Role of Government in monitoring framework for addressing

Malnutrition Pakistan

Trends of Under-nutrition

• Stunting improved from 1965 (48%) to 1994 (36.3%) but deteriorated from 2001 (41.6%) to 2011 (43.7%).

• Wasting rate continued to worsen from 1997 (8.6%) to 2011 (15.1%).

11 8.6

10.8 11.8 14.3 15.1

48

43.3 41.8

36.3

41.6 43.7

NSW

P:1

96

5

MN

S:1

99

7

NN

S:1

98

5-7

NN

S:1

99

0-4

NN

S:20

01

-02

NN

S:2

01

1

Trends of stunting and wasting

Wasting Stunting

61.9%

54.1%

40% 39%

Iron Defficiency Anemia Vitamin A defficiency Vit D defficiency Zink Defficiency

Micro-Nutrient Deficiency among children, Pakistan ( NNS 2011)

•High level of food insecurity also documented in NNS 2011 (58% households were food insecure). •Food Basket, Availability and Consumption Kg/month.

Food Items Food Basket Food Availability

2010-11

Consumption

HIES 2010-11

Wheat 9.00 9.81 8.00

Rice 2.30 1.25 1.00

Pulses 0.90 0.70 0.25

Sugar 1.50 2.70 1.40

Milk (Liters) 4.50 7.50 6.75

Fats & Oil 1.20 1.00 1.00

Meat 1.20 1.60 0.50

Fruits & Veg. 10.50 6.60 5.25

Calories per capita/day

2150 2400 1700

Adequate food supply at the national has not been able to address household food security and individual nutritional adequacy.

Macro Economic Policies & primary healthcare have not be able to address

malnutrition.

Hidden hunger and short term hunger is forth coming issue. Malnutrition is a wide spread population concern, while nutrition interventions

ware limited focus. Nutrition interventions are low cost preventive measures integrated across

sectors, however implementation have been vertical uni sectoral. Poor nutritional awareness & low priority across sectors.

Incidence of nutritional insecurity of marginalized vulnerable groups has

increased in the recent past.

MAJOR ISSUES

PROPOSED POLICY APPROACHES:

• Moving from curative mode within health system to preventive integrated mode across allied sectors

• Population based preventive approaches

• Emphasis on public private partnership in Expanded Nutrition programs

• Food security at all levels

• Addressing the issues of short term hunger

Coordinated Nutrition Approach Across Sectors:

• Nutrition Planning & Monitoring • Agriculture: • Health: (i) Primary Health Care: (ii) Integrating Nutrition Components in vertical programs • Education: • Macro-Economic Framework: • Information & Mass Media • Women Development: • Social Welfare: • Research:

Nutrition Actions – Policy Level 2011

• Nutrition “profile” enhanced:

– Pakistan Integrated Nutrition Strategy (PINS) • Developed province/region level models • partners and donors at federal level

• Provincial Integrated Nutrition Strategy:

– Planning initiated (institutional architecture, sectors) – Priority areas agreed and set – Way forward agreed The work in the Seven provinces & regions in progress & at a

advance stage.

Nutrition Actions-cont:

1. A consortium of Partners, NGO & government at provincial level organized to coordinate Development of proposals.

a. working with the provincial government in capacity building.

b. Providing technical support on nutritional interventions.

c. Work with the provincial governments on long and short term planning.

2. Community awareness program for all nutrition related projects

Opportunities supporting Nutrition

• Devolution:

– Allows new designs for more effective nutrition

interventions

– Facilitates leadership development for increased human and financial resources to all sectors including nutrition

– Encourages use of previous experience and sharing lessons learned across all geographical areas

Opportunities supporting Nutrition

• Global movement and support for SUN

– Brings new focus on multisector actions to address

malnutrition (macro & micro):

– Encourages packages of multi-sectoral preventive interventions

– Focus on Chronic Malnutrition

– Momentum for provincial nutrition policies, strategies and actions

Nutrition Opportunities

• Preparation UN One Programme Phase II and new country programme 2013 to 2017

– Opportunity to prioritize nutrition

– Food and Nutrition Security made a strategic priority in the Public sector with UNICEF, WFP, FAO, UNFPA and others support

Nutrition Priorities – Way Forward

• Strong advocacy to raise profile for nutrition

• Scaling up actual nutrition interventions • Provincial Nutrition Strategies

– Provincial PINS – Action Plans – Inter-sectoral nutrition interventions

addressing direct and root causes in collaboration with line departments and UN agencies

• Start integrated implementation in at least 1 focus district in 2012 per province/region

Nutrition Priorities – Way Forward

• Integrating priority nutrition interventions into government services across sectors

• Developing capacities in nutrition policy, management and implementation at all levels (province/region, district & communities)

• Concerted efforts for Resource mobilization

• Strengthening monitoring, information sharing and coordination to improve effectiveness through joint actions

Malnutrition: a) Working to create awareness in the community about nutritional issues b) Community Management of Acute Malnutrition c) Supplementation through high energy nutritional supplementation.

Micronutrient Deficiencies: a) VAS for the children of 6-59 months age b) Sprinkles for children under 2 years of age c) Universal Salt Iodization (USI) for the control of Iron Deficiency Disorder (IDD) d) Flour Fortification for the Control of Iron Deficiency Anemia (IDA) e) Zinc supplementation programs

Support provided by NGOs addressing Malnutrition and Micronutrients deficiencies

Governments role in addressing Mal-nutrition

1. Federal government is no longer responsible for policy & implementation of health, education & nutrition after their devolution to provinces following recent constitutional reforms.

2. Provincial authorities given the resource, planning & implementation of all development sectors with more policy & financial autonomy.

3. The Federal Govt: has more of the responsibility for monitoring & value added input particularly in the social sectors including Nutrition.

4. The Provinces had more control over management of resources & implementation

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