Pakistan's extraordinary malnutrition trends: Can the odds be overcome in the next 5 years?

I just returned from a short trip to Islamabad to launch the IDS Bulletin on Seeing the Unseen: Breaking the Logjam of Undernutrition in Pakistan, a collaboration between IDS, the Aga Khan University and the Collective for Social Science Research. My presentation is here. 

Pakistan is one of the very few countries in the world where stunting and wasting rates have remained high and are actually increasing.

The odds are stacked against nutrition here. Successive governments have struggled to be trusted amid a fragile context, with plenty of natural disasters, conflicts and unequal development. Effective government is a prerequisite for the coordination, responsiveness and accountability required to address undernutrition. 

For now, the momentum seems to be with nutrition. Earlier this year the Government of Pakistan signed up to the Scaling Up Nutrition movement (SUN), the Government has finally officially released the 2011 National Nutrition Survey, a survey containing a lot of uncomfortable statistics. There are hopes for the Benazir Income Support Programme to have a positive effect on nutrition, with plans to make it even more nutrition relevant. Agricultural programmes are looking for ways to be more nutrition sensitive, and the nutrition dangers of open defecation are increasingly recognised. The Provinces have developed nutrition strategies and their focal points are impressive (they were at the launch). 

Everyone in the nutrition community in Pakistan is now holding their breath while working hard to convert commitment into improved nutrition outcomes. Will these commitments be sustained and will they be turned into action? 

Key questions highlighted at the launch include:

• There are some important people within the Planning Commission who are pulling for nutrition, but what happens if they move departments? (Sartaj Aziz wrote the Foreword to our collection of papers and is now adviser to the PM on Foreign Affairs and National Security, but can he still be a nutrition champion or are his new responsibilities incompatible with this?)
• Nutrition budgets may be constructed but will there be any Government financial contributions?
• There is lots of stated intent to work multisectorally but what will happen when the first turf battle erupts?
• The Provincial nutrition plans are in place but can they be turned into costed implementation plans?
• Can more nutrition personnel be put in post at the sub Province (District) level?
• The 2011 National Nutrition Survey is good, but will the data be released for all to use and will we have to wait until 2021 for a new survey and to 2023 to publicly see the results?
• There are plenty of donors interested in nutrition, but are enough of them focusing on chronic (as opposed to acute) nutrition?
• Will malnutrition ever rouse civil society in Pakistan?
• The current Government cares a lot about economic growth, but how can we make them see that an investment in child growth is an investment in economic growth? 

It is easy to be sceptical and say that nothing has changed for 30 years so why should it now? But we need to remember examples from around the world such as Peru and Maharashtra where suddenly all the pieces fell into place to turn long term stagnation in stunting rates into rapid declines.  

Undernutrition can be turned around, and it is good that these questions are even being asked in Pakistan. Now we need answers.