be insignificant to cope with the miseries of the poor. In addition to this, persistent

high inflation rate, price hikes, escalating population, and growing number of people under the poverty

lines are serious threat to the success the programmes of the social welfare & protection sector. The

support programmes, initiated in recent past like BISP or proposed to be initiated in near future like

Khidmat Card are right steps to reduce some of the miseries of the deprived segment of our population.

However, such activities need to be targeted for improving food security of the households and should

be linked with attainment of certain free services, like education, vaccination etc.

3.5.2 Potential role in nutrition improvement, engagement and role within the

multisectoral framework

One reason for importance of social protection department is that it tackles poverty and vulnerability

directly, so its impacts can be immediate and very effective in order to prevent malnutrition. The causal

framework of malnutrition clearly indicates the poverty as one of the significant underlying

determinants.

Social protection covers a wide range of instruments and objectives, covering both safety nets and so-

called ‘safety ropes’ (i.e., instruments that can enhance income generation and opportunities for the

poor and vulnerable). These can be seen in below figure

Social Protection at a Glance

Risk management

Crop and livestock insurance

Index-based weather insurance

Grain reserves/Precautionary

savings

Contributory social insurance

Income diversification

Destitution

Poverty Traps

Figure 3.9: Social Protection at a glance Source: adapted from de Janvry (pers. comm.)

3.5.3 Food Insecurity and Vulnerability

Food insecurity refers to both the inability to secure an adequate diet at present (i.e. hunger) and the

risk of being unable to do so in the future. People who are already poor & have less to pay for health

services are vulnerable to hunger and malnutrition because they lack the resources to meet their basic

needs on a daily basis (they face chronic food insecurity). They are also highly vulnerable to even small

shocks that will push them closer to destitution, starvation, even premature mortality. Timely and

appropriate social protection in response to poverty-related food insecurity is closely linked to address

malnutrition. People who are not poor, but now face the risk of future poverty are vulnerable to hunger

Income Gain

Safety ropes

Risk reduction

Food

pricestabilization

National grain

reserves

Trade policies

Inco

me,

Con

sum

pti

on

Poverty Line

Income generation

Asset creation

Human capital

formation

Employment

opportunities

Access to land

Input subsidies

Social assistance

Cash transfers

Food subsidies

School feeding

Supplementary feeding

Access to services ( SHI)

Scalable safety nets

Right to food approach

Twin-track approach

Conditional cash transfers

Productive safety nets

Public works programmes

if these risks materialize and they are inadequately protected. Vulnerability to food insecurity operates

at several levels – national, household and individual – and social protection responses are extremely

desired to play its role at each level. Current situation of food insecurity and vulnerability in province

highlights the less focused social protection.

A classification of food insecurity can be better understood from the Amartya Sen’s’entitlement

approach’, originally conceived as a tool for analyzing famines. This approach identifies four food

sources, that include production (what one grows), labor (what one works for), trade (what one buys),

and transfers (what one is given). And then this approach defines food insecurity as “when the sum of all

food derived from these four sources is inadequate to meet minimum consumption needs at the

individual, household or national level”.

The below table explains the role of the social sector in addressing different sources of insecurity.

3.5.4 Women Empowerment

Social protection efforts to generate employment and income and to protect households against the

manifestations of poverty and against household shocks (e.g. Serious illness and hospitalization), can be

particularly useful for addressing malnutrition, especially if interventions are targeted to women.

Studies have shown that additional income tends to be spent on food and on family health when

women are the recipients of the cash transfers, and that this increased spending, if the transfer is large

enough, and thus it can ultimately lead to a reduction in levels of malnutrition within the household.

The Pakistan Government’s Benazir Income Support Program (BISP) is an unconditional cash transfer

program that delivers Rs. 1,000 (US$11) to female beneficiaries in households with a monthly income

below Rs. 6,000. In 2010, about 7% of the country’s population was benefiting from the transfers. The

BISP also includes microcredit financial assistance, and is pilot testing, health and life insurance coverage

and vocational skills training in different parts of the country.

Figure 3.10: Food entitlement gaps & social protection instruments

3.5.5 Overall sectoral objectives

To alleviate the misery of poor people, especially targeting food insecure with severe to

moderate hunger, by protecting their health and providing cash benefits through various

initiatives (Zakat, Charity, BISP etc.)

3.5.6 Intervention Framework

3.5.6.1 Strategy 1: Strengthen social protection sector to scale-up nutrition-sensitive

interventions

Social protection sector is executing various responsibilities such as provision of income (cash)

or consumption (food), protection against livelihood risks, enhancement of the social status to

the socially excluded, marginalized and vulnerable community. Household food security

develops the perspective that leads to individuals access to adequate food as established in

international human rights law. The right to adequate food is realized when every man, woman

and child, alone or in community with others, has physical and economic access at all times to

adequate food or means for its procurement. The right to adequate food shall therefore not be

interpreted in a narrow or restrictive sense that equates it with a minimum package of calories,

proteins and other specific nutrients. The social protection sector has responsibilities to

perform such actions that may be beneficial for the scaling-up of nutrition-sensitive

input subsidies

crop & Livestock insurance

Production

public works program

LabourFood price stabilization

food subsidies

grain reserves

Trade

school feeding

conditional cash transfers

unconnditional cash transfers

Transfer

interventions and adequate access to food throughout the life-cycle. The best delivery of

services by social protection sector can be achieved only by strengthening the sector.

INTERVENTION MATRIX


Nature of

Intervention

Impact on

nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

Formulation and

implementation of

nutrition & gender

sensitive policies

and strategies of

social protection

sector

1.1 Establishment of Social

protection authority (Policy

level)

√ --

Scaling-up social

protection

sector will be

helpful in

economic

access as well as

various

nutrition-

sensitive

interventions

that ultimately

will help to

improve

nutrition

indicators

1.2 Prioritize the preparing the

existing policies/legislation of

Social Protection sectoral

more nutrition-responsive and

its effective implementation

(Policy level)

√ --

1.3 Develop nutrition specific

legislations about Zakat, Bait-

ul-Mall, and PVTC (policy

level)

√ --

1.4 Increase coordination

between federation and

federating units on nutrition-

sensitive social protection

(Policy level)

√ --

To create enabling

environment for

1.5 Develop and strengthen

linkage with LHWs, SH&NS, √ -- These strategic

actions will

mainstreaming

nutrition in sector &

improving multi-

Sectoral

coordination by

year 2015

teachers, local NGOs for

promoting social aspects of

addressing malnutrition

(Develop a mechanism of coordination

to effectively implement strategies)

(Implementation level)

improve the

coordinated

implementation

for multi-

sectoral

integrated

nutrition

strategy

through various

nutrition-

sensitive

interventions

that ultimately

will help to

improve

nutrition

indicators

1.6 Initiate screening through

School Health and Nutrition

Supervisors, response in

coordination with health

department to integrate

nutrition intervention with

women and children focused

approach (Implementation

level)

√ --

1.7 Mapping of districts through

impartial surveys, and

utilization of this data to

strengthen nutrition

interventions of social welfare

department (BISP data can be

used at this time)


√ --

1.8 Create linkages of livestock

department with BISPs

program “Wasela-e-Rozgar”

and upcoming new social

protection schemes to

support for ultra-poor

segment of the society by up-

scaling home based livestock

& Agriculture through

backyard poultry farming &

kitchen gardening


√ --

1.9 Advocacy with BISP for linking

BISP beneficiaries with √ --

“Kitchen gardening Scheme”


3.5.6.2 Strategy 2: Improving the economic access to address nutritional needs through

poverty alleviation and social protection

The access to safe and nutritious food is among basic human right. Currently, 963 million people are

malnourished and living in dire poverty across the world attributable to lack in economic access.

Nutrient deficiencies and insufficient economic access ultimately directs to unhealthy life of children and

burden on GDP. Food security through enhancing purchasing capacity (economic access) is definitely an

enormous challenge and it requires an integrated approach with the dedicated involvement of the

Governmental and civil society including NGOs, CBOs and development partners. Punjab although

produce three quarters of the food and feeds the other provinces as well yet food security in Punjab

(60%) is higher than national average (58%) of the country. It means the producers (poor farmers)

themselves have not access to the adequate food, and the compromised economic access to the food is

by far the most critical factor. Therefore, the NNS, 2011 data itself makes the case for improving the

economic access to food. The exercise should be targeted for comprehensive nutrition services to all of

the population especially targeting and prioritizing the first 1000+ days, preschoolers, kids in elementary

schools and adolescent female.

INTERVENTION MATRIX


Nature of


nutrition Nutrition

Sensitive

Nutrition

Specific

By 2015, introduce

cash transfer

system for

improving the

economic access to

adequate food to

meet minimum

nutritional needs

2.1 Link the cash transfer via

vouchers and assistance from

BISP with evident based

nutrition need (Implementation

level)

√ --

Economic

access to

health/ food

will ultimately

lead to an

improvement in

nutrition

indicators 2.2 Cash transfer amounts should be

linked to provincial food price √ --

indices so that real value remains

constant throughout the year

(Policy level)

2.3 Conduct research intervention to

assess the impact on improving

nutrition through cash transfer

scheme (BISP data could be

used), and implement impartial

program monitoring with third

party validation (Policy level)

√ --

By 2015, introduce

conditional cash

transfer (CCT)

policies with the

intention of

targeted approach

2.4 Introduce conditional cash

transfer (CCT) and make BISP or

any other such program

conditional for beneficiaries to

enroll their daughters in schools

(Policy level)

√ --

Economic

access to

health/ food

will ultimately

lead to an

improvement in

nutrition

indicators 2.5 Piloting of a conditional cash

transfer program using

vouchers and linked to the

utilization of health and nutrition

services by target population

groups, while being particularly

attentive to supply side

constraints which may be

encountered by these groups

(Policy level)

√ --

2.6 Targeted and conditional food

subsidies for poor instead of

generic subsidies and will be

linked with inflation rate by 2014

(Policy level)

√ --

3.5.6.3 Strategy 3: Promote nutrition awareness for healthy & safe dietary practices

Awareness regarding healthy & safe dietary practices can play a tremendous role in eradication of

malnutrition. Various recent reports revealed a significant inverse association between awareness and

nutritional deficiency indicators. Hunger and malnutrition affects huge segment of the population in

countries where education level is low. In relation to the manifestation of nutrition-related information-

seeking behaviors during whole life, the poor can be targeted to be exposed to nutrition information

from a variety of sources, including the family doctor. In many countries, variety of nutrition education

interventions and social marketing initiatives are being used by the Food Stamp Program to improve

food resource management, food safety, dietary quality, and food security for low-income households.

The policy should link comprehensive sequential nutrition education, access to nutritious meal,

promotion of child nutrition programs to reinforce positive health outcomes for all children in socially &

economically excluded population. Pregnancy-specific nutrition information for married couples

especially in poor (in Dar-ul-Amaans, PVT Centers, Sanat Zaars, Zakat councils) is equally important

because it is one of the few things that they can apply in their daily lives to protect the health of the

fetus.

INTERVENTION MATRIX

Strategy



nutrition Nutrition

Sensitive

Nutrition

Specific

To use Social

Protection

Sector platform

for promoting

nutrition

awareness for

healthy & safe

dietary

practices in

poorest

community of

Punjab

1.1 Seminars/ targeted

inclusion of nutrition

module in Sanat-Zars (1 day

- 1 week nutrition specific

trainings) (Implementation

level)

√ --

Access to

educational

materials and

awareness about

dietary practices

(especially

among females)

will ultimately

lead to uptake of

nutrition

indicators

1.2 Seminars/ targeted

inclusion of nutrition

module / workshops in

PVTC (1 week-15 days

nutrition module to Zakat

families)


√ --

1.3 Seminars/ workshops in

Rescue homes (Darul-Aman)


√ --

1.4 Enhance nutrition

awareness through

distributing IEC material

poorest 2,50,000 zakat

families of Punjab using

zakat committees (25,000)


√ --

3.6 AGRICULTURE

3.6.1 Crop Sector

3.6.1.1 Overview of the sector

The economy of Punjab, Pakistan is one that is largely based on agriculture and industry. Punjab is the

largest province of Pakistan in terms of population, and also has the largest and fastest growing

economy in the country compared to other provinces and administrative units.

Agriculture is backbone of Pakistan's economy. It accounts for 21% of the GDP and with addition to

agro-based products, it almost fetches 80% of the country’s total export earnings. More than 45% of the

labour force is engaged in this sector.

The Province of Punjab covers 29% of the total reported, 57% of the total cultivated and 69% of the total

cropped area of Pakistan. And this way Punjab contributes a major share in the agricultural economy of

the country by providing about 83% of cotton, 80% of wheat, 97% fine aromatic rice, 63% of sugarcane

and 51% of maize to the national food production. Among fruits, mango accounts for 66%, citrus more

than 95%, guava 82% and dates 34% of total national production of these fruits18.

During 2012-13, agriculture sector exhibited a growth of 3.3 percent against growth of 3.5% of last

year19, on the back of positive growth in agriculture related sub sectors, Crops grew at 3.2 percent,

Livestock 3.7 percent, Forestry 0.1 percent and Fishing 0.7 percent. The agriculture subsector

component which includes important crops, other crops, grew by 2.3 percent and 6.7 percent,

respectively except cotton ginning that declined 2.9 percent. Important crops accounted for 25.2

18 Economic survey of Pakistan 2013 19 Economic survey of Pakistan 2013

percent of agricultural value added and has experienced a growth of 2.3 percent in fiscal year 2012-13

against growth of 7.4 percent in 2011-12.

The per capita food intake has increased from 2410 calories daily in 2011-12 to 2450 calories in 2012-13.

The per capita protein availability has also increased from 71.5grams per day in 2011-12 to 72.5 grams in

2012-13.

3.6.1.1.1 Live Stock & Diary Development

Livestock is an important sub sector of agriculture, which accounts for 55.44 percent of agriculture value

addition. Its share in GDP is 11.9 percent. This sub-sector is highly labor intensive. It has also emerged as

a major source of income for the small farmers as well as the landless rural poor. Livestock has recorded

a growth of 3.7 percent against the growth of 3.9 percent last year.

Livestock plays an important role in poverty reduction in the rural areas of Punjab, actively involves the

participation of women, and has been identified as a priority investment area by the provincial

government.

3.6.1.1.2 The Fisheries

The fisheries sub sector of agriculture, having 2.05 percent share in agriculture recorded a growth of 0.7

percent against the growth of 3.8 percent last year. The development of the fishery sector also will have

an impact on poverty reduction and the availability of nutritious food.

3.6.1.2 Contribution in GDP, Poverty Alleviation, Women empowerment- Workforce

Agriculture share towards national income shows steady decline in previous years, currently it accounts

for just over a fifth of the GDP, and still it continues to employ 45% of the total work force.

Year Agriculture in GDP % Labour force in Agriculture %

1995-1996 26.1% 46.8%

1999-2000 25.9% 48.4%

2003-2004 22.9% 43.7%

2007-2008 21.3% 44.7%

2010-2011 21.2% 44.9%

Source: Economic Survey of Pakistan

A comparison of overall economic growth rate with the rate of growth in agriculture shows that

agriculture has grown slowly compared with the GDP. Agricultural growth rates declined in all periods

since the 1980s except for the last five years which witnessed a minor improvement over the previous

half decade. The gap between agricultural and GDP growth rates was particularly high between 2000

and 2005 which was a period of relatively high GDP growth – agriculture recorded its lowest growth in

the said period.

3.6.1.3 Potential role in nutrition improvement

Agriculture department is critically important in alleviating all forms of malnutrition due to their impact

on diversity of output, impact on food prices (levels, relative prices, fluctuations, and spatial variation)

and levels of incomes. The food and agriculture sector therefore has a major role to play towards

improvement of nutritional status of the province. NNS shows wealth has an important link with

nutrition, but the presence of malnourished children, even in high-income groups indicates that

nutritional outcomes are more complex than a household’s economic status.

With agriculture being the source of income and livelihood for 70 to 80% of people suffering from

hunger in developing countries, it is clear that sustainable reductions in poverty, food insecurity and

under nutrition cannot be obtained without special attention to the development of the agriculture

sector in these countries. Focusing on the distinctive relationship between agriculture, food and

nutrition, Govt. needs to focus, to protect, promote and improve food-based systems to ensure

sustainable food and nutrition security, improve diets, combat micronutrient deficiencies, and raise

levels of nutrition, and in so doing, achieve the nutrition-related Millennium Development Goals

(MDGs).

Not only are there high levels of malnutrition and micronutrient deficiency in Punjab but there has been

a lack of improvement in nutritional outcomes in last decade. Nutritional outcomes are correlated with

income and food consumption, but also depend on a range of other factors such as health, disease and

water and sanitation conditions. The results of the latest nutrition survey, which showed no

improvement in nutrition indicators, have highlighted the urgency of making nutrition improvement an

important agenda in future social policy planning in Pakistan & Punjab.

3.6.1.2.1 Casual Pathway of Malnutrition and the Agriculture Sector

It is important to understand the casual pathway of malnutrition in order to identify its linkages with

different sectors. As shown in figure malnutrition is lined with house hold food insecurity and this way

Agriculture sector can play an important role.

3.6.1.3 Food Security Resources

Food security is one of the contributors of under nutrition; however, addressing food security alone, as

seen from the experience of many countries, is not enough to improve under nutrition. The Rome

Declaration on World Food Security in 1996 defined “food security as a situation where all people at all

times, have physical and economic access to sufficient, safe and nutritious foods to meet their dietary

needs in accordance with their food preferences for an active and healthy life”. Overall, 58% of Pakistan

is food-insecure; with Punjab has 60% food insecurity – despite being labeled as the food basket of

Pakistan.

Figure 3.11: Food Security Situation -Punjab20

Food security in Pakistan is inter-dependent on local food production, the extent to which local farmers

own the land and the produce grown, food inflation, and consumption of food by women and children.

Agriculture, although a key sector of the national economy (one-fifth of the net GDP), has been

experiencing stagnation. Punjab is the main food-producing province; however, surplus food-producing

districts in Punjab have decreased from 21 to 14. (SDPI, 2009). More importantly, in Punjab where

20 NNS 2011

40.5

32.2

18.5

8.8

Food Security in Punjab

Food Secure

Food Insecure Without Hunger

Food Insecure With HungerModerate

Food Insecure With HungerSevere

agriculture is vibrant, its benefits are not being translated into nutrition unless emphasis is given to

what is grown and its capture by the local population. Emphasis within agriculture in all provinces

remains on cash crops, which have higher income gains than kitchen farming. Although kitchen farming

has lower income gains, it directly benefits food-insecure households. Agriculture policies have tended

to be dominated by economists with agriculture interpreted in terms of economic growth and GDP

contribution rather than adoption of a development vision focusing on equitable distribution of

benefits. This has resulted in cash crop policies and the state focusing on wheat rather than crop

diversification and political, economic, and technical support is required to small farmers for land

cultivation and crop diversification.

