Scaling up nutrition: experiences from Balochistan, Pakistan
Muhammad Sheraz and Dr. Ali Nasir Bugti
Muhammad Sheraz is the Nutrition Information Management Officer for the Department of Health within the Government of Balochistan.
Dr. Ali Nasir Bugti is the Provincial Coordinator for Nutrition for the Department of Health within the Government of Balochistan.
Balochistan is the most underdeveloped of four provinces of Pakistan and has a very poor health and nutrition situation. According to the 2011 National Nutrition Survey, the prevalence of stunting in Balochistan is 52.2 %, amongst the highest in the world. The prevalence of wasting is 16.1%, exceeding the WHO-threshold of 15%, indicating a public health emergency. Women and children also suffer from some of the world’s highest levels of vitamin and mineral deficiencies with maternal anemia at 47.3% and Vitamin A deficiency in children at 74%. Based on current trends, Balochistan is not on track to achieve the Millennium Development Goal of halving the 1990 level of undernutrition by 2015.
The Government of Balochistan and its partners recognise the implications of such high levels of undernutrition on economic and human development and as a result are now undertaking a multi-sectoral nutrition approach in line with the SUN Movement.
The SUN Framework includes three main components:
- Evidence-based and cost-effective interventions to prevent and treat undernutrition, with highest priority to the minus 9 to 24 month window of opportunity, termed ‘the first 1000 days’
- A multi-sectoral approach that includes integrating nutrition in related sectors and using indicators of undernutrition as one of the key measures of overall progress in these sectors
- Substantially scaled up domestic and external assistance, through a coordinated development partner response, for country-owned nutrition programmes and capacities.
Pakistan, and Balochistan in particular, has made significant progress on this since 2010. In September 2011, the Economic Affairs Division of Pakistan took an important step when it called a meeting of development partners and donors currently engaged in and funding different projects in Pakistan (referred to as the D-10 Group) to discuss nutrition. During the meeting, the provinces committed to preparing multi-sectoral nutrition plans. Since then, Balochistan has:
- Developed a policy guidance document to assess provincial levels of undernutrition, identify sectoral programmes associated with reducing undernutrition, and to begin identifying possible roles for these sectors in a collective effort to reduce undernutrition in the province. The document also contains the list of benefits likely to accrue to each of the sectors from improved nutrition in the province.
- Finalised an Inter-Sectoral Nutrition strategy. This strategy seeks both to prevent and treat undernutrition directly (nutrition-specific interventions) and also addresses the determinants of undernutrition (nutrition-sensitive interventions.) The focus is on hygiene practices, access to safe water, sanitation and health services, household food security, access to a diversified diet, socioeconomic constraints and literacy.
For each sector the strategy includes a set of strategic objectives, outcomes, outputs, and activities with a plan for a coordinating entity to be lodged in the Provincial Department of Planning and Development. The strategy identifies a subset of indicators included in a ‘Results Monitoring Framework’. The ongoing monitoring and review of these indicators will provide the Province with a means of assessing progress of the strategy on an ongoing basis. Given the diversity and multi-sectoral causes of undernutrition, a separate unit focusing on planning and monitoring will be created and housed in the Planning and Development Department to maintain accountability for all key levels and observe overall progress. The strategy’s underlying approach will be to “plan multi sectorally, implement sectorally and then review multi sectorally”. The next stage will be to cost the plan. Currently the Planning and Development Department includes sections such as agriculture and health, but not nutrition. The Health Section is currently looking at nutrition with plans to establish a separate Nutrition Section to plan and monitor overall progress of the inter-sectoral strategy.
- Identified a Provincial Nutrition Steering Committee, chaired by the Additional Chief Secretary for Development, the second highest ranking official at the provincial level after the Chief Secretary. The department heads for health, agriculture and other relevant departments are members.
