Provision of Nutrition Services to Returnees of North Waziristan Agency, FATA, Pakistan. FATA is the most underdeveloped region of Pakistan where majority of the population lives in rural areas. Their economy is based on agriculture and their subsistence-level use of natural resources. Overall Literacy rate is very low (17%) while in women the literacy rate is as low as 3%. Infant mortality is estimated to be high, as 86 deaths per 1,000 live births, while under 5 mortality rates is 104 per 1000 live births. Similarly, maternal mortality is assumed to be greater than 600 deaths per 100,000 live births (FATA DoH, 2006). Only 25.8 % deliveries are conducted by skilled birth attendants.

North-western areas of KP and FATA have experienced significant conflict, sectarian violence and military operations by the government armed forces since July 2008. The complex emergencies and IDP crises resulted in huge losses to the infrastructure and life, and continue to affect a significant number of people from KP and FATA. North Waziristan Agency faced continuous insurgency due to multiple factors and involvement of different militant groups. Security forces of Pakistan started operation Zarb-e- Azab in North Waziristan Agency in 2014 resulting in displacement of 104002 families from the area. Majority of the families settled down in four districts (Bannu, DI Khan, Lakki Marwat, Tank) of KP while those who were unable to afford rents moved to Bakakhel IDP camp. In October 2015 return to North Waziristan agency started and as of 30th April, 2017 more than 84000 IDPs families returned to their native areas in NWA. Currently 20685 families are in displacement most of them residing in District Bannu. The number of people actually returned is lesser than the number quoted because of the unavailability of facilities and resources in the return area.
To achieve the proposed objectives of the project, CERD apart from community outreach team, will work in close coordination with health facility based DoH staff for ensuring effective service delivery and sustainability of the project. Capacity building of the DoH staff and active involvement of the trained Community Nutrition Volunteers (CNVs) in the screening campaigns, field activities and (Maternal, Infant and Young Child Nutrition (MIYCN) will ensure transfer of skills to the real owners of the healthcare system. The services will be established in five new health facilities at Razmak, Datta Khel and Ghulam Khan and will continue provision of nutrition services in the existing 5 nutrition sites established by Relief Pakistan in public sector Health Facilities including establishment of one stabilization center at Miran Shah Hospital. Community based MIYCN services will be available in the catchment area of each Nutrition site. Breast feeding counselors (BFCs) will carry one on one session both at community and health facilities. BFC areas will be established at each Nutrition site to facilitate mothers and care givers. At least 3 Mother support Groups (MSGs) will be constituted and engaged in project activities in the catchment area of each Health Facility. The Nutrition team will conduct cooking demonstration for preparation of Local high density recipes both at Health facility and community level.

The project will be focusing on the Management of Acute Malnutrition in the marginalized segments (children under 5 and PLW) of North Waziristan Agency. Health care providers at health facility and community level will be capacitated on CMAM amp MIYCN to ensure the sustainability of the project. Similarly, there will be more focus on preventive and promotive aspects of acute and chronic malnutrition. The nutrition team will establish linkages and functional referral mechanism to focus on first 1000 Golden Days of life. The team will strongly discourage the distribution and utilization of Breast Milk Substitutes as part of relief package. The team will coordinate with relevant clusters, UNICEF, UNWFP, WHO and DoH for the establishment of Nutrition Stabilization Centre at Miran sha