Power structures are of critical importance in terms of who owns the farming land and in deciding what

is grown and the capture by the local households. There is highly inequitable ownership of land, with

only 44 per cent of the rural population in Pakistan owning land and the majority being landless,

dependent for work, food, and shelter on large landholders, and often trapped into cycles of debt and

poverty. With predominance of large landholdings, there tends to be cultivation of economically

productive cash crops of direct cash benefit to landholders rather than kitchen gardening and small

livestock of nutritional benefit to the local populace. Moreover, the Haari’s working at the farms have

no rights over the food grown, leading to little capture of agriculture into food consumption. Poverty

is highest in populations lacking land ownership and drops by at least ten percentage points with

ownership of land.21

Whilst Punjab has the lowest absolute figure of landlessness, there are high pockets in Southern Punjab.

Food security has also been affected by steep inflation during 2008–2012, and worst of its nature in

2013, affecting even essential food commodities.The amount spent on food is 53.86 per cent of

income22, which is comparatively much higher than 30 per cent spending on food in India23 and 10 per

cent in the developed economy of the USA24. Nationally, the poorest households spend around 58.75

per cent of their income on food, compared to 39.5 per cent, showing regressive impact of inflation.

21 PIDE 2001

22 SPDC 2004

23 Banerjee &Duflo 2007

24 USDA 2005

With stretched food budgets, the poor are unable to absorb the effects of increases, leading to a diet

with less nutritious foods or foregoing of meals.

Table 3.2: Food security resources and poverty in Pakistani provinces, 2009 – 2011

Food Security or Poverty Status

Sindh Punjab KPK Baluchistan Pakistan

Agriculturally

productive land² 27.3 83.0 16.5 3.0 30.0

Poverty incidence³ 31.0 26.0 29.0 48.0 33.0

Rural areas 38 24 27 51 35

Small towns 40 43 41 44 30

Poverty incidence ³

- No land ownership

- Land ownership

41.3

20.9

26.0

12.3

32.0

19.5

52.5

42.6

31.8

17.9

It indicates that poverty is less as compared to other provinces and better than national average.

Nevertheless the poverty is more in small town as compared to rural area. This area needs more

nutrition specific and sensitive interventions.

3.6.1.3.1 Food Diversity and caloric Intake situation

Studies and survey shows close linkage between caloric intake& food diversity with stunting and under

nutrition. Presence of malnourished children and women in food secure house hold clearly indicates

poor eating practices and lack of awareness regarding importance of food diversity and required caloric

intake.

MICS 2011 revealed Punjab situation showing highest stunting in southern districts of Punjab, Khanewal,

R.Y.Khan, Bahawalpur, and Bahawalnagar, Muzaffargarh & Rajanpur, the crop harvesting data from

same districts clears the picture by showing that most of these districts show increased production of

cash crops rather nutritious/or food crops during the previous years

3.6.1.4 Overall sectoral objectives

To improve Access of the most disadvantaged population to Nutritious foods

3.6.1.4.1 Nutrition specific objectives


Enhance productivity of grains and pulses

Address malnutrition through bio fortification


Create awareness on importance of food diversification and healthy dietary practices

To prioritize development of zinc rich wheat variety

Empowering Women labor involved in Agriculture sector

3.6.1.5 Intervention framework

3.6.1.5.1 Strategy 1: Mainstreaming Nutrition in Agriculture

Punjab Government is contemplating to develop its Agricultural policy on the wake of devolution;

hence, there is an opportunity to make it more inter-sectoral, nutrition sensitive, gender sensitive and

pro-poor. The policy should focus on open the doors for small farmers to have access to latest

machinery on installment and subsidized cost. Agriculture and food security is a vital component of

Government planning documents and strategy papers i.e. “Vision 2030”, the Medium-Term

Development Framework 2005-2010, and the Poverty Reduction Strategy Paper II (PRSP-II).

The nutrition may be mainstreamed in Agriculture Sector by captivating given policy decisions.

INTERVENTION MATRIX


Nature of


Nutrition

Nu

trit

ion

sen

siti

ve

Nu

trit

ion

spec

ific

To develop Policy

frame work to

create enabling

environment for

mainstreaming

1.1 Develop and promulgate

Provincial Nutrition sensitive

Agriculture Policy

√ -- Access to food

throughout the

year will

improve the

food security 1.2 Policy decision to add nutrition

in IEC material of the √ --

Nutrition in Sector

& improving

multi-Sectoral

coordination by

year 2015

agriculture sector situation and

ultimately

reduce the

malnutrition

burden

1.3 Develop Gender Sensitive and

pro poor Provincial Food

Security Strategy

√ --


BISP beneficiaries with “Kitchen

gardening Scheme”

√ --

1.5 Policy to encourage increasing

of female agriculture extension

officer and field assistant

√ --

1.6 Enforcement of strict regulatory

measures to control the sale of

uncertified seeds, harmful

pesticides and medicine with

adverse effect on human health

√ --

It may have

effect on food

security at

household level

and may lead to

improve in food

consumption 1.7 Shifting from traditional

agriculture to value added

Agriculture and promotion of

semi-urban/ house hold

agriculture / kitchen gardening

through provision of quality

seed on subsidized rate and

technical support at the

doorstep

√ --

To build capacity

of implementing

staff at district and

UC level on

nutrition manual

by 2016

1.8 Conduct training of district and

UC level staff √ --

It may have

impact on the

life of women

working in

agriculture

sector, More

than 45%

women force is

engaged here,

change in

behavior of

child care giver

has directly

1.9 Conduct training of farmers √ --

1.10 Create awareness

among farmers on use of

nutritious food, healthy dietary

habits, hygiene and health √ --

effect on Child

Nutrition.

3.6.1.5.2 Strategy 2: Increase Productivity in nutritious food (by developing and promoting high

yielding varieties of grains & pulses)

Background/Rationale:

The objectives of Agriculture Sector are to provide food security to the community targeting especially

poor and vulnerable, women, and children. The availability of pulses particularly lentil, the moon and

mash is low as compared to the consumption at National & Provincial level and prices of pulses are also

high and are becoming out of reach of the segment of the community that needs to buy pulses as

alternate expensive source of protein, i.e. meat and fish. The focus will be to promote cultivation of

pulses to make the country and province self-sufficient in the production of affordable sources of these

nutrient rich commodities.

Pulses (Lentil, Gram, Moong and Mash) are a rich source of protein obtained from plants (Bio source).

They are sown on about five percent of the country’s total cultivated area. The area and production

under these pulses in 2012-13 in Pakistan was around 2.89 million acres and 0.863 million tons

respectively. This production has been declining over the years in all provinces including Punjab.

The National Level area, production, and consumption of pulses i.e. Moong, Mash, Gram & Lentil during

2011-12 & 2012-13 is as under:

Table 3.3: Area & Production of Pulses 2011-2012 and 2012-201325

25 Agriculture department Punjab PC1

Punjab 2011-12 2012-13

Area

(000 ha)

Production

(000 tons)

Area

(000 ha)

Production

(000 tons)

Mung 119.6 80.7 116.8 78.5

Mash 19.5 6.4 17.9 6.1

Gram 920.1 224.7 908.1 691

Lentil (Masoor) 12.7 5.1 12.4 5.4

Reasons of declining trend of area and production of Pulses

i. Reduction in cultivated area of Moong, Mash and Lentil is ascribed to crop substitution by

Cotton and other cash crops.

ii. The reason of intermittent production figures are attributed to moisture and adversaries of

frost during Gram growth period.

Table 3.4: National Production, consumption & gap of major pulses 2012-201326

Crop

Production (Tons) Consumption (Tons) Gap (Tons)

Punjab National Punjab National Punjab National

Moong 78000 90000 65900 110000 12100 -20000

Mash 6050 10900 29990 50000 -23943 -39100

Lentil 5420 10800 33060 55000 -27640 -44200

Gram 691000 751000 414000 600000 277000 151000

The above table shows that there is a big gap between production and consumption. There is a dire

need to take new initiatives for enhancement of production.

26 Agriculture department Punjab PC1

The below given strategic actions may be taken to increase the production of high yield variety of

pulses.

INTERVENTION MATRIX


Nature of


nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

To develop,

promote and

increase the

production of high

yield varieties of

pulses

2.1 Development of pre-

basic/basic seed of high

yielding varieties of pulses

√ -- Will be help full

to address the

protein energy

malnutrition as

well as increase

the food security

2.2 Promotion of certified seed by

distribution among farmers at

subsidized prices and

demonstration of modern

production technology and

farmer gatherings

√ --

2.3 Capacity building and training

of farmers √ --

2.4 Distribution of Seed to

Farmers √ --

2.5 Awareness (Mass media

campaign, Farmer days,

Seminars)

√ --

2.6 Advocacy for correct

processing √ --

3.6.1.5.3 Strategy 3: Equitable access to vegetables and fruits


Vegetables play a vital role in our diets, as these support the normal functioning of the different body

systemsby providing vitamins, minerals, fiber, essential oils and phytonutrients. While eating cooked

vegetables is healthy, in certain instances it is advantageous to eat raw vegetables. This is because

cooking process destroys essential nutrients such as vitamin C and also kills vital enzymes that help

human body to digest such foods. Therefore, the medical researchers and nutritionists insist on

increasing the share of vegetable intake in daily diet. However, per capita consumption of vegetables in

Pakistan is very low i.e. 46kg/annum against the minimum requirement of 73 kg/annum. Quite recently,

the increased trend in production of high quality vegetables has been realized. There is a need to boost

the vegetable production to extend its availability by providing latest technology for vegetable crops.

Vegetable seed production is also an important concern as Pakistan is importing major portion of the

vegetable seeds.

It is proposed to enhance vegetable production in urban, semi urban & rural areas through

diversification of high value vegetable crops in the province. It is a fact that this sub-sector has not been

given due importance in the past, as a result of which we could not exploit it’s potential to cope with the

growing demand (quantity and quality) of vegetables in the domestic as well as international markets.

The increased cultivation/production of vegetables would not only meet the increasing demand of the

population of Punjab province on one hand and fetch its share in addressing malnutrition.

The production of vegetables i.e. tomato, onion, chilies , and garlic is low due to sowing of traditional ,

low yielding varieties, use of poor quality seed, inadequate use of hybrid seeds, weed infestation,

imbalance use of fertilizer, improper management of insect / pest & diseases, post-harvest losses and

inefficient marketing system. Therefore, production of vegetables, especially tomato, onion, garlic,

potato and chilies is not coping with the domestic demand of the increasing population and also has

declining trend which resultantly inflating the prices of these commodities for the consumers.

INTERVENTION MATRIX


Nature of


nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

To Develop,

promote and

increase

production of

vegetables

(Vitamins and

3.1 Development &Provision of

Good Quality Seed and

Seedlings

√ --

Will be help full to

fill the gap of

micronutrient as

well as energy

nutritional

insecurity 3.2 Promotion of certified seed by √ --

mineral sources) distribution among farmers at

subsidized prices and

demonstration of modern

production technology and

farmer gatherings

3.3 Capacity building and training

of farmers √ --


Farmers √ --



Seminars)

√ --

3.6 Advocacy for correct

processing √ --

3.7 Promotion of quality

certification as per

international standards

√

3.6.1.5.4 Strategy 4: Addressing Malnutrition through bio-fortification

Background/Rationale: Zinc is one of the essential trace elements and, as such, a member of one of the

major subgroups of the micronutrients that have attained such prominence in human nutrition and

health. Two billion people worldwide are not getting enough zinc through their diets. Zinc deficiency is a

major health problem in developing countries, especially among young children. Zinc deficiency

weakens their immune system and leaves them vulnerable to conditions such as diarrhea, pneumonia

and malaria. Zinc deficiency is also accountable for impairing physical and intellectual development,

preventing children from reaching their full potential. UNICEF estimates that diarrhea accounts for

nearly two million deaths in children every year. Diarrhea is preventable and treatable, but in developing

countries, only 35% of children with diarrhea receive the recommended treatment of oral rehydration

salts and zinc supplements. NNS 2011 reveal 39.2% zinc deficiency in Pakistan zinc deficiency at 38.4% in

Punjab.

INTERVENTION MATRIX

Strategy


Nature of


nutrition Nutrition

Sensitive

Nutrition

Specific

To develop zinc

fortified wheat

variety to reduce

zinc deficiency

4.1 Development &Production

of zinc enrich wheat seed √ --

Will be help full to

fill the gap of

micronutrient.

4.2 Promotion of certified seed

by distribution among

farmers at subsidized prices

and demonstration of

modern production

technology and farmer

gatherings

√ --

4.3 Capacity building and

training of farmers √ --


Farmers √ --



Seminars)

√ --

3.6.1.5.5 Strategy 5: Scaling up of Kitchen gardening


Kitchen gardening is a globally proven cost effective strategy to increase accessibility of vegetables and

fruits. The agriculture department launched kitchen gardening project in 2011. Although, the project

gained limited popularity among the dwellers of urban, semi urban and rural areas due to unavailability

of good quality seed and compromised capacity. Kitchen gardening program in Punjab needs to be

converted into movement by involving all stakeholders working and concerned with vegetable business

to produce healthy and nutritious vegetables at big lawns, houses, abandoned places, containers,

fences, trellis. Scalability of seed provision for kitchen gardening project with immediate increase in

number of seed packets from 100,000 to 450,000 per year along with increasing the seed types and

quality of seed in packets.

INTERVENTION MATRIX


Nature of


nutrition N

utr

itio

n

Sen

siti

ve

Nu

trit

ion

Spec

ific

To Increase

availability of

micronutrient rich

food especially for

poor and

vulnerable

community

5.1 Promotion of kitchen

gardening √ --

Will be help full

to fill the gap of

micronutrient.

5.2 Provision of quality seed at

subsidized rates √ --

5.3 Hands on training of

households on kitchen

gardening

√ --

5.4 Development and promotion

of micronutrient rich varities

of seeds for farmers

√

5.5 Mainstreaming the research

for bio fortified foods with

micronutrients

√

5.6 Capacity building of farmers

on bio fortification techniques √

3.6.1.5.6 Strategy 6: Increase accessibility of animal protein sources at household level


It is evident that at present poor segment of the society as neither access nor have the capacity to

access protein rich animal foods. The home based poultry and raring of livestock is the way to increase

access of poor segment to nutritious food. The livestock department may create linkages with BISPs

program “Wasela-e-Rozgar” and upcoming new social protection schemes to support for ultra-poor

segment of the society by up-scaling home based livestock and backyard kitchen farming. This will help

the poor to have access the more sources of protein and enhance household income.

INTERVENTION MATRIX


Nature of


nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

Up-scale

household

livestock

production to

increase the

access to protein

rich foods

6.1 Promote backyard poultry

farming by provision of

subsidized layer chicken with

cock to eligible families

(women)

√ --

Increase in access

of protein

sources/

consumption

protein and

enhance 6.2 Provision of small cattle of

excellence genetic profile on

subsidized rate for raring and

future reproductive growth

√ --

6.3 Livestock department will

provide free of services,

technical support, vaccination,

and veterinary medical

services

√ --

3.6.2 LIVESTOCK AND DAIRY SECTOR

3.6.2.1 Overview of the Sector

Livestock & Dairy Development Department was established in 1973 in Punjab. Livestock and Dairy

sector is continuously achieving value attributable to imperative role in national economic uplift, food

security, rural development, poverty alleviation, employment generation, and foreign exchange

earnings. Livestock & Dairy sector also play significant part in Pakistan’s economy and contributes about

11.9 percent in the GDP of Pakistan. This sector is considered a net source of invariable income for rural

and middle grade agri-business holders. Livestock sector contributed about 55.4 percent in year 2012-

13.

Livestock works as a buffer between the small farmers economy and disaster. Small animals, particularly

sheep, goat and poultry and their products (milk, meat and eggs), are consumed by farmers themselves

that enrich their regular diets with high quality protein (with high BV) and fulfill the need of essential

amino acids. Livestock and dairy resources are similarly ubiquitous in poor communities across the

world. According to estimation, poor rural households keep two thirds of resource in the form of various

types of livestock. Similar information for poor urban households is scarce, but a recent survey found

that more than one-half of all urban households were keeping livestock; the highest rates were found in

the most densely populated, lower-income areas.

The livestock-keeping systems practiced by the poor have produced per animal or land unit well below

those in the industrialized countries. There are many reasons for this pattern of lower productivity.

Smallholder management systems are typically low or no input, letting animals forage for themselves,

feeding on plants or waste that otherwise would not be used. In many cases, relative prices of feed and

livestock products provide insufficient incentives to use purchased inputs to develop intensive

production systems (e.g., milk to feed price ratios of 1:1) The poor often keep a mix of different species,

trading off specialization for better protection against risks.

Livestock systems of the poor reflect the resource constraints that they face (e.g., financial,

access to information and services, and landlessness), as well as their varied reasons for keeping

livestock, which include the following:

Producing Food

Generating Income

Providing Manure

Producing Power

Serving as Financial Instruments

Enhancing Social Status

3.6.2.2 Livestock & Diary and Nutrition Connect

In spite of recent growth in consumption, many people have not equitable access to animal-

based foods that are believed as complete, nutrient-dense, and important for the high quality protein

and bio-available micronutrients sources, particularly for children and pregnant and lactating women.

Animal-based foods are also imperative source for improving the nutritional status of low-income

households. Livestock products like meat, milk and eggs provide proteins with high biological value as

well as bio-available micro-nutrients such as iron, zinc, vitamin A, vitamin B12 and calcium that are

critically the base of major malnutrition ailments. International dietary guidelines on levels of energy

and protein consumption do not distinguish between plant and animal sources. They suggest that the

intake of energy needed by an adult in a day varies from 1680 to 1990 kilocalories (kcals) in total,

depending on the country. They also suggest that the safe level of protein consumption is about 58 g per

adult per day 27.

3.6.2.3 Nutrition sepecific objectives of sector:

Poverty alleviation by supporting livestock subsistence farmers & women organize, empower &

hand hold

Productivity enhancement through improved genetics, balanced nutrition & careful husbandry

Better functioning markets and regulatory regime

Private enterprise development to optimally realize potential of livestock assets

Provision of quality products (dairy & meat) for domestic consumers & export market apply

research & technology

3.6.2.4 Intervention Frame work

3.6.2.4.1 Strategy 1: Increase the productivity by sustainable livestock farming and capacity

development to combat protein energy malnutrition

Rationale/Background: Growing world population and increasing threat of protein deficiency are

strategic concerns that are encouraging more struggles to raise food production along with sustainable

livestock farming that upsurge the productivity of meat (protein) markets and secure the vulnerable

community from protein deficiency (hidden hunger). The World Bank reported that the demand of meat

would increase to 85% by 2030 (World-Bank, 2008b). Application of technology and engineering can

leads to sustainable livestock production, as well as it also can improve the conversion of feed to meat

that ultimately reduce the cereal consumption for feed, increase production of meat, decrease in price

due to availability. All outcome aspects go in the favor of an approach to reduce the consequences of

hunger (Zhou, Zhang, & Xu, 2012).

