Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694842133819.pdf (Pakistan)
CHAPTER 21 NUTRITION F ood is a basic need of everyone and therefore, access to food is the fundamental right of every human being.

Every individual has a right to adequate nutritious food.

Eating too little or eating an unbalanced diet creates malnutrition.

According1to a report, malnutrition is directly responsible for 3,00,000 deaths per year in children younger than five years in developing countries and contributes indirectly to more than half of all deaths in children worldwide.
Pakistan also suffers from high rates of malnutrition among children and mothers.

It occurs due to number of reasons particularly low nutritional knowledge, awareness and improper food intake; inadequate health care services; insufficient intake of protein, vitamins and minerals.

United Nation in 2010 started Scaling up Nutrition (SUN) Movement to overcome malnutrition in the world by adopting multi-sectoral strategy.

This strategy contains nutrition specific and nutrition sensitive approaches.
Pakistan joined the global SUN Movement in 2013 to overcome malnutrition issues in the country.

The Vision 2025 envisages hunger free Pakistan by adopting innovative and cost-effective strategy.

Accordingly, the Plan aims for the provision of safe food and adequate nutrition at all levels along with communication strategy for awareness and behaviour change.

A National Nutrition Policy is being formulated on the basis of provincial policy strategies.
Performance review 2014 Nutritional situation The Global Gathering 2014 for Scaling Up Nutrition (SUN) Movement was held in Rome, Italy prior to the second international conference on nutrition (ICN2) in November 2014 with the theme ‘Better Nutrition Better Lives’ and with the aim to address global nutrition issues and challenges.

It proposes a flexible policy framework to address nutrition challenges and identify priorities for enhanced international cooperation on nutrition.
A delegation from Pakistan participated in both the international events particularly Deputy Chairman Senate participation in the Ministerial Conference to overcome malnutrition.

According to the GFSI2 Pakistan has been placed at the 77th position amongst the 109 countries ranked by the new GFSI, (2014).

Millions of people around the world are malnourished due to inadequate dietary intake and illness especially children and women of child bearing age over time.
Child malnutrition status of the Southern Asian Countries (SAC) is given bellow: 1Harohalli R Shashidhar 2Global Food Security Index Nutrition Prevalence (%) of child malnutrition <5 years anthropometry of SAARC Country Afghanistan Bangladesh Bhutan India Iran Maldives Nepal Pakistan Sri Lanka Under-weight Stunting Wasting 33 36.8 12.8 43.5 4.6 17.8 29.1 32 26.3 59.3 41.4 33.6 47.9 6.8 20.3 40.5 45 14.7 8.6 15.7 5.9 20 4 10.2 11.2 10.5 21.4 Source: World Health Organization (WHO) Global Targets Tracking Tool The NNS3 (2011) reflects a widespread micronutrient deficiency among children up to five years and pregnant & lactating women suffering from anaemia, zinc, iodine, and vitamin-A deficiencies.
Data shows that 44 per cent of the children less than five years are stunted, 32 per cent are underweight, 15 per cent wasted and 62 per cent are iron deficient.

The data of underweight mothers illustrate that 18 per cent, 14 per cent, 20 per cent at the national, urban and rural respectively.

In addition, Anaemia and other micronutrient deficiencies such as Iron, Zinc, Vitamin A and D are widespread in the country.
In this regard, to reduce malnutrition among children and mothers, first time having nutrition specific interventions, provinces developed and approved PC-1s with the help of nutrition development partners: Nutrition Support Programme for Sindh (NSP); Balochistan Nutrition Programme for Mothers and Children (BNPMC), while the Punjab and Khyber Pakhtunkhwa (KPK) have integrated health reforms PC-1s with nutrition strong component.
Governments of Baluchistan & KP enacted Protection and Promotion of Breastfeeding and Child Nutrition Acts in 2014 and 2015 respectively, while the Punjab government notified the Infant Feeding Act.
At national level, the Ministry of National Food Security and Research submitted the National Food and Nutrition Security Policy for approval, the PC-II for Zero Hunger Programme initiated and technical committee as well recommended first Wheat Variety having Zinc in it whereas the Ministry of National Health Services, Regulation and Coordination revitalised the National Food Fortification Alliance (NFA) and strengthen Primary Healthcare (PHC) system.
The nutrition development partners (WFP, FAO, UNICEF, WHO, WB, MI, GAIN, Save the Children, Harvest Plus, etc.)

are supporting at national and provincial level through various interventions to improve malnutrition in the country.

