Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Page 1
GOVERNMENT OF Punjab
Multi-sector Nutrition Strategy
For Addressing Malnutrition in Punjab
Page 2
Table of Contents Executive Summery ........................................................................................................................... 76
1 CHAPTER 1: INTRODUCTION & BACKGROUND .......................................................................... 1211
1.1 Introduction ....................................................................................................................... 1211
1.2 Situation Analysis (nutrition related) National level ............................................................ 1312
1.3 Causality framework .......................................................................................................... 1413
1.4 Punjab profile .................................................................................................................... 1615
1.5 Rationale for Multi-Sectoral Strategy ................................................................................. 1615
1.6 Development Process of Nutrition Strategy ........................................................................ 1817
2 CHAPTER 2: OVERVIEW OF THE STRATEGY ................................................................................. 2019
2.1 Objectives .......................................................................................................................... 2019
2.1.1 Strategic Objectives .................................................................................................... 2019
2.1.2 Specific Objectives/Expected outcomes ...................................................................... 2119
2.2 Conceptual framework ....................................................................................................... 2322
2.2.1 Strategic direction ...................................................................................................... 2422
2.2.2 Guiding principles ....................................................................................................... 2524
2.2.3 Intervention Framework ............................................................................................. 2624
3 CHAPTER 3: SECTORAL PERSPECTIVE – STRATEGIC SECTORAL PLANS ......................................... 2726
3.1 PLANNING AND DEVELOPMENT (P&D) ................................................................................... 2726
3.1.1 Overview of the sector ................................................................................................... 2726
3.1.1.1 Potential role in nutrition improvement, engagement and role within the multisectoral
framework ..................................................................................................................................... 2726
3.2 HEALTH SECTOR ..................................................................................................................... 2827
3.2.1 Overview of the sector ................................................................................................... 2827
3.2.1.1 Lady Health Workers (LHW) ........................................................................................ 2827
3.2.1.2 MNCH program: ......................................................................................................... 2827
3.2.1.3 School Health & Nutrition Program:............................................................................ 2827
3.2.2 Potential role in nutrition improvement ......................................................................... 2928
3.2.2.1 Causal Pathway of Malnutrition .................................................................................. 2928
3.2.2.2 Care for Mothers and Children ................................................................................... 3029
3.2.3 Objectives ...................................................................................................................... 3130
3.2.4 Intervention framework ................................................................................................. 3231
Page 3
3.2.4.1 Strategy 1: Mainstreaming Nutrition in Health ............................................................ 3231
3.2.4.2 Strategy 2: Equitable access to Nutrition services to poor and marginalized people .... 3332
3.2.4.3 Strategy 3: Strengthening capacity of Provincial and local governments on nutrition to
provide basic services in an inclusive and equitable manner ...................................................... 3635
3.3 WASH .................................................................................................................................... 3736
3.3.1 Overview of the sector ................................................................................................... 3736
3.3.1.1 Public Health & engineering department (PHED) ....................................................... 3736
3.3.1.2 Achievements of Public Health & Engineering Department ......................................... 3836
3.3.2 Potential role in nutrition improvement, engagement and role within the multisectoral
framework ..................................................................................................................................... 3837
3.3.4 Intervention framework ................................................................................................. 4039
3.3.4.1 Strategy 1: Equitable access to safe & clean water ...................................................... 4039
3.3.4.2 Strategy 2: Promote best practices & behavioral change regarding hygiene practices . 4341
3.3.4.3 Strategy 3: Equitable access to Total Sanitation Services ............................................. 4543
3.3.4.4 Strategy 4: Development and implementation of Policies and Strategies .................... 4847
3.4 FOOD ................................................................................................................................. 4947
3.4.1 Overview of the sector ................................................................................................... 4947
3.4.2 Punjab Food Department ........................................................................................... 5048
3.4.2.1 Potential role in nutrition improvement, engagement and role within the Multisectoral
framework ..................................................................................................................................... 5048
3.4.2.2 Food Security ............................................................................................................. 5048
3.4.3 Overall Sectoral objectives .................................................................................................... 5250
3.4.3.1 Nutrition specific objectives: related to nutrition specific strategic plan ........................ 5250
3.4.4 Punjab Food Authority ................................................................................................... 5250
3.4.4.1 Potential role in nutrition improvement: .................................................................... 5250
3.4.5 Overall Objectives ...................................................................................................... 5351
3.4.5.1 Nutrition specific objectives: related to the Nutrition Specific Strategic Plan ............. 5351
3.4.6 Intervention framework ............................................................................................. 5351
3.5 SOCIAL PROTECTION .............................................................................................................. 5957
3.5.1 Overview of the sector ................................................................................................... 5957
Implementation of U.N. Conventions ratified by Government of Pakistan .............................. 6058
3.5.2 Potential role in nutrition improvement, engagement and role within the multisectoral
framework ..................................................................................................................................... 6158
Page 4
3.5.3 Food Insecurity and Vulnerability ............................................................................... 6260
3.5.4 Women Empowerment .............................................................................................. 6360
3.5.6 Intervention Framework ................................................................................................ 6461
3.5.6.1 Strategy 1: Strengthen social protection sector to scale-up nutrition-sensitive
interventions ............................................................................................................................. 6461
3.5.6.2 Strategy 2: Improving the economic access to address nutritional needs through poverty
alleviation and social protection ................................................................................................ 6764
3.5.6.3 Strategy 3: Promote nutrition awareness for healthy & safe dietary practices ............ 6866
3.6 AGRICULTURE ........................................................................................................................ 7067
3.6.1 Crop Sector .................................................................................................................... 7067
3.6.1.1 Overview of the sector ................................................................................................... 7067
3.6.1.1.1 Live Stock & Diary Development .............................................................................. 7168
3.6.1.1.2 The Fisheries ........................................................................................................... 7168
3.6.1.2 Contribution in GDP, Poverty Alleviation, Women empowerment- Workforce ............ 7168
3.6.1.3 Potential role in nutrition improvement ......................................................................... 7269
3.6.1.2.1 Casual Pathway of Malnutrition and the Agriculture Sector .................................... 7270
3.6.1.3 Food Security Resources ............................................................................................. 7370
3.6.1.3.1 Food Diversity and caloric Intake situation .............................................................. 7572
3.6.1.4 Overall sectoral objectives .............................................................................................. 7673
3.6.1.4.1 Nutrition specific objectives .................................................................................... 7673
3.6.1.5 Intervention framework ................................................................................................. 7673
3.6.1.5.1 Strategy 1: Mainstreaming Nutrition in Agriculture ................................................. 7673
3.6.1.5.2 Strategy 2: Increase Productivity in nutritious food (by developing and promoting high
yielding varieties of grains & pulses) .......................................................................................... 7875
3.6.1.5.3 Strategy 3: Equitable access to vegetables and fruits .............................................. 8077
3.6.1.5.4 Strategy 4: Addressing Malnutrition through bio-fortification ............................... 8279
3.6.1.5.5 Strategy 5: Scaling up of Kitchen gardening ............................................................. 8380
3.6.1.5.6 Strategy 6: Increase accessibility of animal protein sources at household level ....... 8481
3.6.2 LIVESTOCK AND DAIRY SECTOR ...................................................................................... 8582
3.6.2.1 Overview of the Sector ............................................................................................... 8582
3.6.2.2 Livestock & Diary and Nutrition Connect .................................................................... 8683
3.6.2.3 Nutrition sepecific objectives of sector: ...................................................................... 8784
Page 5
3.6.2.4 Intervention Frame work ............................................................................................ 8784
3.6.2.4.2 Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical
access to livestock-based products ............................................................................................ 8986
3.6.2.4.3 Strategy 3: Increase accessibility of animal protein sources at household level
especially for vulnerable community .......................................................................................... 9188
3.6.3 FISHERIES AND AQUACULTURE SECTOR.......................................................................... 9289
3.6.3.1 Overview of the Sector ............................................................................................... 9289
3.6.3.3 Overall Objective of the sector: .................................................................................. 9591
3.6.3.4 Intervention Matrix .................................................................................................... 9592
3.7 EDUCATION SECTOR (PUNJAB) ............................................................................................... 9996
3.7.1 Overview of the sector ................................................................................................... 9996
3.7.2 Potential role in nutrition improvement ................................................................... 10097
3.7.3 Nutrition specific objectives of the Education Sector ................................................ 10198
3.7.4 Intervention Matrix .................................................................................................. 10299
4 CHAPTER 4: IMPLEMENTATION OF THE STRATEGY / OPERATIONALIZATION .......................... 109106
4.1 Implementation Model .................................................................................................. 109106
4.2 Organizational Structure ................................................................................................ 110107
4.2.1 Provincial ............................................................................................................... 111107
4.2.2 District.................................................................................................................... 113109
4.2.3 Community ............................................................................................................. 114110
4.3 Harmonization and Synergy ........................................................................................... 115112
4.4 Capacity Building ............................................................................................................ 116113
4.5 Communication Strategy ................................................................................................ 117113
4.6 Monitoring, Evaluation and Accountability ..................................................................... 117113
4.6.1 Measuring the progress: result based monitoring framework ................................. 118114
4.7 Research and development ............................................................................................ 120116
4.8 Public private partnership/Bussiness Network ............................................................... 123119
4.9 Financial framework/ resource management ................................................................. 123119
4.9.1 Financial Management ........................................................................................... 123119
4.9.2 Establishment of Joint Funding Pool ....................................................................... 124120
4.9.3 Funds Flow ............................................................................................................. 124120
Page 6
LIST OF FIGURES
Figure 1.1: Causal pathway of Malnutrition, ......................................................................................... 154
Figure 1.2: Sectors involved in reducing the burden of malnutrition & food insecurity ......................... 187
Figure 1.3: process of developing Multisectoral plan in the Province ................................................... 198
Figure 3.4: Sources of Drinking water in Punjab ................................................................................. 4130
Figure 3.5: Percentage of house hold with availability of water & soap .............................................. 4332
Figure 3.6: Integrated Total Sanitation Model .................................................................................... 4634
Figure3.7: Statistics about type of Toilets used in Punjab ................................................................... 4735
Figure 3.8: Relevance of food security & Stunting .............................................................................. 5139
Figure 3.9: Social Protection at a glance Source: adapted from de Janvry (pers. comm.) .................. 6250
Figure 3.10: Food entitlement gaps & social protection instruments.................................................. 6452
Figure 3.11: Food Security Situation -Punjab ...................................................................................... 7362
Figure 3.12: Figure 3: Relationship between Maternal education and Child Stunting (Source: NNS 2011)
........................................................................................................................................................ 10190
LIST OF TABLES
Table 3.1: MTDF Targets and MDGs ................................................................................................... 3837
Table 3.2: Food security resources and poverty in Pakistani provinces, 2009 – 2011 .......................... 7572
Table 3.3: Area & Production of Pulses 2011-2012 and 2012-2013 .................................................... 7876
Table 3.4: National Production, consumption & gap of major pulses 2012-2013 ............................... 7976
Table 3.5: Table Protein Quality Comparison of Fish Protein with other animal Proteins .................... 9390
Table 3.6: Aquaculture practices ........................................................................................................ 9490
Table 3.7: Consumption of Fish in Various Provinces of Pakistan (KGs per capita per annum) ............ 9895
Page 7
Executive Summery Punjab is the most populous province and play imperative role in the economy of Pakistan. The
economy of Punjab is predominantly based on the agricultural sector along with significant contribution
of industry. In spite of the major contribution (about 68%) to the annual food grain production in
Pakistan, the food security and malnutrition indicators in Punjab exhibit meager condition. Pakistan
National Nutrition Survey (2011) reported 58% household food insecurity in Pakistan and 59.5% in
Punjab. This figure shows more food insecurity in Punjab as compared to national average and is very
interesting as Punjab is a hub for agricultural production.
On the account of Nutritional Profile of Punjab, 34% of children are underweight, 42% stunted and 13%
of children were wasted in under five years of age. It was also estimated that about half the children
(49%) aged 0–5 months were exclusively breastfed (MICS, 2007–08). Furthermore, micronutrient
deficiencies in Punjab also indicate an alarming situation. Vitamin A deficiency, that reduces immune
function and impaired eyesight, influences 41.8% of women and 51.0% of children. Moderate and
severe anemia, resulting in part from iron deficiency, and reducing the flow of oxygen from the
lungs to the rest of the body, affects 49.3% of pregnant women in the province and 60.3% of children.
Overall, there seems no major difference and improvement in nutrition indicators compared to national
averages.
Planning & Development Department Punjab, while realizing its role in tackling the grave issue of
malnutrition in Punjab, constituted a Steering Committee (SC) with representation of relevant sectors
including government departments and international development partners. This committee was given
the mandate to develop Nutrition Policy Guiding Notes (NPGN), Punjab. The Steering Committee
constituted a Technical Working Group (TWG) in August 2012 and the TWG subsequently notified six
sectoral technical groups namely Agriculture Sector, Food Sector, Health Sector, Education Sector, Social
Protection Sector and WASH Sector. The sectoral groups were comprised of representatives of relevant
Government departments, development partners, academia and civil society. These sectoral groups,
through meetings and consultative process, developed their respective nutrition policy guidance notes.
These notes were refined through a series of meetings at the provincial and national level and were
then approved by Steering Committee in its meeting held on 07-02-2014. The same consultative
process has been adopted for the development of this strategy with the support of two consultants
supported by UNICEF.
Page 8
The objectives of the multi-sector nutrition strategy are to
Improve the food security indicators to reduce the chronic malnutrition by increasing the
awareness, equitable access to safe and nutritious food including water
Minimize malnutrition associated damage to human capital and economic growth
Reduce acute malnutrition in order to address its long lasting effects
Strategy has identified following outcomes to be achieved by the program in order to attain the main
objectives of the proposed strategy.
1: Policies, plans and multi-sector coordination planned & implaced at provincial and local levels
Development and establishment of protocols for the implementation of proposed multi sectoral
nutrition interventions from provincial to the local level is the focus of this outcome. The strategy will
provide the well-constructed & comprehensive infrastructure for implementation along with reporting,
monitoring and evaluation in order to make the approach ready to practice.
1. The multi-sectoral strategy will specifically focus on enhancing coordination in order to define the
coordination mechanism among participating sectors, donors, and other implementing partners
2. Capacity building of all sectors on implementation and monitoring of progress towards scaling up
nutrition through the multi-sector approach, by defining a core set of multi-sector monitoring and
evaluation indicators
3. Strategy will identify technical as well as funding gaps in the government capacity and provide the
single platform for all partners and donors to chip in to their priority areas to maximize the
coverage, avoid any duplication and support the provincial government.
2: Well-coordinated sectoral plans to maximize the impact of nutrition ‘specific’ and nutrition
‘sensitive’ interventions leading to improved nutritional status of targeted population
This outcome of the strategy will maintain and strengthen the already existing key nutrition ‘specific’
interventions by health department, including, nutrition specific activities performed during biannual
MCH weeks celebrated across the province. Like Vitamin A supplementation and de-worming for all
children aged 6-59 and 12-59 months, respectively; Iron Folic Acid (IFA) supplementation and education
campaign on maternal and child nutrition specially designed for these weeks. Some other routine
activities of health department include the use of zinc in the management of diarrhea together with ORS
and universal salt iodisation. It will also further strengthen and expand Community Infant and Young
Child Feeding (IYCF) program. In addition, a modified model of the CMAM program with the major
Page 9
addition of maternal nutrition and use of micronutrient supplementation for the treatment of MAM
children & PLWs will be scaled up with initial focus in high risk districts. It also supports strategies with
respect to flour & oil fortification.
Furthermore, the outcome will contribute through the education sector to improve and scale up core
nutrition ‘sensitive’ interventions with particular focus on enhancing adolescent girls’ education, life
skills and nutritional status through its School Health and Nutrition Program. The core interventions
include:
Ensure equitable access to education, with particular focus on increasing enrollment and
retention of the girl child
Introduction of Nutrition, Health & Hygiene education modules in schools and education
curriculum
Improve knowledge regarding nutrition among teachers, parents/caregiver's children and
adolescents engaged in schooling
To support the health department in malnutrition screening among children and adolescents
and improve nutritional status among school going children through appropriate referrals,
health & nutrition education and promotion activities
Introduction and promotion of Nutrition as a professional track for post-graduate education and
employment
The outcome will contribute to reduce incidence of infections – with a focus on reducing diarrheal
diseases and ARI among young children, mothers and adolescent girls. It aims to attain this by
Increasing access of “improved” or non-surface water
Enhancing Rural Population Coverage (Barani, Brackish and Contaminated Areas)
Improving quality control of water (by providing Water Testing Facilities and through provision
of Water Filtration Plants)
Enhancing sanitation, environmental sustainability and open defecation free (ODF) environment
Functionalizing Rural Water Supply Schemes and replacing old water supply pipe lines for
eradication of gastroenteritis in 15 cities of Punjab
Increasing public awareness about water safety, safe hygiene practices, and water conservation
Finally, the outcome through the agriculture sector will aim to
Mainstreaming nutrition in agriculture
Enhance productivity of grains and pulses (increase availability of nutritious foods)
Page 10
Address malnutrition through bio-fortification
Promote kitchen gardening at household level (Equitable access to vegetables and fruits)
Create awareness on the importance of food diversification and healthy dietary practices
prioritize development of zinc rich wheat variety
Empower Women labor involved in Agriculture sector
3: Capacity building of provincial as well as local government on nutrition to provide basic services in
an inclusive and equitable manner
This outcome aims to strengthen nutrition related capacities of all involved sectors in multi-sectoral
approach as well as all implementing partners to integrate proposed set of interventions in provincial
and district level planning and monitoring. The multi-sectoral approach will strengthen the capacity of
all involved sectors and other stakeholders at all levels through cross-sectoral (between sectors) and
inter-sectoral (within sectors) coordination depending upon nutrition-sensitive or nutrition-specific
intervention. Capacities will be developed at three levels: the first level will be the policy making level
that also includes the political participation/ownership. The second level will be the implementing
institutions/ sector from province to union council level (such as Fields Assistant, School Health Nutrition
Supersvisors, Teachers, etc.). Lastly, the third level will include the individuals who will be implementing
these activities. Leadership is proposed from the nutrition cell at PSPU under the P&D department at
provincial level to ensure that capacity is built on all levels with increased ownership and commitment.
Effective and coordinated implementation of the proposed strategy is imperative in realization of the
objectives of the strategy. The implementation is proposed to be done in partnership between all
responsible departments. Implementation of this strategy will be mainly through three distinct ways;
1) adjustments in already implemented or existing programmes by making them more nutrition
sensitive.
2) seeking funds and implementing nutrition sensitive interventions by developing PC-1s against
approved interventions in this strategy using their own resources.
3) seeking funds through Nutrition Cell from the pool of resources allocated for implementation of
nutrition strategy for nutrition specific and high priority nutrition sensitive interventions. The
implementation model will vary from intervention to intervention for effective implementation.
Page 11
There are interventions in all sectors, which are department specific and therefore the implementing
department will take lead in its planning and implementation within the sector. Some interventions are
multi-institutional within each sector and some are multisectoral, and their effective implementation
requires coordinated implementation frame-work from all involved departments and/or sectors.
Page 12
1 CHAPTER 1: INTRODUCTION & BACKGROUND
1.1 Introduction
Malnutrition and food insecurity are the most serious health concerns throughout the world and the
significant contributors in child morbidity & mortality. These indices instigate a preventable
embarrassment to global society and induce serious political, economic, and social consequences1. In
developing countries, nearly one-third of children are undernourished (underweight or stunted), and
more than 30% people are enduring different kinds of micronutrient deficiency that undermine
economic growth and perpetuates poverty. Although, numerous efforts were directed to tackle
malnutrition over past few decades, but consequential successes have not been observed, even at
times, with the application of well-tested approaches or strategies. The ineffectiveness is quite evident
from unsatisfactory progress towards achieving MDG to halve the global hunger by 2015 (Target 1.C).
Stunting, wasting, and intrauterine growth retardation presents the most overwhelming concerns
affecting the children, and cause 2.2 million deaths of children (under 5 years). Overall, nutrition-related
factors result in 35% of child deaths and 11% of the total global disease burden2. Change in dietary
habits and inequitable access to food, services and nutritional information are also the contributing
factors for malnutrition. Excess intake, attributable to change in dietary pattern, proliferate the
prevalence of over-weight and obesity. According to WHO report more than 1.4 billion adults (over 20
years) were overweight worldwide in 2008, among those 500 million (200 million men and 300 million
women) found were obese. Poor nutritional status and high prevalence of malnutrition are mainly
attributable to various factors like food insecurity, poverty, lack of knowledge/information, poor dietary
habits (imbalance diet intake), poor maternal and child health, as well as deficiency of micronutrients
(especially iodine & zinc) in soil.
The health and nutrition status indicators of Pakistan are even worse compared to countries having
lower Gross National Product and lower per capita income. According to the Pakistan’s National
Nutrition Survey 2011, various malnutrition indicators like stunting, wasting, and micronutrient
deficiencies are endemic in Pakistan. Although, some of the nutrition indicators for Punjab are slightly
better compared to other provinces, yet the situation is more than worse, as a whole and demand for
effective and targeted strategic actions to tackle the issues immediately. In order to combat the severe
threats posed by malnutrition and achieving the commitments towards MDGs, Government of the
1 Scrimshaw, N.S. (1986). Fed Proc., 45(10), 2421-2426. 2 Blacketal., (2008). The Lancet. 371 (9608):243-260.
Page 13
Punjab along with international development partners keenly developed “Nutrition Policy Guidance
Notes (NPGN), Punjab”. The core of the policy is to adopt a Multi-Sectoral approach for effectively
tackling the grave and persistent issue of malnutrition. This nutrition strategy is based on the (NPGN)
and focuses on various nutrition specific / sensitive strategic actions to be implemented by various
involved sectors targeted to improving nutrition indicators of masses in Punjab.
1.2 Situation Analysis (nutrition related) National level
The Government of Pakistan, in the recent past, has shown its commitment to reinforce nutritional and
health status, especially by improving the nutrition indicators and women empowerment and to make
quick progress towards achieving MDGs. Various programs and projects are in the pipeline to improve
nutrition and food adequacy for a healthy and productive life. Pakistan has also joined the Scaling-Up
Nutrition (SUN), which reiterates its commitment to a healthy nation. Pakistan is now confronting
transecting challenges to feed increasing population, where people are already suffering from nutrient
deficiencies and do not have factual access to adequate micronutrients, protein and energy in their
diet3,4. Despite the inadequate dietary intake and overburden of malnutrition, current indices revealed
that in Pakistan about 33.9% mothers fall in the overweight range (according to BMI>24.9 kg/m2) and
about 14.1% are categorized as underweight (BMI<18.5 kg/m2) because of imbalanced diet and change
in dietary pattern3. However, positive signs have been witnessed as Economic Survey of Pakistan (2013),
indicates that per capita food intake and protein availability has increased in the last two years (from
2410 Kcal/day to in 2450 Kcal/day and 71.5 g/day to 72.5g/day, respectively).
The Pakistani community largely consumes cereals based diet as staple food that contributes to 62% of
total energy. However, the food consumption pattern as well as food diversification is not according to
the Food Guide Pyramid and instigates various nutrition related maladies. Attributable to lifestyle
modifications, inadequate access due to seasonal variation, unorganized market facilities, improper food
supply chain and escalating poverty, the fruits, vegetables, fish and meat consumption are inadequate
as compared to actual requirements. However, the per capita milk consumption is significantly higher in
comparison to other Asian countries. According to National Nutrition Survey 2011, prevalence of
micronutrient deficiencies in women were; iron deficiency anemia (37.0%), anemia (51.0%), zinc
deficiency (47.6%), vitamin A deficiency (46.0%), and vitamin D deficiency (68.9%). While, the
prevalence of micronutrient deficiencies in non-pregnant women were; anemia 50.4%, iron deficiency
3 NNS, 2011 [National Nutrition Survey Pakistan] Government of Pakistan.
4 Economic Survey of Pakistan, 2013
Page 14
anemia 26.8%, vitamin A deficiency 42.1%, zinc deficiency 41.3% and vitamin D deficiency 66.8%. The
micronutrient deficiencies in children (<5 years of age) are also widely prevalent; iron deficiency 43.8%,
anemia 61.9%, zinc deficiency 39.2%, vitamin A deficiency 54.0%, and vitamin D deficiency 40.0%.
Moreover, the indicators of stunting (43.7%) and wasting (15.1%) have deteriorated in 20115compared
to 20016 stunting 37% and wasting 13%. The high level of food insecurity (58%) has also led Govt to
establish Ministry of National Food Security and Research at the federal level to improve the food
security situation in Pakistan, which is one of the major underlying causes for malnutrition in the
country.
1.3 Causality framework
Malnutrition is the outcome and manifestation of either unavailability or lesser availability of one or
more vital nutrients to the body, especially when they require the most. They are many key factors,
which cause this nutrients’ insecurity, depending upon the situation. The key factors which might
instigate the hunger and food insecurity include rapid population growth, climate change, calamities,
low food productivity, incompetent supply chain, post- and pre-harvest losses, frequent food price
hikes, food and water safety issues, untrained and low quality human resource in the food supply chain,
inequitable access to health services and knowledge,7
Among these, climate change is persistently posing serious threats and is influencing agricultural
production and food chain. Frequent floods in Pakistan have impacted large segment of the population
and have left many more vulnerable. Similarly, the death toll is in hundreds due to recent drought in
THAR which caused serious food and water insecurity in large geographical area. The victims are also
prone to even relatively smaller shocks in future, as they lose their assets including livestock and
backyard poultry. Although, irrigated agriculture is essential to meet the food demand and reduce the
hunger and food insecurity by increasing the food production for vulnerable community, yet frequent
calamities and disease outbreaks in one part of the world also impact big time in adjacent countries and
several regions are faced with various concerns that intimidate the sustainability
5 NNS, 2011 [National Nutrition Survey Pakistan] Government of Pakistan.
6 NNS, 2001 [National Nutrition Survey Pakistan] Government of Pakistan.
7 Beddington et al., 2012. Agriculture & Food Security, 1(10), 1-9. doi:10.1186/2048-7010-1-10
Page 15
Figure 1.1: Causal pathway of Malnutrition8,9
The undernourishment (macro nutrient deficiencies & hidden hunger) may cause intrauterine growth
and mental retardation; low birth weight; poor health/ high burden of morbidity; reduced physical and
mental performance; and ultimately constrain community and national development. There are more
different concerns that associated with malnutrition prevalence and the food insecurity situation in the
different parts of the world, especially in developing countries, where the whole resources are not
utilized or somewhere lack of resources create hurdles.
8 Sources: UNICEF, 1990 9 Benson & Shekar, 2006. Washington, DC: World Bank.
Page 16
1.4 Punjab profile
Punjab is the most populous province and play imperative role in the economy of Pakistan. The
economy of Punjab is predominantly based on the agricultural sector along with significant contribution
of industry. In spite of the major contribution (about 68%) to the annual food grain production in
Pakistan, the food security and malnutrition indicators in Punjab exhibit meager condition. In this
province, devastating burden of under-nutrition remains a substantial health concern and induce
enduring adverse consequences. The overburden of malnutrition also instigates the maternal and child
morbidity as well as elevated mortality rates. The infant mortality rate in Punjab is 82 per 1000 live
births, while the child mortality rate (under 5 years) is 104 per 1000 live births (MICS Punjab, 2011). It is
estimated that about 92% of the population in the province have access to improved drinking water
sources; whereas 58% of the population has access to proper sanitation facility (Health Department,
Punjab 2014). Pakistan National Nutrition Survey (2011) reported 58% household food insecurity in
Pakistan and 59.5% in Punjab. This figure, showing more food insecurity in Punjab compared to a
national average, is very interesting as Punjab is a hub for agricultural production. This also reveals that
the producers, especially small holders, they are food insecure due to poverty driven lesser access to
food. In spite of this situation, there is also an increasing trend of obesity, especially in women and NNS,
2011 revealed that 29.9% women are either overweight or obese, while lower percentage is
underweight (17.7%). This situation again reveals the increasing trends towards un-balanced dietary
patterns.
On the account of Nutritional Profile of Punjab, 34% of children underweight, 42% stunted and 13% of
children were wasted in under five years of age. It was also estimated that about half the children (49%)
aged 0–5 months were exclusively breastfed (MICS, 2007–08). Furthermore, micronutrient deficiencies
in Punjab also indicate an alarming situation. Vitamin A deficiency, that reduces immune function and
impaired eyesight, influences 41.8% of women and 51.0% of children. Moderate and severe anemia,
resulting in part from iron deficiency, and reducing the flow of oxygen from the lungs to the rest of
the body, affects 49.3% of pregnant women in the province and 60.3% of children. Overall, there seems
no major difference and improvement in nutrition indicators compared to national averages.
1.5 Rationale for Multi-Sectoral Strategy
Food insecurity and malnutrition induce considerable economic cost comprising reduced lifetime
productivity, expanding poverty, slowing down economic development, lowering the quality of human
Page 17
resource and resource deprivation10. Vulnerable community (chronically hungry and/or severely
malnourished) requires immediate assistance to rescue. Although, most of the world’s vulnerable
communities facing hunger by some means rely on agriculture and related fields like fisheries and
livestock for their survival, however, some other concerns like lack of knowledge, inadequate access to
food, insufficient health and hygiene facilities also associated with their vulnerability.
