Malnutrition is widespread in Pakistan
The effects of malnutrition are globally recognised as being devastating and far reaching. Malnutrition is widespread across Pakistan. Forty four percent of children under 5 are stunted and unlikely to reach their full mental and physical potential. Macronutrient and micronutrient deficiencies and an increase in overweight and obesity are negatively impacting population health and development. The burden varies across the country and progress is hampered by several factors: unaffordability of, and poor physical access to, nutritious foods; rapid population growth, especially in urban areas; poverty; security issues; and vulnerability to natural and man-made shocks.
Addressing malnutrition in a sustainable manner in Pakistan must take a lifecycle approach with a special focus on children under 2 years of age, adolescent girls and pregnant and lactating women. It must include a range of context-specific, targeted interventions that engage stakeholders across multiple sectors at national and provincial levels.
Fill the Nutrient Gap (FNG) in Pakistan: Purpose
A challenge in addressing malnutrition in Pakistan is the complexity of policy frameworks after devolution. In addition, nutrition has been viewed as a technical and mainly health sector issue and there has been little multi-sectoral engagement. Policy priorities and the level of progress in developing and implementing multi-sector nutrition action plans differ among provinces. There is no harmonisation with national policy development activities. The National Scaling Up Nutrition (SUN) Secretariat, housed within the Nutrition Section, Ministry of Planning, Development and Reform, felt that the FNG process could facilitate greater understanding of the provincial malnutrition contexts. It could also serve to strengthen and align actions at national and provincial levels, across sectors and stakeholders.
The FNG assessment was led by the Pakistan SUN Secretariat and SUN Core Group, with technical assistance from the World Food Programme (WFP) country office, regional bureau and Rome headquarters, which together formed Pakistan’s FNG team. A range of stakeholders participated at provincial and national levels. The objective was to use the FNG tool to identify cost-effective actions; build consensus; and prioritise appropriately, focusing on the first 1,000 days from conception to a child’s second birthday, adolescent girls and pregnant and lactating women. This would enable identifying and scaling up of national and provincial nutrition-specific and nutrition-sensitive policies and interventions across food, health and social protection systems, with the aim of improving Pakistan’s nutrition indicators and the lives of its people.
FNG in Pakistan: Process
FNG in Pakistan ran from November 2016 to April 2017. The analysis comprised a comprehensive literature review of available secondary data sources in combination with linear programming (LP) using the Cost of the Diet (CotD) software. The aim was to understand context-specific barriers to adequate nutrient intake and to model potential interventions to improve access to nutrients, particularly from nutritious foods.
At the start of the process, the Pakistan FNG team met with government, non-government, United Nations (UN) and donor stakeholders to: introduce the FNG process; decide on the level of analysis; collate key secondary data sources and; identify possible interventions, entry points and transfer mechanisms to test in the CotD modelling. It was agreed that secondary data analysis would be carried out at a national level, presenting regionally specific data when available. Over 190 data sources were identified and reviewed, and a number of data gaps were identified. The LP analysis intervention modelling was carried out for Khyber Pakhtunkhwa (KP), Punjab, Sindh and Balochistan provinces, and stakeholder inputs from each were specifically sought. The detailed FNG process in Pakistan is illustrated in Figure 1.