06 May 2017

Pakistan's malnutrition problem: the need for new capacities and stakeholders

I was in Pakistan last week meeting with the GAIN Pakistan team under the leadership of Qaiser Munir Pasha, and with the government and many of our development partners.

The last time I was in Pakistan, in 2013, it was to launch an IDS Bulletin Seeing the Unseen: Breaking the Logjam of Undernutrition in Pakistan”.  The lead paper by Zulfi Bhutta, Haris Gazdar and me noted the coming together of three events: the massive flooding of 2010 and 2011, which exposed chronic as well as acute undernutrition; with the recent decentralisation of health services to the provinces; and the results from the 2011 National Nutrition Survey, which show an increase in stunting, have created some momentum for nutrition”.

Returning 4 years later it is clear that the momentum is still there, but that it badly needs the oxygen of some new (and hopefully encouraging) nutrition data.  The good news is that there is a new national nutrition survey being planned for 2017-18.  And a new census is also in the works (the first for about 20 years) which is also good news because it opens up the possibility of linking the census with the survey to create very fine grained maps of undernutrition and diet quality (see the GNR 2016 for the possibilities). 

And these maps are needed, because decentralization of health services (including nutrition specific interventions) to the 5 provinces has allowed us “see another unseen” -- that of capacity gaps in the implementation and monitoring of the scaling of these interventions.  Like India, the real energy for improving nutrition is likely to come at the subnational administrative levels, hopefully creating competition between them and forcing the Federal government to do more to help them.  So we need to invest in these capacities.

There is some movement on the nutrition sensitive front with activity around nutrition sensitive WASH given the very high levels of water pollution and open defecation.  And there is a growing urgency around the need to address adolescent nutrition, via schooling, empowerment, and social protection interventions. 

What is desperately missing however is engagement with the private sector on nutrition issues, especially around food value chains.  Pakistan is more urban than most South Asian countries and this means more food purchases from the market.  And that means that businesses are important agents of adding nutrition to the food value chain—and of taking it out.  The potential seems significant for government to mobilise businesses for nutrition improvement. It is true that Pakistan does not do terribly well in the World Bank’s Doing Business ranking for 2016 (138th out of 189 countries) but it is not far behind India. 

What we should be interested in is a ranking of ease of Doing Business to Improve Nutrition.  This can surely be developed—preferably at the provincial level. 

1 comment:

Unknown said...

Highly Appreciated for the Overcoming the Malnutrition from Pakistan by Lawrence Haddad