World Health Organization (WHO) Assembly emphasized on nutritious and healthy foods and lifestyles
in 2012-13 to decrease non-communicable diseases (NCDs) burden in entire world. The endeavors to
reduce malnutrition burden and food insecurity for economic and human development in Pakistan
requires involving agriculture (crop, livestock, & fisheries), food (safety, handling, storage &
preservation) water, sanitation & hygiene (WASH), social welfare, women development, health as well
as education sectors. These sectors along with some others have also been identified at global level and
scaling-up nutrition, movement also revolves around multi-sectoral approaches to tackling malnutrition
across the globe. Moreover, coordination and close collaboration between various sectoral players like
government, development partners, academia and civil society is also the need of the hour for
addressing immediate, underlying and basic causes of malnutrition having roots across the sectors.
Consequently, improvement in nutrition indicators at reasonable pace will only be possible through
multi-sectoral approach by involving relevant sectors that have substantial potential for declining
chronic malnutrition in the province. WHO particularly gives emphasis on the long term sustainable
contribution of “Agriculture and Food Sectors”. The consensus report further elaborated that along with
ensuring food security throughout the world; both sectors must ensure the adequate access to safe and
good quality foods. Multisectoral experience in nutrition from countries like Nepal, Thailand, Peru and
Brazil confirm that such a centrally-placed coordination mechanism is imperative for ‘planning
multisectorally, implementing sectorally, and reviewing sectorally as well as multisectorally’.
10 (FAO, 2012) http://www.fao.org/docrep/016/i3027e/i3027e00.htm
Page 18
Figure 1.2: Sectors involved in reducing the burden of malnutrition & food insecurity
1.6 Development Process of Nutrition Strategy
Planning & Development Department Punjab, while realizing its role in tackling the grave issue of
malnutrition in Punjab, constituted a Steering Committee (SC) with representation of relevant sectors
including government departments and international development partners. This committee was given
the mandate to develop Nutrition Policy Guiding Notes (NPGN), and provide strategic advice on
developing nutrition strategies and operational plans of Punjab. The steering committee was also
mandated to facilitate the resource generation and budgetary allocations from Punjab Government and
development partners. The Steering Committee constituted a Technical Working Group (TWG) in August
2012 and the TWG subsequently notified six sectoral technical groups namely Agriculture Sector, Food
Sector, Health Sector, Education Sector, Social Protection Sector and WASH Sector. The sectoral groups
were comprised of representatives of relevant Government departments, development partners,
academia and civil society. These sectoral groups, through meetings and consultative process,
developed their respective nutrition policy guidance notes. These notes were refined through a series of
meetings at the provincial and national level and were then approved by Steering Committee in its
Malnutrition &
Food Insecurity
Agriculture Crop,
Livestock, Fisheries
Food
Health
Water, Sanitation & Hygiene
Education
Social Protection
INGOs& Other
development Partners
Page 19
meeting held on 07-02-2014. The same consultative process has been adopted for the development of
this strategy with the support of two consultants supported by UNICEF.
Recognizing the complexity of the issue of malnutrition for economic and human development and for
efforts to achieve the Millennium Development Goals, the Government of Punjab and its partners have
decided to undertake a Multisectoral nutrition plan to address the issue involving all key sectors which,
collectively, have considerable potential for reducing malnutrition in the province.
The following picture illustrates the process of developing Multisectoral plan in the Province.
Figure 1.3: process of developing Multisectoral plan in the Province
In a nutshell targeted, well-coordinated and integrated multisectoral approach is the core of this
strategy, which aims to develop ownership in involved sectors to realize their role in reducing the
burden of malnutrition from the province of the Punjab. If implemented in letter and spirit, this multi-
sector nutrition strategy is believed to be appropriately responding to impending crises of malnutrition
from the province.
Multi-sectoral strategy
Sector-specific Working Groups
Development of Policy Guideline notes
P & D Steering Committee
D-10 Meetings (Planning Commission of Pakistan)
Page 20
2 CHAPTER 2: OVERVIEW OF THE STRATEGY
A casual pathway to malnutrition provokes the need of the multisectoral approach because of its
effectiveness to combat the overwhelming burden of malnutrition. Keeping in view the threatening
situation of nutrition indicators in Punjab, the Govt. of Punjab has decided to initiate a multisectoral
strategy in order to intervene the causes of under nutrition from underlying causes to immediate ones.
Multisectoral approach will be comprehensive, valuable and most effective way to adopt the both
nutrition specific and nutrition sensitive interventions, involving all related sectors with their poteintial
role. This strategy is going to define the implementation and coordination (both horizontal and vertical)
mechanisms at all levels within the sectors in collaboration with development partners. Multisectoral
strategy is mainly focused on single work plan with common objective of all sectors and partners, thus
making it convenient for partners to chip in at their priority area and will help to maximize the coverage
& avoid any duplication. The effective implementation of multisectoral strategic intervention will
certainly play a key role in reducing ever-escalating burden of malnutrition mainly and will also be
helpful in improving the food-security indicators.
2.1 Objectives
2.1.1 Strategic Objectives
The objectives of the multi-sector nutrition strategy are to
Improve the food security indicators to reduce the chronic malnutrition by increasing the
awareness, equitable access to safe and nutritious food including water
Minimize malnutrition associated damage to human capital and economic growth
Reduce acute malnutrition in order to address its long lasting effects
These objectives will be achieved by considering both nutrition specific as well as nutrition sensitive
interventions equally important. Nutrition specific interventions will be implemented largely through
the health sector, and nutrition sensitive interventions mostly by other sectors including education,
agriculture, WASH and social protection, in well-coordinated manner with developing-partners and
government will add into the impact of the strategy.
Page 21
2.1.2 Specific Objectives/Expected outcomes
The multi sectoral strategy is designed in a way that every sectoral plan will work effectively at all levels
from provincial to local in order to achieve a common goal of reduction in acute as well chronic
malnutrition and other nutrition associated maladies. Each sector, health, education, agriculture, social
work, WASH & local government will implement their assigned plans in multi-sector coordinated
manner and will be monitored and evaluated sectorally as well as multi- sectorally. Following outcomes
are defined to be achieved by the program in order to attain the main objectives of the proposed
strategy. Expected results/ specific objectives
1: Policies, plans and multi-sector coordination planned & implaced at provincial and local levels
Development and establishment of protocols for the implementation of proposed multi sectoral
nutrition interventions from provincial to the local level is the focus of this outcome. The strategy will
provide the well-constructed & comprehensive infrastructure for implementation along with reporting,
monitoring and evaluation in order to make the approach ready to practice.
1. The multi-sectoral strategy will specifically focus on enhancing coordination in order to define
the coordination mechanism among participating sectors, donors, and other implementing
partners
2. Capacity building of all sectors on implementation and monitoring of progress towards scaling up
nutrition through the multi-sector approach, by defining a core set of multi-sector monitoring and
evaluation indicators
3. Strategy will identify technical as well as funding gaps in the government capacity and provide the
single platform for all partners and donors to chip in to their priority areas to maximize the
coverage, avoid any duplication and support the provincial government.
2: Well-coordinated sectoral plans to maximize the impact of nutrition ‘specific’ and nutrition
‘sensitive’ interventions leading to improved nutritional status of targeted population
This outcome of the strategy will maintain and strengthen the already existing key nutrition ‘specific’
interventions by health department, including, nutrition specific activities performed during biannual
MCH weeks celebrated across the province. Like Vitamin A supplementation and de-worming for all
children aged 6-59 and 12-59 months, respectively; Iron Folic Acid (IFA) supplementation and education
campaign on maternal and child nutrition specially designed for these weeks. Some other routine
activities of health department include the use of zinc in the management of diarrhea together with ORS
Page 22
and universal salt iodisation. It will also further strengthen and expand Community Infant and Young
Child Feeding (IYCF) program. In addition, a modified model of the CMAM program with the major
addition of maternal nutrition and use of micronutrient supplementation for the treatment of MAM
children & PLWs will be scaled up with initial focus in high risk districts. It also supports strategies with
respect to wheat flour & oil/ghee fortification.
Furthermore, the outcome will contribute through the education sector to improve and scale up core
nutrition ‘sensitive’ interventions with particular focus on enhancing adolescent girls’ education, life
skills and nutritional status through its School Health and Nutrition Program. The core interventions
include:
Ensure equitable access to education, with particular focus on increasing enrollment and
retention of the girl child
Introduction of Nutrition, Health & Hygiene education modules in schools and education
curriculum
Improve knowledge regarding nutrition among teachers, parents/caregiver's children and
adolescents engaged in schooling
To support the health department in malnutrition screening among children and adolescents
and improve nutritional status among school going children through appropriate referrals,
health & nutrition education and promotion activities
Introduction and promotion of Nutrition as a professional track for post-graduate education and
employment
The outcome will contribute to reduce incidence of infections – with a focus on reducing diarrheal
diseases and ARI among young children, mothers and adolescent girls. It aims to attain this by
Increasing access of “improved” or non-surface water
Enhancing Rural Population Coverage (Barani, Brackish and Contaminated Areas)
Improving quality control of water (by providing Water Testing Facilities and through provision
of Water Filtration Plants)
Enhancing sanitation, environmental sustainability and open defecation free (ODF) environment
Functionalizing Rural Water Supply Schemes and to replace old water supply pipe lines for
eradication of gastroenteritis in 15 cities of Punjab
Increasing public awareness about water safety, safe hygiene practices, and water conservation
Finally, the outcome through the agriculture sector will aim to
Page 23
Mainstreaming nutrition in agriculture
Enhance productivity of grains and pulses (increase availability of nutritious foods)
Address malnutrition through bio-fortification
Promote kitchen gardening at household level (Equitable access to vegetables and fruits)
Create awareness on the importance of food diversification and healthy dietary practices
prioritize development of zinc rich wheat variety
Empowering Women labor involved in Agriculture sector
3: Capacity building of provincial as well as local government on nutrition to provide basic services in
an inclusive and equitable manner
This outcome aims to strengthen nutrition related capacities of all involved sectors in multi-sectoral
approach as well as all implementing partners to integrate proposed set of interventions in provincial
and district level planning and monitoring. The multi-sectoral approach will strengthen the capacity of
all involved sectors and other stakeholders at all levels through cross-sectoral (between sectors) and
inter-sectoral (within sectors) coordination depending upon nutrition-sensitive or nutrition-specific
intervention. Capacities will be developed at three levels: the first level will be the policy making level
that also includes the political participation/ownership. The second level will be the implementing
institutions/ sector from province to union council level (such as Fields Assistant, School Health Nutrition
Supersvisors, Teachers, etc.). Lastly, the third level will include the individuals who will be implementing
these activities. Leadership is proposed from the nutrition cell at PSPU under the P&D department at
provincial level to ensure that capacity is built on all levels with increased ownership and commitment.
2.2 Conceptual framework
The therapeutic approach to treat malnutrition are complex and vary in different situations. Inadequate
access to basic human requirements such as lack of safe drinking water, poor hygiene conditions (and its
associated diseases such as diarrhea, infectious disease, parasites), drought or any emergencies leading
to a collapse of social networks, then it comes social beliefs and taboos (due to lack of knowledge)
affecting food and specially nutrient intake. These are few highlighted causes which can determine the
nutritional status of a community, household or individual. Any strategy aiming to treat or prevent
malnutrition needs to identify clearly the direct and underlying causes of malnutrition in the country or
province specific context. The conceptual framework of malnutrition adopted by UNICEF in 2000
Page 24
proposes a multi-sectoral analysis of malnutrition causes, which can guide for further assessments,
project design, their implementation, monitoring and evaluation.
2.2.1 Strategic direction
Key strategic directions for multi-sector nutrition plan will be following:
2.2.1.1 Scaling up of nutrition specific interventions of proven effectiveness
Most of the sectors i.e. agriculture, Food, education, wash, social protection and specially Department
of health Punjab has already identified and started working on nutrition specific interventions in the
province. The strategy will provide direction towards scaling up of already identified & proposed cost
effective interventions of proven effectiveness by sectors in an equitable and coordinated manner. The
multi sectoral nutrition strategy will serve as the basis for the implementation of all sectoral plans as a
government’s plan to improve the nutrition indicators.
2.2.1.2 Identification and implementation of sector specific nutrition sensitive interventions
(Multisectoral approach: plan multisectorally, implement sectorally)
The strategy will identify nutrition sensitive interventions with major focus on sectors other than health
and will provide the single platform for intersectoral planning. The strategy will focus on “plan
multisectorally-implement sectorally & then monitor and evaluate sectorally as well as multi sectorally”.
2.2.1.3 Target groups
This strategy will be addressing the most vulnerable segments of the society in equitable manner. Target
group for the proposed interventions will be adolescent, all married females with special focus to
pregnant & lactating mothers, and all children of less than 5 years of age.
2.2.1.4 1000 days plus model
In order to focus on the window of opportunity when stunting occurs, from conception to two years of
age, strategy is designed with 1000 days plus model to catch the problem even before conception.
Adolescent & maternal component of interventions is thus mainly considered in order to prevent the
issue even before it occurs.
2.2.1.4.1 Women empowerment / Women Focused Approach (As SUN countries pursue goals in a
way that empowers women at every level.)
The strategy will be women & child friendly design. In order to maximize the participation of most
disadvantaged segment of the society women focused approach will be introduced. Capacity of women
Page 25
already working with different sectors will be improved through trainings that leads to their
empowerment. The strategy will also ensure the participation of women & most disadvantaged in the
decision making process at all levels through mainstreaming their participation from provincial to local
level.
2.2.1.5 Over nutrition (Childhood obesity, adolescent health)
Over nutrition, especially childhood obesity is very much associated with lifestyle and eating patterns.
The strategy will also add the behavior change related to unwanted weight gain and over consumption
of refined & processed foods.
2.2.2 Guiding principles
Key guiding principles of the strategy will be as following :
2.2.2.1 The fundamental right to be free from hunger
Every child born has a fundamental right to be free from hunger, thus the Multisectoral approach will be
designed in a way to ensure the availability safe, enough & nutritionally adequate food to every child at
all times.
2.2.2.2 Gender empowerment
Gender balance and women empowerment will be guiding principle of the strategy in order to ensure
equitable access of nutrition services. Women being more vulnerable towards malnutrition will be
addressed through women focused approach of the strategy.
2.2.2.3 Geographical convergence
Equitable geographical coverage with special focus to far flung and disadvantaged area will be very
important principal for the implementation of proposed Multisectoral strategy.
2.2.2.4 Evidenced based interventions
All the interventions that will be proposed to be scaled up should be necessarily evidence based. So
strategy will propose to pick internationally proven intervention relevant to the local context, then
should be piloted and will only recommend to be scaled up once evidence is being generated.
2.2.2.5 Equity in distribution
The poorest of the poor will be the real target of the strategy. Equity in distribution of all nutrition
related interventions will take up the most marginalized segment of the society in the account. And
Page 26
provide the services very much according to need based, e.g. malnourished children about food secure
household will be provided with counseling of right choice not the food supplementation.
2.2.3 Intervention Framework
Figure 2.1: Intervention Framework [Source: Adapted from (Black et al., 2013) by A. Dorward]
Page 27
3 CHAPTER 3: SECTORAL PERSPECTIVE – STRATEGIC SECTORAL PLANS
3.1 PLANNING AND DEVELOPMENT (P&D)
3.1.1 Overview of the sector
The Planning and Development Department (P&D), Government of Punjab, is the principal planning
organization at the provincial level. It coordinates and monitors development programs and activities of
various departments of the provincial government. The department also prepares the overall medium
term framework of development activities in the province. The medium term development framework
lays down the development activities to be carried out in various sectors of the provincial economy. In
this manner the Planning & Development department is one of the main actors in the growth of the
economic potential of the province. Bureau of Statistics Punjab, Agency for Barani Areas Development
(ABAD) & Directorate General Monitoring & Evaluation are attached departments of P & D Punjab.
The mandate of the P&D department includes, provision of technical support and coordination to
various Government departments in their planning activities. The P&D department is also the main
government agency working with foreign donors in the province.
The main objectives of the Planning and development department are:
Assessment of the material and human resources of the province
Formulation of long and short term plans.
Recommendations concerning, prevailing economic conditions, economic policies or measures.
Examination of such economic problems as may be referred to it for advice.
Coordination of all economic activities in the provincial government.
3.1.1.1 Potential role in nutrition improvement, engagement and role within the multisectoral
framework
Considering the domain of Planning & Development Department Punjab and multisectoral strategy, P&D
has a central role in planning, implementation, coordination and M&E. The planning role of P&D has
been discussed in first chapter (1.6 Development Process of Nutrition Strategy) and the detailed
description is documented in Chapter 04 of this strategy.
Page 28
3.2 HEALTH SECTOR
3.2.1 Overview of the sector
Health Department is the key with the fundamental responsibility for ensuring the health of the entire
population of the province. The Health Department delivers preventive as well as curative health care
services of Primary Health Care level to Tertiary level. The infrastructure in the province consists of
2,461 Basic Health Units (BHUs), 293 Rural Health Centers (RHCs), 88 Tehsil Headquarters Hospitals
(THQs), 34 District Headquarter Hospitals (DHQs) and23 Teaching/ tertiary Care Hospitals.
Keeping in consideration the key role of the health sector in addressing malnutrition, the Punjab health
department has already started implementing an RMNCH & Nutrition program in an integrated manner
through its vertical programs i-e LHW Program & MNCH program.
3.2.1.1 Lady Health Workers (LHW)
The Lady health worker program is operating in all 36 districts of Punjab with 47000 thousand LHWs
working in the community. After the floods of 2010 LHW program remained main implementer of the
CMAM & nutrition programs in the flood affected districts of Punjab. More than 15000 LHWs are fully
trained in basic nutrition and IYCF.
Moreover the community component of the nutrition program is also responsible of LHWs. It includes,
screening, referral and follow up of identifying malnourished cases in the community. Provision of iron,
folic acid tablet to all females of child bearing age, micronutrient supplements for suspected cases of
MAM children, & BCC with special focus to nutrition is added to LHWs routine jds now.
3.2.1.2 MNCH program:
Community midwives are engaged in community based nutrition related programs like MCH week, and
special weeks like breast feeding weeks. All CMWs will be trained on IYCF & basic nutrition under the
RMNCH & Nutrition program.
3.2.1.3 School Health & Nutrition Program:
Total 1,754 School and Nutrition, Health Specialists (SH&NS) are appointed at a Basic Health Unit level.
The School Health and Nutrition Specialist (SH&NS) visits every primary and middle school in the
catchment area, preferably once in a month for delivering lectures on health education and health
lifestyle. The SH&NS also carries out screening of students for eye, ENT, dental, skin and general physical
problems. The trained school teachers also assist in these activities.
Page 29
3.2.2 Potential role in nutrition improvement
The combination of inefficient health services and burden of malnutrition has been identified
impediments in achieving MDGs. High levels of malnutrition are consistent with high rates of infant and
maternal mortality. The infant mortality rate in Punjab is 81 per 1000 live births, higher than the
national average. At the same time, relation between health especially infectious disease and
malnutrition cannot be ignored. In a well-nourished child, a common infectious disease is usually a
passing illness. While for an already malnourished child the same disease can precipitate, life-long
disabilities such as Vitamin A deficiency can cause even blindness. Similarly rapid sequence of infections
can leads towards malnutrition.
A slow sequence of disease accompanied with malnutrition & poor health services leads to stunting,
wasting, and affects mental development, decisively handicapping the affected millions that do not die.
The survivors remain with difficulties in terms of cognitive and physical development. Their handicap
though invisible, marks lifelong effects, leaving them less productive throughout their life.
The Malnutrition–Health complex is drain on human resource. One condition aggravates the other.
Infections lead to malnutrition and malnutrition may exacerbate infections increasing the duration,
severity, morbidity, and mortality. Malnutrition, health and poverty are closely linked with each other;
already poor people who are also malnourished and unhealthy and vice versa. It is envisaged that health
status improvements will enable individuals to avail more choices/opportunities that can help in
improving quality of their lives like attaining education, competing for better employment opportunities
and contributing towards their families and society’s betterment, hence enjoying their life.
Improved health behaviors and ensured access to primary health care package including the nutrition as
an important component of primary health care services will not only reduce the suffering at individual
level but will also reduce the cost of treatment. In the end, investment in treatment of complicated
cases will be decreased and would allow planning for the development projects. It is difficult to put
these benefits in figures, but their significance cannot be overlooked.
3.2.2.1 Causal Pathway of Malnutrition
Casual pathway for Malnutrition clearly shows linkages between health and nutrition. As poor health
and insufficient health, surfaces are the main contributor towards increasing the malnutrition Burdon.
Page 30
Figure 3.1: Health sector specific area of interventions mapped on the causal pathway of malnutrition
3.2.2.2 Care for Mothers and Children
Adequate nutrition influences the health status of women and children to a great extent. The
prevalence of anemia is significantly high amongst pregnant women; this coupled with low caloric intake
during pregnancy has a negative impact on the growth of the fetus, resulting in nearly 28% of births
being low weight. Women and children in Punjab also suffer from high rates of deficiencies in essential
Page 31
vitamins and minerals. The MMR for Punjab (227 per 100,000 live births11) is lower as compared to
other regions of the country; however, it is still high when compared with neighboring countries of
South Asia. The High TFR and MMR in the province are also indicative of the fact that the experience of
pregnancy and other reproductive health related aspects among women in Punjab predispose them to a
high risk of morbidity and mortality.
This data reflect the abysmal conditions of Nutrition among the more vulnerable segments of the
population that include the women and children of the province. This snapshot of Nutritional status
indicates that Punjab is far from achieving the health related MDG targets. Such nutrition indicators on
the part of the provincial health department also warrant a comprehensive and effective plan of action
on a war footing, to improve the existing deplorable health & nutrition conditions and indicators for the
women and children. Moreover the nutrition indicators could be improved only by adopting integrated
primary health care approach as all indicators are interlinked with each other. Health sector alone may
not be able to achieve MDGs but its prime importance and role in multi-sectoral approach cannot be
overlooked Nutrition Specific
3.2.3 Objectives Following are nutrition Specific Strategic objectives of health sectors By the end of 2020:
To develop Policy framework to create an enabling environment for mainstreaming Nutrition in
Sector & improving multi-Sectoral coordination mechanisms by the year 2015
To develop nutrition communication strategy and development of IEC material for other sectors
by December, 2015
To reduce 50% micronutrient deficiencies among maternal Infant & young Child (MIYC)
micronutrient status (Vitamin A, Iodine, Iron) improved from an existing baseline (NNS 2011) by
2020
TO 20% reduced in prevalence of stunting among children under -5 Years
To reduce acute malnutrition from 15% to 9% by 2020
To 50% reduce prevalence of underweight among children under-5 Years
To 50% reduce low birth weight babies (<2,500 grams)
To train 80% of Health Care providers on Nutrition
11 The Pakistan Demographic and Health Survey 2006-07
Page 32
3.2.4 Intervention framework
3.2.4.1 Strategy 1: Mainstreaming Nutrition in Health
Integration of nutrition services into routine healthcare system is being experimented globally, although
the patterns of integration and the issues related to the integration process. Mainstreaming nutrition in
regular channels of the Directorate General of Health Services can address the malnutrition issues
directly.
Apart from current initiatives, routine health system of the province lacks nutrition lens. Proposal for
integrated services is a way forward not only to continue existing interventions through an integrated
approach, but also to expand their scope and introduce new nutrition interventions. Currently the
department of health is initiating integrated nutrition services approach into primary health care as well
as a tertiary health care system through a PC1 in selected target districts with the aim to expand into all
over the province. However, in order to harmonize the system in all over the province following
strategies are recommended to be initiated on war footing basis.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
Nutrition
Nu
trit
ion
sen
siti
ve
Nu
trit
ion
spec
ific
To develop Policy
framework to
create an enabling
environment for
mainstreaming
Nutrition in Sector
& improving
multi-Sectoral
coordination
mechanisms by
the year 2015
1.1 Develop and promulgate rules for implementation of Breast feeding Act 2009
√ -- Development,
promulgate and
implementation
of nutrition
sensitive
policies will
ultimately lead
to uptake of
nutrition
indicators
1.2 Policy decision to integrate nutrition as part of EPHS and revision of JDs of HCPs & SHNS accordingly
√ --
1.3 To take up with PFA and other stakeholders regarding development of, mandatory legislation on wheat flour fortification with iron and folic acid, salt iodization
√ --
1.4 Policy to institutionalize Gender Sensitive and pro poor approach in all health plans ( PC1s)
√ --
1.5 Advocacy with BISP to convert its cash transfer scheme into
√ --
Page 33
conditional cash transfer
To develop nutrition communication strategy and development of IEC material for other sectors by December , 2015
1.6 Develop consensus among stakeholders of each sector in communication framework by December, 2014
√ --
Impact on lives of women and children by sensitizing them to adopt positive health behavior
1.7 Develop linkages and provide support to other sectors in implementation of communication strategy and training of their staff.
√ --
1.8 Create awareness among the community on use of nutritious food, healthy dietary habits, hygiene and health
√ --
3.2.4.2 Strategy 2: Equitable access to Nutrition services to poor and marginalized people
Nutrition Program Punjab is currently working in seven target districts of Punjab (D.G. Khan, RajanPur,
Muzaffargarh, Layyah, Mianwali, Rahim Yar Khan, Bhakkar). The Punjab Nutrition Program is modified
version of CMAM (Community based treatment of acute malnutrition) as SAM (Severe Acute
Malnourished children) are treated by provision of RUTF (Ready to use therapeutic food).
To address micronutrient deficiencies, MMS (multi-micro nutrient supplementation) is proposed
intervention to be provided to MAM children and PLWs, in addition to nutritional counseling. Currently
the high default rate in the OTP (Outpatient therapeutic program) is a challenge in the treatment of SAM
children. Extended health house is another intervention proposed to reduce the default rate & maximize
the SAM treatment coverage. In extended health houses, SAM child will be provided follow-up visits
services. SAM child is expected to visit the facility after every 7 days, while in this approach LHW will
examine and provide RUTF at home during follow up visits and child will visit the facility after every 14
days.
Community Health workers (SHNS, LHWs, CMWs) are proposed to be trained on IYCF & Basic Nutrition
in order to provide all communities based services to address malnutrition that include, Screening,
Referral, Follow-up, support in breastfeeding, all components of IYCF & nutrition counseling. Health care
providers are also proposed to be trained on facility level treatment protocols of malnutrition in
addition to the same IYCF & Basic Nutrition.
Page 34
INTERVENTION MATRIX
Strategic Objective Strategy Action(s)
Nature of
Intervention Impact on
Nutrition
Nu
trit
ion
sen
siti
ve
Nu
trit
ion
spec
ific
80% of children
with SAM
accessing services
on Severe Acute
Malnutrition
(SAM)
management as
per National
guidelines,
especially in the
most affected
districts by 2020
2.1 Establish nutrition treatment centers
(OTPs) for SAM children from 80 to 930
by the year 2017 -- √
Early detection
and treatment of
wasting will
ultimately reduce
stunting.
2.2 Establish nutrition treatment centers (SC) for SAM children with complication from 8 to 36 by the year 2017
-- √
Maternal Infant &
young Child
(MIYC)
micronutrient
status (Vitamin A,
Iodine, Iron)
improved by 50%
from existing
baseline (NNS
2011) by 2020
2.3 Enforcement mechanism of salt iodization developed and implemented by 2015
√ --
By addressing Micronutrient deficiencies stunting can be prevented.
2.4 Ensure quality of iodized salt by strengthening and up gradation of existing lab system by 2015
√ --
2.5 Advocate with PFA for effective implementation regarding fortification of oil & Ghee with vit A & D by 2014
√ --
2.6 Assessment of existing mechanism of provision of Vit A biannually with NIDs by 2014
√ --
2.7 Increase in coverage of Vit A from 73% to 95% during NIDs by 2016
-- √
2.8 Conduct research to assess absorption and storage of iron. √ --
2.9 Research on compliance on uptake of iron √ --
2.10 Provision of iron folic acid to PLW and adolescent girls through community health workers
-- √
Page 35
2.11 Exploring & establishing protocols for nutrition screening of adolescent girl -- √
2.112.12 Promote and provide deworming tablets to children and adolescent girls.
-- √
2.122.13 Provision of iron syrup and tablets in all health facilities -- √
2.132.14 Ensure develop and enforce of flour fortification law by 2014 √ --
2.142.15 Demand Generation of fortified foods through Lady Health Workers
√
Reduction in low birth weight babies by 50% of existing baseline (NNS 2011) by 2020 by Improving maternal health
2.152.16 Promote healthy timing and spacing of pregnancy √ --
Low birth weight babies are more prone towards malnutrition and infections
2.162.17 Increase coverage of ANC by health care providers √ --
2.172.18 Provision of calcium and vitamin D supplements to PLW -- √
2.182.19 Counseling of pregnant women to take one extra meal and food diversity in accordance with the food pyramid
√ --
Reduce prevalence of stunting among children of under five years from 39% to 27% ( 2% reduction annually by 2020
2.192.20 Increase in early initiation within one hour from 15% to 60%. -- √
Reduction in stunting is the main goal of the nutrition strategy to decrease malnutrition.
2.202.21 Increase exclusive breastfeeding from 22% to 50% -- √
2.212.22 Increase the number of children fed in accordance with all three IYCF practices (breast milk consumption, timely introduction of solid foods, food diversity, frequency and consistency of weaning food.)
-- √
2.222.23 %age of mothers aware of at least two benefits of exclusive breastfeeding.
√ --
2.232.24 Percentage of mothers aware of all components of IYCF practices.
√ --
2.242.25 %age of mothers able to identify at least two signs of childhood illness (e.g. Pneumonia)
√ --
Reduction in acute malnutrition from
2.252.26 Increase in coverage of fully immunized children from 34.6% to 90%. √ --
Timely identification and
Page 36
15% to 9% by 2020 2.262.27 Establishment of nutrition treatment sites at 30% BHUs and all RHCs of Province
-- √ treatment of wasting/acute malnutrition prevent stunting. 2.272.28 Establishment of
Stabilization Centers (SCs) in all DHQs & Teaching Hospitals.