Intervention Matrix

27 WHO, FAO,UNU,2007


Nature of


nutrition Nutrition

Sensitive

Nutrition

Specific

To increase the gross annual meat production from 3,379,000 tons in 2013 to 5,000,000 tons as well as gross milk production from 49,512,000 tons in 2013 to 80,000,000 tons by the end of 2020 (according to Economic Survey of Pakistan)

1.1 Enhance livestock production through adaptation of latest technology (biotechnology & genetic engineering, improved reproductive technologies, precision animal breeding) and breed improvement (implementation & policy level)

√ --

Increase in meat

production will

surely increase

the access to

protein source

that ultimately

reduce the

burden of Protein

Energy

Malnutrition.

Increase in

production will

also be helpful to

improve the food

security situation

and family

income of poor

farmers.

1.2 Promote and provide various livestock animals of excellence genetic profile on subsidized rate for raring and rapid reproductive growth (implementation & policy level)

√ --

1.3 Strengthen the provision of cost effective and safe livestock (cattle & poultry) feed (implementation level)

√ --

1.4 Promote the latest embryo transfer technology and provide semen’s injections of excellence genetic profile animals at free of cost/subsidized cost (implementation & policy level)

√ --

1.5 Increase the number of dairy farms and milch animals (2-5% annually) from the existing in 2012-2013 (implementation level)

√ --

1.6 Skills enhancement of livestock sector’s individuals (staff & farmers) by conducting trainings at UC and districts level (implementation level)

Strengthen

veterinary medical

and diagnostic lab

facilities by 2020

to control and

reduce the risk of

outbreak

1.7 Up-gradation of the existing lab

facilities for proper diagnosis &

safety testing of feeds and food

(milk & meat) in regions, where

the labs are already present but

are with limited capacity or non-

operational (implementation &

policy level)

√ --

Proper and in-

time diagnosis of

livestock animal

will ultimately

increase the

livestock

production

1.8 Establishing new livestock

diagnostic lab facilities in regions

where there is need but there are

no labs (implementation & policy

level)

√ --

1.9 Provide various services at free of

cost (technical support,

vaccination, and veterinary

medical services) to control and

reduce the risk of outbreak

(implementation & policy level)

√ --

3.6.2.4.2 Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access

to livestock-based products

Rationale/Background

Malnutrition are only social and moral problems that embarrass to our global society but also induce

considerable economic cost comprising reduced lifetime productivity, expanding poverty, slow

economic development and resource deprivation (FAO, 2012). Vulnerable community (chronically

hungry and malnourished people) required immediate assistance to rescue and polices making as well

as implementation to prevent the community from hunger and nutrient deficiency in future. However,

most of the world’s vulnerable communities facing hunger by some means rely on agriculture and

related fields like fisheries, livestock, dairy and forestry for the survival of life. Accordingly, due to this

reason upgrading agricultural and food systems are critical for the advancement of vulnerable people

encountering malnutrition. Accordingly, it can be expected that hidden huger (along with its

consequences) can be managed or prevented by applying technological and engineering applications

principally in two fields viz. Agricultural & livestock (production of food) and food systems (food supply

chain) (Premanandh, 2011; FAO, 2012).

Intervention Matrix


Nature of


nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

To increase the gross annual milk consumption from 39,945,000 tons in 2013 to 80,000,000 tons as well as gross eggs consumption from 13,813 million in 2013 to 20,000 million by the end of 2020 (according to Economic Survey of Pakistan)

2.1 Increase the awareness of livestock-based protein sources (meat, milk and egg) importance and its consumption through literature, extension services, mass media campaigns and education (implementation level)

√ --

Easily access to animal based protein sources will ultimately reduce the burden of hidden hunger

2.2 Introduce and promote the value added livestock-based (meat, milk and egg) products especially at school level (implementation level)

√ --

2.3 Promote the consumption of egg and poultry meat (5% annually from existing in 2012-2013) so that poor families may also consumed protein with high biological value at very low price (implementation level)

√ --

2.4 Promote the consumption of milk and milk product (5% annually from existing in 2012-2013) to reduce the risk of various essential nutrients deficiency (implementation level)

√ --

Introduce and

promote various

livestock-based

products by non-

conventional

indigenous

resources as value

addition especially

2.5 Promote the consumption of camel milk and its product to uplift the economic situation of community in desert area and also to reduce the nutrient deficiency (implementation level)

√ --

Introduction of

non-conventional

resources will

increase the

access to protein,

uplift economic

situation, and will

ultimately reduce

2.6 Introduce various milk products (like cheese, whey protein, casein, ice cream, chocolates, bioactive peptides etc.) especially from

√ --

in vulnerable

community to

reduce nutrient

deficiency by 2017

camel milk as value addition (implementation level)

the burden of

Protein Energy

Malnutrition. 2.7 Launch various research project and strengthen/scaling up the existing ones to develop various value added products from non-conventional indigenous resources (implementation level)

√ --

To ensure and

improve safe as

well as quality of

livestock products

from farm to fork

by 2020

2.8 Enhance the quality of the livestock-based products (meat, egg, milk etc.) by introducing the modern and safe processing techniques, and supply chain (cold storage, good transportation etc.) (implementation level)

√ --

Easily access to

safe animal based

protein sources

will ultimately

reduce the

burden of hidden

hunger 2.9 Increase availability of quality of livestock-based products (meat, egg, milk etc.) in local markets and develop the mechanism to control the increases in prices (policy level)

√ --

2.10 Mandatory Safety/Management Certification of large livestock farms in five years, medium size in 10 years, and all livestock farms in 15 years

√ --

2.11 Continuous professional development, capacity enhancement, trainings and awareness campaigns for all involved in food supply chain starting from producers to consumer desk

√ --

3.6.2.4.3 Strategy 3: Increase accessibility of animal protein sources at household level especially

for vulnerable community


It is evident that at the present poor segment of the society as neither access nor have the capacity to

access protein rich animal foods. The home based poultry and raring of livestock is the way to increase

access of poor segment to nutritious food. The livestock department may create linkages with BISPs

program “Wasela-e-Rozgar” and upcoming new social protection schemes to support for ultra-poor

segment of the society by up-scaling home based livestock and backyard kitchen farming. This will help

the poor to have access the more sources of protein and enhance household income.

INTERVENTION MATRIX


Nature of


nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

Up-scale

household

livestock

production to

increase the

access to protein

rich foods

3.1 Promote backyard poultry farming by provision of subsidized layer chicken with cock to eligible families (women) (Implementation level)

√ --

Increase in access of protein sources/ consumption of protein increases that ultimately reduce the protein energy malnutrition

3.2 Provision of small cattle of excellence genetic profile on subsidized rate for raring and future reproductive growth (Implementation level)

√ --

To create enabling

environment for

mainstreaming

Nutrition in Sector

& improving multi-

Sectoral

coordination by

year 2015

3.3 Create linkages of livestock department with BISPs program “Wasela-e-Rozgar” and upcoming new social protection schemes to support for ultra-poor segment of the society by up-scaling home based livestock and backyard kitchen farming (Implementation level)

√ --

3.6.3 FISHERIES AND AQUACULTURE SECTOR

3.6.3.1 Overview of the Sector

The fisheries sector contributes about 1% to the GDP of Pakistan. According to FAO statistics, the total

fish production in Pakistan was about 594,935 tons in 2011 out of total fish production53,000 tons

came from capture fisheries and 141,935 tons were produced from aquaculture. However, Pakistan also

exported fish to USA, Japan, Sri Lanka, Singapore, the EU and the Gulf States and the total value of

commodity trade and production for the period 2008-2009 was registered at US$ 231million (FAO

Statistics, 2014).This sector also has an opportunity of employment to a substantial segment of

population. Growing population of Pakistan (2.2 percent growth rate/year, 2002-03) with inadequate

sources of protein demands the utilization of all available resources to improve the availability and

consumption of protein (per capita). According to FAO/WHO report, adult protein intake per day should

not below than one-gram protein/kg of body weight.

According to nutrition perspective, fish is a good source of many vital nutrients (micro- and macro-

nutrients) especially a source of protein with high biological value (BV) similar to that of land animals.

However, fish consumption in Pakistan is not much satisfactory as a meager increase in per capita fish

consumption (from 1.0 kg in 1961 to 2.3 kg/annum in 2010) was observed. On the other hand, world’s

average fish consumption increased from 9.0 kg to 16.3 kg/annum over the same period (FAO, 2005).

The statistics clarify the facts that although fish consumption is important, but trends in Pakistan is not

satisfactory. Total fish production from rivers/streams are estimated to be 3,102,408, canals, drains &

abandoned canals 346,803, Lakes127,109, Dams/ reservoirs195,670, waterlogged areas 3031600,

deltaic area 700000, flood water area 1000000, and Fish farms 60230 (DOF, GOP&WWF-Pakistan).

Table 3.5: Table Protein Quality Comparison of Fish Protein with other animal Proteins28

Sou

rce

Bio

logi

cal

Val

ue

(%)

Net

Pro

tein

Uti

lizat

ion

(%)

Dig

esti

bili

ty

(%)

Pro

tein

Effi

cien

cy

Rat

io

Pro

tein

Gai

n/1

00

gram

s

pro

tein

con

sum

ed

Fish 96.0 80.0 85.0 3.55 77.0

Beef 74.0 68.0 99.0 2.30 13 (cattle)

Chicken 74.0 71.0 85.0 - 18.0

Fisheries and Aquaculture sector have greater business potential and can exert beneficial impact on

GDPs of a country. In Pakistan, the fish fauna is rich, but only seven warm water species and two cold

water species are cultivated on a commercial scale. It is very unfortunate that recent efforts in shrimp

culture production in the Indus delta region did not succeed due to the unavailability of good quality

hatchery-produced seed. Although, freshwater carp farming is carried out on a large scale in Punjab,

Sindh and K.P.K. However, efforts are required to improve the potential of northern area of Pakistan for

trout culture. Aquaculture in Pakistan is controlled by provincial government headed by the Director

General. The office of the FDC is responsible for policy, planning and coordination with provincial

fisheries departments. Besides FDC, Pakistan Agriculture Research Council (PARC) and Asian

28 Khan (1986), Progressive Farming, Volume 6, No. 5 (Sep/Oct) 1986. Pakistan Agricultural Research Council,

Islamabad.

Development Bank (ADB) continually assisted in strengthening the development of hatcheries and

juvenile production, model farms, transfer of technology, human resource development, as well as the

strengthening of extension services.

Table 3.6: Aquaculture practices

Place No. Hatchery Area

Punjab 88

Sindh 5 Thatta, Mirpur Sacro&Sukkar

KPK 38

Since 1998, overall fish production has decreased by nearly 2 percent per year. Although this downward

trend may be attributed mainly to the marine capture sector, inland freshwater resources of NWFP,

Northern Areas, and Baluchistan are exploited below potential, with low productivity and high poverty

levels encountered amongst inland fishing communities. Despite its endowment in natural resources,

Pakistan ranks 28th among fishing nations in terms of production, and 50th in terms of export earnings.

Addressing lack of land, seed, feed and technology for aquaculture production are necessary steps,

along with addressing post-harvest losses and improving hygiene conditions which reduce the

marketability of fish products and are one of the main constraints to export earnings. In addition to the

supply of sub-optimal quality fish products on domestic markets, consumer awareness of the benefits

linked to increased fish consumption. Finally, institutional weaknesses in and outside the fisheries

sector, and inadequate capacity of its stakeholders need to be rectified in priority to ensure that both

fisheries and aquaculture develop sustainably and in harmony with other sectors of the economy, while

receiving the support they need to do so.

Any word how that can benfit the poorest populations, or the socioeconomic profile of those that have

access to fisheries, aquaculture?

3.6.3.2 Responsibilities of sector:

Conservation

Check on fishing without license

Restriction on catching undersized fish

Protection of fish against use of explosives/ poisons

Restriction on mesh size of nets

Reservation of fish breeding grounds

Observance of annual close season

Protection of fish against release of industrial effluents and solvents

3.6.3.3 Overall Objective of the sector:

1. Increase the contribution of fisheries and aquaculture sectors to national economic growth to

contribute to improved diets.

2. Increase the contribution of fisheries and aquaculture sectors to improve household’s food

security and nutritional status and by that contribute to alleviate poverty. Increase the

contribution of the fisheries and aquaculture sectors to better nutrition among food insecure

households

Key measurable indicators of progress towards the achievement of the three policy goals of national

economic growth, poverty alleviation and food security, will include:

Higher per capita fish consumption

Improved fishers and fish-farmers’ incomes

Creation of well-paid employment in the fisheries and aquaculture sectors

Increased export earnings from aquatic products

3.6.3.4 Intervention Matrix

3.6.3.4.1 Strategy 1: Capacity Development: Strengthening the fisheries sector to increase the

productivity by scaling up the existing resources to combat malnutrition


Fish contributed much to the survival and health of a significant portion of the world’s population. Fish is

especially important in the developing world. In far eastern countries of Asia people derive as much as

75% of their daily protein from fish. Similarly, West African derived 30% of animal protein intake from

fish. Fish is considered as “rich food for poor people” attributable to rich source of vital nutrients such as

proteins (with high Biological Value), essential poly-unsaturated fatty acids, vitamins and minerals.

Fisheries and aquaculture sector play significant role in providing livelihood opportunities to coastal

inhabitants in developing countries. Hence, fish production can play a significant role to improve food

security situation in Pakistan. However, in recent year, production of fish declined due to a number of

factors due to less number of hatcheries, inappropriate fish feed, lack of expertise and climate change or

increasing water pollution. Production of quality seed is one of the major constraints in fisheries

development. It is estimated that fish seed accounts for approximately 30% of production costs.

Similarly, production of poor quality seed will results in low growth/production. This ultimately

decreases the profit margin of fish farmers, sometime push poor and marginal farmers into greater

economic risk. A common practice is carp seed production, which suffers from inbreeding, inter-species

hybridization and, overall, is genetically degraded. Hence, on priority bases it is now the responsibility of

the people involves to preserve pure genetics of the breed.

Northern Areas have plenty of cold-water resources and considered fit for trout fish farming. A study

was conducted in 2004 to find out cost of trout fish farming and its profitability. Their findings revealed

that total cost (capital and variable costs) of Rs. 234 was incurred to achieve a kg trout fish and its selling

price was Rs.310. The net revenue came to Rs.76 per kg of fish (Hassan et al. 2007). Accordingly, it

demonstrated that the trout fish farming provides a great opportunity for exploiting the abundant cold-

water reservoirs in northern areas for income generation.

Intervention Matrix

Strategy Objective

Strategy Action(s)



Nutrition Specific

To increase the production of fish from 594,935 tons in 2011 to 800,000 tons by the end of 2019 (according to FAO Statistics)

1.1 Increase the number of hatcheries from 88 to 150 by the end of 2020 to ensure the availability of high quality seed (implementation level)

√ --

Increase in fish production will surely increase the access to protein source that ultimately reduce the burden of protein energy malnutrition and micronutrients deficiencies (i.e. Vitamin A, Iodine, essential fatty acids etc.) Increase in production will also be helpful to improve the food security situation.

1.2 Promote and strengthen the economical fish-feed production (implementation level)

√ --

1.3 Development and provision of seed of high yielding varieties of various fish species by some genetic modification (implementation level)

√ --

1.4 Promotion of high yielding fish-seed (lowest price of available protein) by distribution among farmers at subsidized rates and demonstration of modern production technology to reduce pre & post-harvest losses (implementation level)

√ --

1.5 Skills enhancement of fishery √ --

sectors individuals (staff & farmers) by conducting trainings at UC and districts level (implementation level)

1.6 Increase the number of fish farms (5% annually) from the existing in 2012-2013(implementation level)

√ --

1.7 Increase the capacity of the existent fish farms (10% annually) by the end of 2020(implementation level)

√ --

1.8 Promote the trout fish farming in natural water resources to increase the trout production (5% annually from existing in 2012-2013)(implementation level)

√ --

1.9 Initiate shrimp cultivation in the Indus delta to increase the shrimp production (5% annually from existing in 2012-2013)(implementation level)

√ --

3.6.3.4.2 Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access

to aquaculture/fish food


Food from aquatic resources has been an important component of human diet and considered as an

important food source in many parts of the world especially in Asia. It also contributes in food security

and poverty alleviation. However, in the recent years the production of marine capture fisheries has

decreased in the whole world in comparison to escalating per capita demand owing to increasing

population. Hence, the challenges of meeting future world fish supply needs and improving food

security are indeed daunting. However, the importance of future fish availability for food security and

nutrition in highly populated developing countries will be a priority.

Fish is one of the main sources of protein providing significant amount of animal meat and is a growing

food source in Asia and in other developing countries. Fish products provide an excellent source of

protein due to their amino acid composition and protein digestibility that ranges from 85-90%. Fish

protein also offers a variety of vitamins and minerals including vitamins A and D, phosphorus,

magnesium, selenium and iodine. Moreover, fish is also perceived as healthy food by consumers,

especially in comparison with meat, the main source of animal protein. Scientific data indicated that fish

oil is a rich source of PUFA mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), so

regular fish consumption and the intake of ω-3 PUFA play an important role in the primary and

secondary prevention of blood pressure, coronary heart disease and stroke (Artham et al. 2008). Fish

consumption at 40-60 g daily with high ω-3 fatty acids lower the risk of macular degeneration, that

causes blindness, significantly reduced coronary heart disease mortality in high-risk populations

(INFOFISH, 2002).

In Pakistan, domestic consumption of fish is estimated to be 26% with 19% being exported, while 55% of

the produced going for fishmeal that indicated poor quality of fish being produced in the country. Per

capita consumption of fish in Pakistan is varied; Baluchistan consumed 6.80 kg per capita/year (1975-76)

and this figure further declined to 5.28 kg per annum (2002-03). In Sind, consumption rate was ablated

from 4.25 kg per capita/year (1975-76) to 2.98 kg per capita/year (2002-03). Although, per capita/year

fish consumption of Punjab and KPK increased from 0.12 and 0.04 kg in 1975-76 to 1.00 and 0.71 kg in

2002-03respectively, however still considered to be low.29

Table 3.7: Consumption of Fish in Various Provinces of Pakistan (KGs per capita per annum)30

Year Pakistan Punjab Sind KPK

1975-76 1.28 0.12 4.25 0.04

1980-81 1.99 0.36 4.30 0.17

1985-86 1.80 0.57 4.10 0.04

1990-91 1.70 0.74 3.71 0.74

1995-96 1.81 0.98 2.58 0.41

2000-01 1.76 1.00 2.90 0.65

2002-03 1.77 1.00 2.98 0.71

Intervention Matrix

Strategy Strategy Action(s) Nature of Impact on

29 Wasim 2007

30 Government of Pakistan (1980, 1991-92, 2002-03), Agricultural Statistics of Pakistan. Ministry of Food, Agriculture

and Livestock, Islamabad.

Objective Intervention nutrition

Nutrition Sensitive

Nutrition Specific

To increase the per capita consumption of fish from 2 kg/year to 5 kg/year by the end of 2020 through awareness, value addition and cost effective fish products

2.1 Increase the awareness of fish meat importance and its consumption through literature, extension services, mass media campaigns and education (implementation level)

√ --

Increases in per capita consumption ultimately reduce the burden of protein energy malnutrition and other micronutrients deficiencies.

