Preventable undernutrition leads to underachieving generations in Pakistan
Pakistan, the sixth most populous country in the world, has one of the highest levels of wasting (15%) and stunting (44%) in children, and the slowest rate of decline in stunting.
This was the stark analysis of the Global Nutrition Report 2016, launched in Pakistan at the end of 2016 at an event co-sponsored by Palladium, alongside the International Food Policy Research Institute, and organized by the Aga Khan University and the Planning Commission of Pakistan. The report is the only annual ‘stock take’ of nutrition that charts country progress, challenges and examples of success. Politicians, representatives of national and provincial governments, development partners, NGOs, and the private sector came together to plot a path for better nutrition in Pakistan. The focus of the event identified the most effective strategies to implement simple activities for better healthcare and provision, the identification of nutrition-sensitive initiatives in the agriculture and Water, Sanitation and Hygiene (WASH) sectors, as well as exploring the untapped potential for contributions from the private sector and investments in sustainable governance for multi-sectoral nutrition.
Below we explore four key themes that emerged from the launch event of the 2016 Global Nutrition Report in Pakistan.
1. The generational impact of preventable health issues
In presenting the Global Nutrition Report 2016, Professor Bhutta, of the Sick Kids Centre for Global Child Health, noted that undernutrition creates ripples of inter-generational impact, but many of these issues could be mitigated by prioritising simple health activities that respond to preventable health and nutrition problems. Undernutrition is the ‘new normal’, but it is not our destiny. More countries than ever are on the verge of meeting nutrition targets.
Progress, however, will require less talk and more action in three critical areas – SMART commitments in country plans, multi-stakeholder alliances with the power to make change, and investment in governance, financing and data. Pakistan, with the slowest stunting decline in South Asia, is not on course to meet its nutrition targets. Major geographical, income and educational disparities perpetuate the crisis. Accelerating the implementation of simple interventions – such as exclusive breastfeeding, Iron-Folic acid supplementation in pregnancy, zinc provision in diarrhoea and awareness of minimum acceptable dietary diversity – can break the cycle of chronic under-nutrition.
2. Positioning agriculture and food systems for better nutrition – building on good practices
Charlotte Dufour, of the Food and Agriculture Organization’s Nutrition and Food Division, was clear that solutions to deficient agricultural production, food insecurity and undernutrition seldom coincide in development projects unless they are specifically tailored to incorporate nutrition targets. Nutrition ‘sensitive’ agriculture is, therefore, a marked shift away from both the mainstream agriculture policies of governments and humanitarian food relief work by the development community. The discussion highlighted three pathways for moving towards improved nutrition: i) focusing on homestead food production of nutrient-dense crops, diversifying produce, and investing in small scale livestock; ii) prioritising the empowerment of women and nutrition education on diversified diets; iii) engaging with private markets to provide quality inputs for harvesting and livestock rearing, support for safe processing and packaging, and market access for sale. These pathways need government support in linking agriculture and nutrition to social protection programmes, shaping policy incentives for private sector engagement and investing in the capacity of local stakeholders.
3. WASH – stories of change from South Asia
Nutrition discourse has often centred on hand washing to prevent instances of childhood diarrhoea that frequently stunt growth and development. Dr. Md. Mahbubur Rahman, from icddrb Dhaka, took guests through initial lesson learning from the WASH trial in Bangladesh. In his view, expanded causal pathways are coming to light which demonstrate that the quality of drinking water and sanitation are contributing to helminthic infections and enterogen colonization in young children which can reduce immunity and food absorption. This is an increasingly relevant issue in our understanding of WASH’s role in responding to undernutrition.
Clearly, regular access to clean water supplies is critical. Pakistan will rank as the most water stressed country in South Asia and 23rd globally by 2040. Further, all South Asian countries share the common problem of open defecation. The WASH sector needs an expanded and actionable menu of activities to support better nutrition. In South Asia, there are a number of approaches showing signs of success: i) reducing time for water collection by women care givers by bringing water sources closer to home; ii) water harvesting in water insufficient areas; iii) incentivising private sector to develop innovations in household water storage and affordable hand-washing; iv) integrating WASH-related behavioural change in community health and school settings; v) going beyond demand for, and access to, toilets for their hygienic use.
4. Sustainable governance for nutrition – unlocking barriers
A panel discussion moderated by Dr. Shehla Zaidi, Aga Khan University, brought together government civil servants, legislators, and the World Bank to discuss underlying challenges related to nutrition governance in Pakistan. The speakers highlighted that moving our response from ‘high potential’ to ‘active promise’ requires the effective coordination of mobilised funding, targeted and monitored direction of funding, and budgetary tracking linked to results. Political momentum also has a major role to play in ensuring the leadership translate plans into definitive actions. Finally, the panel emphasised the need for investment in critical capacity building – especially for deciphering nutrition sensitive interventions, nutrition coordination and monitoring to maximize investment. Without this fundamental infrastructure, there will be failure to translate the positive momentum in Pakistan, and other counties, into meaningful action.
Palladium’s response to undernutrition
Palladium takes a holistic approach to combatting undernutrition. We provide technical assistance to the European Union’s Nutrition Advisory Services, support community demand and accountability for health and nutrition services through the UK aid-funded Empowerment, Voice and Accountability for Better Health and Nutrition project in Pakistan, and deliver access to quality reproductive, maternal, newborn and child healthcare for hard to reach women, adolescents and children through the Maternal Newborn and Child Health project in Nigeria (MNCH2), also funded by UK aid. Undernutrition is also a result of ineffectual agricultural markets, and Palladium supports food security and the economic empowerment of women through our partnerships with agri-businesses, governments and communities across the world – the Livelihoods and Food Security Project in Zimbabwe and Propcom Mai-karfi in Nigeria being notable examples delivered with UK aid.