-- √
2.282.29 Increase in percentage of identifying SAM children enrolled for treatment at nutrition site.
-- √
2.292.30 Increase percentage of registered children successfully treated for severe acute malnutrition, according to national guideline protocols.
√ --
2.302.31 Provision of MMS sachet to 60% of identified MAM children. -- √
2.312.32 Increase in percentage of children suffering from diarrhea treated with ORS & Zinc.
-- √
2.322.33 Develop facility for local production of RUTF for MAM children.nutritional products like RUTF, and supplementray food at local level
√
2.34 Explore and establish appropriate protocols for the treatment of MAM keeping the local context in mind.
-- √
3.2.4.3 Strategy 3: Strengthening capacity of Provincial and local governments on
nutrition to provide basic services in an inclusive and equitable manner
The above described nutrition services are quite new to the department of health, and there is an
intense need to build capacity of the existing system as well as health care providers for quality
provision of nutrition services. The Punjab Policy guidance note on Nutrition shows that there is a strong
association between factors such as poverty and women’s education and malnutrition. Special efforts
are thus needed to reach the poorest households and the communication for behavior change needs to
be designed in a way to effectively communicate with illiterate and less educated mothers.
INTERVENTION MATRIX
Strategic Objective Strategy Action(s) Nature of
Intervention
Impact on
Nutrition
Page 37
Nu
trit
ion
sen
siti
ve
Nu
trit
ion
spec
ific
80% of Health
Care providers
trained on
Nutrition
3.1 Development of training modules for
different cadres √ -- Well-trained
professionals
can identify
malnutrition
timely and
provide quality
services in order
to minimize the
complications.
3.2 Trainings of Provincial master trainers √ --
3.3 Trainings of Community health workers and health care providers on Nutrition
√ --
3.3 WASH
3.3.1 Overview of the sector
By 1978 Public Health Engineering Department (PHED) was finally evolved and then placed under the
umbrella of H&PP. However, very soon this sector was also renamed called “Housing Physical &
Environmental Planning” (HP & EP) in 1978 plus attached this was “Environmental Protection Agency”
(EPA). In 1996, EPA was detached and HP& EP was given another name “Housing, Urban Development &
Public Health Engineering Department (HUD & PHED)” and consist of the following sectors: Punjab
Housing and Town Planning Agency (PHATA); Public Health Engineering Department (PHED); Lahore
Development Authority (LDA); Rawalpindi Development Authority (RDA); Gujranwala Development
Authority (GDA); Faisalabad Development Authority (FDA); Multan Development Authority (MDA);
Water and Sanitation Agency, Lahore; Water and Sanitation Agency, Rawalpindi; Water and
Sanitation Agency, Gujranwala; Water and Sanitation Agency, Faisalabad; Water and Sanitation
Agency, Multan; Traffic Engineering and Transport Planning Agency (TEPA), Lahore; Parks & Horticulture
Authority (PHA), Lahore; Parks & Horticulture Agency (PHA), Faisalabad; Parks & Horticulture Authority
(PHA), Multan; Improvement Trusts (Murree & Sargodha).
3.3.1.1 Public Health & engineering department (PHED)
The main objective of “PHED” is to improve quality of life of the people of Punjab through the provision
of “Safe Drinking Water” in areas like Brackish, Barani (Fig. 1) and areas where ground water is polluted
or contaminated or else inappropriate for drinking purposes. Similarly PHED aimed to provide clean
Page 38
atmosphere “Pollution Free Environment” through improving Sewerage / Drainage Schemes and
Construction of Sewage Treatment Plants to meet MDGs).
3.3.1.2 Achievements of Public Health & Engineering Department
Govt. of Punjab sectoral policy aimed to achieve MDGs within due time to provide safe Water
Supply & Sanitation facilities as appropriate. PHED have allocated and provided enough
financial resources asunder.
Description Population Coverage (%)
Projected Year of Reaching MDG
MDG’s Targets
2015 in % 2006-
07 2007-
08 2008-
09 2009-
10 2010-
11 2011-
12
Urban Water Supply
66.2 71.9 75.5 83 85 87 2009-10 80
Rural Water Supply
30.8 32.7 36.1 38 45 48 2020-21 65
Urban Sewerage/ Drainage
68.5 72.0 76.0 79 83 85 2010-11 82
Rural Sewerage/ Drainage
41.3 43.8 48.6 50 53 56 2015-16 70
3.3.2 Potential role in nutrition improvement, engagement and role within the
multisectoral framework
The one of the main objectives of the sector is achieving MDG7, which is broadly defined by UN,
covering environmental policy, preservation of biodiversity, access to water and sanitation and urban
development. The target to measure MDG7 is” Halve, by 2015, the proportion of the population without
sustainable access to safe drinking water and basic sanitation”.
Progress in provision of safe drinking water and sustainable sanitation services is imperative as these
conditions have a direct impact on targets in other MDGs goals. The effectiveness of preventive health
measures and risk of communicable and waterborne diseases is dependent on the quality water and
sanitation services provided to the population. Enrolment rates are also affected by the lack of water
and sanitation facilities in schools, thereby having a major impact on the achievement of education
indicators as well.
Page 39
Poor environment (unsafe drinking water and poor sanitation and hygiene, or WASH), the underlying
determinants of malnutrition, often lead to increases in diarrheal disease, a leading cause of child death
in Pakistan, which decreases the absorption of nutrients consumed. Accordingly, even when food
consumption is sufficient, such bacterial, infection can lead to malnutrition in children12. Additionally,
open defecation, improper sanitation facilities and unsanitary waste disposal contaminate food in the
household as well as food production.
While a large majority of households in Punjab utilizes piped water or water from a tube well or bore
well for drinking, (88.9%), it is important to note that there are numerous opportunities for pathogens
to make their way into the water prior to ingestion, during water collection, transport, storage and/or
transfer to drinking vessels. The Punjab Municipal Water Act has been drafted and should reduce the
misuse of ground water. Nearly 22% (PLSM 2011) of households do not have access to hygienic sanitary
facilities. In addition, while hand washing after defecation and before the preparation of a meal (99.0%
and 97.4%, respectively) is substantially higher than that in many developing countries, soap is available
only in an estimated 77% of Punjabi households. The likelihood of women being free of anemia in
Punjab is twice as high where toilet facilities are available at home (73% vs. 36 %.)
Figure 3.2: Linkages with Nutrition Indicators
12 WHO, 2008
Odds of stunting at 24 months of age increase by a factor of 1.05 with each episode of diarrhoea (Lancet 2008, data pooled from 9 studies)
Improvements in sanitation were associated with increases in height ranging from 0.8cm to 1.9cm (Esrey 1996, multi-country analysis, sample size almost 17.000)
Children with worst conditions for water source, water storage and sanitation were 1·0 cm shorter in stature (Lancet 2004, Peru)
“The total number of deaths caused directly and indirectly by malnutrition induced by unsafe water, inadequate sanitation and insufficient hygiene is 860,000 deaths per year in children
under five years of age” (WHO 2008)
Page 40
Figure 3.3: WHO pathway linking WASH & malnutrition
3.3.3 Overall Sectoral objectives
To increase access of to “improved drinking water” or non-surface water: MDG 7
To enhance Rural Population Coverage (Barani, Brackish and Contaminated Areas)
Improving quality control of water (by providing Water Testing Facilities and through provision of Water Filtration Plants)
To enhance sanitation, environmental sustainability and open defecation free (ODF) environment
To make dysfunctionally Rural Water Supply Schemes functional and to replace old water supply pipelines for eradication of gastroenteritis in 15 cities of Punjab
Increase public awareness about water safety, safe hygiene practices, and water conservation
3.3.4 Intervention framework
3.3.4.1 Strategy 1: Equitable access to safe & clean water
Background/Rationale: While recognizing that access to safe drinking water is the basic human right of
every citizen and that it is the responsibility of the state to ensure its provision to all citizens, Provincial
government is committed to provision of adequate quantity of safe drinking water to the entire
population at an affordable cost and in an equitable, efficient and sustainable manner.
While Government of Punjab (GoPb) to fulfill its commitments and responsibilities in achieving MDGs
has developed and approved Punjab Drinking Water Policy in May 2011. Inadequate and unsafe water,
Page 41
poor sanitation, and unsafe hygiene practices are the main causes of diarrhea, which results in at least
1.9 million under-5 child deaths annually.
Around 80% of all diseases are attributed to water and sanitation related causes. Inadequate disposal of
human excreta and personal hygiene are associated with a range of diseases including polio, diarrheal
diseases, jaundice, typhoid, malaria, dengue viral fever and cholera. Sanitation is both a public and a
private good, and that individual hygiene behavior can affect the whole community if your neighbors
defecate in the open, then your children risk excreta-related diseases even when the members of your
own household use a sanitary toilet, wash their hands, and practice good hygiene. Factors related to
water, sanitation and hygiene affect children’s right to education in many ways. In an atmosphere of
poor health, children are unable to fulfill their education potential for example; 400 million school-aged
children a year are infected by intestinal worms, which, research shows, sap their learning abilities.
Figure 3.4: Sources of Drinking water in Punjab source from where they put
INTERVENTION MATRIX
Strategy Objective
Strategy Action(s)
Nature of Intervention Impact on
nutrition Nutrition Sensitive
Nutrition Specific
To increase the access to water in Punjab by 2020and reduce
1.1 Provide drinking water under Changa Paani Programme through early implementation and completion of project in all districts
√ --
Access to safe drinking water will ultimately reduce the risk
Page 42
the arduous labour of women in carrying it in all vulnerable communities by 2020
of Punjab by 2020 (Implementation level) depends upon approval and avaibility of resouces
of water-borne diseases and lead to uptake of nutrition indicators
1.2 Provide clean drinking water by installing filtration plants under Saaf Paani Programme through early implementation and completion of project by 2020 (Implementation level) consultation with saaf pani company
√ --
1.3 Provide hand pumps in areas where the provision of tap water facility is currently not feasible (Implementation Level) subject to provision of fincial resouces
√ --
1.4 Rehabilitation of dysfunctional rural water supply schemes 172 (2015)schemes are arpproved and rest are subjected to approval and finicial (Implementation Level)
√ --
1.5 Ensure availability of safe drinking water by installation of small water filtration plants in schools (Implementation Level) mandare of school dept
-- √
To increase access to clean/safe drinking water in all vulnerable communities punjab by 2020
1.6 Ensure scaling and sustain functioning of installed water filtration plants saaf pani company
√ -- Access to safe drinking water will ultimately reduce the risk of water-borne diseases and lead to uptake of nutrition indicators
1.7 Initiate water treatment projects with special awareness campaign at household and community level by distribution of chlorinating tablets etc. subject to availability to functional resources or (initiate a project)
√ --
1.8 Establish water quality testing facilities and regular sampling of water from various water projects starting from water source to household level water qualiy testing lab (mobility) strengthing of water quality labs and ensuring regular provision of water testing servicing
√ --
1.9 Introduce community based effective monitoring mechanism comprising elected UC representatives, school council
√ --
Formatted: Adjust space between Latin and Asian text,Adjust space between Asian text and numbers
Formatted: Indent: Left: 0"
Formatted: Indent: Left: 0"
Formatted: Indent: Left: 0"
Page 43
members and CBOs for provision of safe drinking water mechanism under process
1.10 Plan and introduce proper operation and maintenance mechanism for keeping the facilities functional
√ --
To reduce misuse and depletion of ground water
1.11 Increase water conservation with increased and improved water storage capacity
√ --
1.12 Launch a campaign for awareness to reduce water wastage and misuse
√ --
3.3.4.2 Strategy 2: Promote best practices & behavioral change regarding hygiene
practices
Background/Rationale: Wash is an important prerequisite for ensuring the right to basic education with
a water-related disease. Hand washing practices reduce the risk of infectious diseases associated with
microbial infections. Hand washing practices with soap are the single most important factor in
preventing the spread of pathogens and antibiotic resistance in healthcare settings.
Figure 3.5: Percentage of house hold with availability of water & soap13
Proposed hygiene promotion actions should aim to encourage healthy behavior changes among target
13 MICS 2011
76.8
19.4
2.5
0
10
20
30
40
50
60
70
80
90
Water + Soap Available Only Water AvailableBoth Water + Soap not available
Per
cen
t H
ou
seh
old
Page 44
communities. Interventions will follow a community driven approach to hygiene promotion and focus on
personal hygiene promotion relating to hand washing (at critical times), latrine usage, water transport,
storage, and consumption as well as infrastructure maintenance and management related to latrines
and water points. The community workers should equip with basic skills on community participation,
awareness raising methodologies and basic prevention and control of water and sanitation related
infections. Likely training topics will include personal hygiene, latrine use & maintenance, hand washing,
safe water use, diarrheal disease prevention and management, ORS, and malaria prevention and
treatment.
Hygiene promotion should aim to motivate beneficiaries to use latrines by explaining the health benefits
they are going to gain through such practices and in connection to other healthy behaviors and
maintaining clean latrines. Messages need to be delivered in a way that they can be readily understood
by target group and language, design of IEC materials for illiterate people, gender considerations,
cultural norms etc.
INTERVENTION MATRIX
Strategy Objective
Strategy Action(s)
Nature of Intervention Impact on
nutrition Nutrition Sensitive
Nutrition Specific
To Launch campaign and awareness programs to promote hygiene practices
2.1 Conduct awareness campaigns an community sessions through integration approach by community workers like SH&NS, LHW, CMW, agriculture field assistant, school teachers, civil society, union council, CBOs, KHATTEEB of local MASAJIDS (AUQAF Dept.) and local media (Policy Level)
√ --
Access to educational materials and awareness about sanitation and hygiene practices (especially among females) will ultimately reduce the health risk
2.2 Celebrate the Mother & Child Week, Global Hand Washing Day, World Toilet Day and World Water Day, Anti-Dengue Day to promote hygiene practices (Implementation Level)
√ --
Page 45
2.3 Develop IEC material on nutrition containing guidelines of health and hygiene practices (Policy Level)
√ --
2.4 Creative inclusion of sanitation, hygiene and preventive approaches adressing malnutrition in school curriculum in coordination with the School Education Department and Punjab Curriculum Authority (Policy Level)
√ --
3.3.4.3 Strategy 3: Equitable access to Total Sanitation Services
Background/Rationale: UN declared that access to proper sanitation services is a basic human right to
improve public health and quality of life. It is widely recognized and documented that lack of access to
this essential basic service is associated with adverse impact on public health and environment. The
Millennium Development Goal 7 (MDG-7) assigns the signatory nations to extend access to improved
basic sanitation to at least half of the un-served population by 2015 and to 100% population by 2025.
Sanitation is one of the significant hygienic means of promoting health through prevention of human
contact with the hazards of wastes. “The Pakistan Approach for Total Sanitation (PATS) is towards
achieving and sustaining an open defecation free environment both in rural and urban context with
clear emphasis towards behavior change and social mobilization enhancing the demand side of
sanitation. The approach endorses the use of a number of branded total sanitation models, having a key
role of communities, which include:”
Community Led Total Sanitation
School Led Total Sanitation
Component Sharing
Sanitation Marketing
Disaster Response
Page 46
The literature review revealed that every model has proved its own success in different context. The
above models may be adopted by the provincial and local governments in accordance to suitability of
their local context. The integrated approach of “Total Sanitation” which is comprised of sanitation
demand creation interventions, sustaining demand through supply side interventions, health hygiene
promotion intervention, and drainage & water treatment interventions of “Component Sharing Model.”
Figure 3.6: Integrated Total Sanitation Model sources
This integrated approach will have the chance to produce sustained results. Before the implementation
strategy of “Integrated Model” is delineated, the existing situation is analyzed.
Integrated Total Sanitation Model
Demand Creation
Interventions for ODF
Communities
CLTF, SLTS
Attaining 100 % Adequate
Drainage, Waste water
treatment and solid waste
collection disposal through
Component Sharing
Participatory Health &
Hygiene Promotion
Promotion
Sustaining the Demand
through Supply Side
Interventions
Sanitation Marketing
1. Launching a behavior
change communication
campaign based on
baseline information
regarding Knowledge
Attitude and Practices &
Formative Research
findings
2. Finalization and
triggering of PRA tools for
mobilizing communities
through Community
Activists/ sanitation
Ambassadors(Adapting a
cascading model)
1. Technical training of
masons
2. Construction of low cost
environment friendly
latrines for demonstration
of technical solutions
3. Piloting concept of
sanitation mart
Trainings of sanitation
entrepreneur and sanitation
enterprises
4. Facilitation to develop
linkages with the
microfinance institutions
5. Incentivizing outcomes
1. IEC material on active
health and hygiene key
massages
2. Mass Media/
Communication Campaign
3. IEC campaigns
promoting low-cost
appropriate and informed
sanitation solutions
1. Waste water disposal in
a hygienic way including
small sewerage treatment
units, oxidation ponds etc
2. Underground/ covered
drainage system
3. Solid waste collection
and disposal system
Page 47
Figure3.7: Statistics about type of Toilets used in Punjab source
The above picture shows overall provincial status of toilets used in Province. Further break up of data,
into rural & urban and district wise status shows big differential. According to Multiple Indicator Survey
(MICS), Punjab (2011), 32% of the rural population defecates in open environment, which puts a
significant challenge for Government of Punjab to create an open defecation free environment in the
Province.
LG&CDD has the legal role and mandate of community development in order to improve water supply,
sanitation, hygiene including rural communities, which are more vulnerable and are excluded so far
water, sanitation, and hygiene services are concerned.
Further analysis of MICS 2011 reveals that 61.8% people of Rajanpur, 51.2% of Muzaffargarh, 50.3% of
DG Khan, 48.4% of Chinniot and 44.2% of Jhang defecates in open environment as compared to
provincial average which is 22%.
INTERVENTION MATRIX
Strategy Strategy Action(s) Nutrition Level Impact on
Page 48
Objective Nutrition Sensitive
Nutrition Specific
nutrition
To decrease ODF 23 22% to 10% in province of Punjab by 2020 23-18% 2015
3.1 Scaling up PATS in Punjab to have ODF villages Conduct pilot project of PATS in high risks districts (Rajanpur, Muzaffargarh, DG Khan, Chinniot and Jhang) by 2015 RYK, Layyah, Chakwal, Vehari, Bahawalpur, DGK (PATS project are running )
√ --
Clean environment will be helpful in decreasing health risk factors and reduce the malnutrition burden
Installation of sewerage treatment units by 2020
3.2 Install small scale sewerage treatment units especially with prioritization in those large villages (Implementation Level) resources
√ --
Installation of solid waste management plants by 2020
3.3 Improve solid waste management schemes and mechanism through establishment of solid waste management plants in all over the Punjab to treat agriculture, sewerage and domestic solid waste (Implementation Level) local govt
√ --
3.4 Install composting plants in large cities to manufacture compost fertilizers from this waste (Implementation Level)local govt
√ --
To ensure availability of facilities of quality hygiene and sanitation practices at 100% schools by 2019 (especially in girls school)
3.5 Provide WASH facilities, like soap and toilets, in schools in collaboration with School Education Department (Policy Level) Schoold dept
√ --
3.3.4.4 Strategy 4: Development and implementation of Policies and Strategies
Background/Rationale: Government of Punjab (GoPb) to fulfill its commitments and responsibilities in
achieving MDGs has developed and approved Punjab Drinking Water Policy in May 2011. Recognizing
the significance of sanitation, GoPb is formulating Sanitation Policy for the province. The Policy may
provide a broad framework and policy guidelines to provincial institutions, District Governments and
Page 49
Tehsil Municipal Administrations in order to improve sanitation coverage and services in the province.
The Policy document may envisage a structure for addressing the institutional, administrative, legal,
regulatory, fiscal, social & environmental issues and challenges faced by the sector actors.
INTERVENTION MATRIX
Strategy Objective
Strategy Action(s) Nutrition Level
Impact on nutrition
Nutrition Sensitive
Nutrition Specific
Formulation of nutrition and gender sensitive policies & strategies of WASH sector
4.1 Approval and dissemination of Punjab Drinking Water Strategy by 2015 (Policy Level)inprocess draft complter
√ --
Sanitation and hygiene will ultimately reduce the risk of water-borne diseases and lead to uptake of nutrition indicators
4.2 Approval and dissemination Punjab Sanitation Policy and Strategy by 2015 (Policy Level)CM approved and move to canbient division
√ --
4.3 Approval and dissemination Behavior Change Communication Strategy by 2015 (Policy Level) draft completed and comments are incorporating
√ --
4.4 Approval, dissemination & implementation of Punjab Municipal Water Act 2013 (Policy Level)inprocess of approval move to CM
√ --
3.4 FOOD
3.4.1 Overview of the sector
Punjab economy is mainly agricultural and province is playing a leading role in agricultural production. It
contributes about 68% to the annual food grain production in the country. 51 million acres of land are
cultivated and another 9.05 million acres land is lying as cultivable waste in different parts of the
province (Govt. Punjab). Although, Punjab is predominantly an agricultural province yet 60%14 of its
14 NNS-Pak 2011
Page 50
households are food insecure (higher than the countrywide figure of 58 %). Of these, 18% are classified
as food “insecure with hunger,” and 11.5% are food insecure with severe hunger.
The number of surplus food producing districts in Punjab decreased from 21 to 14, while the food deficit
districts increased from 7 to 14 between the years 2003-04 to 2008-09. During the same time period,
the number of districts with “low” to “extremely low” access to food increased from 35% to 53%15 .Part
of this deterioration in Punjab has been the result of an economic and industrial crisis relating to power
shortages, increased production costs and non-significant growth in household income.
3.4.2 Punjab Food Department
This department was initially developed to distribute important food items, but current government
decided to limit its function to procuring what at support price and supply to the flour mills at subsidized
rates and subsidy may be withdrawn gradually within the next few years. Unfortunately, price of ATTA
became a very sensitive issue and rulers could not gather the political will to withdraw subsidy.
3.4.2.1 Potential role in nutrition improvement, engagement and role within the Multisectoral
framework
Food Department is safeguarding the interests of growers through purchase of wheat on support price
fixed by the Government, maintenance of strategic reserves as well as improving the quality of life of
citizens of Punjab by providing them quality and nutritious flour at reasonable price. Under the Food
Stuff (Control) Act, 1958, Food Department is responsible for regulating the business of food grains,
which include purchases, storage, sales, transfer, and milling. Furthermore, Food Department is
responsible for procurement of wheat for issuance to the mills, to act as government agents to provide a
wheat purchase window to the farmers at support price.
3.4.2.2 Food Security
The concept of food security has emerged and expanded over time to integrate a wide range of food-
related issues and reflects the complexity of the role of food in human society (Cook, 2006). The Rome
Declaration on World Food Security in 1996 defined food security as a situation where ‘All people at all
times, have physical and economic access to sufficient, safe and nutritious foods to meet their dietary
needs and food preferences for an active healthy life’ (World Food Summit, 1996).
15 SDPL et al,2009
Page 51
Food insecurity, the limited or uncertain availability of or access to nutritionally adequate and safe foods
throughout the year, is associated with malnutrition as a key underlying determinant of overall food
intake in the household, depicted in a causal framework of malnutrition. Food insecurity may also be a
more sensitive measure of food issues experienced by low-income families than household income
alone, especially the psychological and social ramifications of a lack of food.16
Wheat is the staple diet of Pakistan. There is major link b/w poverty and consumption pattern of wheat.
The poorest of the poor obtain the highest proportion of energy and nutrients from the wheat as flour
based CHAPPATI is the major food item or, at times, the only food item of their daily meals. Therefore,
focusing on the production of wheat, its proper storage, ensuring its nutrient quality and controlling
price will certainly help in improving food security, especially in population, which is food insecure with
severe hunger. The production of food including wheat rests with Agriculture sector, i.e. Agriculture,
Livestock and Fisheries Departments, however, the food after harvesting, picking, catching, slaughtering
etc. comes under the domain of Food Department. The Food Department is therefore key provincial
department to ensure safe, wholesome, good quality and nutritious food at a reasonable price in
consumer table, thus having a major role in food security in the province. This strategic plan has taken
care of this significant issue to address malnutrition. Additionally, the micronutrient fortification of food
products like flour, edible oil, ghee and salt, and targeted food subsidies will be the key interventions of
this sector, helping to tackle the ever-escalating burden of malnutrition.
Figure 3.8: Relevance of food security & Stunting17
16 Frangillio, 1999 17 Nutrition Policy Guidance Notes, Punjab 2013
Page 52
3.4.3 Overall Sectoral objectives
The objective of the Food Sector Plan:
Improved quality of common mans diet by providing them quality wheat flour (staple diet) at
affordable prices ( with special focus to maximum utilization of micronutrients)
Ensure the food security in Punjab province to maximum population
3.4.3.1 Nutrition specific objectives: related to nutrition specific strategic plan
Ensure food security related to wheat and wheat products
Transportation of wheat from surplus to deficit regions
Provision of quality of wheat by protecting it from insect pests and other hazards
Targeted food support programs
Fortification of wheat flour with micronutrients
3.4.4 Punjab Food Authority
The Government of Punjab has taken an initiative to establish Punjab Food Authority under the "Punjab
Food Authority Act 2011" to ensure availability of safe and wholesome food for human consumption.
The basic purpose is to lay out standards for food articles and to regulate their manufacturing, storage,
distribution, sale and import. Its main function include formulation of standards, procedures, processes,
and guidelines in relation to any aspect of food including food business, food labeling, food additives,
and specify appropriate enforcement systems; Specify procedures and guidelines for setting up and
accreditation of food laboratories; Formulate method of sampling, analysis of samples and reporting of
results; Specify licensing, prohibition orders, recall procedures, improvement notices or prosecution;
Provide scientific advice and technical support to the Government in matters related to food; Collect
and analyze relevant scientific and technical data relating to food; Establish a system of network of food
operators and consumers to facilitate food safety and quality control; Organize training programmes in
food safety and standards; Promote general awareness as to food safety and standards; Levy fee for
registration, licensing and other services; certify food for export.
3.4.4.1 Potential role in nutrition improvement:
Ensuring food safety and quality
Collect and analyze relevant scientific and technical data relating to food safety
Page 53
Standardization including legislation on mandatory fortification of food products i.e. edible oil,
ghee, flour and salt.
3.4.5 Overall Objectives
To ensure availability of safe and wholesome food for human consumption
To enhance quality perspective of the food products
3.4.5.1 Nutrition specific objectives: related to the Nutrition Specific Strategic Plan
Take measures to enhance food safety and quality in the Province
Ensure that the food is safe for human consumption at all stages of food supply chain
Improving the hygienic system and environment of food production / processing
Action against food business operators selling, storing, marketing, etc. adulterated, injurious,
sub-standard, contaminated or unsafe food or food products
Ensuring the effective food control system, including the implementation of voluntary and
mandatory food fortification
3.4.6 Intervention framework
Multi-sectoral efforts are required to eradicate malnutrition and improve health of citizens of the
province. Reduction in nutrient deficiency and malnutrition are likely to be multi-sectoral task, but
clarity on sectoral responsibilities is an essence. The proposed strategic actions by the food sector
involving the Food Department and Punjab Food Authority to address malnutrition through Multi-
Sectoral Nutrition Plan (MSNP) in Punjab is as under:
3.4.6.1 Strategy 1: Physical access to food throughout the year for all targeted groups
Background and Rationale: Food security emerged as a priority issue during the Food price hike in
2007–08 and most recently in 2012-13 and with the realization that global food prices likely to remain
either high and/or frequently fluctuate, with strong adverse implications on food security. There is a
major link b/w poverty and consumption pattern; the poorest of the poor obtain the highest proportion
of energy and nutrients from the wheat as wheat based chappati are the major food item or, at times,
the only food item of their daily meals. Therefore, focusing on the production of wheat, its proper
storage, ensuring its nutrient quality and controlling price will certainly help in improving food security,
especially in population, which is food insecure with severe hunger. Therefore, improving the storage
Page 54
capacity and quality control mechanism of staple food (wheat) is of utmost importance, which is housed
with this sector i.e. Food Department
INTERVENTION MATRIX
Strategy
Objective Strategy Action(s)
Nutrition Level Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
Increase in storage capacity from existing level to 80% by 2020
1.1 Replace wheat storage from bag to silos storage (Policy level)
√ --
Access to food
throughout the
year will
improve the
food security
situation and
ultimately
reduce the
malnutrition
burden
Ensure access to
food throughout
the year
1.2 Explore avenues for Public and Private partnership to preserve and increase storage perishable commodities at their peak harvesting for year-long availability at affordable price (Policy level)
√ --
1.3 Improve Food supply chain and promote the applications of modern technology and engineering to reduce post-harvest losses
√ --
1.4 Introduce and promote cold supply chain to increase the safety of high risk food i.e meat
-- √
3.4.6.2 Strategy 2: Ensure and improve food quality from farm to fork
Background/Rationale: Wheat and other grains quality testing within due time is necessary because low
quality food/grains pose health threats and economic losses to the farmers as well as to the consumers.
Among present day challenge is to introduce a well-managed tracking system where a particular area
grain is diseased or nutritionally unsuitable should be withdrawn from the market or supply chain. In
this regard Interlinking/networking of different food analysis labs with each other is important and there
should be skill development of analyst such as yearly training and time-to-time awareness workshop
regarding field problem as well as how to eradicate them?