2.2 Introduction of value added fish products such as fish cookies, fish chips, fish biscuits, fish nan/chappaties, fish cakes, fish salads, fish samosa, fish biryani, and nimko, etc. (implementation level)

√ --

2.3 Promote the consumption of small size fish(5% annually from existing in 2012-2013) so that poor families may also consumed with low price (implementation level)

√ --

To ensure and improve safe as well as quality of fish from farm to fork

2.4 Enhance the quality of the fish by introducing the modern and safe processing techniques, cold storage, good transportation and improvement in marketing channel, etc. (implementation level)

√ --

Easily access to safe fish products ultimately reduce the burden of hidden hunger

2.5 Enhance the coastal aquaculture production and increase availability in local inland markets (implementation level)

√ --

3.7 EDUCATION SECTOR (PUNJAB)


Education Sector is the largest sector of Punjab, comprising of the School Education Department (SED),

Higher Education Department (HED), Special Education Department, Punjab Curriculum Authority (PCA),

Staff Development Department and Literacy and Non-Formal Basic Education Departments (NFBE). The

SED oversees 53,935 schools with more than 10 million students and 330 thousand teachers (REF). The

SED also supervises the Boards of Intermediate and Secondary Education (BISE), Children libraries,

Punjab Daanish Schools and Centers of Excellence. The HED is overseeing 458 Colleges along with eight

BISE, 12 Public Sector Universities, 20 Autonomous Educational Institutions of Higher Education, and the

Directorate of Public libraries .The PCA deals with development and supervision of curricula, syllabi,

textbooks, and maintenance of standards of education. The duties of the Directorate of Staff

Development include conduct of pre-service and in-service teachers training and a Continuous

Professional Development (CPD) Program. Government of Punjab has established a separate

Department for Literacy & Non-Formal Basic Education to address the problem of dropouts at the

primary level and meet the emerging demand for Non-Formal Basic Education with functional Literacy

and Livelihood skills. In collaboration with international agencies like UNESCO & JICA, the Literacy

&NFBE Department has developed various Projects i.e. Punjab Accelerated Functional Literacy & Non

Formal Basic Education Project, Campaign for Enhancement of Literacy (04 Districts), Community

Learning Centres (Sahiwal Division) and Brick kilns Project (Multan &Khanewal Districts) to combat the

menace of illiteracy and achieve the goal of 100% literacy by 2020. The Department for Literacy

&NFBEhas launched the Punjab Enrollment Emergency Campaign to increase rates of enrollmentamong

school-going children.

In 2009, the Government of Pakistan approved a National Education Policy which aimed to address the

issues of access, equity and quality of education at all levels. The Policy highlighted governance as an

issue requiring urgent attention to improve the status of education and called for increased investment

in the education sector. Under this policy, the government is committed to allocate 7 percent of GDP to

education and provide free universal primary education by 2015 (Economic Survey of Pakistan, 2013)..

Following the 18th Amendment, Education became a Provincial subject and the Government of Punjab

emphasized educational reforms and announced the School Education Reforms Roadmap with the

objective to enhance access, retention and completion of quality education. The Chief Minister of

Punjab has approved allocation ofa fifth of the total Provincial budget (Rs.117 billion) to Higher and

Primary Education under different categories and schemes.

3.5.2 Potential role in nutrition improvement

Education or literacy level and malnutrition indicators are closely interlinked, as demonstrated

in the district-maps (shown below) Literacy rates and maternal education are seen to be

directly related to childhood under-nutrition (underweight, stunting &wasting), indicating that

increases in literacy/education level will be helpful in reduction of the burden of malnutrition in

the province of Punjab.

Maternal and child under-nutrition is also related to maternal autonomy (Nutrition Political

Economy, Pakistan 2013). Further, the National Nutritional Survey 2011 reveals stunting rates

among children reduce significantly with increasing maternal level of education (shown in table

below).

Figure 3.12: Figure 3: Relationship between Maternal education and Child Stunting (Source: NNS 2011)

The inextricable linkage between education, autonomy and malnutrition identify education as an

essential component of any strategy seeking to improve the nutrition status of a population, particularly

children. With a high burden of illiteracy among primary care givers of children i.e. women, an urgent

strategy to improve education among the population in general and among women in particular needs

to be pursued to reduce the burden of malnutrition.

3.5.3 Nutrition specific objectives of the Education Sector Ensure equitable access to education, with particular focus on increasing enrollment and


Introduction of Nutrition, Health &Hygiene education modules in schools and education

curriculum-

Improve knowledge regarding nutrition among teachers, parents/caregivers children and


38%

30%27%

19%

15%

0

10

20

30

40

50

Illiterate Primary Middle Matric Above Matric

% o

f ch

ildre

n s

tun

ted

Education Level

To support health department in malnutrition screening among children and adolescents and

improve nutritional status among school going children through appropriate referrals, health &

nutrition education and promotion activities

Introduction and promotion of Nutrition as a professional track for post-graduate education

and employment

3.5.4 Intervention Matrix

3.5.4.1 Strategy: Equitable access to Education

Several recent studies have demonstrated an association between educational attainment and

nutritional deficiency. Whereas hunger and malnutrition in itself affect the health of children, it

further increases the chance of infections which can potentially affect learning capacity, reduce

attention span, increase absences from school and affect education throughout childhood.

Studies have demonstrated improved educational attainment among children treated for

malnutrition and micronutrient deficiencies. Health and Nutrition Programs targeting infant,

pre-school and school-going children, particularly among the poor are effective in improving

health and educational attainment throughout the life cycle (Jukes et al., 2009).

Intervention Matrix

Strategy Objective


Impact on nutrition

Nutrition Sensitive

Nutrition Specific

To increase Pre-nursery & Nursery enrollment & retention to 80% of eligible girls by 2020

1. Expand the existing network of schools by 2020 (Policy level)

√ -- Access to educational material and awareness of dietary and feeding practices (among care takers &female students)) will lead to an improvement in nutrition indicators

2. Launch enrollment campaign each year especially to increase enrollment of girls (Policy level)

√ --

3. Introduce conditional cash transfer (CCT) policy by 2014, and advocate with BISP or any other such program conditional for beneficiaries to enroll their daughters in schools (Policy Level)

√ --

4. Availability of boundary wall especially in girls’ schools by 2016

√ --

3.5.4.2 Strategy: Improve quality of Education and integrate

Incorporate action oriented inter-sectoral nutrition specific messages in the school-based curriculum

and build capacity of primary and secondary school teachers in the delivery of nutrition messages,

education and activities strengthening nutrition as an integral part. Nutrition education involves

increasing knowledge about the importance of nutrition, providing educational materials that reinforce

messages about healthy dietary practices, imparting skills essential for making dietary changes and

imparting life skills to sustain behavior change. Information gathered during school-based nutritional

screening or assessment will provide the necessary information on which nutritional messages will be

tailored during nutrition education and counseling sessions.

Health professionals need to give careful consideration to the types of nutrition messages that are

presented to adolescents. Most adolescents are present-oriented, which means they are generally not

concerned about how their current eating habits will affect their future health status and most are

unable to apply new concepts to current behaviors or situations (Croll et al., 2001). They are, however,

concerned about their physical appearance, maintaining a healthy weight and having energy. While

teenagers should give consideration to the potential long-term risks of an unhealthy diet and benefits of

healthy eating habits, focusing on short-term benefits with adolescents is more likely to make a lasting

impression on the target group and facilitate dietary change. Nutrition-focused educational materials

and messages must be written in local language and in a style identifiable to the concerned target

group. Some key concepts kept in mind while developing educational material includes use of active

rather than passive voice when presenting information, use of local language and commonly used

phrases and words instead of medical/technical terminology and inclusion of illustrative examples for all

key concepts discussed.

Intervention Matrix

Strategy Objective Strategy Action(s) Nutrition Level

Impact on nutrition

Nutrition Sensitive

Nutrition Specific

To include nutrition in school curricula by June 2015

1. DoE would notify a committee with responsibility/ purpose to develop training modules, dietary guidelines and curriculum (Policy level)

√ --

Quality of education and knowledge about Nutrition interventions will improve health and nutrition status

2. Nutrition curriculum planning within Institutes of Higher Learning in collaboration with international institutes (Policy Level)

√ --

3. Induct a nutrition specialist in the Punjab Curriculum Authority for revision and inclusion of nutrition modules/chapters (Implementation Level)

√ --

4. A provincial regulatory body (Nutrition & Dietetic Council)

√ --

4.5. Creative Inclusion in curricula/ syllabi by the end of 2014 (Implementation level) a) Revise the curricula for

primary , middle, inter level and make it more nutrition focused for boys & girls

b) Add nutrition related text-boxes in curricula/ syllabi

c) Prepare key messages regarding Nutrition ensuring order and consistency, for inclusion in curricula/ syllabi

√ --

Access to educational materials and awareness about dietary habits will ultimately improve health and nutrition status

5.6. New Inclusion in curricula/ syllabi by June 2015 (Implementation level) a) Introduce a chapter

“Preventive Health and Nutrition” in curricula/ syllabi consisting course contents like nutrition, health & hygiene, personal hygiene/sanitation, safe water, food safety and communicable disease

b) Introduce “Nutrition & Health” related new subject from Primary classes onward

√ --

Access to educational materials and awareness about healthy dietary habits will ultimately improve health and nutrition status

To train all the School Health &Nutrition Supervisors (SH&NSs) and school teachers by 2017

1. Launch training modules by June 2015 for School Health & Nutrition Supervisor from each district in nearby well-established Nutrition Departments. The training modules will contain contents regarding counselling of children, teachers, parents and adolescent males & females and screening & referral to nearest health facilities of malnourished

√ --

Training of teachers and SN & HSs will enable delivery of nutrition related activities with a focus on strengthening nutrition as an integral part

children (less than five years of age) and adolescents (Implementation Level)

1. Train teachers by adding Nutrition Modules (Implementation Level) a) Training of trainers by well-

established nutrition department OR by qualified nutritionist/dietician

b) Inclusion of nutrition modules in teachers training programs i.e. In-Service and Pre-Service Teachers Training by School Education Department

c) Introduce virtual/online training program to conduct trainings/ seminars/ workshop to ensure early completion of training programs.

√ --

2. Introduce a mechanism for monitoring of curriculum, facilities and validation of Nutrition related activities at schools and universities level i.e. establish Nutrition & Dietetic Council for monitoring and evaluation of professional level education in Nutrition along with registration of Nutritionists and Dieticians(Policy Level)

√ --

Strengthen the nutritional programs implemented throughout the province; helpful in decreasing malnutrition burden

3.5.4.3 Strategy: Provide and promote quality hygiene and sanitation practices within school

premises

Background/Rationale: Poor physical environment (unsafe drinking water and poor sanitation and

hygiene, or WASH), is one of the underlying determinants of malnutrition, often leading to increased

burden of diarrheal disease – leading cause of child mortality in Pakistan. Additionally, diarrheal disease

decreases intestinal absorption of nutrients. Thus, even when food consumption is sufficient, diarrheal

disease can lead to malnutrition among children by impeding intestinal absorption (WHO, 2008.)

Resultant deficiency in energy, minerals and vitamins have considerable negative impact in about 35% of

all children, leading to deaths and presenting 11% of the global disease burden (Black, Allen, et al

2008).Current evidence suggests that the achievement of good nutritional status is of vital importance

towards attainment of MDG 4. Chronic under-nutrition severely reduced school attendance and

diminishes health, economic and gender potential (UNICEF 2008).

Intervention Matrix


Nutrition Level

Impact on nutrition

Nu

trit

ion

Sen

siti

ve

Nu

trit

ion

Spec

ific

To ensure availability of facilities for implementation of quality hygiene and sanitation practices at 100% schools by 2019 (especially in girls school)

1. Ensure the provision of missing facilities e.g. functional toilets, with proper sanitation and privacy in schools/ colleges with assistance of HUD & PHED (Implementation Level)

√ -

Prevention of diarrhoea& infections, a known risk factor of malnutrition

2. Ensure availability of safe drinking water by installation of water filtration plants in schools with assistance of HUD & PHED (Implementation Level)

-- √

3. Increase water conservation with increased and improved water storage capacity with assistance of HUD & PHED (Implementation Level)

√ --

4. Availability of soaps in school toilets(Implementation Level)

√ √

3.5.4.4 Strategy: Capacity Development- Introduce and Promote Nutrition as a profession

The current curricula for students in school do not provide enough knowledge on the mechanisms

through which micro and macronutrients interact with one another and their role in maintaining optimal

body functions, interferences of these mechanisms and implementation of this knowledge for

prevention of malnutrition and promoting healthy nutrition. Furthermore, tools for nutritional

assessment, analysis, counseling and treatment are not well integrated within the training curricula of

schools and Institutes of Technical Education. To build capacity it is necessary to promote nutrition as

indivisible from health and provide a recognized professional track for training and employment in

Nutrition related fields.

Intervention Matrix

Strategy Objective


Impact on nutrition

Nutrition Sensitive

Nutrition Specific

To promote recognition of Nutrition as a profession and to introduce it as a post-graduate subject by 2019

1. Increase opportunities for professional level degree and post-graduate courses in Nutrition (Policy Level)

√ --

Will strengthen the nutritional programs implemented throughout the province and will be helpful in decreasing malnutrition burden

2. Strengthen already existing degree providing departments/institutes by training and capacity development of existing faculty (Implementation Level)

√ --

3. Promote establishment ofNutrition departments within Institutes of higher learning (Policy Level)

√ --

4. EstablishNutrition & Dietetic Council for monitoring and evaluation of professional level education in Nutrition along with registration of Nutritionists and Dieticians (Policy Level)

√ --

3.5.4.5 Strategy: Improvement of nutritional status among school going children

Background/Rationale: An integrated approach based on multi-dimension may be needed to

improve nutritional status of the school-going children.

Intervention Matrix

Strategy Objective Strategy Action(s) Nutrition Level

Impact on nutrition

Nutrition Sensitive

Nutrition Specific

To perform complete screening of school going children enrolled

1. Ensure screening and delivery of essential package of nutrition service to school-going childrenon a quarterly basis. Package of care includes

-- √

On time diagnosis will facilitate to decrease malnutrition burden (especially

in public sector on quarterly basis

screening and referral for malnutrition at an early stage (Implementation Level)

prevalence of hidden hunger)

To introduce mid-day meal at all schools in high risk districts by 2015

2. Provide micronutrient fortified high-energy biscuits and dates, to enhance school performance and improve micronutrient levels, particularly vitamins, minerals and proteins. The scheme will start from Southern Districts which have poorer nutrition status among women and children and will scale up over time. (Implementation Level)

-- √

Enhance school performance and help improve nutrition indicators linked to vitamins, minerals and protein consumption

To introduce deworming services at all schools in high risk areas/district by 2014

3. Promote biannual de-worming of children (Implementation Level) -- √

To introduce nutritious foods &daily physical activity at all schools by 2014

4. Promote Availability of healthy nutritious foods at school canteen:

a) Through encouraging availability of nutritious food commodities in school canteens

b) Discouraging school canteens from selling junk food and carbonated drinks (Policy Level)

-- √

Preventive approach will be helpful in reducing malnutrition burden

5. Introduce daily physical activity at schools(Policy Level)

-- √

To launch campaigns and awareness programs

6. Raise awareness: a) Seminars, awareness

sessions, and other awareness activities by SHNS, LHWs, CMWs, Field assistant agriculture department teachers and respected of the area, involvement of private sector, private practitioners

b) Distribution of IEC material c) Celebration of special days

like (World Food Day,

√ --

Access to educational materials and awareness about dietary practices (especially among females) will ultimately lead to uptake of nutritionindicators

breastfeeding day, water, egg days)

d) Arrange parent-teacheradvocacy meetingsfor health promotion, Nutrition needs among children& household members, menu planning, kitchen gardening and animal raising at household level

4 CHAPTER 4: IMPLEMENTATION OF THE STRATEGY /

OPERATIONALIZATION

4.1 Implementation Model Effective and coordinated implementation of the proposed strategy is imperative in realization of the

objectives of the strategy. The implementation is proposed to be done in partnership between all

responsible departments. Implementation of this strategy will be mainly through three distinct ways; 1)

adjustments in already implemented or existing programmes by making them more nutrition sensitive

2) seeking funds and implementing nutrition sensitive interventions by developing PC-1s against

approved interventions in this strategy using their own resources 3) seeking funds through Nutrition Cell

from the pool of resources allocated for implementation of nutrition strategy for nutrition specific and

high priority nutrition sensitive interventions. The implementation model will vary from intervention to

intervention for effective implementation. There are interventions in all sectors, which are department

specific and therefore the implementing department will take lead in its planning and implementation

within the sector. Some interventions are multi-institutional within each sector and some are

multisectoral, and their effective implementation requires coordinated implementation frame-work

from all involved departments and/or sectors.

NUTRITION PLANNING AND IMPLEMENTATION FRAMEWORK – AN HOUR GLASS MODEL

Provincial technical working groups

Food Sector

Health Sector

Education Sector

WASH Sector

Social Protection

Social Welfare & Women Development

Agriculture, Livestock, Fisheries Sector

PROVINCE

UC

4.2 Organizational Structure

Figure 131 organizational structure of Punjab multi sectoral nutrition program

The real challenge in implementation of multi-sectoral strategy is “coordination from province to

districts to city council/ward/village and fixing the verifiable responsibilities at all levels”. Each

intervention will be monitored by specific technical committees constituted at all levels named

“Malnutrition Addressing Committees”. Coordination may be further improved by framing joint

implementation framework indicating the clear roles and responsibilities of each sector.

UC level

coordination & implementation

Tehsil level

coordination & implementation

District level coordination & implementation

Provincial level coordination & implementation

Policy level P&D

PMAC

DMAC

UMAC

TMAC

Nutrition Cell at PSPU

Coordination line

Coordination line

School Health & Nutrition Supervisor ↔ Teacher ↔

LHWs ↔ Field Assistant Agriculture ↔ UC Secretory

DISTRICTS IMPLEMENTATION COMMITTEE DCO ↔ EDO Edu ↔ EDO Health ↔ EDO Agriculture

↔ DO Public Health Engineering ↔ ADLG/TMA

4.2.1 Provincial

4.2.1.1 Nutrition Cell at PSPU

The Punjab multisectoral nutrition implementation program will be designed in an effective institutional

framework using the existing arrangements and establishing new ones for policy direction, coordination,

monitoring and evaluation

Provincial level oversight/management structure will be housed in P&D department Punjab as P&D

works as central department for monitoring and evaluation of development plans, policies and

programs. For this purpose, nutrition cell will be housed in PSPU, which will be reporting to P&D. This

cell will be responsible to arrange quarterly progress review meetings of PMAC in order to review and

track the progress. Nutrition cell will also facilitate collaboration and partnerships among different

stakeholders in planning, and implementation of nutrition programs.

Nutrition cell will have three professionals (supported by partners) that will support the PMAC in the

area of information management and data analysis, including different aspects of the monitoring of

nutrition information across the sectors and evaluation. This cell will also support for development of

multisectoral nutrition communication strategy.

