new IDS Bulletin on Undernutrition in Pakistan, coincidentally during the week of the Pakistan elections.
Pakistan is one of the few countries where stunting rates are actually increasing and so my two fantastic co-editors Zulfiqar Bhutta and Haris Gazdar and I put out a call for Pakistani authors to write about malnutrition in Pakistan: what was driving it, what could be done about it, and what needed to happen for solutions to be put in play. We reviewed and present 12 interesting papers (see list below).
The timing seems to be good for nutrition in Pakistan. First, in dealing with the acute malnutrition from the floods of 2010, the Pakistan people woke up to the incredibly high levels of chronic malnutrition in their country (the first part of the title of the Bulletin is "Seeing the Unseen" refers to this). Second, the devolution of power in the health system in 2010-11 has brought a fresh set of government interests to the table and it is hoped that this will allow some regions at least to form new alliances to reduce malnutrition, away from existing bureaucratic barriers and traps. Finally, the National Nutrition survey of 2011 has given a transparent and clear picture of the levels, patterns and causes of malnutrition in the country.
The Bulletin, supported by DFID, talks about all of this. It showcases some government initiatives that have worked (the Tawana school feeding programme which was nevertheless closed down amid claims of corruption, and the salt iodisation programme) and it explores the political opportunities and problems faced in getting nutrition higher up the development agenda. View the overview pre peer review version here.
Getting the two main political parties to pay attention to nutrition will not be easy. The voters are most worried about security and jobs. If the manifestos of political parties reveal their souls, what do the manifestos of the PPP (who lead the current coalition) and the PML-N parties say? The PPP manifesto mentions nutrition 6 times, the PML-N manifesto, not at all. The PPP manifesto links nutrition to schooling, health, empowerment, family planning and social protection (the Benazir Income Support Programme). The PML-N manifesto is more concerned with economic growth. On the face of it, the platforms for nutrition to take hold seem stronger in the PPP manifesto, but for both parties, we need to make the connection between nutrition, economic growth and stability. The evidence from elsewhere is available, but it would be so much more powerful if there was some Pakistan evidence too.
What about the elephants in the room?
Neither manifesto talks much about security, terrorism or corruption--three issues that the Bulletin authors did not have much to say about either. This is understandable--it is difficult to talk publicly about these issues, but we need to know more about the effective delivery of nutrition services in such a fragile and conflict affected contexts. This is surely a good future agenda for nutrition research--how do we need to think differently and act differently in these contexts, and who are the "we" in the first place?
On April 15, Pakistan signed up to the Scaling Up Nutrition movement. This is a good sign. Another would be to create a nutrition budget, allocate resources to it, make sure the Benazir Income Support Programme is nutrition sensitive, sign off on the National Nutrition Survey findings and build up the Pakistan nutrition research community. Pakistan ranks poorly on the Hunger and Nutrition Commitment Index (HANCI). I hope the elections and SUN can begin to change that, slowly but surely.