Food availability Availability of essential food items in the country has been sustained during the fiscal year 2014-15 to meet the food consumption requirements; moreover, export of surplus wheat and sugar was allowed.
The per capita per annum availability of major foods worked as in 3National Nutrition Survey Annual Plan 2015-16 158 Nutrition kilogrammes; cereals 161, pulses 5.2, sugar 32, meat 21 and milk 130 litre respectively.

The caloric availability calculated as 2485 kcal per capita per day.
Food consumption The food consumption information is worked out from HIES4 and according to the 2011-12 data of food consumption kg per capita per month remained about: wheat 7.7, Rice 1.0, Pulses 0.1 Sugar 1.3, Meat 0.6 and Milk 6.6 litres respectively.

Calories intake comes round 1700 kcal as compared to availability 2485 whereas recommended food consumption dietary allowance (RDA) is 2150 kcal.

There is wide gap between food availability and consumption.
Cost of food basket The price increase in food items has direct impact on food consumption.

The cost of food basket is worked out on the monthly basis from Pakistan Bureau of Statistics data.

Based on national average, the estimated average food expenditure has been Rs2258 per person per month in 2014-2015 (July 2014 to February 2015).

This expenditure corresponds to commodities for basic food basket for provision of 2150 calories, 60 grams protein (including some micronutrients).
Outlook 2015-16 Multi-sectoral approach has been adopted to reduce malnutrition.

The provincial Nutrition Policy Guidance Notes and Strategy and SUN roadmaps have been developed and approved within the parametres of the Vision 2025.

In order to implement the province-specific nutrition multi-sectoral policy and strategy the national strategy will be developed.

The SUN Movement Secretariat at national and provincial levels is being established at each planning and development department.
It will enhance strong coordination and collaboration at each level for implementation of multi-sectoral strategy and development of M&E system.

This will also develop linkages among all public sector departments & provinces, SUN Networks and the Global SUN Movement Secretariat.

The Global SUN Movement working through networks, that is, donors, UN, Civil Society Alliance (CSA) and business.
In Pakistan, government, donors, UN, Civil Society Alliance (CSA) are functioning, whereas business, and research and academia networks are going to be established to streamline SUN Movement innovative approaches.
interventions At national and provincial levels, nutrition development partners are supporting through including: Community-Based Management of Acute Malnutrition various (CMAM), Management of Severe Acute Malnutrition and Nutrition Surveillance system, trainings and development manual, integrated community case management (CCM) of diarrhoea, pneumonia and malaria through the Lady Health Workers (LHWs), behaviour change and communication; food and nutrition security through Strategic Priority Area (SPA-VI).
Lipid-based nutrient supplement for malnourished pregnant and lactating women is currently under development and being tested for safety and acceptability to replace the Wheat Soya Blend (WSB) and vegetable oil ration for pregnant and nursing mothers.

Wheat flour fortification with iron and folic acid has been launched in AJK whereas the same is going to be revitalized in Punjab and other provinces.
The Universal Salt Iodization (USI) Programme is being implemented and will be continued in 110 districts by enhancing quality control and assurance.

Bio-fortified high zinc wheat variety (Zincol 2015), which contains 38 micro-gram zinc 4Household Integrated Economic Survey Annual Plan 2015-16 159 Nutrition per gram, has been recommended by the Variety Evaluation Committee (VEC) of the PARC for its release by the Provincial Seed Councils for its commercial cultivation during crop season of 2015-16.
An amount of Rs100 million in the PSDP 2015-16 has been allocated for a project titled ‘National Initiative for SDGs/ Nutrition’.