4.2.1.2 A provincial malnutrition addressing committee (PMAC)

A provincial malnutrition addressing committee (PMAC) is proposed at provincial level in order to

provide a platform for planning of nutrition-specific and nutrition-sensitive programs, coordination, and

information dissemination, to review and share progress & monitoring. The committee will also be

responsible to track implementation status of program, timely identifying bottle necks, addressing

problems. The secretariat of the Punjab multi Sectoral program (PMSNP) will be based in the P&D

Department and nutrition cell in PSPU will facilitate the procedure of coordination & review the

progress. It is proposed that under the chairmanship of P&D department, following departments will

represent in the PMAC.

• Agriculture Sector (Departments of Agriculture, Livestock & Dairy Development and

Fisheries)

• Food Sector (Department of Food, Punjab Food Authority)

• Education Sector (Departments of School Education, Higher Education, Literacy, Punjab

Curriculum Authority, University(s))

• Health Sector (Departments of Health)

• WASH Sector (Departments of Public health engineering (PHED) and local government)

• Social Protection Sector (Departments of Social Welfare & Bait-ul-Maal, Women

Development, BISP)

Participating sectors will be responsible to mainstream nutrition into their respective sectors and

implement the planned interventions with in their domain. A continuous and ongoing reporting will be

part of every sector’s routine reporting system.

4.2.1.2.1 ToRs of the PMAC

The PMAC will be responsible for ;

• Incorporate & prioritize nutrition in all sectors (develop nutrition specific/ sensitive plans)

• Devise effective and ongoing monitoring system through reviewing/ revise routine reporting

& recording tools in order to incorporate nutrition indicators of multi sectoral nutrition

strategy in to it.

• Finance management through mobilizing resources required for nutrition sensitive &

nutrition specific activities.

• Advocate and ensure political and partners commitment and support

• Continuously assess and review the program implementation status

• Devise outcome based accountability system for mid-term and final evaluations

• Devise research based monitoring and evaluation system

Figure 142 Provincial malnutrition addressing committee

The PMAC will be assisted by a nutrition cell in the PSPU that will be responsible for:

• Coordination and information management: building linkages with DHIS, HMIS etc.

• Development & operationalization of multisectoral nutrition strategy reporting system

• Development of multisectoral nutrition Communication/advocacy strategy and uniform

messages to be used by each sector

P&D

Health Education AgricultureSocial

protection wash Food

• Support capacity development on planning & implementation of multisectoral nutrition

program.

• Improve coordination with donors and partners for mobilization of financial resources and

technical assistance

4.2.2 District

4.2.2.1 District malnutrition addressing committee (DMAC)

The DCO will notify a district level malnutrition addressing committee DMAC . District level committee

will be responsible for implementation of multisectoral nutrition program in whole district and where

there is phased / partial implementation this committee will perform selection and identification of CCs

or wards for implementation. The committee will have the representation of all district level

participating sectors and will work under the guidance provincial level PMAC. This implementing

committee will work under the chairmanship of DCO in each district.

This committee will be constituted again on the same pattern of PMAC ensuring the representation

from all concerned departments. Representation from civil society, and CBOs will also be given in the

composition of DMAC

4.2.2.1.1 ToRs of the DMAC:

Micro plan & implementation of nutrition related interventions in line with the Punjab

multi-sector nutrition program

Incorporate multisectoral nutrition indicators in the district monthly and annual monitoring

plans

Ensure multi-sectoral coordination at implementation level and district level

Devise evaluation procedures and report evaluation results to PMAC and corrective actions

proposed or taken, if any

Timely reporting of the all implementing sectors and PMAC and Nutrition Cell at PSPU

The DMACs will rely on technical support from the health department through the district nutrition

officer (one nutrition qualified school & nutrition supervisor will be nominated as district nutrition

officer).

4.2.3 Community

4.2.3.1 Union-council malnutrition addressing committee (UMAC)

At union council level (now called as city council in urban set-up and ward in rural set-up) a Union

Council Malnutrition Addressing Committee (UMAC) will be established in order to ensure the

community level implementation. This composition of the committee will be as following.

• Convener: Facility-based Medical Officer

• Secretary: School Health & Nutrition Education Supervisor

• Members: Representative of Livestock (if any), Agriculture (if any), Secretary of CC or Ward,

Heads of School Education Councils in CC or ward, Lady Health Supervisor, One school teacher

from all schools in CC or Ward, Chairmen of Zakat Councils in CC or ward, 02 public

representatives (at least one female)

4.2.3.1.1 ToRs of the UMAC:

• Implement nutrition interventions under the guidelines of DMAC

• Implement monitoring plan and furnish monitoring reports as per direction of DMAC

• Ensure timely & quality reporting of the all implementing sectors

• Improve multi-sector coordination to attain common goal of reducing chronic malnutrition-

nutrition at CC or ward level.

4.3 Harmonization and Synergy

UMAC

DMAC

PMAC

4.4 Capacity Building It is anticipated that the capacity of various sectors and departments involved in implementation of this

strategy is very week including policy makers, implementers, monitors and evaluators. Therefore,

capacity building itself should be taken as key pre-requisite for effective implementation. Capacity

MO

SH&NS

education

livestock

Agri

LHS

UC-sectray

DCO

health

education

Food

Agri

wash

social protection

P&D

health

education

Food

Agri

wash

social protection

Co

ord

ina

tion

line

Co

ord

ina

tion

line

Rep

ort

ing

line

R

epo

rtin

g lin

e

M&E unit

M&E unit

M&E unit

building of sectors from planning to implementation of multisectoral nutrition approach will be of prime

importance for the successful implementation of the program. An assessment to analyses sectoral

capacity should be targeted and focused in order to decide the type, level and number of human

resource needed for effective implementation. For this purpose, a workshop involving all sectors will be

conducted and a comprehensive plan for human resource development on the areas of strategy

implementation will be developed followed by actual capacity building with the support of partners.

4.5 Communication Strategy A comprehensive targeted & uniform communication strategy is key to achieve objectives of this

strategy. The development of the communication strategy will require formative research keeping the

local context in view including traditional beliefs, taboos and traditions that are common in urban &

especially in rural areas of Punjab.

The research will investigate the basic and underlying causes behind the maternal nutrition and infant &

young child feeding practices. In this way an appropriate, uniform & effective behavior change

communication packages and training modules can be designed for every sector.

4.6 Monitoring, Evaluation and Accountability The core concept of monitoring and evaluation of multisectoral nutrition strategy is based on following:

• Are the right things are being done? (The type of interventions)

• Are the right things being done well? (Implementation gaps)

• Are the right things being done enough? (Planning gaps)

• Have the interventions made a difference? (Overall impact of the strategy), and how do we

know? (Evaluation mechanism)

Participating sectors will institute a systematic approach to reporting through integrating key nutrition

sensitive indicators. The monitoring frame-work will be indicator based and will comprise of monitoring

at all levels including inputs & services monitoring, outputs monitoring, outcomes monitoring and

impact monitoring. The monitoring indicators against each intervention have been given in RFAs

(Annexures----). However, complete monitoring frame-work of each intervention will be developed in

PC-1 of that particular intervention.

This will be the first experience of its nature in Punjab where various sectors will have to work together

on common objective of reducing the prevalence of malnutrition. In order to ensure that sectors are

able to work in a coherent and adopting geographically focused approach, an inter-sectoral project

management and monitoring team will be recruited through Nutrition Cell at PSPU at provincial level

oversight and monitoring. The strategy assumes that mid-term and end evaluation of the inter-sectoral

nutrition intervention would be undertaken to assess the impact of these interventions. All participating

sectors will be responsible as well as accountable for their part of implementation in the joint

monitoring & evaluation system.

4.6.1 Measuring the progress: result based monitoring framework

4.6.1.1 Monitoring the impact of Multisectoral interventions

Impact is assessed by calculating & documenting the changes in the nutritional status of target group

(women and children) as a result of implementation of proposed Multisectoral interventions.

Proposed M&E frame work will consist of three parts.

1. Impact assessment can be done by using standardized survey procedures

(Demographic and Health or Nutrition Surveys, for example) and calculating

the average rate of reduction for only few selected indicators – such as

prevalence of acute & chronic malnutrition in children under five years of

age.

2. Proposed M&E Framework will also include a description of how the

contribution of all participating sectors will be measured and reported is

described below.

3. Nutrition Cell will Monitor the services (outputs) provided by thesectors

and assess the implementation status of the strategy. It will measure the

commitments made by the sectors to monitor and report on the

contribution of its services. (M&E frame work attached in annexure)

4.6.1.2 M&E unit: structure, function and use of information, feedback system

Routine monitoring of the activities will be conducted at UC and district level and reporting and

coordination line will be same as described in the figure 3.

The M&E Framework will provides a framework for the collection of data of all relevant indicators with a

view to assess & evaluate impact, outcomes and outputs of the Multisectoral nutrition interventions

through a proposed mechanisim. To measure the impact of proposed interventions the M&E Framework

will use the secondary data that will be collected by routine reporting sytem of sectors at provincial level

and collated by the Multisectoral reporting system by nutrition cell. While outcomes will be measured

by the participating sectoral focal Persons (PMAC) will take the lead in collecting and reporting data.

4.6.1.3 Provincial level (Centralized M&E at P&D)

Provincial level monitoring will be more result based and focused. For this purpose uniform monitoring

checklist will be developed and shared with all sectors. Every sector will be responsible to share

monitoring reports with timeline, as may be appropriate, with Nutrition Cell of P&D, housed in PSPU.

Reports will be analyzed by nutrition cell and feedback will be shared with relevant sectors through TWG

meetings at provincial level as well as with district level implementation team.

4.6.1.4 District level (Office of DCO)

District level monitoring check lists will be developed at provincial level on uniform format covering

district level implementation activities of all sectors. DCO office will be compiling the sectoral

monitoring reports and sharing the consolidated reports at provincial level.

4.6.1.5 Community level (Office of the Medical Officer/Local Union Council)

At UC level MO will be responsible to engage every sector representation in monitoring as well as

implementation and reporting.

4.7 Research and development

Implementation model based on evidence based interventions is key to success in realization of this

strategy. Therefore, research and development has been envisioned core this strategy. An important

step prior to implementation is availability of data generated through evidence based effectiveness

studies. In this strategy, a three tier research based eveidence generation is proposed:

P&D

(Nutrition Cell)

Agriculture

Education

HealthSosical

protection

Food

Wash

UC -monitoring

reports

DCO office

Fee

d b

ack

Feed back Feed back

Figure 164 Multisectoral monitoring & feedback system

• Exploratory research: to identify the issues related to nutritional status, its impact on health,

magnitude/gravity of the issues and causal framework of the issues. This part has mostly been

done by the NNS, 2011. As ~four years’ time has passed since NNS data was collected, it is

proposed that the baseline data should be reconfirmed by small survey in three districts (one

district each from North, South & Central Punjab)

• Constructive research: Small scale piloting in on-ground conditions is proposed for evidence

generation for effectiveness of the interventions. These might include 1) Implementation Trials:

A valuable approach that would generate knowledge about successful implementation

alternative strategies using a randomized trial design and might require multiple location and

multilevel analyses to fully examine impact. 2) Research on Increasing Rates of Intervention

Adoption and Participation: Research to test the rate of adoption and rate of participation of a

particular program in urban, peri-urban and rural settings and communities with different ethnic

background. 3) Encouragement Designs: Randomized designs to test various modalities of

recruitment, incentives, or persuasion messages to influence their choice to participate in one

or another intervention condition.

• Empirical research: testing the effectives of the solutions. This research will be ongoing and will

make the part of continuous monitoring and evaluation process.

Sometime, programs prove to be efficacious in controlled trials, however, the effectiveness might be

different under real-world conditions. In the real world, translation of science-based interventions often

stumbles, might be largely unguided, and may lead towards uneven, incomplete, and disappointing

outcomes and ultimately poor realization of strategic objectives. The research in constructive and

empirical domain especially is linked with factors associated with the adoption and use of scientifically

validated interventions by service systems also focusses on maintenance and sustainability issues at the

practice level that can be used to for effective and coordinated implementation.

Translational research, will accompany with implementation of many strategic interventions of this

strategy, and will help to explore the factors that influence the ongoing quality of implementation; and

in such studies, implementation quality itself will be the outcome of the research.

One of the core theme of this strategy is taking “implementation as a science” and using research &

development as base of this science. The ongoing process of research explores and scientifically testifies

the adoption potential of key interventions and redesigning from the lessons learnt to achieve strategic

objectives.

There will variable research requirements for various inter- and intra- sectoral interventions. A

consultative workshop involving all the sectors will be conducted before the implementation of the

strategy to identify research needs for effective implementation, monitoring and evaluation of proposed

interventions.

31A typical research based model for community interventions adopted from adopted from (O'Connell

and others, 2009)*

31 * http://www.ncbi.nlm.nih.gov/books/NBK32764/#ch11.s1-National Academies Press (US); 2009.

http://www.nap.edu/

4.8 Public private partnership/Bussiness Network

Bussiness network or private sector can play a vital role in Multisectoral approach to address

malnutrition. A research by world Economic Forum concluded that “the “business Case” for companies

to engage in hunger-reduction efforts varies by industry, by company and by company’s activities.

Nearly every step in the food production and consumption process offers opportunities for some type of

business involvement”.32

Contribution of any company to overcome malnutrition will obviously vary depending on the type of

industry, sector, stage in the food value chain, and type of intervention. It will also be influenced by

other participating sectors, partners.

Involvement of business network is proposed to complement Multisectoral nutrition spproch to address

malnutrition. Every participating sector will soordinate and identify relevant interventions with private

sector and corporate sector will be involved in the process.

It is proposed to establish business network for nutrition at provincial level to coordinate with relevant

sectors . It is further proposed that focal point should be nominated for business network, focal point is

proposed to reaches out to sectoral focal Point and other Networks and liaises at provincial and district

level Organise multi-stakeholder convenings to define potential contributions by the private sector and

agree on ways of working with all sectors.

4.9 Financial framework/ resource management

4.9.1 Financial Management

After approval of the Multisectoral nutrition strategy all sectors will develop PC-1s against approved

strategic actions or if already have developed, will revise their plans to be in line with the proposed

interventions in multisectoral nutrition strategy. The departments will seek funds for implementing

nutrition sensitive interventions against approved interventions in this strategy using their own

resource, however, funds will be allocated through Nutrition Cell from the pool of resources allocated

for implementation of nutrition strategy against nutrition specific and high priority nutrition sensitive

interventions.

32 Harnessing Private Sector Capabilities to meet Public needs: The potential of partnerships to Advance progress on Hunger, Malaria and basic education. The world economic forum, Geneva: 2006.

4.9.2 Establishment of Joint Funding Pool

To meet the resources against nutrition specific and high priority nutrition sensitive interventions, Joint

Funding Pool at P&D level will be established for implementing this multi sectoral strategy. The

government of Punjab and development partners will make their committed contributions into the pool

of funds. Any development partner(s) willing to support multisectoral nutrition strategy of Punjab may

join this arrangement at any point of time under the established arrangements. The P&D along with

PSPU shall be responsible for coordination and release of funds. The development partners and the

government of Punjab will make their annual contributions in the pool. The first installment will be

based on the approved plans/PC1s recommended by the TWG and the subsequent installment(s) might

be linked with expenses reported and progress made over the indicators.

4.9.3 Funds Flow

Department of Health has been implementing nutrition specific interventions and has recently started

implementing the integrated RMNCH & Nutrition program in Punjab. These most of the nutrition

specific interventions will be now onwards DoH’s routine activities and it is proposed that these

nutrition specific programmes would continue to be funded according to the current sectoral

arrangements. The same approach will be followed for nutrition sensitive programs, and if some

additional resources are required then these can be obtained from joint funding pool. The multi

sectoral programs and budget will be prepared as per sectoral plans and on the recommendations of

technical working group (TWG). The nutrition plans will be prepared by the sectors to be in line with the

targets/milestones set by the Multisectoral technical working group for five years as given in result

frame-work analysis. The pay for performance package will be designed by the P&DPSPU nutrition cell

to encourage participating departments to increase their performance in implementation of the

strategy.

Annextures

Annex-1 Result Framework Analysis of Health Sector

Strategy

Objective Strategy Action(s) Indicators

Base

Line

Means of

Verifications

TIME LINE (Years) Key

Assumptions Y

1

Y

2

Y

3

Y

4

Y

5

Strategy 1: Mainstreaming Nutrition in Health

To develop

Policy frame

work to create

enabling

environment

for

mainstreaming

Nutrition in

Sector &

improving

multi-Sectoral

coordination

mechanisms

by year 2015

1.1 Develop and promulgate rules

for implementation of Breast

feeding Act 2009

Policy

notification &

direction issued

TBD Policy

notification &

directive

available/

promulgation

material

available

√ √ √ √ √

Subject to

political

ownership and

subject to

implementation 1.2 Policy decision to integrate

nutrition as part of EPHS and revision of JDs of HCPs &

SHNS accordingly

TBD

1.3 To take up with PFA regarding

development of, legislation on

flour fortification with iron, salt

iodization

TBD

1.4 Policy to institutionalize

Gender Sensitive and pro poor

approach in all health plans

(PC1s)

TBD

1.5 Advocacy with BISP to convert

its cash transfer scheme into

conditional cash transfer

No. of meetings

held with BISP

TBD

Minutes of

meeting

available √ √ √ √ √

Subject to

political

ownership and

Subject to

change in

policy of BISP

To develop

nutrition

communication

strategy and

development of

IEC material

for other sectors

by December ,

2015

1.6 Develop consensus among

stakeholders of each sector on

communication framework by

December, 2014

Meeting/Seminar

Conducted Nil

Record

maintained √ √ √ √ √

Subject to

implementation

and subject to

funding

1.7 Develop linkages and provide

support to other sectors in

implementation of

communication strategy and

training of their staff

Nil √ √ √ √ √

1.8 Create awareness among

community on use of nutritious

food, healthy dietary habits,

hygiene and health

Nil √ √ √ √ √

Strategy 2: Equitable access to Nutrition services to poor and marginalized people

80% of children

with SAM

accessing services

on Severe Acute

Malnutrition

(SAM )

management as

per National

guidelines

especially in the

most affected

districts by 2020

2.1 Establish nutrition treatment

centers (OTPs) for SAM

children from 80 to 930 by the

year 2017

# of new nutrition

treatment centers

(OTPs) for SAM

children

established

80

New operational

centers/ Record

available

20

0

50

0

93

0

Subject to

availability of

funds

2.2 Establish nutrition treatment

centers (SC) for SAM children

with complication from 8 to

36 by the year 2017

# of new nutrition

treatment centers

(OTPs) for SAM

children with

8

New operational

centers/ Record

available

15

25

36

Subject to

availability of

funds

complication

established

Reduction in

low birth weight

babies by 50%

of existing

baseline (NNS

2011) by 2020 by

Improving

maternal health

Reduction in low birth weight

babies by 50% of existing baseline

by 2020 by improving maternal

health

% of babies with

low birth weight

Health

Department

(quarterly/

annual Reports)

10 %

20 %

30 %

40 %

50 %

Subject to

availability of

funds and

implementation

2.3 Enforcement mechanism of salt

iodization developed and

implemented by 2015

Policy notification

TBD

Policy notified/

promulgation

material

available

√ √ √ √ √

Subject to

political

ownership and

subject to

implementation

2.4 Ensure quality of iodized salt

by strengthening and up

gradation of existing lab system

by 2015

# of districts with

new labs

established TBD

New operational

labs/ Record

available 10

20

30

Subject to

political

ownership and

availability of

funds

2.5 Advocate with PFA for

effective implementation

regarding fortification of oil &

Ghee with vit A & D by 2014

Notification &

direction issued

TBD

Notification &

directive


Subject to

political

ownership and

availability of

funds

2.6 Assessment of existing

mechanism of provision of

Vitamin A biannually with

NIDs by 2014

Policy notification

TBD

Policy notified

√ √ √ √ √

Subject to

implementation

2.7 Increase in coverage of Vit A

from 73% to 95% during NIDs

by 2016

% of coverage of

Vit A during NIDs 73%

Health

Department

(quarterly/

annual Reports)

80 %

95 %

Subject to

availability of

funds and

implementation

2.8 Conduct research to assess

absorption and storage of iron.

