Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694842017256.pdf (Pakistan)
Nutrition 269 Chapter 22 NUTRITION The human resource development of Pakistan is substantially undermined due to poor physical and mental growth of its population resulting in poor performance in socio-economic engagements.

Malnutrition remains a major cause of affecting children’s physical and mental growth having burden on the health and education sectors, while at later age, low labour productivity leading to poverty, and consequently deteriorated socio-economic development of the country.
Nutrition is also an important poverty determinant cutting across all sectors.

The malnutrition burden is being carried over at least for the last two decades without any change.

Malnutrition is prevalent in the country in spite of overall sufficient food availability, and curative nutrition provided by the primary health care system.

According to the National Nutrition Survey (2011), there has been no substantive change over the decades in nutritional status of under-five-year children.
Indicators NNS 2001 NNS 2011 Source: National Nutrition Survey Underweight 38 31.5 Stunted 31 43.7 (Per cent) Wasted 11.6 15.1 Besides general malnutrition, micronutrient deficiencies also remain prevalent, as reported in the NNS 2011.

It reflects a widespread micronutrient deficiency of Iron, Vitamin-A, Vitamin D and Zinc among children up to five years and mothers.

Only the status of Iodine improved during the last decade.
Inadequate or inappropriate food intake and inefficient biological utilisation results in hidden hunger, macro and micro nutrient imbalances.

Factors affecting malnutrition are considered to food security, feeding practices, access to health care, water supply, sanitation, education and nutrition awareness.

Nutrition interventions are low-cost preventive actions to be integrated in the sectoral programmes, but receive low priority.
The efforts are to improve the nutritional status of the population, particularly women and children, through adequate diet and nutritional awareness as envisaged in the Pakistan Vision 2025.
The Scaling up Nutrition Movement and multi-sectoral strategies will help the government departments at the federal and provincial levels to overcome malnutrition problem through various interventions because:  Direct implications of the early nutrition on an individual’s performance, ill health and disability  Improves productivity and economic development  Critical parameter to affect poverty and MDGs  Impacts public and private health care expenditures 11th Five Year Plan 270 Nutrition It requires   strong coordination among stakeholders for synergy, effectiveness, monitoring and to report at all level capacity building – human resource (secretarial and technical)  Nutrition Surveillance System, and  plan of work and budgetary resources.
The Policy, strategy development and its implementation will be helpful to overcome malnutrition because nutrition investments can help break the poverty cycle and increase the GDP by at least 2-3 per cent annually.
Situational analysis Strengths The positives are:  Sufficient food availability due to increased agricultural production  Food fortification and supplementation programmes  Food security activities to meet the challenges of food insecurity  Nutrition awareness activities and programmes  The findings of the NNS (2011) provide a baseline for an analysis of malnutrition throughout the country, and raise awareness among masses about nutrition.
 Presence of high-level academia in the nutrition sector further enhances its urgency and importance at the national level.

 Strong private sector involvement in nutritional interventions further strengthens the coordination mechanism and reduce burden on the government.
Weaknesses The negatives are:  Uneven distribution mechanism of food       Limited and improper education, and awareness Lack of capacity and coordination Lack of ownership of nutrition programmes Lack of substantial budgetary allocations Low political commitment Improper monitoring of the implementation of nutrition programmes Opportunities The prospects are:  Multi-sectoral strategies approach 11th Five Year Plan Nutrition 271  Agriculture extension  Health infrastructure improvement  Bio-fortification of food crops  Wheat flour fortification  Pakistan as member of Scaling up Nutrition (SUN) Movement  Strengthening of provinces after the 18th Constitutional amendment Issues and challenges The challenges are:  Malnutrition  Household food insecurity   Limited education and awareness Limited resources  Political commitment   Limited multi-sectoral Buy-in Limited technical and institutional capacity Future roadmap Short-term (2-3 years)  Advocacy and awareness at all levels to put nutrition at the centre of the national development agenda  Finalisation of nutrition strategic and policy framework  Resource allocation to priority sectors  Integrated preventive interventions focused on children and pregnant and lactating women  Food fortification of wheat flour with iron and folic acid  Agronomic biofortification of food grain crops through application of micronutrient fertilizers  Research in nutrition through universities and research organisations  Extensive use of media for nutrition education  Approach international organisations for interventions at larger scale Medium-term (3-5 years)  Expansion of nutrition supplementation programmes  Revised curriculum with focus on nutrition education and establish national nutrition degree awarding research institute 11th Five Year Plan 272 Nutrition  Academic training in nutrition at the university level  Centre of excellence of nutrition needs to be established at least one in each province, and one at the federal level to promote research  Provision of Nutritionists and Dieticians in hospitals  Support to nutrition intervention with quality  Implementation with coverage of quality nutrition interventions  Enhance water supply and sanitation facilities  Reduce poverty in rural areas through creating business opportunities on-farm and off- farm for the farmer community 11th Five Year Plan