Programmes The following are the interventions for 2015-16.

 Nutrition Specific Interventions are going to be taken care in each province through approved projects which are given as under:  Nutrition Support Programme for Sindh (NSP), costing Rs4,118 million, has been approved and is going to be implemented during this year.
The overall goal of the project is to improve the nutritional status of male and female children under five years and that of pregnant and lactating women in nine selected districts.

 The Balochistan Nutrition Programme for Mothers and Children (BNPMC), costing Rs1,493 million, has also been approved and it will be implemented this year.
The overall goal of the project is to improve the nutritional status of male and female children under five years age, including women reproductive age, by improving the coverage of effective nutrition interventions in the selected seven district.

 In the Punjab and Khyber Pakhtunkhwa (KP) integrated health reforms programmes, having nutrition strong component, started implementation and are going to be strengthened.
 Universal Salt Iodization (USI) Programme is being implemented with the assistance of the development partners Micronutrient Initiative (MI), WFP, UNICEF and Global Alliance for Improved Nutrition (GAIN) will be continued in 110 districts to benefit almost 174 million population of the country.

A technical and financial review of the programme will be conducted.
 The National Food Fortification Alliance has been re-established at the Ministry of National Health Services, Regulation and Coordination to restart fortification programme which was abandoned due to devolution.

Hence wheat flour fortification with iron and folic acid is being revitalized to overcome micronutrient deficiency disorders with the support of the UN agencies and Nutrition Development Partners.
Under nutrition sensitive approaches are:  Benazir Income Support Programme (BISP) will continue their services as effective social safety Net Measures by providing cash incentives to the poor segments of the population through the country.

 National Zero Hunger Programme with joint collaboration between public sector and UN agencies is being devised to address hunger and malnutrition.
 Various Scaling Up Nutrition (SUN) Movement Networks (government, UN, donors, CSA, business and research and academia) will be streamlined.

The SUN secretariat and units at all levels will start functioning to deliver the desired results.
 Advocacy for launch of the multi-sectoral nutrition strategies in Balochistan, and Khyber Pakhtunkhwa provinces, while advocating with the Sindh and Punjab governments for implementation of their multi-sectoral nutrition strategies will be provided by nutrition partners.
Pre-Budget Advocacy Seminars will be conducted in all provinces by Save the Annual Plan 2015-16 160 Nutrition Children to secure budgetary allocation for scaling up nutrition and intervention of the multi-sectoral nutrition strategies in Pakistan.

 All four provinces in Pakistan have promulgated laws on breastfeeding.

During 2015-16, it will be carrying out follow up activities for the implementation of the laws on breastfeeding in all provinces and at the federal level.
 By 2015, to improve maternal and new-born health, Save the Children will ensure increased access and availability of quality Maternal and Newborn Health services to 4.2 million beneficiaries in its target districts.

The expected results include 1,00,000 (49 per cent) of pregnant women attended by skilled birth attendants in our target areas (expected no.
of deliveries is the denominator), 2,700 health workers (facility based and community based) trained on the MNCH, FP topics and Emergency Preparedness, 14,000 (40per cent) married women using contraceptive methods (short-term and long- term) in target areas , 95 health facilities strengthened to provide the MNCH&FP services in the areas (through selective repair and renovation, including risk reduction and preparedness, essential supplies and equipment, trained human resource ), and one million mothers and newborns indirectly reached through health interventions.
 To establish child health services and promote child health, Save the Children will promote use of key child health services and preventive practices for 6 million children under five years of age in its targeted districts.

 To improve child nutrition, Save the Children will improve child feeding practices for 1,50,000 infants and young children in its target districts.
To increase coverage of the CMAM, it will increase community-based management of the CMAM interventions for 3,50,000 children 6-59 months in its target districts.

Annual Plan 2015-16 161