Page 55
INTERVENTION MATRIX
Strategy
Objective Strategy Action(s)
Nutrition Level Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
Strengthen lab
facilities to
ensure food
safety and
quality by 2016
2.1 Up-gradation of the existing lab facilities for testing of micro-nutrients in foodsflour, wheat quality & safety testing in regions, where the labs are already present but are with limited capacity or non-operational(Policy level)
√ --
Up-gradation & establishment of lab will be helpful in provision of safe and nutritious food and ultimately improve nutrition indicator
2.2 Establishing new lab testing facility in regions where there is need but there are no labs (policy level Level)
√ --
3.4.6.3 Strategy 3: Provision of safe food
Background and Rationale: Low quality food/grains pose health threats and economic losses to the
farmers as well as to the consumers. “A safe and nutritionally adequate diet is a basic individual right
and an essential condition for sustainable development, especially in developing countries” (Gro Harlem
Brundtland). Therefore, establishment of effective and integrated food control system throughout the
province is critical for ensuring food safety. For this purpose, scaling up of Punjab Food Authority to
whole of Punjab and its capacity development in terms of access to sophisticated lab facilities,
availability of trained manpower in food safety, improvement and harmonization of rules, standards and
regulation with international standards is of utmost important. Currently the domain of Punjab food
authority is only in Lahore and is likely to extend its network from Lahore to four other divisional
headquarters of Punjab i.e. Faisalabad, Gujranwala, Rawalpindi, and Multan in 2014. It is recommended
to extend its network in all 36 districts of Punjab province by 2020. Moreover, purposeful action will
Page 56
need to be initiated to produce manpower capable of inspecting food and food premises by starting /
scaling-up of professional programs in food safety.
INTERVENTION MATRIX
Strategy
Objective Strategy Action(s)
Nutrition Level Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
Strengthen and expansion of Punjab Food Authority to improve food safety
3.1 Phase-wise extending the
Punjab Food Authority to whole
of Punjab by 201720 (Policy
level)
√ --
Improvement in
food safety
increase
nutrition status
and reduce
disease burden 3.2 Establishing lab facilities at district level parallel with the extension of Punjab Food Authority for safety & quality testing of food products & testing facility of micro nutrient (Policy level)
√ --
Improve the food
safety
management
systems by
legislation,
promulgate and
implement
3.3 Improving the capacity of inspection services through revising and harmonizing the food rules with (Codex Alimentarious Commission(CAC), OIE, and IPPC) (implementation Level)
√ --
Provision of safe
food ultimately
lead to uptake of
nutrition
indicators
3.4 Continuous professional development, capacity enhancement, trainings and awareness campaigns for all involved in food supply chain starting from producers to consumer desk
√ --
Awareness to
food safety
will reduce
health risks and
ultimately lead
to uptake of
nutrition
indicators
Page 57
3.5 Promoting and advising to get Food Safety Management Certification like HACCP, BRC, ISO-22000 etc. by food business operators, targeting specifically the large industries and high risk food processors for 3 years
√ --
Certification will
be beneficial in
food safety and
it will also
will reduce
health risks
3.6 Mandatory Food Safety Certification of large food industries in five years, medium size in 10 years, and all food business operation in 15 years
√ --
Certification will
effective in food
safety and it will
also
will reduce
health risks
3.7 Roadside should be upgraded to minimum hygine standards √ --
3.4.6.4 Strategy 4: Ensure Economic Access To Food
Background Rationale: Majority of the nation faces financial problem and hence pose with limited
access to the food. Targeting poor group and making subsidies on wheat flour/or-other grains would
have positive impact on decreasing malnutrition in the country. Similarly, production of wheat is not
much satisfactory to the extent it should be and need careful consideration. Although food production
on large scale is necessary however, where indicated or people with limited resources need home
livestock and garden production (home scale agribusiness). Monthly cash system like BISP, Zakat and
other Charity has to be properly in place for targeted groups particularly, women and children.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nutrition Level Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
Improve the economic access to food by subsidies and price control and regulation
4.1 Targeted and conditional food subsidies for poor instead of generic subsidies and may be linked with inflation rate by 2014(Policy level)
√ --
Access to food at
economical price
will improve the
food security
Page 58
mechanism 4.2 Putting in place the price control and regulation mechanism especially for staple food (Policy level)
√ --
situation and
ultimately reduce
the malnutrition
burden
3.4.6.5 Strategy 5: Reduce micronutrient deficiency in adolescents girls, pregnant &
lactating mothers and children’s through fortification
Background/Rationale: Globally 79 countries have legislation to mandatory fortification at least one
major cereal grain. Of these, 78 countries fortify wheat flour, 12 countries fortify maize products, and 5
countries fortify rice. Currently 78 countries require fortification of wheat flour produced in industrial
mills. All the countries fortify wheat flour with at least iron and folic acid except Australia which does not
include iron, and Venezuela, the United Kingdom, and the Philippines which do not include folic acid.
Additionally, seven countries fortify at least half their industrially milled wheat flour through voluntary
efforts. We estimate that 31% of the world’s industrially milled wheat flour is fortified with at least iron
or folic acid through these mandatory and voluntary efforts.We define mandatory as legislation that has
the effect of requiring fortification of one or more type of grain with at least iron or folic acid. Most
countries permit fortification. Encouraging and advising on minimal, nutrient friendly and innovative
food processing techniques for qualitative and quantitative retention of vital nutrients.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nutrition Level Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
Develop Promulgate and implement, legislation regarding the fortification of food by 2014
5.1 Create awareness on benefits
for use of fortified flour, salt
and edible oil (Policy level)
√ -- Promulgation
and legislation
of fortification
eventually lead
to the uptake of
nutrition
indicators
5.2 Legislation of mandatory wheat
flour fortification with iron and
folic acid by 2014 for flour
milling industry and in five
years in flour grinding industry
(chakki flour) (policy level)
√ --
Page 59
5.3 Develop supplu chain
mechanisim for micro feeders
and premix.
√ --
5.35.4 Start enforcement of
mandatory legislation after one
year of enactment.
√ --
5.45.5 Develop mechanism for pass
through of fortification cost to
consumer.
√ --
5.55.6 Establish market based,
sustainable, suppy chain
mechanism for premix and
microfeeders for flour millers.
√
5.7 Legislation on mandatory
universal salt iodization by
December 2016 4 (policy level)
5.6 (legislation target is 2014, implementation target is 2016)
√ --
5.75.8 Devise robust
implementation strategy to
ensure Vitamin A and Vitamin
D fortification in ghee and
oil(Implementation level)
-- √
3.5 SOCIAL PROTECTION 3.5.1 Overview of the sector
Social Welfare initiatives of the Punjab Government provide social welfare, protection and development
that may lead to improvement in quality of life. The base of “Social Welfare” in Pakistan is “Adl-o-Ehsan
and Haqooq-ul-ibad” that according to Islamic law stand affluent society and the state responsible for
the welfare of the people. Similarly, the constitution of Pakistan enforces the state to ablate misery and
sufferings of citizen living in the state irrespective of caste, gender, creed or race. The Secretary to
Department of Social Welfare & BAIT-UL-MAAL oversees all matters. BAIT-UL-MAAL committees have
Formatted: Font: Not Bold, Not Italic
Formatted: Indent: Left: 0.07", Space After: 0 pt, Linespacing: single, No bullets or numbering
Page 60
been established at the district level to assist the council in the distribution of funds to vulnerable and
needy families. To keep fairness in this sector, Punjab Social Service Board (Governor Punjab is the
president of the board) was established in 1970 to enhance efficiency and departmental coordination
within welfare/voluntary organizations (NGOs) in the private sector. The board provides financial and
technical assistance to the Voluntary Social Welfare Agencies (Registration & Control) ordinance, 1961.
Social Welfare & BAIT-UL-MAAL is chaired by “Deputy Director” at divisional level who controls and
monitors ongoing Social Welfare Programmes in the public and private sector. Each Deputy Director is
further assisted by Assistant Directors at District level and social welfare officers who are in control of
Projects at Tehsil/sub-Tehsil level. Social protraction has tremendous role in provision of financial
support for Health. Social Health Insurance provides shelter to insured people who cannot pay high
treatment costs during sickness. The concept has also been adapted to newly industrialized and
developing countries.
Social Protection Sector has key component departments including federal & provincial departments;
Social Welfare, Bait-ul-Maal, Zakat, Women Development & Benazir Income Support Programme.
Some of the functions being performed by this sector, which reflect the objectives of its component
departments
Promote sustainable socio economic development
Voluntary participation in community development programs for socio economic development
Reviews and propose amendments in the existing laws
Training & rehabilitation services for economically and socially oppressed and vulnerable groups
Training and rehabilitation of the disabled persons
Mass education, motivation and advocacy campaigns and NGO development for poor community
Social and economic welfare of women
Coordination of women development effort and gender mainstreaming
Implementation of National Plan of Action through cash transfers and women development
Implementation of U.N. Conventions ratified by Government of Pakistan
Provision of social & monitory assistance programs for poor, disabled, widows, orphans, the
indignant, the destitute and the sick
Page 61
Provision of professional, medical and financial assistance to patients and addicts and their
families through professional social workers, hospitals, Health Welfare Committees (Zakat),
Patients Welfare Societies (NGOs) and District BAIT-UL-MAAL Committees
Welfare and poverty alleviation of poor segments of the society
Although all the departments included in social protection sector are working, may be in different ways,
to provide social & financial protection to the poor segment of Pakistan but still reach only to small
proportion of the >50 million poor. Furthermore, the protection being provided, although very
important, seems to be insignificant to cope with the miseries of the poor. In addition to this, persistent
high inflation rate, price hikes, escalating population, and growing number of people under the poverty
lines are serious threat to the success the programmes of the social welfare & protection sector. The
support programmes, initiated in recent past like BISP or proposed to be initiated in near future like
Khidmat Card are right steps to reduce some of the miseries of the deprived segment of our population.
However, such activities need to be targeted for improving food security of the households and should
be linked with attainment of certain free services, like education, vaccination etc.
3.5.2 Potential role in nutrition improvement, engagement and role within the
multisectoral framework
One reason for importance of social protection department is that it tackles poverty and vulnerability
directly, so its impacts can be immediate and very effective in order to prevent malnutrition. The causal
framework of malnutrition clearly indicates the poverty as one of the significant underlying
determinants.
Social protection covers a wide range of instruments and objectives, covering both safety nets and so-
called ‘safety ropes’ (i.e., instruments that can enhance income generation and opportunities for the
poor and vulnerable). These can be seen in below figure
Social Protection at a Glance
Risk management
Crop and livestock insurance
Index-based weather insurance
Grain reserves/Precautionary
savings
Contributory social insurance
Income diversification
Page 62
Destitution
Poverty Traps
Figure 3.9: Social Protection at a glance Source: adapted from de Janvry (pers. comm.)
3.5.3 Food Insecurity and Vulnerability
Food insecurity refers to both the inability to secure an adequate diet at present (i.e. hunger) and the
risk of being unable to do so in the future. People who are already poor & have less to pay for health
services are vulnerable to hunger and malnutrition because they lack the resources to meet their basic
needs on a daily basis (they face chronic food insecurity). They are also highly vulnerable to even small
shocks that will push them closer to destitution, starvation, even premature mortality. Timely and
appropriate social protection in response to poverty-related food insecurity is closely linked to address
malnutrition. People who are not poor, but now face the risk of future poverty are vulnerable to hunger
Income Gain
Safety ropes
Risk reduction
Food
pricestabilization
National grain
reserves
Trade policies
Inco
me,
Con
sum
pti
on
Poverty Line
Income generation
Asset creation
Human capital
formation
Employment
opportunities
Access to land
Input subsidies
Social assistance
Cash transfers
Food subsidies
School feeding
Supplementary feeding
Access to services ( SHI)
Scalable safety nets
Right to food approach
Twin-track approach
Conditional cash transfers
Productive safety nets
Public works programmes
Page 63
if these risks materialize and they are inadequately protected. Vulnerability to food insecurity operates
at several levels – national, household and individual – and social protection responses are extremely
desired to play its role at each level. Current situation of food insecurity and vulnerability in province
highlights the less focused social protection.
A classification of food insecurity can be better understood from the Amartya Sen’s’entitlement
approach’, originally conceived as a tool for analyzing famines. This approach identifies four food
sources, that include production (what one grows), labor (what one works for), trade (what one buys),
and transfers (what one is given). And then this approach defines food insecurity as “when the sum of all
food derived from these four sources is inadequate to meet minimum consumption needs at the
individual, household or national level”.
The below table explains the role of the social sector in addressing different sources of insecurity.
3.5.4 Women Empowerment
Social protection efforts to generate employment and income and to protect households against the
manifestations of poverty and against household shocks (e.g. Serious illness and hospitalization), can be
particularly useful for addressing malnutrition, especially if interventions are targeted to women.
Studies have shown that additional income tends to be spent on food and on family health when
women are the recipients of the cash transfers, and that this increased spending, if the transfer is large
enough, and thus it can ultimately lead to a reduction in levels of malnutrition within the household.
The Pakistan Government’s Benazir Income Support Program (BISP) is an unconditional cash transfer
program that delivers Rs. 1,000 (US$11) to female beneficiaries in households with a monthly income
below Rs. 6,000. In 2010, about 7% of the country’s population was benefiting from the transfers. The
BISP also includes microcredit financial assistance, and is pilot testing, health and life insurance coverage
and vocational skills training in different parts of the country.
Page 64
Figure 3.10: Food entitlement gaps & social protection instruments
3.5.5 Overall sectoral objectives
To alleviate the misery of poor people, especially targeting food insecure with severe to
moderate hunger, by protecting their health and providing cash benefits through various
initiatives (Zakat, Charity, BISP etc.)
3.5.6 Intervention Framework
3.5.6.1 Strategy 1: Strengthen social protection sector to scale-up nutrition-sensitive
interventions
Social protection sector is executing various responsibilities such as provision of income (cash)
or consumption (food), protection against livelihood risks, enhancement of the social status to
the socially excluded, marginalized and vulnerable community. Household food security
develops the perspective that leads to individuals access to adequate food as established in
international human rights law. The right to adequate food is realized when every man, woman
and child, alone or in community with others, has physical and economic access at all times to
adequate food or means for its procurement. The right to adequate food shall therefore not be
interpreted in a narrow or restrictive sense that equates it with a minimum package of calories,
proteins and other specific nutrients. The social protection sector has responsibilities to
perform such actions that may be beneficial for the scaling-up of nutrition-sensitive
input subsidies
crop & Livestock insurance
Production
public works program
LabourFood price stabilization
food subsidies
grain reserves
Trade
school feeding
conditional cash transfers
unconnditional cash transfers
Transfer
Page 65
interventions and adequate access to food throughout the life-cycle. The best delivery of
services by social protection sector can be achieved only by strengthening the sector.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention
Impact on
nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
Formulation and
implementation of
nutrition & gender
sensitive policies
and strategies of
social protection
sector
1.1 Establishment of Social
protection authority (Policy
level)
√ --
Scaling-up social
protection
sector will be
helpful in
economic
access as well as
various
nutrition-
sensitive
interventions
that ultimately
will help to
improve
nutrition
indicators
1.2 Prioritize the preparing the
existing policies/legislation of
Social Protection sectoral
more nutrition-responsive and
its effective implementation
(Policy level)
√ --
1.3 Develop nutrition specific
legislations about Zakat, Bait-
ul-Mall, and PVTC (policy
level)
√ --
1.4 Increase coordination
between federation and
federating units on nutrition-
sensitive social protection
(Policy level)
√ --
To create enabling
environment for
1.5 Develop and strengthen
linkage with LHWs, SH&NS, √ -- These strategic
actions will
Page 66
mainstreaming
nutrition in sector &
improving multi-
Sectoral
coordination by
year 2015
teachers, local NGOs for
promoting social aspects of
addressing malnutrition
(Develop a mechanism of coordination
to effectively implement strategies)
(Implementation level)
improve the
coordinated
implementation
for multi-
sectoral
integrated
nutrition
strategy
through various
nutrition-
sensitive
interventions
that ultimately
will help to
improve
nutrition
indicators
1.6 Initiate screening through
School Health and Nutrition
Supervisors, response in
coordination with health
department to integrate
nutrition intervention with
women and children focused
approach (Implementation
level)
√ --
1.7 Mapping of districts through
impartial surveys, and
utilization of this data to
strengthen nutrition
interventions of social welfare
department (BISP data can be
used at this time)
(Implementation level)
√ --
1.8 Create linkages of livestock
department with BISPs
program “Wasela-e-Rozgar”
and upcoming new social
protection schemes to
support for ultra-poor
segment of the society by up-
scaling home based livestock
& Agriculture through
backyard poultry farming &
kitchen gardening
(Implementation level)
√ --
1.9 Advocacy with BISP for linking
BISP beneficiaries with √ --
Page 67
“Kitchen gardening Scheme”
(Implementation level)
3.5.6.2 Strategy 2: Improving the economic access to address nutritional needs through
poverty alleviation and social protection
The access to safe and nutritious food is among basic human right. Currently, 963 million people are
malnourished and living in dire poverty across the world attributable to lack in economic access.
Nutrient deficiencies and insufficient economic access ultimately directs to unhealthy life of children and
burden on GDP. Food security through enhancing purchasing capacity (economic access) is definitely an
enormous challenge and it requires an integrated approach with the dedicated involvement of the
Governmental and civil society including NGOs, CBOs and development partners. Punjab although
produce three quarters of the food and feeds the other provinces as well yet food security in Punjab
(60%) is higher than national average (58%) of the country. It means the producers (poor farmers)
themselves have not access to the adequate food, and the compromised economic access to the food is
by far the most critical factor. Therefore, the NNS, 2011 data itself makes the case for improving the
economic access to food. The exercise should be targeted for comprehensive nutrition services to all of
the population especially targeting and prioritizing the first 1000+ days, preschoolers, kids in elementary
schools and adolescent female.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
By 2015, introduce
cash transfer
system for
improving the
economic access to
adequate food to
meet minimum
nutritional needs
2.1 Link the cash transfer via
vouchers and assistance from
BISP with evident based
nutrition need (Implementation
level)
√ --
Economic
access to
health/ food
will ultimately
lead to an
improvement in
nutrition
indicators 2.2 Cash transfer amounts should be
linked to provincial food price √ --
Page 68
indices so that real value remains
constant throughout the year
(Policy level)
2.3 Conduct research intervention to
assess the impact on improving
nutrition through cash transfer
scheme (BISP data could be
used), and implement impartial
program monitoring with third
party validation (Policy level)
√ --
By 2015, introduce
conditional cash
transfer (CCT)
policies with the
intention of
targeted approach
2.4 Introduce conditional cash
transfer (CCT) and make BISP or
any other such program
conditional for beneficiaries to
enroll their daughters in schools
(Policy level)
√ --
Economic
access to
health/ food
will ultimately
lead to an
improvement in
nutrition
indicators 2.5 Piloting of a conditional cash
transfer program using
vouchers and linked to the
utilization of health and nutrition
services by target population
groups, while being particularly
attentive to supply side
constraints which may be
encountered by these groups
(Policy level)
√ --
2.6 Targeted and conditional food
subsidies for poor instead of
generic subsidies and will be
linked with inflation rate by 2014
(Policy level)
√ --
3.5.6.3 Strategy 3: Promote nutrition awareness for healthy & safe dietary practices
Awareness regarding healthy & safe dietary practices can play a tremendous role in eradication of
malnutrition. Various recent reports revealed a significant inverse association between awareness and
Page 69
nutritional deficiency indicators. Hunger and malnutrition affects huge segment of the population in
countries where education level is low. In relation to the manifestation of nutrition-related information-
seeking behaviors during whole life, the poor can be targeted to be exposed to nutrition information
from a variety of sources, including the family doctor. In many countries, variety of nutrition education
interventions and social marketing initiatives are being used by the Food Stamp Program to improve
food resource management, food safety, dietary quality, and food security for low-income households.
The policy should link comprehensive sequential nutrition education, access to nutritious meal,
promotion of child nutrition programs to reinforce positive health outcomes for all children in socially &
economically excluded population. Pregnancy-specific nutrition information for married couples
especially in poor (in Dar-ul-Amaans, PVT Centers, Sanat Zaars, Zakat councils) is equally important
because it is one of the few things that they can apply in their daily lives to protect the health of the
fetus.
INTERVENTION MATRIX
Strategy
Objective Strategy Action(s)
Nature of Intervention Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
To use Social
Protection
Sector platform
for promoting
nutrition
awareness for
healthy & safe
dietary
practices in
poorest
community of
Punjab
1.1 Seminars/ targeted
inclusion of nutrition
module in Sanat-Zars (1 day
- 1 week nutrition specific
trainings) (Implementation
level)
√ --
Access to
educational
materials and
awareness about
dietary practices
(especially
among females)
will ultimately
lead to uptake of
nutrition
indicators
1.2 Seminars/ targeted
inclusion of nutrition
module / workshops in
PVTC (1 week-15 days
nutrition module to Zakat
families)
(Implementation level)
√ --
Page 70
1.3 Seminars/ workshops in
Rescue homes (Darul-Aman)
(Implementation level)
√ --
1.4 Enhance nutrition
awareness through
distributing IEC material
poorest 2,50,000 zakat
families of Punjab using
zakat committees (25,000)
(Implementation level)
√ --
3.6 AGRICULTURE
3.6.1 Crop Sector
3.6.1.1 Overview of the sector
The economy of Punjab, Pakistan is one that is largely based on agriculture and industry. Punjab is the
largest province of Pakistan in terms of population, and also has the largest and fastest growing
economy in the country compared to other provinces and administrative units.
Agriculture is backbone of Pakistan's economy. It accounts for 21% of the GDP and with addition to
agro-based products, it almost fetches 80% of the country’s total export earnings. More than 45% of the
labour force is engaged in this sector.
The Province of Punjab covers 29% of the total reported, 57% of the total cultivated and 69% of the total
cropped area of Pakistan. And this way Punjab contributes a major share in the agricultural economy of
the country by providing about 83% of cotton, 80% of wheat, 97% fine aromatic rice, 63% of sugarcane
and 51% of maize to the national food production. Among fruits, mango accounts for 66%, citrus more
than 95%, guava 82% and dates 34% of total national production of these fruits18.
During 2012-13, agriculture sector exhibited a growth of 3.3 percent against growth of 3.5% of last
year19, on the back of positive growth in agriculture related sub sectors, Crops grew at 3.2 percent,
Livestock 3.7 percent, Forestry 0.1 percent and Fishing 0.7 percent. The agriculture subsector
component which includes important crops, other crops, grew by 2.3 percent and 6.7 percent,
respectively except cotton ginning that declined 2.9 percent. Important crops accounted for 25.2
18 Economic survey of Pakistan 2013 19 Economic survey of Pakistan 2013
Page 71
percent of agricultural value added and has experienced a growth of 2.3 percent in fiscal year 2012-13
against growth of 7.4 percent in 2011-12.
The per capita food intake has increased from 2410 calories daily in 2011-12 to 2450 calories in 2012-13.
The per capita protein availability has also increased from 71.5grams per day in 2011-12 to 72.5 grams in
2012-13.
3.6.1.1.1 Live Stock & Diary Development
Livestock is an important sub sector of agriculture, which accounts for 55.44 percent of agriculture value
addition. Its share in GDP is 11.9 percent. This sub-sector is highly labor intensive. It has also emerged as
a major source of income for the small farmers as well as the landless rural poor. Livestock has recorded
a growth of 3.7 percent against the growth of 3.9 percent last year.
Livestock plays an important role in poverty reduction in the rural areas of Punjab, actively involves the
participation of women, and has been identified as a priority investment area by the provincial
government.
3.6.1.1.2 The Fisheries
The fisheries sub sector of agriculture, having 2.05 percent share in agriculture recorded a growth of 0.7
percent against the growth of 3.8 percent last year. The development of the fishery sector also will have
an impact on poverty reduction and the availability of nutritious food.
3.6.1.2 Contribution in GDP, Poverty Alleviation, Women empowerment- Workforce
Agriculture share towards national income shows steady decline in previous years, currently it accounts
for just over a fifth of the GDP, and still it continues to employ 45% of the total work force.
Year Agriculture in GDP % Labour force in Agriculture %
1995-1996 26.1% 46.8%
1999-2000 25.9% 48.4%
2003-2004 22.9% 43.7%
2007-2008 21.3% 44.7%
2010-2011 21.2% 44.9%
Source: Economic Survey of Pakistan
A comparison of overall economic growth rate with the rate of growth in agriculture shows that
agriculture has grown slowly compared with the GDP. Agricultural growth rates declined in all periods
since the 1980s except for the last five years which witnessed a minor improvement over the previous
Page 72
half decade. The gap between agricultural and GDP growth rates was particularly high between 2000
and 2005 which was a period of relatively high GDP growth – agriculture recorded its lowest growth in
the said period.
3.6.1.3 Potential role in nutrition improvement
Agriculture department is critically important in alleviating all forms of malnutrition due to their impact
on diversity of output, impact on food prices (levels, relative prices, fluctuations, and spatial variation)
and levels of incomes. The food and agriculture sector therefore has a major role to play towards
improvement of nutritional status of the province. NNS shows wealth has an important link with
nutrition, but the presence of malnourished children, even in high-income groups indicates that
nutritional outcomes are more complex than a household’s economic status.
With agriculture being the source of income and livelihood for 70 to 80% of people suffering from
hunger in developing countries, it is clear that sustainable reductions in poverty, food insecurity and
under nutrition cannot be obtained without special attention to the development of the agriculture
sector in these countries. Focusing on the distinctive relationship between agriculture, food and
nutrition, Govt. needs to focus, to protect, promote and improve food-based systems to ensure
sustainable food and nutrition security, improve diets, combat micronutrient deficiencies, and raise
levels of nutrition, and in so doing, achieve the nutrition-related Millennium Development Goals
(MDGs).
Not only are there high levels of malnutrition and micronutrient deficiency in Punjab but there has been
a lack of improvement in nutritional outcomes in last decade. Nutritional outcomes are correlated with
income and food consumption, but also depend on a range of other factors such as health, disease and
water and sanitation conditions. The results of the latest nutrition survey, which showed no
improvement in nutrition indicators, have highlighted the urgency of making nutrition improvement an
important agenda in future social policy planning in Pakistan & Punjab.
3.6.1.2.1 Casual Pathway of Malnutrition and the Agriculture Sector
It is important to understand the casual pathway of malnutrition in order to identify its linkages with
different sectors. As shown in figure malnutrition is lined with house hold food insecurity and this way
Agriculture sector can play an important role.
Page 73
3.6.1.3 Food Security Resources
Food security is one of the contributors of under nutrition; however, addressing food security alone, as
seen from the experience of many countries, is not enough to improve under nutrition. The Rome
Declaration on World Food Security in 1996 defined “food security as a situation where all people at all
times, have physical and economic access to sufficient, safe and nutritious foods to meet their dietary
needs in accordance with their food preferences for an active and healthy life”. Overall, 58% of Pakistan
is food-insecure; with Punjab has 60% food insecurity – despite being labeled as the food basket of
Pakistan.
Figure 3.11: Food Security Situation -Punjab20
Food security in Pakistan is inter-dependent on local food production, the extent to which local farmers
own the land and the produce grown, food inflation, and consumption of food by women and children.
Agriculture, although a key sector of the national economy (one-fifth of the net GDP), has been
experiencing stagnation. Punjab is the main food-producing province; however, surplus food-producing
districts in Punjab have decreased from 21 to 14. (SDPI, 2009). More importantly, in Punjab where
20 NNS 2011
40.5
32.2
18.5
8.8
Food Security in Punjab
Food Secure
Food Insecure Without Hunger
Food Insecure With HungerModerate
Food Insecure With HungerSevere
Page 74
agriculture is vibrant, its benefits are not being translated into nutrition unless emphasis is given to
what is grown and its capture by the local population. Emphasis within agriculture in all provinces
remains on cash crops, which have higher income gains than kitchen farming. Although kitchen farming
has lower income gains, it directly benefits food-insecure households. Agriculture policies have tended
to be dominated by economists with agriculture interpreted in terms of economic growth and GDP
contribution rather than adoption of a development vision focusing on equitable distribution of
benefits. This has resulted in cash crop policies and the state focusing on wheat rather than crop
diversification and political, economic, and technical support is required to small farmers for land
cultivation and crop diversification.
Power structures are of critical importance in terms of who owns the farming land and in deciding what
is grown and the capture by the local households. There is highly inequitable ownership of land, with
only 44 per cent of the rural population in Pakistan owning land and the majority being landless,
dependent for work, food, and shelter on large landholders, and often trapped into cycles of debt and
poverty. With predominance of large landholdings, there tends to be cultivation of economically
productive cash crops of direct cash benefit to landholders rather than kitchen gardening and small
livestock of nutritional benefit to the local populace. Moreover, the Haari’s working at the farms have
no rights over the food grown, leading to little capture of agriculture into food consumption. Poverty
is highest in populations lacking land ownership and drops by at least ten percentage points with
ownership of land.21
Whilst Punjab has the lowest absolute figure of landlessness, there are high pockets in Southern Punjab.
Food security has also been affected by steep inflation during 2008–2012, and worst of its nature in
2013, affecting even essential food commodities.The amount spent on food is 53.86 per cent of
income22, which is comparatively much higher than 30 per cent spending on food in India23 and 10 per
cent in the developed economy of the USA24. Nationally, the poorest households spend around 58.75
per cent of their income on food, compared to 39.5 per cent, showing regressive impact of inflation.
21 PIDE 2001
22 SPDC 2004
23 Banerjee &Duflo 2007
24 USDA 2005
Page 75
With stretched food budgets, the poor are unable to absorb the effects of increases, leading to a diet
with less nutritious foods or foregoing of meals.
