Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694842069294.pdf (Pakistan)
Chapter 21|NUTRITION A ccess to safe and nutritious food is a basic right of every citizen to survive and thrive.

Adequate nutrition is required to have proper body functions for healthy and productive life.

A balanced diet comprising of six essential nutrients: macronutrients (carbohydrates, protein & fats); micronutrients (vitamins and minerals); and water in appropriate combinations meet daily requirements of nourishment.
Malnutrition is a big public health challenge1 and one in three people is affected with malnutrition in one form or another.

An estimated 45 per cent of deaths of children under age 5 are linked to malnutrition2.

In Pakistan, 9.5 million children are stunted and 3.5 million children are wasted.

3 The Global Food Security Index (GFSI) considers the core issues of affordability, availability, and quality across a set of 113 countries.
The index is a dynamic quantitative and qualitative benchmarking model, constructed from 28 unique indicators, that measures these drivers of food security across both developing and developed countries.

Pakistan ranked 74 in affordability, 75 in availability and 83 in quality and safety out of 113 countries4.

Malnutrition and diet are considered largest risk factors responsible for the global burden of diseases seriously affecting the economic growth5.
According to recent study conducted by Ministry of Planning, Development & Reform, the loss to Gross Domestic Product (GDP) is about 3 per cent in Pakistan due to under nutrition which is Rs 704 Billion ($7.6 billion) annually.

Progressive development in nutrition has been initiated with the adoption of Pakistan Vision 2025 and is contributing towards the achievement of SDGs and World Health Assembly (WHA) Global targets.
Performance review 2016-17 Food availability and cost of food basket Food Availability Pakistan is an agricultural country and 2/3rd of its population is directly or indirectly dependent on agriculture.

The trend on the availability of essential food items is assessed through food balance sheets every year.

The food availability situation in the country sustained during 2016-17 to meet the overall national requirements by adjusting import and export of food commodities.
The caloric availability through major food items remained at 2,485 calories per capita per day (Fig-1).

1IFPRI (2015) 2Black et al.
2013 3Global Nutrition Report (GNR), 2016 4GFSI, 2016 5Forouzanfar et al., 2015 Annual Plan 2017-18 150 Nutrition Fig-1 Availability of Calories per capita per day s e i r o a C l 2500 2480 2460 2440 2420 Series1 2012-13 2450 2013-14 2484 2014-15 2470 2015-16 2473 2016-17 2485 The availability of all essential food items for last five years is given in the following table: Food Items Units Food availability per capita per annum 2013-14 2014-15 2012-13 Cereals Pulses Sugar Milk* Meat Poultry Eggs Edible Oil/Ghee P: provisional * Milk availability has been revised according to FAO criteria 161.0 6.5 32.0 169.80 13.13 5.74 6.0 12.6 Kg Kg Kg Ltr Kg Kg Dozen Ltr 162.0 7.0 32.0 170.0 13.10 6.10 6.0 14.0 160.0 7.0 31.0 167.0 13.14 5.42 6.0 13.5 2015-16 2016-17 (P) 162.0 7.0 32.0 170.0 13.8 6.03 6.0 14.0 162.5 6.5 31.5 170.2 14.5 6.02 6.0 14.5 Cost of food basket Food basket cost is estimated every month using representative information from Pakistan Bureau of Statistics (PBS).
This expenditure corresponds to commodities for basic food basket for provision of 2150 calories, 60 grams protein.

The average cost for the last three years from 2014-15 to 2016-17 at national level has been worked out which revealed significant difference among the years and months.
However, overall cost trend of the food basket is similar among the years and remained low during January to April (Fig-2): Nutrition interventions/activities in Interest Pakistan Multi- sectoral Nutrition Strategy final phase of is development.

National and provincial level consultations have been in completed.

nutrition has increased over the time with stronger political involvement at and provincial national level, leading to significant financial pledges and policy Following commitments.
interventions have been Annual Plan 2017-18 s R t s o C 2400 2350 2300 2250 2200 2150 2100 2050 2000 1950 Fig-2 Cost of Food Basket (Rs) per capita/month 2014-15 2015-16 2016-17 Nutrition 151 made to create awareness about the importance of nutrition among different segments of society:  Political involvement; Leveraging the budgetary and legislative powers of parliamentarians, in five seminars almost 110 parliamentarians have been engaged in policy planning events to keep nutrition agenda at higher priority by holding several advocacy and awareness sessions in provinces and at national level.
 Media campaigns; Capacity building exercises for media personnel have been carried out in five seminars engaging 125 media personalities for spearheading nutrition awareness as part of behavior change communication campaigns.

 Early Childhood Development (ECD); ECD Task force has been established with the aim to provide a high level platform for policy/strategic framework, planning, coordination, exchange of information.
The ECD would care the most critical period of first 1,000 days and carrying it up to 8 years to develop full physical and mental potential.