- Identified an Inter-sectoral Technical Working Group (TWG) under the Department of Planning and Development. Each sector will have a specific TWG and the Nutrition TWG and Steering Committee are now guiding the transformation of the Inter-Sectoral Nutrition strategy into an operational plan.
Nutrition and other sectors have been asked to prepare and cost their proposals, in line with the nutrition specific and sensitive interventions suggested by the multi-sectoral nutrition strategy for each sector. The steering committee and nutrition TWG aims to identify adequate resources to fund these through either government funds or donor funding. At the time of writing, only the Health Sector has costed their plan for a total of 14.92 million USD (1492 million Pak Rupees) over a three-year period (July 2014 to June 2017), which will target 7 high-risk districts (out of Balochistan’s 30 districts in total). Within this, the budget for community-based management of acute malnutrition (CMAM) and Infant and Young Child Feeding (IYCF) combined is 5.42 million USD. The health sector plan aims to:
- Increase access and availability of IYCF and CMAM services across the targeted districts for targeted populations (male and female children 0-5 years and pregnant and lactating women);
- Improve consumption of micronutrients through fortification and supplementation;
- Enhance level of knowledge and increase awareness of nutrition interventions among households who have children less than 5 years of age and pregnant/lactating women;
- Strengthen the nutrition programme within the health department; and
- Strengthen Monitoring and Evaluation Systems with the focus on generating information for evidence based planning and implementation.
Multi donor trust funds are available for the various interventions and the Department of Health of Balochistan is ready and prepared to implement once the project proposal is approved at national level.
Expected challenges
The multi-sectoral approach will require a high level of commitment, effective coordination, and informed leadership for its success. Some of the possible challenges facing Balochistan in effective implementation include:
- Accountability: The newly formed Nutrition Section within the Planning and Development Department will not have stated authority to hold other departments accountable to delivering on their nutrition related results. How other sectors will be made accountable to the nutrition section is still a big question mark and a key challenge ahead.
- Priority: Nutrition is not a common agenda for all sectors and thus the level of understanding and priorities within other sectors may vary.
- Resources: There may not be the necessary resources to make the nutrition strategy operational as donor funding for nutrition sensitive plans for other sectors other than health currently does not exist.
- Capacity: There is limited capacity within other sectors, particularly with regards to nutrition sensitive programming, that could limit their understanding on what human resource capacity is required to roll out nutrition sensitive interventions.
- Coordination: The province has no previous experience in inter-sectoral coordination for thematic programming.
For more information, please contact Muhammad Sheraz: Mohammad.sheraz@live.com
More like this
NEX: Update on IYCF progress in Balochistan, Pakistan
Muhammad Sheraz and Dr. Ali Nasir Bugti Muhammad Sheraz is the Nutrition Information Management Officer for the Department of Health within the Government of Balochistan. Dr....
NEX: SUN Experiences: Lessons from Pakistan
Muhammad Aslam Shaheen is SUN Focal Point in Pakistan. Dr. Ali Ahmad Khan is Programme Officer for the SUN Secretariat, Ministry of Planning, Development and Reform,...
FEX: SUN experiences: lessons from Pakistan
By Muhammad Aslam Shaheen and Dr. Ali Ahmad Khan Lisez cet article en français ici Muhammad Aslam Shaheen is Chief of Nutrition at the Ministry of Planning Development...
FEX: Wasting prevention and treatment - central to stunting reduction in Pakistan
View this article as a pdf Lisez cet article en français ici Click here to listen to more information on the work being done in Pakistan on the ENN podcast channel By...
FEX: Wasting prevention and treatment – central to stunting reduction in Pakistan
This is a summary of a Field Exchange field article that was included in issue 63 - a special edition on child wasting in South Asia. The original article was authored by Saba...
NEX: Providing district-level coverage for nutrition programming in Balochistan, Pakistan province
Hassan Hasrat is the Chief Executive Officer of the Society for Community Action Process (SCAP-Balochistan), a local NGO. He has ten years' experience in health, nutrition and...