Table 3.2: Food security resources and poverty in Pakistani provinces, 2009 – 2011
Food Security or Poverty Status
Sindh Punjab KPK Baluchistan Pakistan
Agriculturally
productive land² 27.3 83.0 16.5 3.0 30.0
Poverty incidence³ 31.0 26.0 29.0 48.0 33.0
Rural areas 38 24 27 51 35
Small towns 40 43 41 44 30
Poverty incidence ³
- No land ownership
- Land ownership
41.3
20.9
26.0
12.3
32.0
19.5
52.5
42.6
31.8
17.9
It indicates that poverty is less as compared to other provinces and better than national average.
Nevertheless the poverty is more in small town as compared to rural area. This area needs more
nutrition specific and sensitive interventions.
3.6.1.3.1 Food Diversity and caloric Intake situation
Studies and survey shows close linkage between caloric intake& food diversity with stunting and under
nutrition. Presence of malnourished children and women in food secure house hold clearly indicates
poor eating practices and lack of awareness regarding importance of food diversity and required caloric
intake.
MICS 2011 revealed Punjab situation showing highest stunting in southern districts of Punjab, Khanewal,
R.Y.Khan, Bahawalpur, and Bahawalnagar, Muzaffargarh & Rajanpur, the crop harvesting data from
same districts clears the picture by showing that most of these districts show increased production of
cash crops rather nutritious/or food crops during the previous years
Page 76
3.6.1.4 Overall sectoral objectives
To improve Access of the most disadvantaged population to Nutritious foods
3.6.1.4.1 Nutrition specific objectives
Mainstreaming nutrition in agriculture
Enhance productivity of grains and pulses
Address malnutrition through bio fortification
Promote kitchen gardening at household level (Equitable access to vegetables and fruits)
Create awareness on importance of food diversification and healthy dietary practices
To prioritize development of zinc rich wheat variety
Empowering Women labor involved in Agriculture sector
3.6.1.5 Intervention framework
3.6.1.5.1 Strategy 1: Mainstreaming Nutrition in Agriculture
Punjab Government is contemplating to develop its Agricultural policy on the wake of devolution;
hence, there is an opportunity to make it more inter-sectoral, nutrition sensitive, gender sensitive and
pro-poor. The policy should focus on open the doors for small farmers to have access to latest
machinery on installment and subsidized cost. Agriculture and food security is a vital component of
Government planning documents and strategy papers i.e. “Vision 2030”, the Medium-Term
Development Framework 2005-2010, and the Poverty Reduction Strategy Paper II (PRSP-II).
The nutrition may be mainstreamed in Agriculture Sector by captivating given policy decisions.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
Nutrition
Nu
trit
ion
sen
siti
ve
Nu
trit
ion
spec
ific
To develop Policy
frame work to
create enabling
environment for
mainstreaming
1.1 Develop and promulgate
Provincial Nutrition sensitive
Agriculture Policy
√ -- Access to food
throughout the
year will
improve the
food security 1.2 Policy decision to add nutrition
in IEC material of the √ --
Page 77
Nutrition in Sector
& improving
multi-Sectoral
coordination by
year 2015
agriculture sector situation and
ultimately
reduce the
malnutrition
burden
1.3 Develop Gender Sensitive and
pro poor Provincial Food
Security Strategy
√ --
1.4 Advocacy with BISP for linking
BISP beneficiaries with “Kitchen
gardening Scheme”
√ --
1.5 Policy to encourage increasing
of female agriculture extension
officer and field assistant
√ --
1.6 Enforcement of strict regulatory
measures to control the sale of
uncertified seeds, harmful
pesticides and medicine with
adverse effect on human health
√ --
It may have
effect on food
security at
household level
and may lead to
improve in food
consumption 1.7 Shifting from traditional
agriculture to value added
Agriculture and promotion of
semi-urban/ house hold
agriculture / kitchen gardening
through provision of quality
seed on subsidized rate and
technical support at the
doorstep
√ --
To build capacity
of implementing
staff at district and
UC level on
nutrition manual
by 2016
1.8 Conduct training of district and
UC level staff √ --
It may have
impact on the
life of women
working in
agriculture
sector, More
than 45%
women force is
engaged here,
change in
behavior of
child care giver
has directly
1.9 Conduct training of farmers √ --
1.10 Create awareness
among farmers on use of
nutritious food, healthy dietary
habits, hygiene and health √ --
Page 78
effect on Child
Nutrition.
3.6.1.5.2 Strategy 2: Increase Productivity in nutritious food (by developing and promoting high
yielding varieties of grains & pulses)
Background/Rationale:
The objectives of Agriculture Sector are to provide food security to the community targeting especially
poor and vulnerable, women, and children. The availability of pulses particularly lentil, the moon and
mash is low as compared to the consumption at National & Provincial level and prices of pulses are also
high and are becoming out of reach of the segment of the community that needs to buy pulses as
alternate expensive source of protein, i.e. meat and fish. The focus will be to promote cultivation of
pulses to make the country and province self-sufficient in the production of affordable sources of these
nutrient rich commodities.
Pulses (Lentil, Gram, Moong and Mash) are a rich source of protein obtained from plants (Bio source).
They are sown on about five percent of the country’s total cultivated area. The area and production
under these pulses in 2012-13 in Pakistan was around 2.89 million acres and 0.863 million tons
respectively. This production has been declining over the years in all provinces including Punjab.
The National Level area, production, and consumption of pulses i.e. Moong, Mash, Gram & Lentil during
2011-12 & 2012-13 is as under:
Table 3.3: Area & Production of Pulses 2011-2012 and 2012-201325
25 Agriculture department Punjab PC1
Page 79
Punjab 2011-12 2012-13
Area
(000 ha)
Production
(000 tons)
Area
(000 ha)
Production
(000 tons)
Mung 119.6 80.7 116.8 78.5
Mash 19.5 6.4 17.9 6.1
Gram 920.1 224.7 908.1 691
Lentil (Masoor) 12.7 5.1 12.4 5.4
Reasons of declining trend of area and production of Pulses
i. Reduction in cultivated area of Moong, Mash and Lentil is ascribed to crop substitution by
Cotton and other cash crops.
ii. The reason of intermittent production figures are attributed to moisture and adversaries of
frost during Gram growth period.
Table 3.4: National Production, consumption & gap of major pulses 2012-201326
Crop
Production (Tons) Consumption (Tons) Gap (Tons)
Punjab National Punjab National Punjab National
Moong 78000 90000 65900 110000 12100 -20000
Mash 6050 10900 29990 50000 -23943 -39100
Lentil 5420 10800 33060 55000 -27640 -44200
Gram 691000 751000 414000 600000 277000 151000
The above table shows that there is a big gap between production and consumption. There is a dire
need to take new initiatives for enhancement of production.
26 Agriculture department Punjab PC1
Page 80
The below given strategic actions may be taken to increase the production of high yield variety of
pulses.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
To develop,
promote and
increase the
production of high
yield varieties of
pulses
2.1 Development of pre-
basic/basic seed of high
yielding varieties of pulses
√ -- Will be help full
to address the
protein energy
malnutrition as
well as increase
the food security
2.2 Promotion of certified seed by
distribution among farmers at
subsidized prices and
demonstration of modern
production technology and
farmer gatherings
√ --
2.3 Capacity building and training
of farmers √ --
2.4 Distribution of Seed to
Farmers √ --
2.5 Awareness (Mass media
campaign, Farmer days,
Seminars)
√ --
2.6 Advocacy for correct
processing √ --
3.6.1.5.3 Strategy 3: Equitable access to vegetables and fruits
Background/Rationale:
Vegetables play a vital role in our diets, as these support the normal functioning of the different body
systemsby providing vitamins, minerals, fiber, essential oils and phytonutrients. While eating cooked
vegetables is healthy, in certain instances it is advantageous to eat raw vegetables. This is because
cooking process destroys essential nutrients such as vitamin C and also kills vital enzymes that help
Page 81
human body to digest such foods. Therefore, the medical researchers and nutritionists insist on
increasing the share of vegetable intake in daily diet. However, per capita consumption of vegetables in
Pakistan is very low i.e. 46kg/annum against the minimum requirement of 73 kg/annum. Quite recently,
the increased trend in production of high quality vegetables has been realized. There is a need to boost
the vegetable production to extend its availability by providing latest technology for vegetable crops.
Vegetable seed production is also an important concern as Pakistan is importing major portion of the
vegetable seeds.
It is proposed to enhance vegetable production in urban, semi urban & rural areas through
diversification of high value vegetable crops in the province. It is a fact that this sub-sector has not been
given due importance in the past, as a result of which we could not exploit it’s potential to cope with the
growing demand (quantity and quality) of vegetables in the domestic as well as international markets.
The increased cultivation/production of vegetables would not only meet the increasing demand of the
population of Punjab province on one hand and fetch its share in addressing malnutrition.
The production of vegetables i.e. tomato, onion, chilies , and garlic is low due to sowing of traditional ,
low yielding varieties, use of poor quality seed, inadequate use of hybrid seeds, weed infestation,
imbalance use of fertilizer, improper management of insect / pest & diseases, post-harvest losses and
inefficient marketing system. Therefore, production of vegetables, especially tomato, onion, garlic,
potato and chilies is not coping with the domestic demand of the increasing population and also has
declining trend which resultantly inflating the prices of these commodities for the consumers.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
To Develop,
promote and
increase
production of
vegetables
(Vitamins and
3.1 Development &Provision of
Good Quality Seed and
Seedlings
√ --
Will be help full to
fill the gap of
micronutrient as
well as energy
nutritional
insecurity 3.2 Promotion of certified seed by √ --
Page 82
mineral sources) distribution among farmers at
subsidized prices and
demonstration of modern
production technology and
farmer gatherings
3.3 Capacity building and training
of farmers √ --
3.4 Distribution of Seed to
Farmers √ --
3.5 Awareness (Mass media
campaign, Farmer days,
Seminars)
√ --
3.6 Advocacy for correct
processing √ --
3.7 Promotion of quality
certification as per
international standards
√
3.6.1.5.4 Strategy 4: Addressing Malnutrition through bio-fortification
Background/Rationale: Zinc is one of the essential trace elements and, as such, a member of one of the
major subgroups of the micronutrients that have attained such prominence in human nutrition and
health. Two billion people worldwide are not getting enough zinc through their diets. Zinc deficiency is a
major health problem in developing countries, especially among young children. Zinc deficiency
weakens their immune system and leaves them vulnerable to conditions such as diarrhea, pneumonia
and malaria. Zinc deficiency is also accountable for impairing physical and intellectual development,
preventing children from reaching their full potential. UNICEF estimates that diarrhea accounts for
nearly two million deaths in children every year. Diarrhea is preventable and treatable, but in developing
countries, only 35% of children with diarrhea receive the recommended treatment of oral rehydration
salts and zinc supplements. NNS 2011 reveal 39.2% zinc deficiency in Pakistan zinc deficiency at 38.4% in
Punjab.
Page 83
INTERVENTION MATRIX
Strategy
Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
To develop zinc
fortified wheat
variety to reduce
zinc deficiency
4.1 Development &Production
of zinc enrich wheat seed √ --
Will be help full to
fill the gap of
micronutrient.
4.2 Promotion of certified seed
by distribution among
farmers at subsidized prices
and demonstration of
modern production
technology and farmer
gatherings
√ --
4.3 Capacity building and
training of farmers √ --
4.4 Distribution of Seed to
Farmers √ --
4.5 Awareness (Mass media
campaign, Farmer days,
Seminars)
√ --
3.6.1.5.5 Strategy 5: Scaling up of Kitchen gardening
Background/Rationale:
Kitchen gardening is a globally proven cost effective strategy to increase accessibility of vegetables and
fruits. The agriculture department launched kitchen gardening project in 2011. Although, the project
gained limited popularity among the dwellers of urban, semi urban and rural areas due to unavailability
of good quality seed and compromised capacity. Kitchen gardening program in Punjab needs to be
converted into movement by involving all stakeholders working and concerned with vegetable business
Page 84
to produce healthy and nutritious vegetables at big lawns, houses, abandoned places, containers,
fences, trellis. Scalability of seed provision for kitchen gardening project with immediate increase in
number of seed packets from 100,000 to 450,000 per year along with increasing the seed types and
quality of seed in packets.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition N
utr
itio
n
Sen
siti
ve
Nu
trit
ion
Spec
ific
To Increase
availability of
micronutrient rich
food especially for
poor and
vulnerable
community
5.1 Promotion of kitchen
gardening √ --
Will be help full
to fill the gap of
micronutrient.
5.2 Provision of quality seed at
subsidized rates √ --
5.3 Hands on training of
households on kitchen
gardening
√ --
5.4 Development and promotion
of micronutrient rich varities
of seeds for farmers
√
5.5 Mainstreaming the research
for bio fortified foods with
micronutrients
√
5.6 Capacity building of farmers
on bio fortification techniques √
3.6.1.5.6 Strategy 6: Increase accessibility of animal protein sources at household level
Background/Rationale:
It is evident that at present poor segment of the society as neither access nor have the capacity to
access protein rich animal foods. The home based poultry and raring of livestock is the way to increase
access of poor segment to nutritious food. The livestock department may create linkages with BISPs
Page 85
program “Wasela-e-Rozgar” and upcoming new social protection schemes to support for ultra-poor
segment of the society by up-scaling home based livestock and backyard kitchen farming. This will help
the poor to have access the more sources of protein and enhance household income.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
Up-scale
household
livestock
production to
increase the
access to protein
rich foods
6.1 Promote backyard poultry
farming by provision of
subsidized layer chicken with
cock to eligible families
(women)
√ --
Increase in access
of protein
sources/
consumption
protein and
enhance 6.2 Provision of small cattle of
excellence genetic profile on
subsidized rate for raring and
future reproductive growth
√ --
6.3 Livestock department will
provide free of services,
technical support, vaccination,
and veterinary medical
services
√ --
3.6.2 LIVESTOCK AND DAIRY SECTOR
3.6.2.1 Overview of the Sector
Livestock & Dairy Development Department was established in 1973 in Punjab. Livestock and Dairy
sector is continuously achieving value attributable to imperative role in national economic uplift, food
security, rural development, poverty alleviation, employment generation, and foreign exchange
earnings. Livestock & Dairy sector also play significant part in Pakistan’s economy and contributes about
11.9 percent in the GDP of Pakistan. This sector is considered a net source of invariable income for rural
and middle grade agri-business holders. Livestock sector contributed about 55.4 percent in year 2012-
13.
Page 86
Livestock works as a buffer between the small farmers economy and disaster. Small animals, particularly
sheep, goat and poultry and their products (milk, meat and eggs), are consumed by farmers themselves
that enrich their regular diets with high quality protein (with high BV) and fulfill the need of essential
amino acids. Livestock and dairy resources are similarly ubiquitous in poor communities across the
world. According to estimation, poor rural households keep two thirds of resource in the form of various
types of livestock. Similar information for poor urban households is scarce, but a recent survey found
that more than one-half of all urban households were keeping livestock; the highest rates were found in
the most densely populated, lower-income areas.
The livestock-keeping systems practiced by the poor have produced per animal or land unit well below
those in the industrialized countries. There are many reasons for this pattern of lower productivity.
Smallholder management systems are typically low or no input, letting animals forage for themselves,
feeding on plants or waste that otherwise would not be used. In many cases, relative prices of feed and
livestock products provide insufficient incentives to use purchased inputs to develop intensive
production systems (e.g., milk to feed price ratios of 1:1) The poor often keep a mix of different species,
trading off specialization for better protection against risks.
Livestock systems of the poor reflect the resource constraints that they face (e.g., financial,
access to information and services, and landlessness), as well as their varied reasons for keeping
livestock, which include the following:
Producing Food
Generating Income
Providing Manure
Producing Power
Serving as Financial Instruments
Enhancing Social Status
3.6.2.2 Livestock & Diary and Nutrition Connect
In spite of recent growth in consumption, many people have not equitable access to animal-
based foods that are believed as complete, nutrient-dense, and important for the high quality protein
and bio-available micronutrients sources, particularly for children and pregnant and lactating women.
Animal-based foods are also imperative source for improving the nutritional status of low-income
Page 87
households. Livestock products like meat, milk and eggs provide proteins with high biological value as
well as bio-available micro-nutrients such as iron, zinc, vitamin A, vitamin B12 and calcium that are
critically the base of major malnutrition ailments. International dietary guidelines on levels of energy
and protein consumption do not distinguish between plant and animal sources. They suggest that the
intake of energy needed by an adult in a day varies from 1680 to 1990 kilocalories (kcals) in total,
depending on the country. They also suggest that the safe level of protein consumption is about 58 g per
adult per day 27.
3.6.2.3 Nutrition sepecific objectives of sector:
Poverty alleviation by supporting livestock subsistence farmers & women organize, empower &
hand hold
Productivity enhancement through improved genetics, balanced nutrition & careful husbandry
Better functioning markets and regulatory regime
Private enterprise development to optimally realize potential of livestock assets
Provision of quality products (dairy & meat) for domestic consumers & export market apply
research & technology
3.6.2.4 Intervention Frame work
3.6.2.4.1 Strategy 1: Increase the productivity by sustainable livestock farming and capacity
development to combat protein energy malnutrition
Rationale/Background: Growing world population and increasing threat of protein deficiency are
strategic concerns that are encouraging more struggles to raise food production along with sustainable
livestock farming that upsurge the productivity of meat (protein) markets and secure the vulnerable
community from protein deficiency (hidden hunger). The World Bank reported that the demand of meat
would increase to 85% by 2030 (World-Bank, 2008b). Application of technology and engineering can
leads to sustainable livestock production, as well as it also can improve the conversion of feed to meat
that ultimately reduce the cereal consumption for feed, increase production of meat, decrease in price
due to availability. All outcome aspects go in the favor of an approach to reduce the consequences of
hunger (Zhou, Zhang, & Xu, 2012).
Intervention Matrix
27 WHO, FAO,UNU,2007
Page 88
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition Nutrition
Sensitive
Nutrition
Specific
To increase the gross annual meat production from 3,379,000 tons in 2013 to 5,000,000 tons as well as gross milk production from 49,512,000 tons in 2013 to 80,000,000 tons by the end of 2020 (according to Economic Survey of Pakistan)
1.1 Enhance livestock production through adaptation of latest technology (biotechnology & genetic engineering, improved reproductive technologies, precision animal breeding) and breed improvement (implementation & policy level)
√ --
Increase in meat
production will
surely increase
the access to
protein source
that ultimately
reduce the
burden of Protein
Energy
Malnutrition.
Increase in
production will
also be helpful to
improve the food
security situation
and family
income of poor
farmers.
1.2 Promote and provide various livestock animals of excellence genetic profile on subsidized rate for raring and rapid reproductive growth (implementation & policy level)
√ --
1.3 Strengthen the provision of cost effective and safe livestock (cattle & poultry) feed (implementation level)
√ --
1.4 Promote the latest embryo transfer technology and provide semen’s injections of excellence genetic profile animals at free of cost/subsidized cost (implementation & policy level)
√ --
1.5 Increase the number of dairy farms and milch animals (2-5% annually) from the existing in 2012-2013 (implementation level)
√ --
1.6 Skills enhancement of livestock sector’s individuals (staff & farmers) by conducting trainings at UC and districts level (implementation level)
Page 89
Strengthen
veterinary medical
and diagnostic lab
facilities by 2020
to control and
reduce the risk of
outbreak
1.7 Up-gradation of the existing lab
facilities for proper diagnosis &
safety testing of feeds and food
(milk & meat) in regions, where
the labs are already present but
are with limited capacity or non-
operational (implementation &
policy level)
√ --
Proper and in-
time diagnosis of
livestock animal
will ultimately
increase the
livestock
production
1.8 Establishing new livestock
diagnostic lab facilities in regions
where there is need but there are
no labs (implementation & policy
level)
√ --
1.9 Provide various services at free of
cost (technical support,
vaccination, and veterinary
medical services) to control and
reduce the risk of outbreak
(implementation & policy level)
√ --
3.6.2.4.2 Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access
to livestock-based products
Rationale/Background
Malnutrition are only social and moral problems that embarrass to our global society but also induce
considerable economic cost comprising reduced lifetime productivity, expanding poverty, slow
economic development and resource deprivation (FAO, 2012). Vulnerable community (chronically
hungry and malnourished people) required immediate assistance to rescue and polices making as well
as implementation to prevent the community from hunger and nutrient deficiency in future. However,
most of the world’s vulnerable communities facing hunger by some means rely on agriculture and
related fields like fisheries, livestock, dairy and forestry for the survival of life. Accordingly, due to this
reason upgrading agricultural and food systems are critical for the advancement of vulnerable people
encountering malnutrition. Accordingly, it can be expected that hidden huger (along with its
consequences) can be managed or prevented by applying technological and engineering applications
Page 90
principally in two fields viz. Agricultural & livestock (production of food) and food systems (food supply
chain) (Premanandh, 2011; FAO, 2012).
Intervention Matrix
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
To increase the gross annual milk consumption from 39,945,000 tons in 2013 to 80,000,000 tons as well as gross eggs consumption from 13,813 million in 2013 to 20,000 million by the end of 2020 (according to Economic Survey of Pakistan)
2.1 Increase the awareness of livestock-based protein sources (meat, milk and egg) importance and its consumption through literature, extension services, mass media campaigns and education (implementation level)
√ --
Easily access to animal based protein sources will ultimately reduce the burden of hidden hunger
2.2 Introduce and promote the value added livestock-based (meat, milk and egg) products especially at school level (implementation level)
√ --
2.3 Promote the consumption of egg and poultry meat (5% annually from existing in 2012-2013) so that poor families may also consumed protein with high biological value at very low price (implementation level)
√ --
2.4 Promote the consumption of milk and milk product (5% annually from existing in 2012-2013) to reduce the risk of various essential nutrients deficiency (implementation level)
√ --
Introduce and
promote various
livestock-based
products by non-
conventional
indigenous
resources as value
addition especially
2.5 Promote the consumption of camel milk and its product to uplift the economic situation of community in desert area and also to reduce the nutrient deficiency (implementation level)
√ --
Introduction of
non-conventional
resources will
increase the
access to protein,
uplift economic
situation, and will
ultimately reduce
2.6 Introduce various milk products (like cheese, whey protein, casein, ice cream, chocolates, bioactive peptides etc.) especially from
√ --
Page 91
in vulnerable
community to
reduce nutrient
deficiency by 2017
camel milk as value addition (implementation level)
the burden of
Protein Energy
Malnutrition. 2.7 Launch various research project and strengthen/scaling up the existing ones to develop various value added products from non-conventional indigenous resources (implementation level)
√ --
To ensure and
improve safe as
well as quality of
livestock products
from farm to fork
by 2020
2.8 Enhance the quality of the livestock-based products (meat, egg, milk etc.) by introducing the modern and safe processing techniques, and supply chain (cold storage, good transportation etc.) (implementation level)
√ --
Easily access to
safe animal based
protein sources
will ultimately
reduce the
burden of hidden
hunger 2.9 Increase availability of quality of livestock-based products (meat, egg, milk etc.) in local markets and develop the mechanism to control the increases in prices (policy level)
√ --
2.10 Mandatory Safety/Management Certification of large livestock farms in five years, medium size in 10 years, and all livestock farms in 15 years
√ --
2.11 Continuous professional development, capacity enhancement, trainings and awareness campaigns for all involved in food supply chain starting from producers to consumer desk
√ --
3.6.2.4.3 Strategy 3: Increase accessibility of animal protein sources at household level especially
for vulnerable community
Background/Rationale:
It is evident that at the present poor segment of the society as neither access nor have the capacity to
access protein rich animal foods. The home based poultry and raring of livestock is the way to increase
access of poor segment to nutritious food. The livestock department may create linkages with BISPs
program “Wasela-e-Rozgar” and upcoming new social protection schemes to support for ultra-poor
Page 92
segment of the society by up-scaling home based livestock and backyard kitchen farming. This will help
the poor to have access the more sources of protein and enhance household income.
INTERVENTION MATRIX
Strategy Objective Strategy Action(s)
Nature of
Intervention Impact on
nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
Up-scale
household
livestock
production to
increase the
access to protein
rich foods
3.1 Promote backyard poultry farming by provision of subsidized layer chicken with cock to eligible families (women) (Implementation level)
√ --
Increase in access of protein sources/ consumption of protein increases that ultimately reduce the protein energy malnutrition
3.2 Provision of small cattle of excellence genetic profile on subsidized rate for raring and future reproductive growth (Implementation level)
√ --
To create enabling
environment for
mainstreaming
Nutrition in Sector
& improving multi-
Sectoral
coordination by
year 2015
3.3 Create linkages of livestock department with BISPs program “Wasela-e-Rozgar” and upcoming new social protection schemes to support for ultra-poor segment of the society by up-scaling home based livestock and backyard kitchen farming (Implementation level)
√ --
3.6.3 FISHERIES AND AQUACULTURE SECTOR
3.6.3.1 Overview of the Sector
The fisheries sector contributes about 1% to the GDP of Pakistan. According to FAO statistics, the total
fish production in Pakistan was about 594,935 tons in 2011 out of total fish production53,000 tons
came from capture fisheries and 141,935 tons were produced from aquaculture. However, Pakistan also
exported fish to USA, Japan, Sri Lanka, Singapore, the EU and the Gulf States and the total value of
commodity trade and production for the period 2008-2009 was registered at US$ 231million (FAO
Statistics, 2014).This sector also has an opportunity of employment to a substantial segment of
population. Growing population of Pakistan (2.2 percent growth rate/year, 2002-03) with inadequate
sources of protein demands the utilization of all available resources to improve the availability and
Page 93
consumption of protein (per capita). According to FAO/WHO report, adult protein intake per day should
not below than one-gram protein/kg of body weight.
According to nutrition perspective, fish is a good source of many vital nutrients (micro- and macro-
nutrients) especially a source of protein with high biological value (BV) similar to that of land animals.
However, fish consumption in Pakistan is not much satisfactory as a meager increase in per capita fish
consumption (from 1.0 kg in 1961 to 2.3 kg/annum in 2010) was observed. On the other hand, world’s
average fish consumption increased from 9.0 kg to 16.3 kg/annum over the same period (FAO, 2005).
The statistics clarify the facts that although fish consumption is important, but trends in Pakistan is not
satisfactory. Total fish production from rivers/streams are estimated to be 3,102,408, canals, drains &
abandoned canals 346,803, Lakes127,109, Dams/ reservoirs195,670, waterlogged areas 3031600,
deltaic area 700000, flood water area 1000000, and Fish farms 60230 (DOF, GOP&WWF-Pakistan).
Table 3.5: Table Protein Quality Comparison of Fish Protein with other animal Proteins28
Sou
rce
Bio
logi
cal
Val
ue
(%)
Net
Pro
tein
Uti
lizat
ion
(%)
Dig
esti
bili
ty
(%)
Pro
tein
Effi
cien
cy
Rat
io
Pro
tein
Gai
n/1
00
gram
s
pro
tein
con
sum
ed
Fish 96.0 80.0 85.0 3.55 77.0
Beef 74.0 68.0 99.0 2.30 13 (cattle)
Chicken 74.0 71.0 85.0 - 18.0
Fisheries and Aquaculture sector have greater business potential and can exert beneficial impact on
GDPs of a country. In Pakistan, the fish fauna is rich, but only seven warm water species and two cold
water species are cultivated on a commercial scale. It is very unfortunate that recent efforts in shrimp
culture production in the Indus delta region did not succeed due to the unavailability of good quality
hatchery-produced seed. Although, freshwater carp farming is carried out on a large scale in Punjab,
Sindh and K.P.K. However, efforts are required to improve the potential of northern area of Pakistan for
trout culture. Aquaculture in Pakistan is controlled by provincial government headed by the Director
General. The office of the FDC is responsible for policy, planning and coordination with provincial
fisheries departments. Besides FDC, Pakistan Agriculture Research Council (PARC) and Asian
28 Khan (1986), Progressive Farming, Volume 6, No. 5 (Sep/Oct) 1986. Pakistan Agricultural Research Council,
Islamabad.
Page 94
Development Bank (ADB) continually assisted in strengthening the development of hatcheries and
juvenile production, model farms, transfer of technology, human resource development, as well as the
strengthening of extension services.
Table 3.6: Aquaculture practices
Place No. Hatchery Area
Punjab 88
Sindh 5 Thatta, Mirpur Sacro&Sukkar
KPK 38
Since 1998, overall fish production has decreased by nearly 2 percent per year. Although this downward
trend may be attributed mainly to the marine capture sector, inland freshwater resources of NWFP,
Northern Areas, and Baluchistan are exploited below potential, with low productivity and high poverty
levels encountered amongst inland fishing communities. Despite its endowment in natural resources,
Pakistan ranks 28th among fishing nations in terms of production, and 50th in terms of export earnings.
Addressing lack of land, seed, feed and technology for aquaculture production are necessary steps,
along with addressing post-harvest losses and improving hygiene conditions which reduce the
marketability of fish products and are one of the main constraints to export earnings. In addition to the
supply of sub-optimal quality fish products on domestic markets, consumer awareness of the benefits
linked to increased fish consumption. Finally, institutional weaknesses in and outside the fisheries
sector, and inadequate capacity of its stakeholders need to be rectified in priority to ensure that both
fisheries and aquaculture develop sustainably and in harmony with other sectors of the economy, while
receiving the support they need to do so.
Any word how that can benfit the poorest populations, or the socioeconomic profile of those that have
access to fisheries, aquaculture?