Research studies Following research studies were carried out during 2016-17:  Nutrition in the Cities: The study based on secondary data analysis on available validated national datasets (MICS, PDHS, and the National Nutrition Survey 2011) to determine the influencing variables for under-nutrition in children under 5 years of age.
It was originally focused on urban areas only but was later expanded to include both rural and urban areas at the provincial level.

 Cost of the Diet Analysis (CoD) is a standardized tool used to calculate the cheapest possible cost of a locally available diet that satisfies all nutritional requirements (energy, protein, fat and micronutrients) of a household or individual.
The study estimated the affordability of nutritious diet by urban, rural dwellings and seasonality on the basis of data pertaining to 28 divisions in the four provinces.

 Economic consequences of under nutrition in Pakistan - an assessment Report.

An assessment was made regarding economic consequences of under-nutrition by analysing the secondary data from 190 different sources using computer modeling for 15 indicators of under nutrition documented in NNS (2011) and PDHS (2013).
The report reveals that not attending these indicators leads to annual loss of $7.6 billion which is near to 3per cent of GDP.

 Fill the Nutrient Gap (FNG) was carried out to strengthen nutrition situation analysis and decision making on interventions to specifically respond to identified nutrient gaps and improve nutrient intake for key target groups.
The FNG is an in-depth analysis of secondary qualitative and quantitative data on nutrition, dietary intake, food security, household food expenditure and socio-economic status as well as intervention modelling using the Cost of Diet (CoD) linear programming tool.

A portfolio of short term nutrition interventions has been identified to overcome malnutrition.

Outlook 2017-18 Nutrition champions and leaders across Pakistan have made an increasingly effective case for investing in nutrition.
All provinces / areas have developed their multi-sectoral nutrition strategies and are in implementing phase in their multi-sectoral plans.

Under Social Safety Net Measure, Benazir Income Support Programme (BISP) served 5.43 million Annual Plan 2017-18 152 Nutrition beneficiaries throughout the country during 2016-17 and will continue to provide cash incentives to the poor segments of the population during 2017-18.
Pakistan SUN Movement with established provincial/areas SUN units and its five networks provides opportunity to improve nutritional situation in the country through coordinated efforts to fulfil national and international commitments.

The SUN Networks: Government, UN, Donors, Civil Society Alliance, Business and Academic& Research (SUNAR PAK) mobilized all stake holders to play their role in the nutritional development of the nation.
Globally 59 SUN countries are striving to achieve the World Health Assembly targets for maternal, infant, and young child nutrition by 2025.

These goals are at core of the 2ndInternational Conference on Nutrition (ICN2) Framework for Action and are integral for achieving the Sustainable Development Goals (SDGs).

In this regard two federal nutrition PC-Is are being prepared to raise nutrition awareness in the country and to overcome malnutrition in the federal areas.
Programmes The following projects/activities are ongoing at national and provincial level:  Federal Government has allocated Rs 100 million in PSDP for the National Initiative for SDGs/Nutrition.

 Food Composition Table (FCT) and Dietary Guidelines (DG) for Pakistan are going to be revised, for providing information on foods & diet to the general public.

The DG has been finalized and is ready for launch whereas FCT research work is going on.
    In Khyber Pakhtunkhwa; three programmes are being implemented namely: Health Integrated Reforms Programme having 4th component as nutrition at a cost of Rs 20 million out of Rs 14.11 billion; Special Initiative for Susta Atta/ Ghee Package at a cost of 2.45 billion and Primary Education School Feeding Programme of Rs 97.6 million have been started.
In Punjab; Health integrated reforms Programme (Integrated Reproductive Maternal New Born & Child Health (IRMNCH) & Nutrition Programme) costing Rs13 billion having 4th component as nutrition with specific allocation of Rs 4 billion; Stunting Prevention Nutrition Programme at a cost of Rs7 billion and WASH Programme at a cost of Rs9 billion in southern 11 districts of Punjab are going to start implementation.
In Balochistan; Nutrition Programme for Mothers & Children has been initiated for implementation in 7 districts at a cost of Rs1.5 billion and multi-sectoral intervention project is going to be finalized.
In Sindh; Nutrition Support Programme has started implementation at a cost of Rs4.5 billion in 13 districts; Saaf Suthro Sindh (SSS) Programme at a cost of Rs278 and Nutrition Sensitive Agriculture” Project for three districts (Jacobabad, Sanghar & Umerkot) at a cost of Rs582 million and budget allocated for “Accelerated Action Plan (AAP) for the Reduction of Stunting and Malnutrition to reduce stunting from 48per cent to 30per cent over the next three years by allocating Rs1 billion every year.
 Ministry of National Food Security and Research with the support of Harvest Plus succeeded to develop a bio-fortified wheat variety “Zincol 2016” to overcome the deficiency of zinc and iron.

 Universal Salt Iodization (USI) Programme in 110 districts through Public Private Partnership is going to be strengthened through quality and quantity measures.

Annual Plan 2017-18