Malnutrition in Pakistan is a complex, multisectoral problem that presents across a continuum of poor nutrition, from under-nutrition due to deficiencies in energy, protein, and micronutrients to problems of overweight, obesity, and non-communicable diseases, resulting from poor quality, energy-dense and micronutrient-poor diets and low physical activity. Over the last decade, Pakistan’s progress in child malnutrition has not been encouraging. The latest National Nutrition Survey (NNS) conducted in 2011 has shown a Global Acute Malnutrition (wasting) rate of 15.1%, higher than the 13% figure of the previous NNS 2001; disaggregate wasting rates in the urban and rural populations were 12.6% and 16.1% respectively. More than 30 % of children are underweight; 44% are stunted, and 49 % of women are moderately anemic. More than half of children under the age of five are anemic, and 39% of children are zinc deficient.

WHO Nutrition Programme focuses on addressing all forms of malnutrition through strengthening and thoroughly evaluating multi-sectoral programs and policies that aim to improve the diets, nutritional status, and health of mothers, infants, and young children at critical stages of the lifecycle. WHO Nutrition Programme is also committed to providing technical support to federal and provincial governments and to federating areas on nutrition specific and sensitive issues.

National Parliament of Pakistan has nested the first ever global forum on SDGs and Nutrition in February 2016, whereby malnutrition situation in Pakistan was declared as an emergency. Dr Ayoub Al Jawaldeh, Nutrition Regional Adviser/EMR, contributed to this National Parliamentary meeting and reiterated WHO’s full collaboration in the fight against malnutrition, through technical assistance on nutritional priority areas.

Coordination

WHO is working in close coordination with Nutrition Wing, Ministry of National Health Services Regulation and Coordination, Planning Commission, UN partners, Donor and other relevant stakeholders in Pakistan.

WHO Pakistan provided technical support to “SUN Secretariat” at Planning and Development Ministry in the development of the “Monitoring & Evaluation Frameworks for Multi-Sectoral Nutrition strategy for KPK, AJK, Balochistan and Gilgit Baltistan. The framework is in the process of finalization and would support progress-tracking on indicators, and identify gaps for policy actions. 

Advocacy on Nutrition

A joint WHO-Scaling Up Nutrition (SUN) Movement mission led by Ms Gerda Verburg Assistant UN Secretary General, for SUN together with Dr Francesco Branca, WHO Director of the Department of Nutrition for Health and Development/HQ and Dr. Ayoub Al Jawaldeh, WHO Regional Advisor on Nutrition/EMRO visited Islamabad, Pakistan  in April 2017.  It’s focus was to foster engagement of health system in nutrition and to sensitize relevant stakeholders including government and development partners on “UN Decade of Action on Nutrition”.

Capacity-building

Capacity building of health care providers is one of the main mandates of WHO. WHO has extensively supported training of care provides on the management of severe acute malnutrition (SAM). During the past biennium, WHO provided a total of 12 stabilization center kits all over Pakistan; in 2017, an additional two centers were provided to Gilgit Baltistan, AJK and FATA. As the next step towards managing malnutrition in the mentioned areas, technical and financial support will be provided to the respective Department of Health in the form of capacity building for trainings in SAM treatment guidelines. With its focus on strengthening monitoring, WHO has also invested in establishment of Health and Nutrition Sentinel Surveillance Sites (HANSS) across all provinces of Pakistan. The mentioned trainings have been conducted in FATA in 2016, where more than 150 health care providers were equipped with knowledge and skills on the management of SAM as well as capacities in monitoring and surveillance at HANSS sites. The remaining trainings are planned to take place in AJK and GB in the third quarter of the current biennium, with the close collaboration of Nutrition Department, Ministry of Health AJK and GB. WHO has also conducted an assessment to review the HANSS and hence identify means for strengthening the existing system as well as expanding where necessary .

 Food safety

WHO has provided technical assistance for reviewing the Food Safety Legislations in Pakistan aiming to identify gaps and weaknesses in the existing food laws and regulations. This review will help to identifying opportunities and highlighting any need for policy development in this important area. Significant effort has also been made in the training of Food Inspectors on “Hazard Analysis of Critical Control Point”. WHO has also provided Food Safety Lab equipment for the training of future food inspector on lab testing of potential harmful food/additives.

Way forward

WHO in collaboration with SUN secretariat at P&D; MoNHSR&C, Nutrition Wing, UN partners; academia and Donors is planning to support country efforts in reducing malnutrition and improving food safety in alignment with Sustainable Development Goals 2 & 3. Priority areas where WHO will be working are:

• Advocacy around Baby Friendly Hospitals Initiative (BFHI) and scaling up

• Nutrition Stabilization Centers support and trainings Technical guidance on Adolescent Nutrition and Supplementation and advocacy around importance of adolescent nutrition

• Advocacy on implementation of Food Safety Regulations and training on HAACP to food inspectors

• Strengthening functionality of Health and Nutrition Surveillance Sites  

• Contextualization and translation of WHO Global policy briefs and target setting for Pakistan in alignment to WHA targets on Nutrition 

• National and provincial advocacy around “WHO decade of Action theme on Nutrition”

• Technical assistance for National Quality control Standards on Food Fortification