3.6.3.2 Responsibilities of sector:
Conservation
Check on fishing without license
Restriction on catching undersized fish
Protection of fish against use of explosives/ poisons
Restriction on mesh size of nets
Page 95
Reservation of fish breeding grounds
Observance of annual close season
Protection of fish against release of industrial effluents and solvents
3.6.3.3 Overall Objective of the sector:
1. Increase the contribution of fisheries and aquaculture sectors to national economic growth to
contribute to improved diets.
2. Increase the contribution of fisheries and aquaculture sectors to improve household’s food
security and nutritional status and by that contribute to alleviate poverty. Increase the
contribution of the fisheries and aquaculture sectors to better nutrition among food insecure
households
Key measurable indicators of progress towards the achievement of the three policy goals of national
economic growth, poverty alleviation and food security, will include:
Higher per capita fish consumption
Improved fishers and fish-farmers’ incomes
Creation of well-paid employment in the fisheries and aquaculture sectors
Increased export earnings from aquatic products
3.6.3.4 Intervention Matrix
3.6.3.4.1 Strategy 1: Capacity Development: Strengthening the fisheries sector to increase the
productivity by scaling up the existing resources to combat malnutrition
Background/Rationale:
Fish contributed much to the survival and health of a significant portion of the world’s population. Fish is
especially important in the developing world. In far eastern countries of Asia people derive as much as
75% of their daily protein from fish. Similarly, West African derived 30% of animal protein intake from
fish. Fish is considered as “rich food for poor people” attributable to rich source of vital nutrients such as
proteins (with high Biological Value), essential poly-unsaturated fatty acids, vitamins and minerals.
Fisheries and aquaculture sector play significant role in providing livelihood opportunities to coastal
inhabitants in developing countries. Hence, fish production can play a significant role to improve food
security situation in Pakistan. However, in recent year, production of fish declined due to a number of
factors due to less number of hatcheries, inappropriate fish feed, lack of expertise and climate change or
increasing water pollution. Production of quality seed is one of the major constraints in fisheries
Page 96
development. It is estimated that fish seed accounts for approximately 30% of production costs.
Similarly, production of poor quality seed will results in low growth/production. This ultimately
decreases the profit margin of fish farmers, sometime push poor and marginal farmers into greater
economic risk. A common practice is carp seed production, which suffers from inbreeding, inter-species
hybridization and, overall, is genetically degraded. Hence, on priority bases it is now the responsibility of
the people involves to preserve pure genetics of the breed.
Northern Areas have plenty of cold-water resources and considered fit for trout fish farming. A study
was conducted in 2004 to find out cost of trout fish farming and its profitability. Their findings revealed
that total cost (capital and variable costs) of Rs. 234 was incurred to achieve a kg trout fish and its selling
price was Rs.310. The net revenue came to Rs.76 per kg of fish (Hassan et al. 2007). Accordingly, it
demonstrated that the trout fish farming provides a great opportunity for exploiting the abundant cold-
water reservoirs in northern areas for income generation.
Intervention Matrix
Strategy Objective
Strategy Action(s)
Nature of Intervention Impact on
nutrition Nutrition Sensitive
Nutrition Specific
To increase the production of fish from 594,935 tons in 2011 to 800,000 tons by the end of 2019 (according to FAO Statistics)
1.1 Increase the number of hatcheries from 88 to 150 by the end of 2020 to ensure the availability of high quality seed (implementation level)
√ --
Increase in fish production will surely increase the access to protein source that ultimately reduce the burden of protein energy malnutrition and micronutrients deficiencies (i.e. Vitamin A, Iodine, essential fatty acids etc.) Increase in production will also be helpful to improve the food security situation.
1.2 Promote and strengthen the economical fish-feed production (implementation level)
√ --
1.3 Development and provision of seed of high yielding varieties of various fish species by some genetic modification (implementation level)
√ --
1.4 Promotion of high yielding fish-seed (lowest price of available protein) by distribution among farmers at subsidized rates and demonstration of modern production technology to reduce pre & post-harvest losses (implementation level)
√ --
1.5 Skills enhancement of fishery √ --
Page 97
sectors individuals (staff & farmers) by conducting trainings at UC and districts level (implementation level)
1.6 Increase the number of fish farms (5% annually) from the existing in 2012-2013(implementation level)
√ --
1.7 Increase the capacity of the existent fish farms (10% annually) by the end of 2020(implementation level)
√ --
1.8 Promote the trout fish farming in natural water resources to increase the trout production (5% annually from existing in 2012-2013)(implementation level)
√ --
1.9 Initiate shrimp cultivation in the Indus delta to increase the shrimp production (5% annually from existing in 2012-2013)(implementation level)
√ --
3.6.3.4.2 Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access
to aquaculture/fish food
Background/Rationale:
Food from aquatic resources has been an important component of human diet and considered as an
important food source in many parts of the world especially in Asia. It also contributes in food security
and poverty alleviation. However, in the recent years the production of marine capture fisheries has
decreased in the whole world in comparison to escalating per capita demand owing to increasing
population. Hence, the challenges of meeting future world fish supply needs and improving food
security are indeed daunting. However, the importance of future fish availability for food security and
nutrition in highly populated developing countries will be a priority.
Fish is one of the main sources of protein providing significant amount of animal meat and is a growing
food source in Asia and in other developing countries. Fish products provide an excellent source of
protein due to their amino acid composition and protein digestibility that ranges from 85-90%. Fish
protein also offers a variety of vitamins and minerals including vitamins A and D, phosphorus,
magnesium, selenium and iodine. Moreover, fish is also perceived as healthy food by consumers,
Page 98
especially in comparison with meat, the main source of animal protein. Scientific data indicated that fish
oil is a rich source of PUFA mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), so
regular fish consumption and the intake of ω-3 PUFA play an important role in the primary and
secondary prevention of blood pressure, coronary heart disease and stroke (Artham et al. 2008). Fish
consumption at 40-60 g daily with high ω-3 fatty acids lower the risk of macular degeneration, that
causes blindness, significantly reduced coronary heart disease mortality in high-risk populations
(INFOFISH, 2002).
In Pakistan, domestic consumption of fish is estimated to be 26% with 19% being exported, while 55% of
the produced going for fishmeal that indicated poor quality of fish being produced in the country. Per
capita consumption of fish in Pakistan is varied; Baluchistan consumed 6.80 kg per capita/year (1975-76)
and this figure further declined to 5.28 kg per annum (2002-03). In Sind, consumption rate was ablated
from 4.25 kg per capita/year (1975-76) to 2.98 kg per capita/year (2002-03). Although, per capita/year
fish consumption of Punjab and KPK increased from 0.12 and 0.04 kg in 1975-76 to 1.00 and 0.71 kg in
2002-03respectively, however still considered to be low.29
Table 3.7: Consumption of Fish in Various Provinces of Pakistan (KGs per capita per annum)30
Year Pakistan Punjab Sind KPK
1975-76 1.28 0.12 4.25 0.04
1980-81 1.99 0.36 4.30 0.17
1985-86 1.80 0.57 4.10 0.04
1990-91 1.70 0.74 3.71 0.74
1995-96 1.81 0.98 2.58 0.41
2000-01 1.76 1.00 2.90 0.65
2002-03 1.77 1.00 2.98 0.71
Intervention Matrix
Strategy Strategy Action(s) Nature of Impact on
29 Wasim 2007
30 Government of Pakistan (1980, 1991-92, 2002-03), Agricultural Statistics of Pakistan. Ministry of Food, Agriculture
and Livestock, Islamabad.
Page 99
Objective Intervention nutrition
Nutrition Sensitive
Nutrition Specific
To increase the per capita consumption of fish from 2 kg/year to 5 kg/year by the end of 2020 through awareness, value addition and cost effective fish products
2.1 Increase the awareness of fish meat importance and its consumption through literature, extension services, mass media campaigns and education (implementation level)
√ --
Increases in per capita consumption ultimately reduce the burden of protein energy malnutrition and other micronutrients deficiencies.
2.2 Introduction of value added fish products such as fish cookies, fish chips, fish biscuits, fish nan/chappaties, fish cakes, fish salads, fish samosa, fish biryani, and nimko, etc. (implementation level)
√ --
2.3 Promote the consumption of small size fish(5% annually from existing in 2012-2013) so that poor families may also consumed with low price (implementation level)
√ --
To ensure and improve safe as well as quality of fish from farm to fork
2.4 Enhance the quality of the fish by introducing the modern and safe processing techniques, cold storage, good transportation and improvement in marketing channel, etc. (implementation level)
√ --
Easily access to safe fish products ultimately reduce the burden of hidden hunger
2.5 Enhance the coastal aquaculture production and increase availability in local inland markets (implementation level)
√ --
3.7 EDUCATION SECTOR (PUNJAB)
3.5.1 Overview of the sector
Education Sector is the largest sector of Punjab, comprising of the School Education Department (SED),
Higher Education Department (HED), Special Education Department, Punjab Curriculum Authority (PCA),
Staff Development Department and Literacy and Non-Formal Basic Education Departments (NFBE). The
SED oversees 53,935 schools with more than 10 million students and 330 thousand teachers (REF). The
SED also supervises the Boards of Intermediate and Secondary Education (BISE), Children libraries,
Punjab Daanish Schools and Centers of Excellence. The HED is overseeing 458 Colleges along with eight
Page 100
BISE, 12 Public Sector Universities, 20 Autonomous Educational Institutions of Higher Education, and the
Directorate of Public libraries .The PCA deals with development and supervision of curricula, syllabi,
textbooks, and maintenance of standards of education. The duties of the Directorate of Staff
Development include conduct of pre-service and in-service teachers training and a Continuous
Professional Development (CPD) Program. Government of Punjab has established a separate
Department for Literacy & Non-Formal Basic Education to address the problem of dropouts at the
primary level and meet the emerging demand for Non-Formal Basic Education with functional Literacy
and Livelihood skills. In collaboration with international agencies like UNESCO & JICA, the Literacy
&NFBE Department has developed various Projects i.e. Punjab Accelerated Functional Literacy & Non
Formal Basic Education Project, Campaign for Enhancement of Literacy (04 Districts), Community
Learning Centres (Sahiwal Division) and Brick kilns Project (Multan &Khanewal Districts) to combat the
menace of illiteracy and achieve the goal of 100% literacy by 2020. The Department for Literacy
&NFBEhas launched the Punjab Enrollment Emergency Campaign to increase rates of enrollmentamong
school-going children.
In 2009, the Government of Pakistan approved a National Education Policy which aimed to address the
issues of access, equity and quality of education at all levels. The Policy highlighted governance as an
issue requiring urgent attention to improve the status of education and called for increased investment
in the education sector. Under this policy, the government is committed to allocate 7 percent of GDP to
education and provide free universal primary education by 2015 (Economic Survey of Pakistan, 2013)..
Following the 18th Amendment, Education became a Provincial subject and the Government of Punjab
emphasized educational reforms and announced the School Education Reforms Roadmap with the
objective to enhance access, retention and completion of quality education. The Chief Minister of
Punjab has approved allocation ofa fifth of the total Provincial budget (Rs.117 billion) to Higher and
Primary Education under different categories and schemes.
3.5.2 Potential role in nutrition improvement
Education or literacy level and malnutrition indicators are closely interlinked, as demonstrated
in the district-maps (shown below) Literacy rates and maternal education are seen to be
directly related to childhood under-nutrition (underweight, stunting &wasting), indicating that
increases in literacy/education level will be helpful in reduction of the burden of malnutrition in
the province of Punjab.
Page 101
Maternal and child under-nutrition is also related to maternal autonomy (Nutrition Political
Economy, Pakistan 2013). Further, the National Nutritional Survey 2011 reveals stunting rates
among children reduce significantly with increasing maternal level of education (shown in table
below).
Figure 3.12: Figure 3: Relationship between Maternal education and Child Stunting (Source: NNS 2011)
The inextricable linkage between education, autonomy and malnutrition identify education as an
essential component of any strategy seeking to improve the nutrition status of a population, particularly
children. With a high burden of illiteracy among primary care givers of children i.e. women, an urgent
strategy to improve education among the population in general and among women in particular needs
to be pursued to reduce the burden of malnutrition.
3.5.3 Nutrition specific objectives of the Education Sector Ensure equitable access to education, with particular focus on increasing enrollment and
retention of the girl child
Introduction of Nutrition, Health &Hygiene education modules in schools and education
curriculum-
Improve knowledge regarding nutrition among teachers, parents/caregivers children and
adolescents engaged in schooling
38%
30%27%
19%
15%
0
10
20
30
40
50
Illiterate Primary Middle Matric Above Matric
% o
f ch
ildre
n s
tun
ted
Education Level
Page 102
To support health department in malnutrition screening among children and adolescents and
improve nutritional status among school going children through appropriate referrals, health &
nutrition education and promotion activities
Introduction and promotion of Nutrition as a professional track for post-graduate education
and employment
3.5.4 Intervention Matrix
3.5.4.1 Strategy: Equitable access to Education
Several recent studies have demonstrated an association between educational attainment and
nutritional deficiency. Whereas hunger and malnutrition in itself affect the health of children, it
further increases the chance of infections which can potentially affect learning capacity, reduce
attention span, increase absences from school and affect education throughout childhood.
Studies have demonstrated improved educational attainment among children treated for
malnutrition and micronutrient deficiencies. Health and Nutrition Programs targeting infant,
pre-school and school-going children, particularly among the poor are effective in improving
health and educational attainment throughout the life cycle (Jukes et al., 2009).
Intervention Matrix
Strategy Objective
Strategy Action(s) Nutrition Level
Impact on nutrition
Nutrition Sensitive
Nutrition Specific
To increase Pre-nursery & Nursery enrollment & retention to 80% of eligible girls by 2020
1. Expand the existing network of schools by 2020 (Policy level)
√ -- Access to educational material and awareness of dietary and feeding practices (among care takers &female students)) will lead to an improvement in nutrition indicators
2. Launch enrollment campaign each year especially to increase enrollment of girls (Policy level)
√ --
3. Introduce conditional cash transfer (CCT) policy by 2014, and advocate with BISP or any other such program conditional for beneficiaries to enroll their daughters in schools (Policy Level)
√ --
4. Availability of boundary wall especially in girls’ schools by 2016
√ --
Page 103
3.5.4.2 Strategy: Improve quality of Education and integrate
Incorporate action oriented inter-sectoral nutrition specific messages in the school-based curriculum
and build capacity of primary and secondary school teachers in the delivery of nutrition messages,
education and activities strengthening nutrition as an integral part. Nutrition education involves
increasing knowledge about the importance of nutrition, providing educational materials that reinforce
messages about healthy dietary practices, imparting skills essential for making dietary changes and
imparting life skills to sustain behavior change. Information gathered during school-based nutritional
screening or assessment will provide the necessary information on which nutritional messages will be
tailored during nutrition education and counseling sessions.
Health professionals need to give careful consideration to the types of nutrition messages that are
presented to adolescents. Most adolescents are present-oriented, which means they are generally not
concerned about how their current eating habits will affect their future health status and most are
unable to apply new concepts to current behaviors or situations (Croll et al., 2001). They are, however,
concerned about their physical appearance, maintaining a healthy weight and having energy. While
teenagers should give consideration to the potential long-term risks of an unhealthy diet and benefits of
healthy eating habits, focusing on short-term benefits with adolescents is more likely to make a lasting
impression on the target group and facilitate dietary change. Nutrition-focused educational materials
and messages must be written in local language and in a style identifiable to the concerned target
group. Some key concepts kept in mind while developing educational material includes use of active
rather than passive voice when presenting information, use of local language and commonly used
phrases and words instead of medical/technical terminology and inclusion of illustrative examples for all
key concepts discussed.
Intervention Matrix
Strategy Objective Strategy Action(s) Nutrition Level
Impact on nutrition
Nutrition Sensitive
Nutrition Specific
To include nutrition in school curricula by June 2015
1. DoE would notify a committee with responsibility/ purpose to develop training modules, dietary guidelines and curriculum (Policy level)
√ --
Quality of education and knowledge about Nutrition interventions will improve health and nutrition status
2. Nutrition curriculum planning within Institutes of Higher Learning in collaboration with international institutes (Policy Level)
√ --
Page 104
3. Induct a nutrition specialist in the Punjab Curriculum Authority for revision and inclusion of nutrition modules/chapters (Implementation Level)
√ --
4. A provincial regulatory body (Nutrition & Dietetic Council)
√ --
4.5. Creative Inclusion in curricula/ syllabi by the end of 2014 (Implementation level) a) Revise the curricula for
primary , middle, inter level and make it more nutrition focused for boys & girls
b) Add nutrition related text-boxes in curricula/ syllabi
c) Prepare key messages regarding Nutrition ensuring order and consistency, for inclusion in curricula/ syllabi
√ --
Access to educational materials and awareness about dietary habits will ultimately improve health and nutrition status
5.6. New Inclusion in curricula/ syllabi by June 2015 (Implementation level) a) Introduce a chapter
“Preventive Health and Nutrition” in curricula/ syllabi consisting course contents like nutrition, health & hygiene, personal hygiene/sanitation, safe water, food safety and communicable disease
b) Introduce “Nutrition & Health” related new subject from Primary classes onward
√ --
Access to educational materials and awareness about healthy dietary habits will ultimately improve health and nutrition status
To train all the School Health &Nutrition Supervisors (SH&NSs) and school teachers by 2017
1. Launch training modules by June 2015 for School Health & Nutrition Supervisor from each district in nearby well-established Nutrition Departments. The training modules will contain contents regarding counselling of children, teachers, parents and adolescent males & females and screening & referral to nearest health facilities of malnourished
√ --
Training of teachers and SN & HSs will enable delivery of nutrition related activities with a focus on strengthening nutrition as an integral part
Page 105
children (less than five years of age) and adolescents (Implementation Level)
1. Train teachers by adding Nutrition Modules (Implementation Level) a) Training of trainers by well-
established nutrition department OR by qualified nutritionist/dietician
b) Inclusion of nutrition modules in teachers training programs i.e. In-Service and Pre-Service Teachers Training by School Education Department
c) Introduce virtual/online training program to conduct trainings/ seminars/ workshop to ensure early completion of training programs.
√ --
2. Introduce a mechanism for monitoring of curriculum, facilities and validation of Nutrition related activities at schools and universities level i.e. establish Nutrition & Dietetic Council for monitoring and evaluation of professional level education in Nutrition along with registration of Nutritionists and Dieticians(Policy Level)
√ --
Strengthen the nutritional programs implemented throughout the province; helpful in decreasing malnutrition burden
3.5.4.3 Strategy: Provide and promote quality hygiene and sanitation practices within school
premises
Background/Rationale: Poor physical environment (unsafe drinking water and poor sanitation and
hygiene, or WASH), is one of the underlying determinants of malnutrition, often leading to increased
burden of diarrheal disease – leading cause of child mortality in Pakistan. Additionally, diarrheal disease
decreases intestinal absorption of nutrients. Thus, even when food consumption is sufficient, diarrheal
disease can lead to malnutrition among children by impeding intestinal absorption (WHO, 2008.)
Page 106
Resultant deficiency in energy, minerals and vitamins have considerable negative impact in about 35% of
all children, leading to deaths and presenting 11% of the global disease burden (Black, Allen, et al
2008).Current evidence suggests that the achievement of good nutritional status is of vital importance
towards attainment of MDG 4. Chronic under-nutrition severely reduced school attendance and
diminishes health, economic and gender potential (UNICEF 2008).
Intervention Matrix
Strategy Objective Strategy Action(s)
Nutrition Level
Impact on nutrition
Nu
trit
ion
Sen
siti
ve
Nu
trit
ion
Spec
ific
To ensure availability of facilities for implementation of quality hygiene and sanitation practices at 100% schools by 2019 (especially in girls school)
1. Ensure the provision of missing facilities e.g. functional toilets, with proper sanitation and privacy in schools/ colleges with assistance of HUD & PHED (Implementation Level)
√ -
Prevention of diarrhoea& infections, a known risk factor of malnutrition
2. Ensure availability of safe drinking water by installation of water filtration plants in schools with assistance of HUD & PHED (Implementation Level)
-- √
3. Increase water conservation with increased and improved water storage capacity with assistance of HUD & PHED (Implementation Level)
√ --
4. Availability of soaps in school toilets(Implementation Level)
√ √
3.5.4.4 Strategy: Capacity Development- Introduce and Promote Nutrition as a profession
The current curricula for students in school do not provide enough knowledge on the mechanisms
through which micro and macronutrients interact with one another and their role in maintaining optimal
body functions, interferences of these mechanisms and implementation of this knowledge for
prevention of malnutrition and promoting healthy nutrition. Furthermore, tools for nutritional
assessment, analysis, counseling and treatment are not well integrated within the training curricula of
schools and Institutes of Technical Education. To build capacity it is necessary to promote nutrition as
Page 107
indivisible from health and provide a recognized professional track for training and employment in
Nutrition related fields.
Intervention Matrix
Strategy Objective
Strategy Action(s) Nutrition Level
Impact on nutrition
Nutrition Sensitive
Nutrition Specific
To promote recognition of Nutrition as a profession and to introduce it as a post-graduate subject by 2019
1. Increase opportunities for professional level degree and post-graduate courses in Nutrition (Policy Level)
√ --
Will strengthen the nutritional programs implemented throughout the province and will be helpful in decreasing malnutrition burden
2. Strengthen already existing degree providing departments/institutes by training and capacity development of existing faculty (Implementation Level)
√ --
3. Promote establishment ofNutrition departments within Institutes of higher learning (Policy Level)
√ --
4. EstablishNutrition & Dietetic Council for monitoring and evaluation of professional level education in Nutrition along with registration of Nutritionists and Dieticians (Policy Level)
√ --
3.5.4.5 Strategy: Improvement of nutritional status among school going children
Background/Rationale: An integrated approach based on multi-dimension may be needed to
improve nutritional status of the school-going children.
Intervention Matrix
Strategy Objective Strategy Action(s) Nutrition Level
Impact on nutrition
Nutrition Sensitive
Nutrition Specific
To perform complete screening of school going children enrolled
1. Ensure screening and delivery of essential package of nutrition service to school-going childrenon a quarterly basis. Package of care includes
-- √
On time diagnosis will facilitate to decrease malnutrition burden (especially
Page 108
in public sector on quarterly basis
screening and referral for malnutrition at an early stage (Implementation Level)
prevalence of hidden hunger)
To introduce mid-day meal at all schools in high risk districts by 2015
2. Provide micronutrient fortified high-energy biscuits and dates, to enhance school performance and improve micronutrient levels, particularly vitamins, minerals and proteins. The scheme will start from Southern Districts which have poorer nutrition status among women and children and will scale up over time. (Implementation Level)
-- √
Enhance school performance and help improve nutrition indicators linked to vitamins, minerals and protein consumption
To introduce deworming services at all schools in high risk areas/district by 2014
3. Promote biannual de-worming of children (Implementation Level) -- √
To introduce nutritious foods &daily physical activity at all schools by 2014
4. Promote Availability of healthy nutritious foods at school canteen:
a) Through encouraging availability of nutritious food commodities in school canteens
b) Discouraging school canteens from selling junk food and carbonated drinks (Policy Level)
-- √
Preventive approach will be helpful in reducing malnutrition burden
5. Introduce daily physical activity at schools(Policy Level)
-- √
To launch campaigns and awareness programs
6. Raise awareness: a) Seminars, awareness
sessions, and other awareness activities by SHNS, LHWs, CMWs, Field assistant agriculture department teachers and respected of the area, involvement of private sector, private practitioners
b) Distribution of IEC material c) Celebration of special days
like (World Food Day,
√ --
Access to educational materials and awareness about dietary practices (especially among females) will ultimately lead to uptake of nutritionindicators
Page 109
breastfeeding day, water, egg days)
d) Arrange parent-teacheradvocacy meetingsfor health promotion, Nutrition needs among children& household members, menu planning, kitchen gardening and animal raising at household level
4 CHAPTER 4: IMPLEMENTATION OF THE STRATEGY /
OPERATIONALIZATION
4.1 Implementation Model Effective and coordinated implementation of the proposed strategy is imperative in realization of the
objectives of the strategy. The implementation is proposed to be done in partnership between all
responsible departments. Implementation of this strategy will be mainly through three distinct ways; 1)
adjustments in already implemented or existing programmes by making them more nutrition sensitive
2) seeking funds and implementing nutrition sensitive interventions by developing PC-1s against
approved interventions in this strategy using their own resources 3) seeking funds through Nutrition Cell
from the pool of resources allocated for implementation of nutrition strategy for nutrition specific and
high priority nutrition sensitive interventions. The implementation model will vary from intervention to
intervention for effective implementation. There are interventions in all sectors, which are department
specific and therefore the implementing department will take lead in its planning and implementation
within the sector. Some interventions are multi-institutional within each sector and some are
multisectoral, and their effective implementation requires coordinated implementation frame-work
from all involved departments and/or sectors.
NUTRITION PLANNING AND IMPLEMENTATION FRAMEWORK – AN HOUR GLASS MODEL
Provincial technical working groups
Food Sector
Health Sector
Education Sector
WASH Sector
Social Protection
Social Welfare & Women Development
Agriculture, Livestock, Fisheries Sector
PROVINCE
UC
Page 110
4.2 Organizational Structure
Figure 131 organizational structure of Punjab multi sectoral nutrition program
The real challenge in implementation of multi-sectoral strategy is “coordination from province to
districts to city council/ward/village and fixing the verifiable responsibilities at all levels”. Each
intervention will be monitored by specific technical committees constituted at all levels named
“Malnutrition Addressing Committees”. Coordination may be further improved by framing joint
implementation framework indicating the clear roles and responsibilities of each sector.
UC level
coordination & implementation
Tehsil level
coordination & implementation
District level coordination & implementation
Provincial level coordination & implementation
Policy level P&D
PMAC
DMAC
UMAC
TMAC
Nutrition Cell at PSPU
Coordination line
Coordination line
School Health & Nutrition Supervisor ↔ Teacher ↔
LHWs ↔ Field Assistant Agriculture ↔ UC Secretory
DISTRICTS IMPLEMENTATION COMMITTEE DCO ↔ EDO Edu ↔ EDO Health ↔ EDO Agriculture
↔ DO Public Health Engineering ↔ ADLG/TMA
Page 111
4.2.1 Provincial
4.2.1.1 Nutrition Cell at PSPU
The Punjab multisectoral nutrition implementation program will be designed in an effective institutional
framework using the existing arrangements and establishing new ones for policy direction, coordination,
monitoring and evaluation
Provincial level oversight/management structure will be housed in P&D department Punjab as P&D
works as central department for monitoring and evaluation of development plans, policies and
programs. For this purpose, nutrition cell will be housed in PSPU, which will be reporting to P&D. This
cell will be responsible to arrange quarterly progress review meetings of PMAC in order to review and
track the progress. Nutrition cell will also facilitate collaboration and partnerships among different
stakeholders in planning, and implementation of nutrition programs.
Nutrition cell will have three professionals (supported by partners) that will support the PMAC in the
area of information management and data analysis, including different aspects of the monitoring of
nutrition information across the sectors and evaluation. This cell will also support for development of
multisectoral nutrition communication strategy.
4.2.1.2 A provincial malnutrition addressing committee (PMAC)
A provincial malnutrition addressing committee (PMAC) is proposed at provincial level in order to
provide a platform for planning of nutrition-specific and nutrition-sensitive programs, coordination, and
information dissemination, to review and share progress & monitoring. The committee will also be
responsible to track implementation status of program, timely identifying bottle necks, addressing
problems. The secretariat of the Punjab multi Sectoral program (PMSNP) will be based in the P&D
Department and nutrition cell in PSPU will facilitate the procedure of coordination & review the
progress. It is proposed that under the chairmanship of P&D department, following departments will
represent in the PMAC.
• Agriculture Sector (Departments of Agriculture, Livestock & Dairy Development and
Fisheries)
• Food Sector (Department of Food, Punjab Food Authority)
• Education Sector (Departments of School Education, Higher Education, Literacy, Punjab
Curriculum Authority, University(s))
• Health Sector (Departments of Health)
• WASH Sector (Departments of Public health engineering (PHED) and local government)
Page 112
• Social Protection Sector (Departments of Social Welfare & Bait-ul-Maal, Women
Development, BISP)
Participating sectors will be responsible to mainstream nutrition into their respective sectors and
implement the planned interventions with in their domain. A continuous and ongoing reporting will be
part of every sector’s routine reporting system.
4.2.1.2.1 ToRs of the PMAC
The PMAC will be responsible for ;
• Incorporate & prioritize nutrition in all sectors (develop nutrition specific/ sensitive plans)
• Devise effective and ongoing monitoring system through reviewing/ revise routine reporting
& recording tools in order to incorporate nutrition indicators of multi sectoral nutrition
strategy in to it.
• Finance management through mobilizing resources required for nutrition sensitive &
nutrition specific activities.
• Advocate and ensure political and partners commitment and support
• Continuously assess and review the program implementation status
• Devise outcome based accountability system for mid-term and final evaluations
• Devise research based monitoring and evaluation system
Figure 142 Provincial malnutrition addressing committee
The PMAC will be assisted by a nutrition cell in the PSPU that will be responsible for:
• Coordination and information management: building linkages with DHIS, HMIS etc.
• Development & operationalization of multisectoral nutrition strategy reporting system
• Development of multisectoral nutrition Communication/advocacy strategy and uniform
messages to be used by each sector
P&D
Health Education AgricultureSocial
protection wash Food
Page 113
• Support capacity development on planning & implementation of multisectoral nutrition
program.