NEX: Filling the Nutrient Gap in Pakistan: Insights to address malnutrition
Dr Aliahmad Khan is a nutritionist with the World Food Programme Pakistan Country Office in Islamabad. Muhammad Aslam Shaheen is Chief of Nutrition and SUN Focal Point in...
Combining WASH and nutrition activities within a multisectoral package to improve young children’s diets and reduce child stunting in Sindh province, Pakistan
View this article as a pdf Click here to listen to an interview with the author on the ENN podcast channel Dr Sahib Jan Badar is the Programme Coordinator of the Accelerated...
Using an in-depth assessment of young children’s diets to develop a Multisectoral Nutrition Communications Strategy in Punjab province, Pakistan
View this article as a pdf Dr Muhammad Nasir is a medical doctor and Programme Manager in the Primary and Secondary Healthcare Departments of the Government of Punjab. Eric...
FEX: Adolescent nutrition in Mozambique: putting policy into practice
Research By Erin Homiak Erin Homiak MPH is seconded to SETSAN Manica as Nutrition Advisor. Her role is funded by UKaid/DFID. She has been working for Concern Worldwide since...
FEX: Integration of essential nutrition interventions into primary healthcare in Pakistan to prevent and treat wasting: A story of change
View this article as a pdf Lisez cet article en français ici Click here to listen to an interview with one of the authors on the ENN podcast channel By Dr Baseer Khan...
NEX: Strengthening nutrition coordination and advocacy in Papua New Guinea: Role of the SUN Pooled Fund
View this article as a pdf Lisez cet article en français ici Otto Tean is National Coordinator of the Nutrition Programme Management Unit (NPMU) and the Papua New...
FEX: Scaling up CMAM in the wake of 2010 floods in Pakistan
By Dr. M. Suleman Qazi Dr. Qazi was engaged by the ENN to capture the lessons from Pakistan on CMAM scale up. Dr Qazi is a medical graduate with a post graduate degree in...
NEX: REACHing for the SUN: UN support for scaling up nutrition in Burkina Faso
Dr Doudou Halidou Maimouna and Ousmane Ouedraogo are the REACH co-ordinators in Burkina Faso. Bertine Ouaro is Head of the Nutrition Department at the Ministry of...
Providing maternal nutrition services at sub-national level in Punjab Province, Pakistan
View this article as a pdf Dr Khawaja Masuood Ahmed is the National Coordinator for Nutrition and for the National Fortification Alliance in the Ministry of Health, Pakistan....
NEX: Editorial
Listen to an interview with the editors on the ENN podcast channel We're proud to introduce this tenth issue of Nutrition Exchange! The publication has grown from a digested...
FEX: Introduction to the special issue
The most recent Lancet series on maternal and child undernutrition (Bhutta et al, 2013) calculated that even with 90% coverage of specific nutrition interventions (addressing...
FEX: Establishing an effective multi-sectoral nutrition information system in Ivory Coast
View this article as a pdf Lisez cet article en français ici Faustin N'Dri is the NIPN Project Coordinator at Secrétariat Technique du Conseil National de la...
en-net: Recruiting for technical assistance consultancy to develop Mozambique Nutrition Financial Tracking, Budgeting and Resource Mobilization Framework
MOZ-03 - TA to Develop Mozambique Nutrition Financial Tracking, Budgeting and Resource Mobilization Framework Click to view complete terms of reference (ToR) Overall...
NEX: Building understanding and capacity for integrating food security and nutrition approaches to address widespread child undernutrition in Niger
Solange Heise Solange Heise is the Food Security and Nutrition Officer at the FAO representation in Niger. Background Niger, a landlocked country in the Sahel of West...
Reference this page
Muhammad Sheraz and Dr. Ali Nasir Bugti (). Scaling up nutrition: experiences from Balochistan, Pakistan. Nutrition Exchange 4, July 2014. p32. www.ennonline.net/nex/4/en/scaling
(ENN_4465)