Research

Conducted TBD

Record

Available √ √ √ √ Subject to

funding, Success

of experiment

2.9 Research on compliance on

uptake of iron

Research

Conducted TBD Record

Available √ √ √ √ Subject to

funding, Success

of experiment

2.10 Provision of iron folic acid to

PLW and adolescent girls

through community health

workers

% of deficient

adolescent girls

provided with iron

folic acid TBD

Record

Available;

Health

Department

(quarterly/

annual Reports) 1

0 %

25

%

50

%

75

%

10

0 %

Subject to

political

ownership and

availability of

funds

2.11 Promote and provide

deworming tablets to children

and adolescent girls.

% of children &

adolescent girls

provided with

deworming tablets TBD

Record

Available;

Health

Department

(quarterly/

annual Reports)

10

%

25

%

50

%

75

%

10

0 %

Subject to

political

ownership and

availability of

funds

2.12 Provision of iron syrup and

tablets in all health facilities

% of government

health facilities

provided with iron

syrup and tablets TBD

Record

Available;

Health

Department

(quarterly/

annual Reports)

10

%

25

%

50

%

75

%

10

0 %

Subject to

political

ownership and

availability of

funds

2.13 Ensure develop and enforce of

flour fortification law by 2016

% of industries

performing

fortification of

flour (% of chakki)

TBD

Availability of

iron fortified

flour

10 % (2 %

)

25 % (5 %

)

100 % (15 %

)

100 % (25 %

)

100 % (10 %

)

Subject to

implementation

Reduction in

low birth weight

babies by 50%

of existing

baseline (NNS

2011) by 2020 by

Improving

maternal health

2.14 Promote healthy timing and

spacing of pregnancy

Seminar

Conducted/

Campaign

launched

Nil

Record

maintained

√ √ √ √ √

Subject to

availability of

funds

2.15 Increase coverage of ANC by

health care providers

2.16 Provision of calcium and

vitamin D supplements to PLW

% of PLW

provided with

calcium and vit. D

supplements TBD

Record

Available;

Health

Department

(quarterly/

annual Reports)

10

%

25

%

50

%

75

%

10

0 %

Subject to

political

ownership and

availability of

funds

2.17 Counseling of pregnant women

to take one extra meal and food

diversity in accordance with

food pyramid

% of pregnant

women aware with

food pyramid TBD

Record

Available;

Health

Department

(quarterly/

annual Reports)

20

%

30

%

40

%

50

%

60

%

Subject to

political

ownership and

availability of

funds

Reduce

prevalence of

stunting among

children of

under five years

from 39% to

27% ( 2%

reduction

annually by

2020

2.18 Increase in early initiation

within one hour from 15% to

60%

% of babies with

early initiation 15% Record

Available;

Health

Department

(quarterly/

annual Reports)

20

%

30

%

40

%

50

%

60

%

Subject to

implementation

2.19 Increase exclusive breast

feeding from 22% to 50%

% of babies with

exclusive breast

feeding 22%

25

%

30

%

35

%

40

%

50

%

Subject to

implementation

2.20 Increase the number of children

fed in accordance with all three

IYCF practices (breast milk

consumption, timely

introduction of solid foods,

food diversity, frequency and

consistency of weaning food.)

Addition in % of

babies fed in

accordance with all

three IYCF

practices

TBD

15

%

30

%

50

%

75

%

10

0 %

Subject to

implementation

2.21 %age of mothers aware of at

least two benefits of exclusive

breast feeding

% of mothers

having knowledge TBD

15

%

30

%

50

%

75

%

10

0 %

Subject to

implementation

2.22 Percentage of mothers aware of

all components of IYCF

practices.

% of mothers


15

%

30

%

50

%

75

%

10

0 %

Subject to

implementation

2.23 %age of mothers able to

identify at least two signs of

childhood illness (e.g.

Pneumonia)

% of mothers


15

%

30

%

50

%

75

%

10

0 %

Subject to

implementation

Reduction in

acute

malnutrition

from 15% to 9%

by 2020

Reduction in acute malnutrition

from 15% to 9% by 2020

% of child

(prevalence) with

acute malnutrition 15%

Reports

Available 14

%

13

%

12

%

10

%

9 %

Subject to

political

ownership and

implementation

2.24 Increase in coverage of fully

immunized children from

34.6% to 90%.

% of immunized

children 34.6%

Reports

Available 40

%

50

%

60

%

75

%

90

%

Subject to

political

ownership and

implementation

2.25 Establishment of nutrition

treatment sites at 30% BHUs

and all RHCs of Province

% of BHUs and

RHCs with

nutrition treatment

sites

TBD

Reports

Available

5 %

10

%

15

%

25

%

30

%

Subject to

political

ownership and

availability of

funds

2.26 Establishment of Stabilization

Centers (SCs) in all DHQs &

Teaching Hospitals.

# of DHQs with

Stabilization

Centers (SCs) TBD

Reports

Available

5

10

15

25

36

Subject to

political

ownership and

availability of

funds

2.27 Increase in percentage of

identified SAM children

enrolled for treatment in

nutrition site.

% of unidentified

SAM children

approached TBD

Reports

Available 15

%

30

%

50

%

75

%

10

0 %

Subject to

political

ownership and

availability of

funds

2.28 Increase percentage of

registered children successfully

treated for severe acute

malnutrition according to

national guideline protocols.

% of children

registered

(successfully

treated for SAM)

TBD

Reports

Available

Subject to

political

ownership and

availability of

funds

2.29 Provision of MMS sachet to

60% of identified MAM

children.

% of children

provided with

MMS sachet TBD

Reports

Available 25

%

30

%

40

%

50

%

60

%

Subject to

political

ownership and

availability of

funds

2.30 Increase in percentage of

children suffering from

diarrhea treated with ORS &

Zinc.

% of children with

diarrhea provided

with with ORS &

Zinc

TBD

Reports

Available 15

%

20

%

30

%

40

%

60

%

Subject to

political

ownership and

availability of

funds

Strategy 3: Strengthening capacity of Provincial and local governments on nutrition to provide basic services in an inclusive and

equitable manner

80% of Health

Care providers

trained on

Nutrition

3.1 Development of training

modules for different cadres

Training modules

developed TBD

Data/Record

Available √ √ Subject to

implementation

and subject to

funding 3.2 Trainings of Provincial master

trainers

# of master trained TBD

Data/Record

Available

50

10

0

20

0

30

0

50

0

3.3 Trainings of Community health

workers and health care

providers on Nutrition

% of Community

health workers and

health care

providers trained TBD

Certificate of

Completion,

Record

maintained,

10

%

20

%

50

%

75

%

10

0%

Annex-2 Result Framework Analysis of Agriculture: Crop Sector

Strategy


Base

Line

Means of

Verifications


Assumptions Y

1

Y

2

Y

3

Y

4

Y

5

Strategy 1: Mainstreaming Nutrition in Agriculture

To develop Policy frame work to create enabling environment for mainstreaming Nutrition in Sector & improving multi-sectoral coordination by year 2015

1.1 Develop and promulgate Provincial Nutrition sensitive Agriculture Policy

Policy notification

TBD

Policy notified

√ √ √ √

Subject to

political

ownership and

Subject to

funding

1.2 Policy decision to add nutrition in IEC material of the agriculture sector

Policy notification

TBD

Policy notified

√ √ √ √

Subject to

political

ownership and

Subject to

funding

1.3 Develop Gender Sensitive and pro poor Provincial Food Security Strategy

Policy notification

TBD

Policy notified

√ √ √ √

Subject to

political

ownership and

Subject to

funding

1.4 Advocacy with BISP for linking BISP beneficiaries with “Kitchen gardening Scheme”

No. of meetings

held with BISP

TBD

Minutes of

meeting

available

√ √ √ √ √

Subject to

political

ownership and

availability of

funding, Subject

to change in

policy of BISP

1.5 Policy to encourage increasing of female agriculture extension officer and field assistant

Policy notification

TBD

Policy notified

√ √ √ √

Subject to

political

ownership and

Subject to

funding

1.6 Enforcement of strict regulatory measures to control the sale of uncertified seeds, harmful pesticides and medicine with adverse effect on human health

Mechanism

notification/ no. of

monthly visits of

market in each

district

TBD

Reports and

result of action

taken Available

12 visits /an

nu

m/

districts

12 visits /an

nu

m/

districts

12 visits /a

nn

um

/

districts

12 visits /an

nu

m/

districts

Subject to

implementation

and subject to

industries

To build capacity

of implementing

staff at district

and UC level on

nutrition manual

1.7 Conduct training of district and UC level staff

% of staff trained

Nil

Certificate of

Completion,

Record

maintained,

0%

20%

50%

75%

100%

Subject to

implementation

and subject to

funding

by 2016 1.8 Conduct training of farmers % of farmers

trained

Nil

Certificate of

Completion,

Record

maintained,

0%

20%

50%

75%

100%

Subject to

implementation

and subject to

funding

1.9 Create awareness among farmers on use of nutritious food, healthy dietary habits, hygiene and health

Seminar

Conducted

Nil Record

maintained √ √ √ √

Subject to

implementation

and subject to

funding

Strategy 2: Increase Productivity in nutritious food (by developing and promoting high yielding varieties of grains & pulses)

To develop, promote and increase the production of high yield varieties of pulses

2.0 To increase in production of the pulses 5% annually from the production of 2012-2013

Increase in

production

Mong:

78000

tons

Reports

available

80000

85000

90000

Subject to

funding and

seasonal

variation Mash:

6050

tons

7000

7500

8500

Lentil:

5420

tons

6000

6500

7500

Gram:

69100

0 tons

75000

0

80000

0

85000

0

2.1 Development of pre-basic/basic seed of high yielding varieties of pulses

Seed available and

tested TBD

Seed available √ √ √ √

Subject to

funding, Success

of experiment

2.2 Promotion of certified seed by distribution among farmers at subsidized prices and demonstration of modern production technology and farmer gatherings

No. demo-plots

established

No. of visits of

community

TBD

Record

maintained

276

276

276

276

Subject to

implementation

and subject to

funding

2.3 Distribution of Seed (Mong, Mash & lentil) to Farmers

No. of seed bags of

40kg distributed TBD

Seed available

9067

13601

18134

Subject to

availability of

funds

2.4 Awareness (Mass media campaign, Farmer days, Seminars)

Campaign

launched; No. of

children/ (girls)

admitted in

schools

TBD

Education

Department

(quarterly/

annual Reports)

√ √ √ √ √

Subject to

political

ownership and

availability of

funds

Strategy 3: Equitable access to vegetables and fruits

To Develop, promote and increase production of vegetables (Vitamins and mineral sources)

3.1 Development & Provision of Good Quality Seed and Seedlings

Quality seed

available and

tested

TBD

Quality seed

available √ √ √ √

Subject to

funding, Success

of experiment

3.2 Promotion of certified seed by distribution among farmers at subsidized prices and demonstration of modern production technology and farmer gatherings

No. demo-plots

established

No. of visits of

community

TBD

Record

maintained

276

276

276

276

Subject to

implementation

and subject to

funding

3.3 Distribution of Seed (Vegetables) to Farmers

No. of seed bags of


Seed available

10000

10000

10000

10000

Subject to

availability of

funds

3.4 Formation of tunnel haring on 50% cost for vegetable cultivation

No. of tunnels in

each districts TBD

Reports

available

1000

1000

1000

Subject to

availability of

funds


No. of events

conducted TBD

Reports

available 10

72

72

72

72

Strategy 4: Addressing Malnutrition through bio-fortification

To develop zinc

fortified wheat

variety to reduce

zinc deficiency

4.1 Development &Production of zinc enrich wheat seed

Seed available and

tested TBD

Seed available

√ √ √ √

Subject to

funding and

success of

experiment

4.2 Promotion of certified fortified seed by distribution among farmers at subsidized prices and demonstration of modern production technology and farmer gatherings

No. demo-plots

established

No. of visits of

community

TBD

Record

maintained

276

276

276

276

Subject to

implementation

and subject to

funding

4.3 Distribution of Seed to Farmers No. of seed bags of


Seed available

10000

10000

10000

10000

Subject to

availability of

funds


No. of events

conducted TBD

Reports

available

10

72

72

72

72

Strategy 5: Scaling up of Kitchen gardening

To Increase

availability of

micronutrient

rich food

especially for

poor and

vulnerable

community

5.1 Promotion of kitchen gardening by conducting meetings of community in each UC (2 meetings/ UC/Month)

No. of meetings

conducted in each

UCs per annum

TBD

Record available

24

24

24

24

24

5.2 Provision of quality seed at subsidized rates

No. of seed packet

distributed 10000

0

Record available

45000

0

50000

0

55000

0

60000

0

65000

0

Subject to

availability of

funds

Strategy 6: Increase accessibility of animal protein sources at household level

Up-scale

household

livestock

production to

increase the

access to protein

rich foods

6.1 Promote backyard poultry farming by provision of subsidized layer chicken with cock to vulnerable community

No. of meetings

conducted in each

UCs per annum

TBD

Record available

24

24

24

24

24

6.2 Provision of small cattle of excellence genetic profile on subsidized rate for raring and future reproductive growth

Annex-3 Result Framework Analysis of Agriculture: Livestock & Poultry

Strategy


Base

Line

Means of

Verifications


Assumptions Y

1

Y

2

Y

3

Y

4

Y

5

Strategy 1: Increase the productivity by sustainable livestock farming and capacity development to combat protein energy

malnutrition

To increase the

gross annual

meat production

from 3,379,000

tons in 2013 to

5,000,000 tons as

well as gross

milk production

from 49,512,000

tons in 2013 to

80,000,000 tons

by the end of

2020 (according

to Economic

Survey of

Pakistan)

1.0 (A) To increase the gross annual

meat production from 3,379,000

tons in 2013 to 5,000,000 tons

by the end of 2020 (according to

Economic Survey of Pakistan)

meat production

per annum in tons

3,3

79,0

00 to

ns

Annual Report

(Economic

Survey of

Pakistan)

4,0

00,0

00 to

ns

4,2

50,0

00 to

ns

4,5

00,0

00 to

ns

4,7

50,0

00 to

ns

5,0

00,0

00 to

ns

Subject to

political

ownership and

Subject to

funding

1.0 (B) To increase the gross

annual milk production from

49,512,000 tons in 2013 to

80,000,000 tons by the end of

2020 (according to Economic

Survey of Pakistan)

Milk production

per annum in tons

49

,51

2,0

00 to

ns

Annual Report

(Economic

Survey of

Pakistan)

55

,00

0,0

00 to

ns

60

,00

0,0

00 to

ns

65

,00

0,0

00 to

ns

70

,00

0,0

00 to

ns

80

,00

0,0

00 to

ns

Subject to

political

ownership and

Subject to

funding

1.1 Enhance livestock production

through adaptation of latest

technology (biotechnology &

genetic engineering,

improved reproductive

technologies, precision

animal breeding) and breed

improvement (implementation

& policy level)

Availability of

excellence genetic

profile breed/

Implementation

of latest

technology

TBD

Excellence

genetic profile

breed available

√ √ √ √

Subject to

funding, Success

of experiment

1.2 Promote and provide various

livestock animals of excellence

genetic profile on subsidized

rate for raring and rapid

reproductive growth


Policy

notification TBD

Policy notified

√ √ √ √

Subject to

political

ownership and

Subject to

funding

1.3 Strengthen the easily provision

of cost effective and safe

livestock (cattle & poultry) feed

(implementation level)

Policy

notification TBD

Policy notified

√ √ √ √

Subject to

political

ownership and

Subject to

funding

1.4 Promote the latest embryo

transfer technology and provide

semen’s injections of excellence

genetic profile animals at free of

cost/subsidized cost


Availability of

excellence genetic

profile animal’s

semen

TBD

Excellence

genetic profile

animal’s semen

available

√ √ √ √ √

Subject to

funding, Success

of experiment

1.5 Increase the number of dairy

farms and milch animals (2-5%

annually) from the existing in

2012-2013 (implementation

level)

# of fish farms

TBD

New farm

established,

Record/Reports

available

5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

industries

1.6 Skills enhancement of livestock

sector’s individuals (staff &

farmers) by conducting trainings

at UC and districts level


% of staff and

farmers trained Nil

Certificate of

Completion,

Record

maintained

0%

20

%

50

%

75

%

10

0%

Subject to

implementation

and subject to

funding

Strengthen

veterinary

medical and

diagnostic lab

facilities by 2020

to control and

reduce the risk

of outbreak

1.7 Up-gradation of the existing lab

facilities for proper diagnosis &

safety testing of feeds and food

(milk & meat) in regions, where

the labs are already present but

are with limited capacity or non-

operational (implementation &

policy level)

Percent of labs up-

graded

TBD

Operational &

up-graded labs/

Record available

10

%

25

%

50

%

75

%

10

0 %

Subject to

political

ownership and

availability of

funds

1.8 Establishing new livestock

diagnostic lab facilities by the

end of 2019, in regions where

there is need but there are no

labs (implementation & policy

level)

# of districts with

new labs

established TBD

New operational

labs/ Record

available 10

20

30

36

Subject to

political

ownership and

availability of

funds

1.9 Provide various services at free

of cost (technical support,

vaccination, and veterinary

medical services) to control and

reduce the risk of outbreak


# of animal

vaccinated &

treated per annum

TBD Record

maintained

√ √ √ √ √

Subject to

implementation

and subject to

funding

Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access to livestock-based products

To increase the

gross annual

milk

consumption

from 39,945,000

tons in 2013 to

80,000,000 tons

2.1 Increase the awareness of

livestock-based protein sources

(meat, milk and egg) importance

and its consumption through

literature, extension services,

mass media campaigns and

education (implementation

level)

# of events/

seminars

conducted annually

(2 events/districts) Nil

Reports

available

10

72

72

72

72

Subject to

funding, Subject

to implementation

as well as gross

eggs

consumption

from 13,813

million in 2013

to 20,000 million

by the end of

2020 (according

to Economic

Survey of

Pakistan)

2.2 Introduce and promote the value

added livestock-based (meat,

milk and egg) products

especially at school level


# of new products

launched TBD

Reports

available 15

20

35

50

50

Subject to

implementation

and subject to

funding

2.3 Promote the consumption of egg

and poultry meat (5% annually

from existing in 2012-2013) so

that poor families may also

consumed protein with high

biological value at very low

price (implementation level)

Annual

consumption of

egg

13

,81

3 m

illion

Annual Reports

available

5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

funding

2.4 Promote the consumption of

milk and milk product (5%

annually from existing in 2012-

2013) to reduce the risk of

various essential nutrients

deficiency (implementation

level)

Annual

consumption of

milk in tons

39

,94

5,0

00 to

ns

Annual Reports

available

5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

funding

Introduce and

promote various

livestock-based

products by non-

conventional

indigenous

resources as

value addition

especially in

vulnerable

community to

reduce nutrient

2.5 Promote the consumption of

camel milk and its product to

uplift the economic situation of

community in desert area and

also to reduce the nutrient

deficiency (implementation

level)

Policy

notification/ TBD

Policy notified

√ √ √ √ √

Subject to

political

ownership,

Subject to

implementation

2.6 Introduce various milk products

(like cheese, whey protein,

casein, ice cream, chocolates,

bioactive peptides etc.)

especially from camel milk as

value addition (implementation

level)

# of new products

launched

TBD

Reports

available

5

10

15

20

20

Subject to

implementation

and subject to

funding

deficiency by

2017

2.7 Launch various research project

and strengthen/scaling up the

existing ones to develop various

value added products from non-

conventional indigenous

resources (implementation

level)

# of project

launched each

year Nil

Project

launched/

Reports

available 5 5 5 5 5

Subject to

implementation

and subject to

funding

To ensure and

improve safe as

well as quality of

livestock

products from

farm to fork by

2020

2.8 Enhance the quality of the

livestock-based products (meat,

egg, milk etc.) by introducing

the modern and safe processing

techniques, and supply chain

(cold storage, good

transportation etc.)