• Improve coordination with donors and partners for mobilization of financial resources and
technical assistance
4.2.2 District
4.2.2.1 District malnutrition addressing committee (DMAC)
The DCO will notify a district level malnutrition addressing committee DMAC . District level committee
will be responsible for implementation of multisectoral nutrition program in whole district and where
there is phased / partial implementation this committee will perform selection and identification of CCs
or wards for implementation. The committee will have the representation of all district level
participating sectors and will work under the guidance provincial level PMAC. This implementing
committee will work under the chairmanship of DCO in each district.
This committee will be constituted again on the same pattern of PMAC ensuring the representation
from all concerned departments. Representation from civil society, and CBOs will also be given in the
composition of DMAC
4.2.2.1.1 ToRs of the DMAC:
Micro plan & implementation of nutrition related interventions in line with the Punjab
multi-sector nutrition program
Incorporate multisectoral nutrition indicators in the district monthly and annual monitoring
plans
Ensure multi-sectoral coordination at implementation level and district level
Devise evaluation procedures and report evaluation results to PMAC and corrective actions
proposed or taken, if any
Timely reporting of the all implementing sectors and PMAC and Nutrition Cell at PSPU
The DMACs will rely on technical support from the health department through the district nutrition
officer (one nutrition qualified school & nutrition supervisor will be nominated as district nutrition
officer).
Page 114
4.2.3 Community
4.2.3.1 Union-council malnutrition addressing committee (UMAC)
At union council level (now called as city council in urban set-up and ward in rural set-up) a Union
Council Malnutrition Addressing Committee (UMAC) will be established in order to ensure the
community level implementation. This composition of the committee will be as following.
• Convener: Facility-based Medical Officer
• Secretary: School Health & Nutrition Education Supervisor
• Members: Representative of Livestock (if any), Agriculture (if any), Secretary of CC or Ward,
Heads of School Education Councils in CC or ward, Lady Health Supervisor, One school teacher
from all schools in CC or Ward, Chairmen of Zakat Councils in CC or ward, 02 public
representatives (at least one female)
4.2.3.1.1 ToRs of the UMAC:
• Implement nutrition interventions under the guidelines of DMAC
• Implement monitoring plan and furnish monitoring reports as per direction of DMAC
• Ensure timely & quality reporting of the all implementing sectors
• Improve multi-sector coordination to attain common goal of reducing chronic malnutrition-
nutrition at CC or ward level.
Page 115
4.3 Harmonization and Synergy
Page 116
UMAC
DMAC
PMAC
4.4 Capacity Building It is anticipated that the capacity of various sectors and departments involved in implementation of this
strategy is very week including policy makers, implementers, monitors and evaluators. Therefore,
capacity building itself should be taken as key pre-requisite for effective implementation. Capacity
MO
SH&NS
education
livestock
Agri
LHS
UC-sectray
DCO
health
education
Food
Agri
wash
social protection
P&D
health
education
Food
Agri
wash
social protection
Co
ord
ina
tion
line
Co
ord
ina
tion
line
Rep
ort
ing
line
R
epo
rtin
g lin
e
M&E unit
M&E unit
M&E unit
Page 117
building of sectors from planning to implementation of multisectoral nutrition approach will be of prime
importance for the successful implementation of the program. An assessment to analyses sectoral
capacity should be targeted and focused in order to decide the type, level and number of human
resource needed for effective implementation. For this purpose, a workshop involving all sectors will be
conducted and a comprehensive plan for human resource development on the areas of strategy
implementation will be developed followed by actual capacity building with the support of partners.
4.5 Communication Strategy A comprehensive targeted & uniform communication strategy is key to achieve objectives of this
strategy. The development of the communication strategy will require formative research keeping the
local context in view including traditional beliefs, taboos and traditions that are common in urban &
especially in rural areas of Punjab.
The research will investigate the basic and underlying causes behind the maternal nutrition and infant &
young child feeding practices. In this way an appropriate, uniform & effective behavior change
communication packages and training modules can be designed for every sector.
4.6 Monitoring, Evaluation and Accountability The core concept of monitoring and evaluation of multisectoral nutrition strategy is based on following:
• Are the right things are being done? (The type of interventions)
• Are the right things being done well? (Implementation gaps)
• Are the right things being done enough? (Planning gaps)
• Have the interventions made a difference? (Overall impact of the strategy), and how do we
know? (Evaluation mechanism)
Participating sectors will institute a systematic approach to reporting through integrating key nutrition
sensitive indicators. The monitoring frame-work will be indicator based and will comprise of monitoring
at all levels including inputs & services monitoring, outputs monitoring, outcomes monitoring and
impact monitoring. The monitoring indicators against each intervention have been given in RFAs
(Annexures----). However, complete monitoring frame-work of each intervention will be developed in
PC-1 of that particular intervention.
This will be the first experience of its nature in Punjab where various sectors will have to work together
on common objective of reducing the prevalence of malnutrition. In order to ensure that sectors are
able to work in a coherent and adopting geographically focused approach, an inter-sectoral project
Page 118
management and monitoring team will be recruited through Nutrition Cell at PSPU at provincial level
oversight and monitoring. The strategy assumes that mid-term and end evaluation of the inter-sectoral
nutrition intervention would be undertaken to assess the impact of these interventions. All participating
sectors will be responsible as well as accountable for their part of implementation in the joint
monitoring & evaluation system.
4.6.1 Measuring the progress: result based monitoring framework
4.6.1.1 Monitoring the impact of Multisectoral interventions
Impact is assessed by calculating & documenting the changes in the nutritional status of target group
(women and children) as a result of implementation of proposed Multisectoral interventions.
Proposed M&E frame work will consist of three parts.
1. Impact assessment can be done by using standardized survey procedures
(Demographic and Health or Nutrition Surveys, for example) and calculating
the average rate of reduction for only few selected indicators – such as
prevalence of acute & chronic malnutrition in children under five years of
age.
2. Proposed M&E Framework will also include a description of how the
contribution of all participating sectors will be measured and reported is
described below.
3. Nutrition Cell will Monitor the services (outputs) provided by thesectors
and assess the implementation status of the strategy. It will measure the
commitments made by the sectors to monitor and report on the
contribution of its services. (M&E frame work attached in annexure)
4.6.1.2 M&E unit: structure, function and use of information, feedback system
Routine monitoring of the activities will be conducted at UC and district level and reporting and
coordination line will be same as described in the figure 3.
The M&E Framework will provides a framework for the collection of data of all relevant indicators with a
view to assess & evaluate impact, outcomes and outputs of the Multisectoral nutrition interventions
through a proposed mechanisim. To measure the impact of proposed interventions the M&E Framework
will use the secondary data that will be collected by routine reporting sytem of sectors at provincial level
Page 119
and collated by the Multisectoral reporting system by nutrition cell. While outcomes will be measured
by the participating sectoral focal Persons (PMAC) will take the lead in collecting and reporting data.
4.6.1.3 Provincial level (Centralized M&E at P&D)
Provincial level monitoring will be more result based and focused. For this purpose uniform monitoring
checklist will be developed and shared with all sectors. Every sector will be responsible to share
monitoring reports with timeline, as may be appropriate, with Nutrition Cell of P&D, housed in PSPU.
Reports will be analyzed by nutrition cell and feedback will be shared with relevant sectors through TWG
meetings at provincial level as well as with district level implementation team.
4.6.1.4 District level (Office of DCO)
District level monitoring check lists will be developed at provincial level on uniform format covering
district level implementation activities of all sectors. DCO office will be compiling the sectoral
monitoring reports and sharing the consolidated reports at provincial level.
4.6.1.5 Community level (Office of the Medical Officer/Local Union Council)
At UC level MO will be responsible to engage every sector representation in monitoring as well as
implementation and reporting.
Page 120
4.7 Research and development
Implementation model based on evidence based interventions is key to success in realization of this
strategy. Therefore, research and development has been envisioned core this strategy. An important
step prior to implementation is availability of data generated through evidence based effectiveness
studies. In this strategy, a three tier research based eveidence generation is proposed:
P&D
(Nutrition Cell)
Agriculture
Education
HealthSosical
protection
Food
Wash
UC -monitoring
reports
DCO office
Fee
d b
ack
Feed back Feed back
Figure 164 Multisectoral monitoring & feedback system
Page 121
• Exploratory research: to identify the issues related to nutritional status, its impact on health,
magnitude/gravity of the issues and causal framework of the issues. This part has mostly been
done by the NNS, 2011. As ~four years’ time has passed since NNS data was collected, it is
proposed that the baseline data should be reconfirmed by small survey in three districts (one
district each from North, South & Central Punjab)
• Constructive research: Small scale piloting in on-ground conditions is proposed for evidence
generation for effectiveness of the interventions. These might include 1) Implementation Trials:
A valuable approach that would generate knowledge about successful implementation
alternative strategies using a randomized trial design and might require multiple location and
multilevel analyses to fully examine impact. 2) Research on Increasing Rates of Intervention
Adoption and Participation: Research to test the rate of adoption and rate of participation of a
particular program in urban, peri-urban and rural settings and communities with different ethnic
background. 3) Encouragement Designs: Randomized designs to test various modalities of
recruitment, incentives, or persuasion messages to influence their choice to participate in one
or another intervention condition.
• Empirical research: testing the effectives of the solutions. This research will be ongoing and will
make the part of continuous monitoring and evaluation process.
Sometime, programs prove to be efficacious in controlled trials, however, the effectiveness might be
different under real-world conditions. In the real world, translation of science-based interventions often
stumbles, might be largely unguided, and may lead towards uneven, incomplete, and disappointing
outcomes and ultimately poor realization of strategic objectives. The research in constructive and
empirical domain especially is linked with factors associated with the adoption and use of scientifically
validated interventions by service systems also focusses on maintenance and sustainability issues at the
practice level that can be used to for effective and coordinated implementation.
Translational research, will accompany with implementation of many strategic interventions of this
strategy, and will help to explore the factors that influence the ongoing quality of implementation; and
in such studies, implementation quality itself will be the outcome of the research.
One of the core theme of this strategy is taking “implementation as a science” and using research &
development as base of this science. The ongoing process of research explores and scientifically testifies
Page 122
the adoption potential of key interventions and redesigning from the lessons learnt to achieve strategic
objectives.
There will variable research requirements for various inter- and intra- sectoral interventions. A
consultative workshop involving all the sectors will be conducted before the implementation of the
strategy to identify research needs for effective implementation, monitoring and evaluation of proposed
interventions.
31A typical research based model for community interventions adopted from adopted from (O'Connell
and others, 2009)*
31 * http://www.ncbi.nlm.nih.gov/books/NBK32764/#ch11.s1-National Academies Press (US); 2009.
Page 123
4.8 Public private partnership/Bussiness Network
Bussiness network or private sector can play a vital role in Multisectoral approach to address
malnutrition. A research by world Economic Forum concluded that “the “business Case” for companies
to engage in hunger-reduction efforts varies by industry, by company and by company’s activities.
Nearly every step in the food production and consumption process offers opportunities for some type of
business involvement”.32
Contribution of any company to overcome malnutrition will obviously vary depending on the type of
industry, sector, stage in the food value chain, and type of intervention. It will also be influenced by
other participating sectors, partners.
Involvement of business network is proposed to complement Multisectoral nutrition spproch to address
malnutrition. Every participating sector will soordinate and identify relevant interventions with private
sector and corporate sector will be involved in the process.
It is proposed to establish business network for nutrition at provincial level to coordinate with relevant
sectors . It is further proposed that focal point should be nominated for business network, focal point is
proposed to reaches out to sectoral focal Point and other Networks and liaises at provincial and district
level Organise multi-stakeholder convenings to define potential contributions by the private sector and
agree on ways of working with all sectors.
4.9 Financial framework/ resource management
4.9.1 Financial Management
After approval of the Multisectoral nutrition strategy all sectors will develop PC-1s against approved
strategic actions or if already have developed, will revise their plans to be in line with the proposed
interventions in multisectoral nutrition strategy. The departments will seek funds for implementing
nutrition sensitive interventions against approved interventions in this strategy using their own
resource, however, funds will be allocated through Nutrition Cell from the pool of resources allocated
for implementation of nutrition strategy against nutrition specific and high priority nutrition sensitive
interventions.
32 Harnessing Private Sector Capabilities to meet Public needs: The potential of partnerships to Advance progress on Hunger, Malaria and basic education. The world economic forum, Geneva: 2006.
Page 124
4.9.2 Establishment of Joint Funding Pool
To meet the resources against nutrition specific and high priority nutrition sensitive interventions, Joint
Funding Pool at P&D level will be established for implementing this multi sectoral strategy. The
government of Punjab and development partners will make their committed contributions into the pool
of funds. Any development partner(s) willing to support multisectoral nutrition strategy of Punjab may
join this arrangement at any point of time under the established arrangements. The P&D along with
PSPU shall be responsible for coordination and release of funds. The development partners and the
government of Punjab will make their annual contributions in the pool. The first installment will be
based on the approved plans/PC1s recommended by the TWG and the subsequent installment(s) might
be linked with expenses reported and progress made over the indicators.
4.9.3 Funds Flow
Department of Health has been implementing nutrition specific interventions and has recently started
implementing the integrated RMNCH & Nutrition program in Punjab. These most of the nutrition
specific interventions will be now onwards DoH’s routine activities and it is proposed that these
nutrition specific programmes would continue to be funded according to the current sectoral
arrangements. The same approach will be followed for nutrition sensitive programs, and if some
additional resources are required then these can be obtained from joint funding pool. The multi
sectoral programs and budget will be prepared as per sectoral plans and on the recommendations of
technical working group (TWG). The nutrition plans will be prepared by the sectors to be in line with the
targets/milestones set by the Multisectoral technical working group for five years as given in result
frame-work analysis. The pay for performance package will be designed by the P&DPSPU nutrition cell
to encourage participating departments to increase their performance in implementation of the
strategy.
Page 125
Annextures
Annex-1 Result Framework Analysis of Health Sector
Strategy
Objective Strategy Action(s) Indicators
Base
Line
Means of
Verifications
TIME LINE (Years) Key
Assumptions Y
1
Y
2
Y
3
Y
4
Y
5
Strategy 1: Mainstreaming Nutrition in Health
To develop
Policy frame
work to create
enabling
environment
for
mainstreaming
Nutrition in
Sector &
improving
multi-Sectoral
coordination
mechanisms
by year 2015
1.1 Develop and promulgate rules
for implementation of Breast
feeding Act 2009
Policy
notification &
direction issued
TBD Policy
notification &
directive
available/
promulgation
material
available
√ √ √ √ √
Subject to
political
ownership and
subject to
implementation 1.2 Policy decision to integrate
nutrition as part of EPHS and revision of JDs of HCPs &
SHNS accordingly
TBD
1.3 To take up with PFA regarding
development of, legislation on
flour fortification with iron, salt
iodization
TBD
1.4 Policy to institutionalize
Gender Sensitive and pro poor
approach in all health plans
(PC1s)
TBD
Page 126
1.5 Advocacy with BISP to convert
its cash transfer scheme into
conditional cash transfer
No. of meetings
held with BISP
TBD
Minutes of
meeting
available √ √ √ √ √
Subject to
political
ownership and
Subject to
change in
policy of BISP
To develop
nutrition
communication
strategy and
development of
IEC material
for other sectors
by December ,
2015
1.6 Develop consensus among
stakeholders of each sector on
communication framework by
December, 2014
Meeting/Seminar
Conducted Nil
Record
maintained √ √ √ √ √
Subject to
implementation
and subject to
funding
1.7 Develop linkages and provide
support to other sectors in
implementation of
communication strategy and
training of their staff
Nil √ √ √ √ √
1.8 Create awareness among
community on use of nutritious
food, healthy dietary habits,
hygiene and health
Nil √ √ √ √ √
Strategy 2: Equitable access to Nutrition services to poor and marginalized people
80% of children
with SAM
accessing services
on Severe Acute
Malnutrition
(SAM )
management as
per National
guidelines
especially in the
most affected
districts by 2020
2.1 Establish nutrition treatment
centers (OTPs) for SAM
children from 80 to 930 by the
year 2017
# of new nutrition
treatment centers
(OTPs) for SAM
children
established
80
New operational
centers/ Record
available
20
0
50
0
93
0
Subject to
availability of
funds
2.2 Establish nutrition treatment
centers (SC) for SAM children
with complication from 8 to
36 by the year 2017
# of new nutrition
treatment centers
(OTPs) for SAM
children with
8
New operational
centers/ Record
available
15
25
36
Subject to
availability of
funds
Page 127
complication
established
Reduction in
low birth weight
babies by 50%
of existing
baseline (NNS
2011) by 2020 by
Improving
maternal health
Reduction in low birth weight
babies by 50% of existing baseline
by 2020 by improving maternal
health
% of babies with
low birth weight
Health
Department
(quarterly/
annual Reports)
10 %
20 %
30 %
40 %
50 %
Subject to
availability of
funds and
implementation
2.3 Enforcement mechanism of salt
iodization developed and
implemented by 2015
Policy notification
TBD
Policy notified/
promulgation
material
available
√ √ √ √ √
Subject to
political
ownership and
subject to
implementation
2.4 Ensure quality of iodized salt
by strengthening and up
gradation of existing lab system
by 2015
# of districts with
new labs
established TBD
New operational
labs/ Record
available 10
20
30
Subject to
political
ownership and
availability of
funds
2.5 Advocate with PFA for
effective implementation
regarding fortification of oil &
Ghee with vit A & D by 2014
Notification &
direction issued
TBD
Notification &
directive
available √ √ √ √ √
Subject to
political
ownership and
availability of
funds
2.6 Assessment of existing
mechanism of provision of
Vitamin A biannually with
NIDs by 2014
Policy notification
TBD
Policy notified
√ √ √ √ √
Subject to
implementation
Page 128
2.7 Increase in coverage of Vit A
from 73% to 95% during NIDs
by 2016
% of coverage of
Vit A during NIDs 73%
Health
Department
(quarterly/
annual Reports)
80 %
95 %
Subject to
availability of
funds and
implementation
2.8 Conduct research to assess
absorption and storage of iron.
Research
Conducted TBD
Record
Available √ √ √ √ Subject to
funding, Success
of experiment
2.9 Research on compliance on
uptake of iron
Research
Conducted TBD Record
Available √ √ √ √ Subject to
funding, Success
of experiment
2.10 Provision of iron folic acid to
PLW and adolescent girls
through community health
workers
% of deficient
adolescent girls
provided with iron
folic acid TBD
Record
Available;
Health
Department
(quarterly/
annual Reports) 1
0 %
25
%
50
%
75
%
10
0 %
Subject to
political
ownership and
availability of
funds
2.11 Promote and provide
deworming tablets to children
and adolescent girls.
% of children &
adolescent girls
provided with
deworming tablets TBD
Record
Available;
Health
Department
(quarterly/
annual Reports)
10
%
25
%
50
%
75
%
10
0 %
Subject to
political
ownership and
availability of
funds
Page 129
2.12 Provision of iron syrup and
tablets in all health facilities
% of government
health facilities
provided with iron
syrup and tablets TBD
Record
Available;
Health
Department
(quarterly/
annual Reports)
10
%
25
%
50
%
75
%
10
0 %
Subject to
political
ownership and
availability of
funds
2.13 Ensure develop and enforce of
flour fortification law by 2016
% of industries
performing
fortification of
flour (% of chakki)
TBD
Availability of
iron fortified
flour
10 % (2 %
)
25 % (5 %
)
100 % (15 %
)
100 % (25 %
)
100 % (10 %
)
Subject to
implementation
Reduction in
low birth weight
babies by 50%
of existing
baseline (NNS
2011) by 2020 by
Improving
maternal health
2.14 Promote healthy timing and
spacing of pregnancy
Seminar
Conducted/
Campaign
launched
Nil
Record
maintained
√ √ √ √ √
Subject to
availability of
funds
2.15 Increase coverage of ANC by
health care providers
2.16 Provision of calcium and
vitamin D supplements to PLW
% of PLW
provided with
calcium and vit. D
supplements TBD
Record
Available;
Health
Department
(quarterly/
annual Reports)
10
%
25
%
50
%
75
%
10
0 %
Subject to
political
ownership and
availability of
funds
Page 130
2.17 Counseling of pregnant women
to take one extra meal and food
diversity in accordance with
food pyramid
% of pregnant
women aware with
food pyramid TBD
Record
Available;
Health
Department
(quarterly/
annual Reports)
20
%
30
%
40
%
50
%
60
%
Subject to
political
ownership and
availability of
funds
Reduce
prevalence of
stunting among
children of
under five years
from 39% to
27% ( 2%
reduction
annually by
2020
2.18 Increase in early initiation
within one hour from 15% to
60%
% of babies with
early initiation 15% Record
Available;
Health
Department
(quarterly/
annual Reports)
20
%
30
%
40
%
50
%
60
%
Subject to
implementation
2.19 Increase exclusive breast
feeding from 22% to 50%
% of babies with
exclusive breast
feeding 22%
25
%
30
%
35
%
40
%
50
%
Subject to
implementation
2.20 Increase the number of children
fed in accordance with all three
IYCF practices (breast milk
consumption, timely
introduction of solid foods,
food diversity, frequency and
consistency of weaning food.)
Addition in % of
babies fed in
accordance with all
three IYCF
practices
TBD
15
%
30
%
50
%
75
%
10
0 %
Subject to
implementation
2.21 %age of mothers aware of at
least two benefits of exclusive
breast feeding
% of mothers
having knowledge TBD
15
%
30
%
50
%
75
%
10
0 %
Subject to
implementation
2.22 Percentage of mothers aware of
all components of IYCF
practices.
% of mothers
having knowledge TBD
15
%
30
%
50
%
75
%
10
0 %
Subject to
implementation
2.23 %age of mothers able to
identify at least two signs of
childhood illness (e.g.
Pneumonia)
% of mothers
having knowledge TBD
15
%
30
%
50
%
75
%
10
0 %
Subject to
implementation
Page 131
Reduction in
acute
malnutrition
from 15% to 9%
by 2020
Reduction in acute malnutrition
from 15% to 9% by 2020
% of child
(prevalence) with
acute malnutrition 15%
Reports
Available 14
%
13
%
12
%
10
%
9 %
Subject to
political
ownership and
implementation
2.24 Increase in coverage of fully
immunized children from
34.6% to 90%.
% of immunized
children 34.6%
Reports
Available 40
%
50
%
60
%
75
%
90
%
Subject to
political
ownership and
implementation
2.25 Establishment of nutrition
treatment sites at 30% BHUs
and all RHCs of Province
% of BHUs and
RHCs with
nutrition treatment
sites
TBD
Reports
Available
5 %
10
%
15
%
25
%
30
%
Subject to
political
ownership and
availability of
funds
2.26 Establishment of Stabilization
Centers (SCs) in all DHQs &
Teaching Hospitals.
# of DHQs with
Stabilization
Centers (SCs) TBD
Reports
Available
5
10
15
25
36
Subject to
political
ownership and
availability of
funds
2.27 Increase in percentage of
identified SAM children
enrolled for treatment in
nutrition site.
% of unidentified
SAM children
approached TBD
Reports
Available 15
%
30
%
50
%
75
%
10
0 %
Subject to
political
ownership and
availability of
funds
Page 132
2.28 Increase percentage of
registered children successfully
treated for severe acute
malnutrition according to
national guideline protocols.
% of children
registered
(successfully
treated for SAM)
TBD
Reports
Available
Subject to
political
ownership and
availability of
funds
2.29 Provision of MMS sachet to
60% of identified MAM
children.
% of children
provided with
MMS sachet TBD
Reports
Available 25
%
30
%
40
%
50
%
60
%
Subject to
political
ownership and
availability of
funds
2.30 Increase in percentage of
children suffering from
diarrhea treated with ORS &
Zinc.