Policy notification

TBD

Policy notified

√ √ √ √ √

Subject to

political

ownership and

Subject to

funding

2.9 Increase availability of quality

of livestock-based products

(meat, egg, milk etc.) in local

markets (10% annually from

existing in 2012-2013) and

develop the mechanism to

control the increases in prices

(policy level)

Amount of

livestock based

product sale in

local markets TBD

Reports

available

10

%

20

%

30

%

40

%

50

%

Subject to

implementation

and subject to

funding

2.10 Mandatory Safety/Management

Certification of large livestock

farms in five years, medium size

in 10 years, and all livestock

farms in 15 years

% of livestock/

poultry farms

certified TBD

Certificate

available,

Record

maintained,

5%

10%

15%

20%

30%

Subject to

implementation

by PFA and

subject to

industries

2.11 Continuous professional

development, capacity

enhancement, trainings and

awareness campaigns for all

involved in food supply chain

starting from producers to

consumer desk

No. of institutes

offering CPD and

Training programs

(No. of person

trained)

TBD

Programs

launched and

trained persons

5 (2

50)

10

(50

0)

15

(75

0)

20

(10

00

)

20

(10

00

)

Subject to

subject to funds

and subject to

institutes

Strategy 3: Increase accessibility of animal protein sources at household level especially for vulnerable community

Up-scale

household

livestock

production to

increase the

access to

protein rich

foods

3.1 Promote backyard poultry

farming by provision of

subsidized layer chicken with

cock to eligible families

(women) (Implementation

level)

# of meetings

conducted in each

UCs per annum TBD

Record

available 24

24

24

24

24

No. of meetings

conducted in

each UCs per

annum

3.2 Provision of small cattle of

excellence genetic profile on

subsidized rate for raring and

future reproductive growth


# of animal (with

excellence genetic

profile) distributed

each year on

subsidized rate

TBD

Record

available 10

00

20

00

50

00

50

00

50

00

Subject to

implementation

and subject to

funding

To create

enabling

environment for

mainstreaming

Nutrition in

Sector &

improving

multi-Sectoral

coordination by

year 2015


department with BISPs program

“Wasela-e-Rozgar” and

upcoming new social protection

schemes to support for ultra-

poor segment of the society by

up-scaling home based livestock

and backyard kitchen farming


Policy notification

TBD

Record

available √ √ Subject to

political

ownership/

Subject to funds/

Subject to

beneficiaries to

implement on

kitchen farming

(never sell out)

# of families

provided with

cattle

Record

available/

families with

cattle

500

1000

5000

5000

# of families

provided with

layers

Record

available/

families with

layers

5000

10000

50000

50000

Annex-4 Result Framework Analysis of Agriculture: Fisheries

Strategy


Base

Line

Means of

Verifications


Assumptions Y

1

Y

2

Y

3

Y

4

Y

5

Strategy 1: Capacity Development: Strengthening the fisheries sector to increase the productivity by scaling up the existing resources to combat protein energy malnutrition

To increase the production of fish from 594,935 tons in 2011 to 800,000 tons by the end of 2020 (according to FAO Statistics)

1.0 To increase the production of fish from 594,935 tons in 2011 to 800,000 tons by the end of 2020 (according to FAO Statistics)

Fish production

per annum in tons

594,935 to

ns

Annual Report

(FAO)

62

0,0

00

ton

s

65

0,0

00

ton

s

70

0,0

00

ton

s

75

0,0

00

ton

s

80

0,0

00

ton

s

Subject to

political

ownership&

implementation

1.10 Increase the number of hatcheriesfrom 88 to 150 by the end of 2020 to ensure the availability of high quality seed (implementation level)

# of hatcheries

88

# of hatcheries

established/

Record/Reports

available 95

105

120

135

150

Subject to

political

ownership and

Subject to

funding

1.11 Promote and strengthen the economical fish-feed production (implementation level)

Policy notification

TBD

Policy notified

√ √ √ √ √

Subject to

political

ownership and

Subject to

funding

1.12 Development and provision of seed of high yielding varieties of various fish species by some genetic modification (implementation level)

High yielding fish

seeds available and

tested TBD

Seed available/

Record maintain √ √ √ √ √

Subject to

political

ownership and

Subject to

funding

1.13 Promotion of high yielding fish-seed (lowest price of available protein) by distribution among farmers at subsidized prices and demonstration of modern production technology to reduce pre & post-harvest losses (implementation level)

Seed availability at

subsidized prices

# of demo-farm

established

TBD

Policy notified/

Farm

established

√

10

√

20

√

30

√

50

√

50

Subject to

political

ownership and

availability of

funding

1.14 Skills enhancement of fishery sectors individuals (staff & farmers) by conducting trainings at UC and districts level (implementation level)

% of staff and

farmers trained Nil

Certificate of

Completion,

Record

maintained

0%

20

%

50

%

75

%

10

0%

Subject to

implementation

and subject to

funding

1.15 Increase the number of fish farms (5% annually) from the existing in 2012-2013(implementation level)

# of fish farms

TBD

New farm

established,

Record/Reports

available

5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

industries

1.16 Increase the capacity of the existent fish farms (10% annually)by the end of 2020(implementation level)

# of fish farm with

increased capacity

TBD

Farm with

increased

capacity,

Record/Reports

available

10

%

20

%

30

%

40

%

50

%

Subject to

implementation

and subject to

funding

1.17 Promote the Trout fish farming in natural water resources to increase the Trout production (5% annually from existing in 2012-2013)(implementation level)

Annual production

of trout fish in tons TBD

Annual Reports

available

5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

funding

1.18 Initiate shrimp cultivation in the Indus delta to increase the shrimp production (5% annually from existing in 2012-2013)(implementation level)

Annual production

of shrimp fish in

tons TBD

Annual Reports

available 5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

funding

Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access to aquaculture/fish food

To increase the per capita consumption of fish from 2 kg/year to 5 kg/year by the end of 2020 through awareness, value addition and cost effective fish products

2.0 To increase the per capita consumption of fish from 2 kg/year to 5 kg/year by the end of 2020 through awareness, value addition and cost effective fish products

Per capita fish

consumption in

kg/Year

2.0kg per year

Annual Reports

available 2.5 kg/yea

r

3.0 kg/yea

r

3.5 kg/yea

r

4.0 kg/yea

r

5.0 kg/yea

r Subject to

funding, Subject

to

implementation

and success of

policies

2.1 Increase the awareness of fish meat importance and its consumption through literature, extension services, mass media campaigns and education (implementation level)

# of events/

seminars

conducted

annually (2

events/districts)

Nil

Reports

available

10

72

72

72

72

Subject to

funding, Subject

to

implementation

2.2 Introduction of value added fish products such as fish cookies, fish chips, fish biscuits, fish nan/chappaties, fish cakes, fish salads, fish samosa, fish biryani, and nimko, etc.

# of fish products

launched TBD

Reports

available

5

10

15

20

20

Subject to

implementation

and subject to

funding


2.3 Promote the consumption of small size fish (5% annually from existing in 2012-2013)so that poor families may also consumed with low price (implementation level)

Annual

consumption of

small fish in tons TBD

Annual Reports

available

5%

10

%

15

%

20

%

25

%

Subject to

implementation

and subject to

funding

To ensure and

improve safe as

well as quality of

fish from farm to

fork

2.4 Enhance the quality of the fish by introducing the modern and safe processing techniques, cold storage, good transportation and improvement in marketing channel, etc. (implementation level)

Policy notification

TBD

Policy notified

√ √ √ √ √

Subject to

political

ownership and

Subject to

funding

2.5 Enhance the coastal aquaculture production and increase availability(10% annually from existing in 2012-2013) in local inland markets (implementation level)

Amount of fish sale

in local inland

markets (in tons) TBD

Reports

available 10

%

20

%

30

%

40

%

50

%

Subject to

implementation

and subject to

funding

Annex-5 Result Framework Analysis of Food Sector

Strategy Objective

Strategy Action(s) Indicators Base Line

Means of Verifications

TIME LINE (Years) Key Assumptions Y

1 Y 2

Y 3

Y 4

Y 5

Strategy 1: Physical access to food throughout the year for all targeted groups

Increase in storage capacity from existing level to 80% by 2020

1.19 Replace wheat storage from bag to silos storage (Policy level)

No. of districts containing silos facilities for storage

TBD

No. of Silo in each districts/ Food Department Reports

5

10

15

20

Subject to political ownership and availability of funds

Ensure access to food throughout the year

1.20 Explore avenues for Public and Private partnership to preserve and increase storage perishable commodities at their peak harvesting for year-long availability at affordable price (Policy level)

Policy notification

TBD

Policy notified

√ √ √ √

Subject to political ownership and Subject to Private partner

1.21 Introduce the applications of cost effective modern technologies to improve food supply chain and reduce post-harvest losses (i.e. preservation by irradiation, integrated pests & rodents control systems, etc.) (Policy level)

Policy notification

TBD

Policy notified/ promulgation material available √ √ √ √

Subject to political ownership and subject to adoption of new technologies

1.22 Introduce and promote cold supply chain to increase the safety of high risk food (Policy level)

Notification& direction issued

TBD

Notification& directive available √ √ √ √ √


Strategy 2: Ensure and improve food quality from farm to fork

Strengthen lab facilities to ensure food safety and quality by 2016

2.5 Up-gradation of the existing lab facilities for wheat quality & safety testing in regions, where the labs are already present but are with limited capacity or non-operational(Policy level)

Percent of labs up-graded

TBD

Operational & up-graded labs/ Record available

10

%

25

%

50

%

75

%

10

0 %


2.6 Establishing new lab testing facility in regions where there is need but there are no labs (policy level Level)

No. of districts with new labs established TBD

New operational labs/ Record available

10

20

30

36


Strategy 3: Provision of safe food

Strengthen and extension of Punjab Food Authority to improve food safety

3.6 Phase-wise extending the Punjab Food Authority to whole of Punjab by 2020 (Policy level)

No. of Districts in which department of PFA established 2

Active PFA department in respective districts

2

5

15

25

36


3.7 Establishing lab facilities at district level parallel with the extension of Punjab Food Authority for safety & quality testing of food products(Policy level)

No. of districts with new labs established (parallel to extension of PFA)

1

New operational labs/ Record available

2

5

15

25

36


Improve the food safety management systems by legislation, promulgate and implement

3.8 Improving the capacity of inspection services through Revising and harmonizing the food rules with (Codex Alimentarious Commission (CAC), OIE, and IPPC) (implementation Level)

Revision of Rules

TBD

Notification& directive available

√ √ √ √ √

Subject to political ownership and subject to facilities available

3.9 Continuous professional No. of institutes TBD Programs 5 (250) 10 (500) 15 (750) 20 (1000) 20 (1000) Subject to

development, capacity enhancement, trainings and awareness campaigns for all involved in food supply chain starting from producers to consumer desk

offering CPD and Training programs (No. of person trained)

launched and trained persons

subject to funds and subject to institutes

3.10 Promoting and advising to get Food Safety Management Certification like HACCP, BRC, ISO-22000 etc. by food business operators, targeting specifically the large industries and high risk food processors for 3 years

% of Large food business certified

TBD

Certificate available, Record maintained,

10%

25%

50%

75%

100%

Subject to implementation by PFA and subject to industries

3.11 Mandatory Food Safety Certification of large food industries in five years, medium size in 10 years, and all food business operation in 15 years

% of medium and small food business certified

TBD

Certificate available, Record maintained,

5%

10%

15%

20%

30%

Subject to implementation by PFA and subject to industries

Strategy 4: Economic Access to food

Improve the economic access to food by subsidies and price control and regulation mechanism

4.1 Targeted and conditional food subsidies for poor instead of generic subsidies and will be linked with inflation rate by 2014(Policy level)

Availability of low price food in market

TBD

Price of food

√ √ √ √


4.2 Putting in place the price control and regulation mechanism especially for staple food (Policy level)

Strategy 5: Reduce micronutrient deficiency in adolescents girls, pregnant & lactating mothers and children’s through fortification

Promulgate and implement, legislation regarding fortification of food by 2016

5.1 Create awareness on benefits for use of fortified flour, salt and edible oil (Policy level)

Seminar Conducted/ awareness material distributed

TBD

Record maintained

√ √ √ √ √

Activity is supposed to be taken initially with support of donors and later on from ADP

5.2 Legislation of mandatory wheat flour fortification with iron and folic acid by 2016 for flour milling industry and in five years in flour grinding industry (chakki flour) (policy level)

% of industries performing fortification of flour (% of chakki)

TBD

Availability of iron fortified flour

25 %(5 %

)

100 %(1

5 %)

100 % (25 %

)

100 % (50 %

)

Subject to implementation

5.3 Legislation on mandatory universal salt iodization by December 2014 (policy level)

% of industries performing fortification of iodine

TBD

Availability of iodized salt

40 %

50 %

100 %

100 %

100 %


5.4 Devise implementation strategy to ensure Vitamin A and Vitamin D fortification in ghee and oil(Implementation level)

% of industries performing fortification of Vitamin A & Vitamin D

TBD

Availability of Vitamin A & D fortified ghee and oil

40 %

50 %

100 %

100 %

100 %


Annex-6 Result Framework Analysis of WASH Sector

Strategy Objective

Strategy Action(s) Indicators Base

Line

Means of Verifications

TIME LINE (Years) Key Assumptions Y

1 Y 2

Y 3

Y 4

Y 5

Strategy 1: Equitable access to safe & clean water

To increase the

access to water

and reduce the

arduous labour

of women in

carrying it in

all vulnerable

communities

by 2020

Increase the access to water and

reduce the arduous labour of

women in carrying it in all

vulnerable communities by 2020

Increase in %

population having

access to improve

source of drinking

water

94.1%

Report

Available/

MICS survey

report

95

%

97

%

99

%

10

0%

10

0

10

0%

Subject to

political

ownership and

availability of

funds

1.1 Provide drinking water under

Changa Paani Programme

through early implementation

and completion of project by

2020 (Implementation level)

# of districts

(villages in

districts) launched

Changa Paani Programme

TBD

Programme

launched

5

10

15

20

36

Subject to

political

ownership and

availability of

funds

1.2 Provide clean drinking water by

installing filtration plants under

Saaf Paani Programme through

early implementation and

completion of project by 2020


# of districts

(villages in

districts) launched

Saaf Paani Programme

TBD

Programme

launched

5

10

15

20

36

Subject to

political

ownership and

availability of

funds

1.3 Provide hand pumps in areas

where the provision of tap

water facility is currently not

feasible (Implementation

Level)

# of hands pump

provided

TBD

Hand pump

functional

(Record

maintained)

1000

2000

2000

2000

2000

Subject to

political

ownership and

availability of

funds

1.4 Rehabilitation of dysfunctional

rural water supply schemes

(Implementation Level)

Notification &

direction issued to

release funds TBD

Notification &

directive


Subject to

political

ownership and

availability of

funds

1.5 Ensure availability of safe

drinking water by installation of

water filtration plants in schools


% of schools

having functional

water filtration

plants

Nil

No. water

Filtration plants

installed in

institutes

10

%

25

%

50

%

10

0 %

% of schools

having

functional water

filtration plants

To increase

access to

clean/safe

drinking water

in all

vulnerable

communities

by 2020

1.6 Install of water filtration plants

to ensure provision of safe

drinking water

# of water filtration

plants installed

TBD

Water filtration

plants functional

(Record

maintained)

500

500

500

500

500

Subject to

political

ownership and

availability of

funds

1.7 Initiate water treatment projects

at household and community

level by distribution of

chlorinating tablets etc.

Project launched

(# of packet of

chlorine tablets

distributed) TBD

Chlorine tablets

distributed 5000

15000

10000

0

10000

0

10000

0

Subject to

political

ownership and

availability of

funds 1.8 Establish water quality testing

facilities and regular sampling

of water from various water

projects starting from water

source to household level

# of districts with

new labs

established TBD

New operational

labs/ Record

available

5

10

20

30

36

Subject to

political

ownership and

availability of

funds

1.9 Introduce community based

effective monitoring

mechanism using elected UC

representatives, school councils

and CBOs

Mechanism

defined;

Committee notified TBD

Minutes of

meeting

√ √ √ √ √

Subject to

political

ownership

1.10 Plan and introduce proper

operation and maintenance

mechanism for keeping the

facilities operational

Mechanism

defined; Strategy

planned TBD

Record

maintained √ √ √ √ √

Subject to

political

ownership

To reduce

misuse and

depletion of

1.11 Increase water conservation

with increased and improved

water storage capacity

# of water

conservation tanks

build TBD

Record

maintained

50

10

0

10

0

10

0

Subject to

implementation

and subject to

funding

ground water

1.12 Launch a campaign for

awareness to reduce water

wastage and misuse

Seminar

Conducted/

Campaign

launched Nil

Record

maintained

√ √ √ √ √

Subject to

availability of

funds; Activity

is supposed to

taken initially

with donor

money and later

on from ADP

Strategy 2: Promote best practices & behavioral change regarding hygiene practices

To Launch

campaign and

awareness

programs to

promote hygiene

practices

Launch campaign and

awareness programs to

promote hygiene practices

% of rural people

having knowledge

of good practices of

sanitation, health &

hygiene

TBD

Report of survey

conducted 10

%

25

%

50

%

10

0 %

10

0 %

Subject to

availability of

funds

2.1 Conduct awareness campaigns

an community sessions through

integration approach by

community workers like

SH&NS, LHW, CMW,

agriculture field assistant,

school teachers, civil society,

union council, CBOs,

KHATTEEB of local

MASAJIDS (AUQAF Dept.)

and local media (Policy Level)

Seminar

Conducted/

Campaign launched

Nil

Record

maintained

√ √ √ √ √

2.2 Celebrate the Mother & Child

Week, Global Hand Washing

Day, World Toilet Day and

World Water Day, Anti-

Dengue Day to promote

hygiene practices


2.3 Develop IEC material on

nutrition containing guidelines

of health and hygiene practices

Officially

announcement of

dates for TBD

Day Celebrated

& Record

available √ √ √ √

Subject to

implementation;

Activity is

(Policy Level) celebration of days

supposed to

taken initially

with donor

money and later

on from ADP 2.4 Creative inclusion of sanitation,

hygiene and preventive

approaches dressing

malnutrition in school

curriculum in coordination with

School Education Department

and Punjab Curriculum

Authority (Policy Level)

Curriculum

reviewed and

Chapter added on

Nutrition and

Hygiene

Nil

Revised

curricula

available

√ √ √

Subject to

implementation

Strategy 3: Equitable access to Total Sanitation Services

To decrease

ODF 22% to

10% in province

in Punjab by

2020

3.1 Conduct pilot project of PATS

in high risks districts (Rajanpur,

Muzaffargarh, DG Khan,

Chinniot and Jhang) by 2015

# of districts with

PATS

implemented TBD

PATS

implemented,

Records

available

5

10

20

30

36

Subject to

political

ownership and

availability of

funds 3.2 Scaling-up the Pakistan

Approach for Total Sanitation

in all districts of Punjab after

the evaluation of Pilot Project

by 2020

Installation of

sewerage

treatment units

by 2020

3.3 Install small scale sewerage

treatment units especially with

prioritization in those large

villages (Implementation

Level)

# of sewerage

treatment units

installed TBD

Functional

sewerage

treatment units

15

25

10

0

10

0

10

0

Subject to

political

ownership and

availability of

funds

3.4 Install small scale solar

sewerage treatment plants


# of sewerage

treatment units

installed TBD

Functional

sewerage

treatment units

15

25

10

0

10

0

10

0

Subject to

political

ownership and

availability of

funds

Installation of 3.5 Improve solid waste # of solid waste TBD Functional 15

25

100

100

100 Subject to

solid waste

management

plants by 2020

management schemes and

mechanism through

establishment of solid waste

management plants in all over

the Punjab to treat agriculture,

sewerage and domestic solid

waste (Implementation Level)

management plants

treatment units

installed

SWM plants political

ownership and

availability of

funds

3.6 Install composting plants in

large cities to manufacture

compost fertilizers from this

waste (Implementation Level)

# of composite

plants installed

TBD

Functional

composite

plants

5

10

10

10

10

Subject to

political

ownership and

availability of

funds To ensure

availability of

facilities of

quality hygiene

and sanitation

practices at

100% schools by

2019

(especially in

girls school)

3.7 Provide WASH facilities, like

soap and toilets, in schools in

collaboration with School

Education Department (Policy

Level)

% of schools

having soaps in

toilets

TBD EMIS

50

%

70

%

10

0 %

10

0 %

10

0 %

% of schools

having soaps &

toilets

Strategy 4: Development and implementation of Policies and Strategies

Formulation of

nutrition and

gender sensitive

policies &

strategies of

WASH sector

4.1 Approval and dissemination of

Punjab Drinking Water Strategy

by 2015 (Policy Level)

Policy

notification &

direction issued

TBD

Policy

notification &

directive

available/

promulgation

material

available

√ √ √ √ √

Subject to

political

ownership and

subject to

implementation 4.2 Approval and dissemination

Punjab Sanitation Policy and

Strategy by 2015 (Policy Level)

4.3 Approval and dissemination

Behavior Change

Communication Strategy by

2015 (Policy Level)

4.4 Approval, dissemination &

implementation of Punjab

Municipal Water Act 2013

(Policy Level)


WASH sectoral Nutrition

Strategy & Operational plan

and its effective implementation

Annex-7 Result Framework Analysis of Social Protection Sector

Strategy


Base

Line

Means of

Verifications


Assumptions Y

1

Y

2

Y

3

Y

4

Y

5

Strategy 1: Strengthen social protection sector to scale-up nutrition-sensitive interventions

Expedition of

approval,

dissemination,

and

implementation

of nutrition-

sensitive social

protection

related drafted

strategies and

act(s)

1.1 Establishment of Social

protection authority (Policy

level)

Notification &

direction issued to

establish authority Nil

Notification &

directive

available √

Subject to

political

ownership and

availability of

funds


existing policies/ legislation of

Social Protection sectoral more

nutrition-responsive and its

effective implementation

(Policy level)

Amendments in

policies &

legislations TBD

Record

maintained

√ √ √

Subject to

political

ownership

1.3 Develop nutrition specific

legislations about Zakat, Bait-

ul-Mall, and PVTC (policy

level)

Revision of Rules

TBD

Notification &

directive

available √

Subject to

political

ownership and

subject to funds

available

1.4 Increase coordination between

federation and federating units

on nutrition-sensitive social

protection (Policy level)

MoU signed with

other sectors

(governmental,

privates, NGOs etc.) TBD

Meetings and

record maintain

√ √ √ √ √

Subject to

political

ownership and

subject to

consent of other

sectors

To create

enabling

environment for

mainstreaming

Nutrition in

Sector &

improving

multi-Sectoral

coordination by

year 2015

1.5 Develop and strengthen

linkage with LHWs, SH&NS,

teachers, local NGOs for

promoting social aspects of

addressing malnutrition

(Develop a mechanism of

coordination to implement on

strategies)


Policy notification

& direction issued/

Mechanism of

coordination

developed

TBD

Policy

notification &

directive

available

√

Subject to

political

ownership and

subject to

consent of

partners

1.6 Initiate screening through

School Health and Nutrition

Supervisors, response in

coordination with health

department to integrate

nutrition intervention with

women and children focused

approach (Implementation

level)

# of visits of

doctor/physician and

School Nutrition

Health Supervisor

TBD

12 visits per

annum per

school √ √ √ √ √

Subject to

implementation

1.7 Mapping of districts through

impartial surveys, and

utilization of this data to

strengthen nutrition

interventions of social welfare

department (Implementation

level)

# of districts of

which survey

performed and map

developed TBD

Record

available/

Developed map 2

5

15

25

36

Subject to

political

ownership and

availability of

funds


department with BISPs program

Policy notification TBD Record available √ √ Subject to

political

“Wasela-e-Rozgar” and

upcoming new social protection

schemes to support for ultra-

poor segment of the society by

up-scaling home based livestock

and backyard kitchen farming


# of families

provided with cattle

Record

available/

families with

cattle

50

0

10

00

50

00

50

00

ownership/

Subject to funds/

Subject to

beneficiaries to

implement on

kitchen farming

(never sell out)

# of families

provided with layers

Record

available/

families with

layers

50

00

10

00

0

50

00

0

50

00

0

# of families

provided with

vegetables & fruits

seeds

Record

available/

families having

seeds

50

00

10

00

0

50

00

0

50

00

0


BISP beneficiaries with

“Kitchen gardening Scheme”


No. of meetings held

with BISP

TBD

Minutes of

meeting

available

√ √ √ √ √

Subject to

political

ownership and

availability of

funding,

Subject to

change in

policy of BISP

Strategy 2: Improving the economic access to nutritional needs by poverty alleviation and social protection

By 2015,

introduce cash

transfer system

for improving

the economic

2.1 Link the cash transfer via

vouchers and assistance from

BISP with evident based

nutrition need (Implementation

level)

% of BISP

beneficiaries

receiving voucher

based on nutrition

need

TBD

Record

maintained/

Families

receiving

voucher

10

%

40

%

80

%

10

0 %

10

0 %

Subject to

political

ownership and

availability of

funds

access to

adequate food to

meet minimum

nutritional needs

2.2 Link cash transfer amounts to

provincial food price indices so

that real value remains constant


% of BISP

beneficiaries

receiving amount

based on food price

TBD

Record

maintained/

Families

receiving

voucher

10

%

20

%

40

%

70

%

10

0 %

Subject to

political

ownership and

availability of

funds

2.3 Conduct research intervention to

assess the impact on improving

nutrition through cash transfer

scheme (BISP data could be

used), and implement impartial

program monitoring with third

party validation


Research conducted/

Dissemination of

knowledge

TBD

Reports and

research papers

available

√ √ √ √

Subject to

availability of

funds

By 2015,

introduce

conditional cash

transfer (CCT)

policies with the

intention of

targeted

approach

2.4 Introduce conditional cash

transfer (CCT) and make BISP

or any other such program

conditional for beneficiaries to

enroll their daughters in schools

(Policy level)

% of BISP

beneficiaries

families admitted

their daughter in

schools Nil

Certificates of

admission

received from

each family 15%

30%

50%

75%

100%

Subject to

political

ownership and

availability of

funding,

Subject to

change in

policy of BISP

2.5 Piloting of a conditional cash

transfer program using

vouchers and linked to the

utilization of health and

nutrition services by target

population groups, while being

particularly attentive to supply

side constraints which may be

encountered by these groups

(Policy level)

Pilot project

conducted/

Dissemination of

knowledge Nil

Reports

available

√ √ √ √

Subject to

availability of

funds

2.6 Targeted and conditional food

subsidies for poor instead of

generic subsidies and will be

linked with inflation rate by

2014 (Policy level)

Availability of low

price food for poor

in market Nil

Price of food

√ √ √ √

Subject to

political

ownership and

availability of

funds

Strategy 3: Promote nutrition awareness for healthy dietary practices

To use Social

Protection

Sector platform

for promoting

nutrition

awareness for

healthy & safe

dietary

practices in

poorest

community of

Punjab

1.1 Seminars/ workshops in

industrial homes (1 day - 1 week

nutrition specific trainings in

Sanat-Zars) (Implementation

level)

# of events

conducted in each

districts per annum Nil

Reports

available

12

24

48

48

48

Subject to

political

ownership and

availability of

funds

1.2 Seminars/ workshops in PVTC

(1week-15days nutrition

module to Zakat families)


# of events

conducted in each


Reports

available

12

24

48

48

48

Subject to

political

ownership and

availability of

funds

1.3 Seminars/ workshops in Rescue

homes (Darul-aman)


# of events

conducted in each


Reports

available

12

24

48

48

48

Subject to

political

ownership and

availability of

funds

1.4 Enhance nutrition awareness

through distributing IEC

material poorest 2,50,000 zakat

families of Punjab using zakat

committees (25,000)


Development of IEC

material and its

distribution Nil

IEC material

developed and

distributed in

families

√ √ √

Subject to funds

and subject to

institutes

Annex-8 Result Frame work for M&E

Results

Chain

Descriptive

Summary

Indicators of Work Performance Means of

Verification

Responsiblity

Goal Improved human

capital, especially

among the poor

segments of society by

improved maternal and

child nutrition and

health status

Eliminate chronic under-nutrition by the year 2020 PDHS, MICS P&D

Purpose Strengthened

multisector

efforts

and other stakeholders

to improve access to

quality nutrition

services for

improved nutrition in

Punjab

By the end of 2020:

• % prevalence of stunting among children under -5

years reduced below 20%

• % prevalence of underweight among children under-5


• % prevalence of wasting among children under-5


• % of women with iron deficiency anemia reduced

below 30%

• % of babies born with low birth weight (<2,500

grams) reduced

• % of children and adolescents (boys and girls) not

completing primary and basic school education

reduced

PDHS, MICS, P&D

Outcomes 1: Policies, plans and

multi-sector

Coordination

improved at Provincial

& district levels.

By the end of 2020:

• Multi-sector commitment and resources for nutrition

are increased to at least 10% annually

• Nutritional information management and data

analysis strengthened and are used to track progress.

• Protocol established for nutrition profiles (as basis for

planning) at local level

Sectoral progress

reports

P&D all Sectors

2: Practices that

promote optimal use of

nutrition ‘specific’ and

nutrition ‘sensitive’

By the end of 2020:

• MIYC micronutrient status (Vitamin A, Iodine,

Anemia) improved

• % of children decreased with Vitamin A deficiency

Routine reporting Health,

services improved,

leading to enhanced

maternal and child

nutritional status

% increase in households using iodized salt.,

% increase in use of zinc in management of

diarrhoea with new ORS)

• Comprehensive Training Package on Nutrition

adapted and rolled-out

• % of mothers and infant and young child feeding

practicing improved as per the recommendations

• % of children with SAM accessing services on Severe

Acute Malnutrition (SAM ) management as per

SPHERE standards increased especially in the most

affected districts

•Prevalence of infections (especially diarrhoea and

ARI) reduced

Adolescent girls awareness and behaviors in relation to

protecting foetal, infant and young child growth

improved

• Parents better informed with regard to avoiding

growth faltering

• Nutritional status of adolescent girls improved

(especially anemia)

• Primary and secondary school enrolment increased,

particularly for girls

Routine reporting Health

• All young mothers and adolescent girls use improved

sanitation facilities

• All young mothers and adolescent girls use soap to

wash hands at critical times

• All young mothers and adolescent girls as well as

children under 2 use improved drinking water

Routine reporting

of sectors

WASH, Health

• Food and nutrition security and agriculture strategy

aligned with nutrition objectives

• % women with heavy workload during pregnancy and

Post partum reduced.

Agriculture,

3: Strengthened capacity

of provincial and local

governments on

nutrition to provide

basic services in an

inclusive and equitable

Nutrition capacity of implementing Nutrition Strategic

Plan strengthened as per evidence-based capacity

building strategy

• Nutrition integrated into local planning and

monitoring

system

P&D, All participating sectors

manner • Collaboration between local bodies’ health,

agriculture, social welfare, and education sector

strengthened at district and UC level

• Social protection measures designed and introduced

to prevent and reduce malnutrition in marginal

population groups with a focus on the critical window

of opportunity– from conception to two years of age

Outputs

Outcome 1: Policies, plans and multi-sector nutrition coordination improved at Provincial and district levels.

Output 1 Policies and plans

updated/reviewed to

incorporate a core set of

nutrition specific/

sensitive

Indicators at Provincial

and district levels.

By the 2014, annual and multiyear plan of all the

relevant sectors reflect indicators and targets on

contribution for reduction of malnutrition

• By the end of 2015, Nutrition related targets and

indicators incorporated in district level plans

Multisectoral

nutrition progress

report (quarterly,

annually)

P&D (Nutrition Cell at PSPU),

PMAC

Output 2 Multi-sector nutrition

coordination

mechanisms functional

at Provincial and

District levels.

High Level Nutrition and Food Security Steering

Committee and coordination mechanisms functional

at Provincial level ( Already Functional in P& D)

• Technical Working Group functional at Provincial

level ( Already functional in PSPU )

By the end of 2014, Nutrition and Food security

steering committee functional at district level with

necessary resources

• By the July 2015, Majority of the planned nutrition

programmes coordinated and monitored by DSC at

district and sub district level..

• By the end of 2015, frequency of joint monitoring

visits by provincial level stakeholders ( Sectors, donors

& UN agencies ) increased.

Multisectoral

nutrition progress

report (quarterly,

annually)

P&D (Nutrition Cell at PSPU),

PMAC (all participating Sectors

Output 3 Bussiness

network/public private

partnership identified

and implaced

Establish Business Network for nutrition at provincial

level:

Nominate focal point or steering group

business network focal point reaches out to

Government Focal Point and other Networks and

liaises at provincial and district level

Organise multi-stakeholder convenings to define

potential contributions by the private sector and agree

on ways of working with all sectors

Multisectoral

nutrition progress

reports

P&D nutrition Cell, Bussiness

Network identified focal point,

all sectors

Outcome 2: Practices that promote optimal use of nutrition ‘specific’ and nutrition ‘sensitive’ services improved, leading to enhanced maternal and

child nutritional status.

Output 3 Maternal and child

nutritional care service

utilisation improved,

especially among the

unreached and poorer

segments of society.

• By the end of 2014, Nutrition Communication

Strategy developed and in place to support

PINS

• % of pregnant women and mothers know the

importance of food diversity & eating three

times a day with animal source food at least

once a day

• Adolescents who report at least two

preventive/dietary nutritional measures

against anaemia increased

• Prevalence of roundworm among school

adolescent reduced

• Hand washing with soap practice increased at

critical times specially among adolescent girls

and young mothers

Multisectoral

nutrition progress

report (quarterly,

annually), surveys

(NNS/others)

P&D (Nutrition Cell at PSPU)

Health in lead with all

participating sectors,

Output 4 Adolescent girls’

parental education, life

skills

and nutrition status

enhanced.

By the end of 2020:

• Class attendance and class promotion rates among

adolescent girls increased

• Dropout rates among school adolescents decreased

• Adolescents who report at least two

preventive/dietary nutritional measures against

anaemia increased.

• Prevalence of roundworm among school adolescents

decreased

Routine reports of

participating

sector

Education

Output 5 Availability and

consumption of

appropriate foods (in

terms of quality,

quantity, frequency and

safety) enhanced.

By the end of 2020:

• Increased consumption of diversified food, especially

animal food or pulses , among pregnant women and

adolescent girls by increasing its production

• Food supply and distribution system strengthened –

food security ensured particularly in food deficit areas

• % infants initiated with breastfeeding within the first

hour and exclusively breastfed for six months

• % of children receiving immunisation and

micronutrient supplements as per the schedule

• Reduction in consumption of junk food by pregnant

mothers, children and adolescent girls

Multisectoral

nutrition progress

report (quarterly,

annually),

Surveys

(NNS/Others)

Health, Agriculture, Food,

Outcome 3: Strengthened capacity of Provincial and local governments on nutrition to provide basic services in an inclusive and equitable manner.

Output 6 Capacity of Provincial

and district levels

enhanced to provide

appropriate support to

improve maternal and

Child nutrition.

By the end of 2020, knowledge on nutrition increased

among key identified staff at provincial and local level

by x% over the baseline of number of new nutrition

service outlets established or improved

• Starting from 2014, different sectors identify focal

persons for nutrition and execution of nutrition

interventions are reflected in their job descriptions

Multisectoral

nutrition progress

report (quarterly,

annually)

P&D (Nutrition Cell) all

Participating sectors

Output 7 Multi-sector nutrition

information updated

and linked both at

Provincial and district

levels.

By the end of 2015, access to the updated nutrition

information system made

available

• Nutrition information system available in all the

sectors

Sectoral progress

reports quarterly,

annually

P&D (Nutrition Cell) all

Participating sectors

Bussiness Network

For Addressing Malnutrition in Punjab · Punjab. This figure shows more food insecurity in Punjab...

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