% of children with
diarrhea provided
with with ORS &
Zinc
TBD
Reports
Available 15
%
20
%
30
%
40
%
60
%
Subject to
political
ownership and
availability of
funds
Strategy 3: Strengthening capacity of Provincial and local governments on nutrition to provide basic services in an inclusive and
equitable manner
80% of Health
Care providers
trained on
Nutrition
3.1 Development of training
modules for different cadres
Training modules
developed TBD
Data/Record
Available √ √ Subject to
implementation
and subject to
funding 3.2 Trainings of Provincial master
trainers
# of master trained TBD
Data/Record
Available
50
10
0
20
0
30
0
50
0
3.3 Trainings of Community health
workers and health care
providers on Nutrition
% of Community
health workers and
health care
providers trained TBD
Certificate of
Completion,
Record
maintained,
10
%
20
%
50
%
75
%
10
0%
Page 133
Annex-2 Result Framework Analysis of Agriculture: Crop Sector
Strategy
Objective Strategy Action(s) Indicators
Base
Line
Means of
Verifications
TIME LINE (Years) Key
Assumptions Y
1
Y
2
Y
3
Y
4
Y
5
Strategy 1: Mainstreaming Nutrition in Agriculture
To develop Policy frame work to create enabling environment for mainstreaming Nutrition in Sector & improving multi-sectoral coordination by year 2015
1.1 Develop and promulgate Provincial Nutrition sensitive Agriculture Policy
Policy notification
TBD
Policy notified
√ √ √ √
Subject to
political
ownership and
Subject to
funding
1.2 Policy decision to add nutrition in IEC material of the agriculture sector
Policy notification
TBD
Policy notified
√ √ √ √
Subject to
political
ownership and
Subject to
funding
1.3 Develop Gender Sensitive and pro poor Provincial Food Security Strategy
Policy notification
TBD
Policy notified
√ √ √ √
Subject to
political
ownership and
Subject to
funding
Page 134
1.4 Advocacy with BISP for linking BISP beneficiaries with “Kitchen gardening Scheme”
No. of meetings
held with BISP
TBD
Minutes of
meeting
available
√ √ √ √ √
Subject to
political
ownership and
availability of
funding, Subject
to change in
policy of BISP
1.5 Policy to encourage increasing of female agriculture extension officer and field assistant
Policy notification
TBD
Policy notified
√ √ √ √
Subject to
political
ownership and
Subject to
funding
1.6 Enforcement of strict regulatory measures to control the sale of uncertified seeds, harmful pesticides and medicine with adverse effect on human health
Mechanism
notification/ no. of
monthly visits of
market in each
district
TBD
Reports and
result of action
taken Available
12 visits /an
nu
m/
districts
12 visits /an
nu
m/
districts
12 visits /a
nn
um
/
districts
12 visits /an
nu
m/
districts
Subject to
implementation
and subject to
industries
To build capacity
of implementing
staff at district
and UC level on
nutrition manual
1.7 Conduct training of district and UC level staff
% of staff trained
Nil
Certificate of
Completion,
Record
maintained,
0%
20%
50%
75%
100%
Subject to
implementation
and subject to
funding
Page 135
by 2016 1.8 Conduct training of farmers % of farmers
trained
Nil
Certificate of
Completion,
Record
maintained,
0%
20%
50%
75%
100%
Subject to
implementation
and subject to
funding
1.9 Create awareness among farmers on use of nutritious food, healthy dietary habits, hygiene and health
Seminar
Conducted
Nil Record
maintained √ √ √ √
Subject to
implementation
and subject to
funding
Strategy 2: Increase Productivity in nutritious food (by developing and promoting high yielding varieties of grains & pulses)
To develop, promote and increase the production of high yield varieties of pulses
2.0 To increase in production of the pulses 5% annually from the production of 2012-2013
Increase in
production
Mong:
78000
tons
Reports
available
80000
85000
90000
Subject to
funding and
seasonal
variation Mash:
6050
tons
7000
7500
8500
Lentil:
5420
tons
6000
6500
7500
Gram:
69100
0 tons
75000
0
80000
0
85000
0
2.1 Development of pre-basic/basic seed of high yielding varieties of pulses
Seed available and
tested TBD
Seed available √ √ √ √
Subject to
funding, Success
Page 136
of experiment
2.2 Promotion of certified seed by distribution among farmers at subsidized prices and demonstration of modern production technology and farmer gatherings
No. demo-plots
established
No. of visits of
community
TBD
Record
maintained
276
276
276
276
Subject to
implementation
and subject to
funding
2.3 Distribution of Seed (Mong, Mash & lentil) to Farmers
No. of seed bags of
40kg distributed TBD
Seed available
9067
13601
18134
Subject to
availability of
funds
2.4 Awareness (Mass media campaign, Farmer days, Seminars)
Campaign
launched; No. of
children/ (girls)
admitted in
schools
TBD
Education
Department
(quarterly/
annual Reports)
√ √ √ √ √
Subject to
political
ownership and
availability of
funds
Strategy 3: Equitable access to vegetables and fruits
To Develop, promote and increase production of vegetables (Vitamins and mineral sources)
3.1 Development & Provision of Good Quality Seed and Seedlings
Quality seed
available and
tested
TBD
Quality seed
available √ √ √ √
Subject to
funding, Success
of experiment
3.2 Promotion of certified seed by distribution among farmers at subsidized prices and demonstration of modern production technology and farmer gatherings
No. demo-plots
established
No. of visits of
community
TBD
Record
maintained
276
276
276
276
Subject to
implementation
and subject to
funding
Page 137
3.3 Distribution of Seed (Vegetables) to Farmers
No. of seed bags of
40kg distributed TBD
Seed available
10000
10000
10000
10000
Subject to
availability of
funds
3.4 Formation of tunnel haring on 50% cost for vegetable cultivation
No. of tunnels in
each districts TBD
Reports
available
1000
1000
1000
Subject to
availability of
funds
3.5 Awareness (Mass media campaign, Farmer days, Seminars)
No. of events
conducted TBD
Reports
available 10
72
72
72
72
Strategy 4: Addressing Malnutrition through bio-fortification
To develop zinc
fortified wheat
variety to reduce
zinc deficiency
4.1 Development &Production of zinc enrich wheat seed
Seed available and
tested TBD
Seed available
√ √ √ √
Subject to
funding and
success of
experiment
4.2 Promotion of certified fortified seed by distribution among farmers at subsidized prices and demonstration of modern production technology and farmer gatherings
No. demo-plots
established
No. of visits of
community
TBD
Record
maintained
276
276
276
276
Subject to
implementation
and subject to
funding
4.3 Distribution of Seed to Farmers No. of seed bags of
40kg distributed TBD
Seed available
10000
10000
10000
10000
Subject to
availability of
funds
Page 138
4.4 Awareness (Mass media campaign, Farmer days, Seminars)
No. of events
conducted TBD
Reports
available
10
72
72
72
72
Strategy 5: Scaling up of Kitchen gardening
To Increase
availability of
micronutrient
rich food
especially for
poor and
vulnerable
community
5.1 Promotion of kitchen gardening by conducting meetings of community in each UC (2 meetings/ UC/Month)
No. of meetings
conducted in each
UCs per annum
TBD
Record available
24
24
24
24
24
5.2 Provision of quality seed at subsidized rates
No. of seed packet
distributed 10000
0
Record available
45000
0
50000
0
55000
0
60000
0
65000
0
Subject to
availability of
funds
Strategy 6: Increase accessibility of animal protein sources at household level
Up-scale
household
livestock
production to
increase the
access to protein
rich foods
6.1 Promote backyard poultry farming by provision of subsidized layer chicken with cock to vulnerable community
No. of meetings
conducted in each
UCs per annum
TBD
Record available
24
24
24
24
24
6.2 Provision of small cattle of excellence genetic profile on subsidized rate for raring and future reproductive growth
Page 139
Annex-3 Result Framework Analysis of Agriculture: Livestock & Poultry
Strategy
Objective Strategy Action(s) Indicators
Base
Line
Means of
Verifications
TIME LINE (Years) Key
Assumptions Y
1
Y
2
Y
3
Y
4
Y
5
Strategy 1: Increase the productivity by sustainable livestock farming and capacity development to combat protein energy
malnutrition
To increase the
gross annual
meat production
from 3,379,000
tons in 2013 to
5,000,000 tons as
well as gross
milk production
from 49,512,000
tons in 2013 to
80,000,000 tons
by the end of
2020 (according
to Economic
Survey of
Pakistan)
1.0 (A) To increase the gross annual
meat production from 3,379,000
tons in 2013 to 5,000,000 tons
by the end of 2020 (according to
Economic Survey of Pakistan)
meat production
per annum in tons
3,3
79,0
00 to
ns
Annual Report
(Economic
Survey of
Pakistan)
4,0
00,0
00 to
ns
4,2
50,0
00 to
ns
4,5
00,0
00 to
ns
4,7
50,0
00 to
ns
5,0
00,0
00 to
ns
Subject to
political
ownership and
Subject to
funding
1.0 (B) To increase the gross
annual milk production from
49,512,000 tons in 2013 to
80,000,000 tons by the end of
2020 (according to Economic
Survey of Pakistan)
Milk production
per annum in tons
49
,51
2,0
00 to
ns
Annual Report
(Economic
Survey of
Pakistan)
55
,00
0,0
00 to
ns
60
,00
0,0
00 to
ns
65
,00
0,0
00 to
ns
70
,00
0,0
00 to
ns
80
,00
0,0
00 to
ns
Subject to
political
ownership and
Subject to
funding
1.1 Enhance livestock production
through adaptation of latest
technology (biotechnology &
genetic engineering,
improved reproductive
technologies, precision
animal breeding) and breed
improvement (implementation
& policy level)
Availability of
excellence genetic
profile breed/
Implementation
of latest
technology
TBD
Excellence
genetic profile
breed available
√ √ √ √
Subject to
funding, Success
of experiment
Page 140
1.2 Promote and provide various
livestock animals of excellence
genetic profile on subsidized
rate for raring and rapid
reproductive growth
(implementation & policy level)
Policy
notification TBD
Policy notified
√ √ √ √
Subject to
political
ownership and
Subject to
funding
1.3 Strengthen the easily provision
of cost effective and safe
livestock (cattle & poultry) feed
(implementation level)
Policy
notification TBD
Policy notified
√ √ √ √
Subject to
political
ownership and
Subject to
funding
1.4 Promote the latest embryo
transfer technology and provide
semen’s injections of excellence
genetic profile animals at free of
cost/subsidized cost
(implementation & policy level)
Availability of
excellence genetic
profile animal’s
semen
TBD
Excellence
genetic profile
animal’s semen
available
√ √ √ √ √
Subject to
funding, Success
of experiment
1.5 Increase the number of dairy
farms and milch animals (2-5%
annually) from the existing in
2012-2013 (implementation
level)
# of fish farms
TBD
New farm
established,
Record/Reports
available
5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
industries
1.6 Skills enhancement of livestock
sector’s individuals (staff &
farmers) by conducting trainings
at UC and districts level
(implementation level)
% of staff and
farmers trained Nil
Certificate of
Completion,
Record
maintained
0%
20
%
50
%
75
%
10
0%
Subject to
implementation
and subject to
funding
Page 141
Strengthen
veterinary
medical and
diagnostic lab
facilities by 2020
to control and
reduce the risk
of outbreak
1.7 Up-gradation of the existing lab
facilities for proper diagnosis &
safety testing of feeds and food
(milk & meat) in regions, where
the labs are already present but
are with limited capacity or non-
operational (implementation &
policy level)
Percent of labs up-
graded
TBD
Operational &
up-graded labs/
Record available
10
%
25
%
50
%
75
%
10
0 %
Subject to
political
ownership and
availability of
funds
1.8 Establishing new livestock
diagnostic lab facilities by the
end of 2019, in regions where
there is need but there are no
labs (implementation & policy
level)
# of districts with
new labs
established TBD
New operational
labs/ Record
available 10
20
30
36
Subject to
political
ownership and
availability of
funds
1.9 Provide various services at free
of cost (technical support,
vaccination, and veterinary
medical services) to control and
reduce the risk of outbreak
(implementation & policy level)
# of animal
vaccinated &
treated per annum
TBD Record
maintained
√ √ √ √ √
Subject to
implementation
and subject to
funding
Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access to livestock-based products
To increase the
gross annual
milk
consumption
from 39,945,000
tons in 2013 to
80,000,000 tons
2.1 Increase the awareness of
livestock-based protein sources
(meat, milk and egg) importance
and its consumption through
literature, extension services,
mass media campaigns and
education (implementation
level)
# of events/
seminars
conducted annually
(2 events/districts) Nil
Reports
available
10
72
72
72
72
Subject to
funding, Subject
to implementation
Page 142
as well as gross
eggs
consumption
from 13,813
million in 2013
to 20,000 million
by the end of
2020 (according
to Economic
Survey of
Pakistan)
2.2 Introduce and promote the value
added livestock-based (meat,
milk and egg) products
especially at school level
(implementation level)
# of new products
launched TBD
Reports
available 15
20
35
50
50
Subject to
implementation
and subject to
funding
2.3 Promote the consumption of egg
and poultry meat (5% annually
from existing in 2012-2013) so
that poor families may also
consumed protein with high
biological value at very low
price (implementation level)
Annual
consumption of
egg
13
,81
3 m
illion
Annual Reports
available
5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
funding
2.4 Promote the consumption of
milk and milk product (5%
annually from existing in 2012-
2013) to reduce the risk of
various essential nutrients
deficiency (implementation
level)
Annual
consumption of
milk in tons
39
,94
5,0
00 to
ns
Annual Reports
available
5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
funding
Introduce and
promote various
livestock-based
products by non-
conventional
indigenous
resources as
value addition
especially in
vulnerable
community to
reduce nutrient
2.5 Promote the consumption of
camel milk and its product to
uplift the economic situation of
community in desert area and
also to reduce the nutrient
deficiency (implementation
level)
Policy
notification/ TBD
Policy notified
√ √ √ √ √
Subject to
political
ownership,
Subject to
implementation
2.6 Introduce various milk products
(like cheese, whey protein,
casein, ice cream, chocolates,
bioactive peptides etc.)
especially from camel milk as
value addition (implementation
level)
# of new products
launched
TBD
Reports
available
5
10
15
20
20
Subject to
implementation
and subject to
funding
Page 143
deficiency by
2017
2.7 Launch various research project
and strengthen/scaling up the
existing ones to develop various
value added products from non-
conventional indigenous
resources (implementation
level)
# of project
launched each
year Nil
Project
launched/
Reports
available 5 5 5 5 5
Subject to
implementation
and subject to
funding
To ensure and
improve safe as
well as quality of
livestock
products from
farm to fork by
2020
2.8 Enhance the quality of the
livestock-based products (meat,
egg, milk etc.) by introducing
the modern and safe processing
techniques, and supply chain
(cold storage, good
transportation etc.)
(implementation level)
Policy notification
TBD
Policy notified
√ √ √ √ √
Subject to
political
ownership and
Subject to
funding
2.9 Increase availability of quality
of livestock-based products
(meat, egg, milk etc.) in local
markets (10% annually from
existing in 2012-2013) and
develop the mechanism to
control the increases in prices
(policy level)
Amount of
livestock based
product sale in
local markets TBD
Reports
available
10
%
20
%
30
%
40
%
50
%
Subject to
implementation
and subject to
funding
2.10 Mandatory Safety/Management
Certification of large livestock
farms in five years, medium size
in 10 years, and all livestock
farms in 15 years
% of livestock/
poultry farms
certified TBD
Certificate
available,
Record
maintained,
5%
10%
15%
20%
30%
Subject to
implementation
by PFA and
subject to
industries
Page 144
2.11 Continuous professional
development, capacity
enhancement, trainings and
awareness campaigns for all
involved in food supply chain
starting from producers to
consumer desk
No. of institutes
offering CPD and
Training programs
(No. of person
trained)
TBD
Programs
launched and
trained persons
5 (2
50)
10
(50
0)
15
(75
0)
20
(10
00
)
20
(10
00
)
Subject to
subject to funds
and subject to
institutes
Strategy 3: Increase accessibility of animal protein sources at household level especially for vulnerable community
Up-scale
household
livestock
production to
increase the
access to
protein rich
foods
3.1 Promote backyard poultry
farming by provision of
subsidized layer chicken with
cock to eligible families
(women) (Implementation
level)
# of meetings
conducted in each
UCs per annum TBD
Record
available 24
24
24
24
24
No. of meetings
conducted in
each UCs per
annum
3.2 Provision of small cattle of
excellence genetic profile on
subsidized rate for raring and
future reproductive growth
(Implementation level)
# of animal (with
excellence genetic
profile) distributed
each year on
subsidized rate
TBD
Record
available 10
00
20
00
50
00
50
00
50
00
Subject to
implementation
and subject to
funding
To create
enabling
environment for
mainstreaming
Nutrition in
Sector &
improving
multi-Sectoral
coordination by
year 2015
3.3 Create linkages of livestock
department with BISPs program
“Wasela-e-Rozgar” and
upcoming new social protection
schemes to support for ultra-
poor segment of the society by
up-scaling home based livestock
and backyard kitchen farming
(Implementation level)
Policy notification
TBD
Record
available √ √ Subject to
political
ownership/
Subject to funds/
Subject to
beneficiaries to
implement on
kitchen farming
(never sell out)
# of families
provided with
cattle
Record
available/
families with
cattle
500
1000
5000
5000
# of families
provided with
layers
Record
available/
families with
layers
5000
10000
50000
50000
Page 145
Annex-4 Result Framework Analysis of Agriculture: Fisheries
Strategy
Objective Strategy Action(s) Indicators
Base
Line
Means of
Verifications
TIME LINE (Years) Key
Assumptions Y
1
Y
2
Y
3
Y
4
Y
5
Strategy 1: Capacity Development: Strengthening the fisheries sector to increase the productivity by scaling up the existing resources to combat protein energy malnutrition
To increase the production of fish from 594,935 tons in 2011 to 800,000 tons by the end of 2020 (according to FAO Statistics)
1.0 To increase the production of fish from 594,935 tons in 2011 to 800,000 tons by the end of 2020 (according to FAO Statistics)
Fish production
per annum in tons
594,935 to
ns
Annual Report
(FAO)
62
0,0
00
ton
s
65
0,0
00
ton
s
70
0,0
00
ton
s
75
0,0
00
ton
s
80
0,0
00
ton
s
Subject to
political
ownership&
implementation
1.10 Increase the number of hatcheriesfrom 88 to 150 by the end of 2020 to ensure the availability of high quality seed (implementation level)
# of hatcheries
88
# of hatcheries
established/
Record/Reports
available 95
105
120
135
150
Subject to
political
ownership and
Subject to
funding
1.11 Promote and strengthen the economical fish-feed production (implementation level)
Policy notification
TBD
Policy notified
√ √ √ √ √
Subject to
political
ownership and
Subject to
funding
Page 146
1.12 Development and provision of seed of high yielding varieties of various fish species by some genetic modification (implementation level)
High yielding fish
seeds available and
tested TBD
Seed available/
Record maintain √ √ √ √ √
Subject to
political
ownership and
Subject to
funding
1.13 Promotion of high yielding fish-seed (lowest price of available protein) by distribution among farmers at subsidized prices and demonstration of modern production technology to reduce pre & post-harvest losses (implementation level)
Seed availability at
subsidized prices
# of demo-farm
established
TBD
Policy notified/
Farm
established
√
10
√
20
√
30
√
50
√
50
Subject to
political
ownership and
availability of
funding
1.14 Skills enhancement of fishery sectors individuals (staff & farmers) by conducting trainings at UC and districts level (implementation level)
% of staff and
farmers trained Nil
Certificate of
Completion,
Record
maintained
0%
20
%
50
%
75
%
10
0%
Subject to
implementation
and subject to
funding
1.15 Increase the number of fish farms (5% annually) from the existing in 2012-2013(implementation level)
# of fish farms
TBD
New farm
established,
Record/Reports
available
5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
industries
1.16 Increase the capacity of the existent fish farms (10% annually)by the end of 2020(implementation level)
# of fish farm with
increased capacity
TBD
Farm with
increased
capacity,
Record/Reports
available
10
%
20
%
30
%
40
%
50
%
Subject to
implementation
and subject to
funding
Page 147
1.17 Promote the Trout fish farming in natural water resources to increase the Trout production (5% annually from existing in 2012-2013)(implementation level)
Annual production
of trout fish in tons TBD
Annual Reports
available
5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
funding
1.18 Initiate shrimp cultivation in the Indus delta to increase the shrimp production (5% annually from existing in 2012-2013)(implementation level)
Annual production
of shrimp fish in
tons TBD
Annual Reports
available 5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
funding
Strategy 2: Reduce nutrient deficiency in targeted groups by increasing the physical access to aquaculture/fish food
To increase the per capita consumption of fish from 2 kg/year to 5 kg/year by the end of 2020 through awareness, value addition and cost effective fish products
2.0 To increase the per capita consumption of fish from 2 kg/year to 5 kg/year by the end of 2020 through awareness, value addition and cost effective fish products
Per capita fish
consumption in
kg/Year
2.0kg per year
Annual Reports
available 2.5 kg/yea
r
3.0 kg/yea
r
3.5 kg/yea
r
4.0 kg/yea
r
5.0 kg/yea
r Subject to
funding, Subject
to
implementation
and success of
policies
2.1 Increase the awareness of fish meat importance and its consumption through literature, extension services, mass media campaigns and education (implementation level)
# of events/
seminars
conducted
annually (2
events/districts)
Nil
Reports
available
10
72
72
72
72
Subject to
funding, Subject
to
implementation
2.2 Introduction of value added fish products such as fish cookies, fish chips, fish biscuits, fish nan/chappaties, fish cakes, fish salads, fish samosa, fish biryani, and nimko, etc.
# of fish products
launched TBD
Reports
available
5
10
15
20
20
Subject to
implementation
and subject to
funding
Page 148
(implementation level)
2.3 Promote the consumption of small size fish (5% annually from existing in 2012-2013)so that poor families may also consumed with low price (implementation level)
Annual
consumption of
small fish in tons TBD
Annual Reports
available
5%
10
%
15
%
20
%
25
%
Subject to
implementation
and subject to
funding
To ensure and
improve safe as
well as quality of
fish from farm to
fork
2.4 Enhance the quality of the fish by introducing the modern and safe processing techniques, cold storage, good transportation and improvement in marketing channel, etc. (implementation level)
Policy notification
TBD
Policy notified
√ √ √ √ √
Subject to
political
ownership and
Subject to
funding
2.5 Enhance the coastal aquaculture production and increase availability(10% annually from existing in 2012-2013) in local inland markets (implementation level)
Amount of fish sale
in local inland
markets (in tons) TBD
Reports
available 10
%
20
%
30
%
40
%
50
%
Subject to
implementation
and subject to
funding
Page 149
Annex-5 Result Framework Analysis of Food Sector
Strategy Objective
Strategy Action(s) Indicators Base Line
Means of Verifications
TIME LINE (Years) Key Assumptions Y
1 Y 2
Y 3
Y 4
Y 5
Strategy 1: Physical access to food throughout the year for all targeted groups
Increase in storage capacity from existing level to 80% by 2020
1.19 Replace wheat storage from bag to silos storage (Policy level)
No. of districts containing silos facilities for storage
TBD
No. of Silo in each districts/ Food Department Reports
5
10
15
20
Subject to political ownership and availability of funds
Ensure access to food throughout the year
1.20 Explore avenues for Public and Private partnership to preserve and increase storage perishable commodities at their peak harvesting for year-long availability at affordable price (Policy level)
Policy notification
TBD
Policy notified
√ √ √ √
Subject to political ownership and Subject to Private partner
1.21 Introduce the applications of cost effective modern technologies to improve food supply chain and reduce post-harvest losses (i.e. preservation by irradiation, integrated pests & rodents control systems, etc.) (Policy level)
Policy notification
TBD
Policy notified/ promulgation material available √ √ √ √
Subject to political ownership and subject to adoption of new technologies
1.22 Introduce and promote cold supply chain to increase the safety of high risk food (Policy level)
Notification& direction issued
TBD
Notification& directive available √ √ √ √ √
Subject to political ownership and availability of funds
Page 150
Strategy 2: Ensure and improve food quality from farm to fork
Strengthen lab facilities to ensure food safety and quality by 2016
2.5 Up-gradation of the existing lab facilities for wheat quality & safety testing in regions, where the labs are already present but are with limited capacity or non-operational(Policy level)
Percent of labs up-graded
TBD
Operational & up-graded labs/ Record available
10
%
25
%
50
%
75
%
10
0 %
Subject to political ownership and availability of funds
2.6 Establishing new lab testing facility in regions where there is need but there are no labs (policy level Level)
No. of districts with new labs established TBD
New operational labs/ Record available
10
20
30
36
Subject to political ownership and availability of funds
Strategy 3: Provision of safe food
Strengthen and extension of Punjab Food Authority to improve food safety
3.6 Phase-wise extending the Punjab Food Authority to whole of Punjab by 2020 (Policy level)
No. of Districts in which department of PFA established 2
Active PFA department in respective districts
2
5
15
25
36
Subject to political ownership and availability of funds
3.7 Establishing lab facilities at district level parallel with the extension of Punjab Food Authority for safety & quality testing of food products(Policy level)
No. of districts with new labs established (parallel to extension of PFA)
1
New operational labs/ Record available
2
5
15
25
36
Subject to political ownership and availability of funds
Improve the food safety management systems by legislation, promulgate and implement
3.8 Improving the capacity of inspection services through Revising and harmonizing the food rules with (Codex Alimentarious Commission (CAC), OIE, and IPPC) (implementation Level)
Revision of Rules
TBD
Notification& directive available
√ √ √ √ √
Subject to political ownership and subject to facilities available
3.9 Continuous professional No. of institutes TBD Programs 5 (250) 10 (500) 15 (750) 20 (1000) 20 (1000) Subject to
Page 151
development, capacity enhancement, trainings and awareness campaigns for all involved in food supply chain starting from producers to consumer desk
offering CPD and Training programs (No. of person trained)
launched and trained persons
subject to funds and subject to institutes
3.10 Promoting and advising to get Food Safety Management Certification like HACCP, BRC, ISO-22000 etc. by food business operators, targeting specifically the large industries and high risk food processors for 3 years
% of Large food business certified
TBD
Certificate available, Record maintained,
10%
25%
50%
75%
100%
Subject to implementation by PFA and subject to industries
3.11 Mandatory Food Safety Certification of large food industries in five years, medium size in 10 years, and all food business operation in 15 years
% of medium and small food business certified
TBD
Certificate available, Record maintained,
5%
10%
15%
20%
30%
Subject to implementation by PFA and subject to industries
Strategy 4: Economic Access to food
Improve the economic access to food by subsidies and price control and regulation mechanism
4.1 Targeted and conditional food subsidies for poor instead of generic subsidies and will be linked with inflation rate by 2014(Policy level)
Availability of low price food in market
TBD
Price of food
√ √ √ √
Subject to political ownership and availability of funds
4.2 Putting in place the price control and regulation mechanism especially for staple food (Policy level)
Strategy 5: Reduce micronutrient deficiency in adolescents girls, pregnant & lactating mothers and children’s through fortification
Page 152
Promulgate and implement, legislation regarding fortification of food by 2016
5.1 Create awareness on benefits for use of fortified flour, salt and edible oil (Policy level)
Seminar Conducted/ awareness material distributed
TBD
Record maintained
√ √ √ √ √
Activity is supposed to be taken initially with support of donors and later on from ADP
5.2 Legislation of mandatory wheat flour fortification with iron and folic acid by 2016 for flour milling industry and in five years in flour grinding industry (chakki flour) (policy level)
% of industries performing fortification of flour (% of chakki)
TBD
Availability of iron fortified flour
25 %(5 %
)
100 %(1
5 %)
100 % (25 %
)
100 % (50 %
)
Subject to implementation
5.3 Legislation on mandatory universal salt iodization by December 2014 (policy level)
% of industries performing fortification of iodine
TBD
Availability of iodized salt
40 %
50 %
100 %
100 %
100 %
Subject to implementation
5.4 Devise implementation strategy to ensure Vitamin A and Vitamin D fortification in ghee and oil(Implementation level)
% of industries performing fortification of Vitamin A & Vitamin D
TBD
Availability of Vitamin A & D fortified ghee and oil
40 %
50 %
100 %
100 %
100 %
Subject to implementation
Page 153
Annex-6 Result Framework Analysis of WASH Sector
Strategy Objective
Strategy Action(s) Indicators Base
Line
Means of Verifications
TIME LINE (Years) Key Assumptions Y
1 Y 2
Y 3
Y 4
Y 5
Strategy 1: Equitable access to safe & clean water
To increase the
access to water
and reduce the
arduous labour
of women in
carrying it in
all vulnerable
communities
by 2020
Increase the access to water and
reduce the arduous labour of
women in carrying it in all
vulnerable communities by 2020
Increase in %
population having
access to improve
source of drinking
water
94.1%
Report
Available/
MICS survey
report
95
%
97
%
99
%
10
0%
10
0
10
0%
Subject to
political
ownership and
availability of
funds
1.1 Provide drinking water under
Changa Paani Programme
through early implementation
and completion of project by
2020 (Implementation level)
# of districts
(villages in
districts) launched
Changa Paani Programme
TBD
Programme
launched
5
10
15
20
36
Subject to
political
ownership and
availability of
funds
1.2 Provide clean drinking water by
installing filtration plants under
Saaf Paani Programme through
early implementation and
completion of project by 2020
(Implementation level)
# of districts
(villages in
districts) launched
Saaf Paani Programme
TBD
Programme
launched
5
10
15
20
36
Subject to
political
ownership and
availability of
funds
1.3 Provide hand pumps in areas
where the provision of tap
water facility is currently not
feasible (Implementation
Level)
# of hands pump
provided
TBD
Hand pump
functional
(Record
maintained)
1000
2000
2000
2000
2000
Subject to
political
ownership and
availability of
funds
1.4 Rehabilitation of dysfunctional
rural water supply schemes
(Implementation Level)
Notification &
direction issued to
release funds TBD
Notification &
directive
available √ √ √ √ √
Subject to
political
ownership and
availability of
funds
Page 154
1.5 Ensure availability of safe
drinking water by installation of
water filtration plants in schools
(Implementation Level)
% of schools
having functional
water filtration
plants
Nil
No. water
Filtration plants
installed in
institutes
10
%
25
%
50
%
10
0 %
% of schools
having
functional water
filtration plants
To increase
access to
clean/safe
drinking water
in all
vulnerable
communities
by 2020
1.6 Install of water filtration plants
to ensure provision of safe
drinking water
# of water filtration
plants installed
TBD
Water filtration
plants functional
(Record
maintained)
500
500
500
500
500
Subject to
political
ownership and
availability of
funds
1.7 Initiate water treatment projects
at household and community
level by distribution of
chlorinating tablets etc.
Project launched
(# of packet of
chlorine tablets
distributed) TBD
Chlorine tablets
distributed 5000
15000
10000
0
10000
0
10000
0
Subject to
political
ownership and
availability of
funds 1.8 Establish water quality testing
facilities and regular sampling
of water from various water
projects starting from water
source to household level
# of districts with
new labs
established TBD
New operational
labs/ Record
available
5
10
20
30
36
Subject to
political
ownership and
availability of
funds
1.9 Introduce community based
effective monitoring
mechanism using elected UC
representatives, school councils
and CBOs
Mechanism
defined;
Committee notified TBD
Minutes of
meeting
√ √ √ √ √
Subject to
political
ownership
1.10 Plan and introduce proper
operation and maintenance
mechanism for keeping the
facilities operational
Mechanism
defined; Strategy
planned TBD
Record
maintained √ √ √ √ √
Subject to
political
ownership
To reduce
misuse and
depletion of
1.11 Increase water conservation
with increased and improved
water storage capacity
# of water
conservation tanks
build TBD
Record
maintained
50
10
0
10
0
10
0
Subject to
implementation
and subject to
funding
Page 155
ground water
1.12 Launch a campaign for
awareness to reduce water
wastage and misuse
Seminar
Conducted/
Campaign
launched Nil
Record
maintained
√ √ √ √ √
Subject to
availability of
funds; Activity
is supposed to
taken initially
with donor
money and later
on from ADP
Strategy 2: Promote best practices & behavioral change regarding hygiene practices
To Launch
campaign and
awareness
programs to
promote hygiene
practices
Launch campaign and
awareness programs to
promote hygiene practices
% of rural people
having knowledge
of good practices of
sanitation, health &
hygiene
TBD
Report of survey
conducted 10
%
25
%
50
%
10
0 %
10
0 %
Subject to
availability of
funds
2.1 Conduct awareness campaigns
an community sessions through
integration approach by
community workers like
SH&NS, LHW, CMW,
agriculture field assistant,
school teachers, civil society,
union council, CBOs,
KHATTEEB of local
MASAJIDS (AUQAF Dept.)
and local media (Policy Level)
Seminar
Conducted/
Campaign launched
Nil
Record
maintained
√ √ √ √ √
2.2 Celebrate the Mother & Child
Week, Global Hand Washing
Day, World Toilet Day and
World Water Day, Anti-
Dengue Day to promote
hygiene practices
(Implementation Level)
2.3 Develop IEC material on
nutrition containing guidelines
of health and hygiene practices
Officially
announcement of
dates for TBD
Day Celebrated
& Record
available √ √ √ √
Subject to
implementation;
Activity is
Page 156
(Policy Level) celebration of days
supposed to
taken initially
with donor
money and later
on from ADP 2.4 Creative inclusion of sanitation,
hygiene and preventive
approaches dressing
malnutrition in school
curriculum in coordination with
School Education Department
and Punjab Curriculum
Authority (Policy Level)
Curriculum
reviewed and
Chapter added on
Nutrition and
Hygiene
Nil
Revised
curricula
available
√ √ √
Subject to
implementation
Strategy 3: Equitable access to Total Sanitation Services
To decrease
ODF 22% to
10% in province
in Punjab by
2020
3.1 Conduct pilot project of PATS
in high risks districts (Rajanpur,
Muzaffargarh, DG Khan,
Chinniot and Jhang) by 2015
# of districts with
PATS
implemented TBD
PATS
implemented,
Records
available
5
10
20
30
36
Subject to
political
ownership and
availability of
funds 3.2 Scaling-up the Pakistan
Approach for Total Sanitation
in all districts of Punjab after
the evaluation of Pilot Project
by 2020
Installation of
sewerage
treatment units
by 2020
3.3 Install small scale sewerage
treatment units especially with
prioritization in those large
villages (Implementation
Level)
# of sewerage
treatment units
installed TBD
Functional
sewerage
treatment units
15
25
10
0
10
0
10
0
Subject to
political
ownership and
availability of
funds
3.4 Install small scale solar
sewerage treatment plants
(Implementation Level)
# of sewerage
treatment units
installed TBD
Functional
sewerage
treatment units
15
25
10
0
10
0
10
0
Subject to
political
ownership and
availability of
funds
Installation of 3.5 Improve solid waste # of solid waste TBD Functional 15
25
100
100
100 Subject to
Page 157
solid waste
management
plants by 2020
management schemes and
mechanism through
establishment of solid waste
management plants in all over
the Punjab to treat agriculture,
sewerage and domestic solid
waste (Implementation Level)
management plants
treatment units
installed
SWM plants political
ownership and
availability of
funds
3.6 Install composting plants in
large cities to manufacture
compost fertilizers from this
waste (Implementation Level)
# of composite
plants installed
TBD
Functional
composite
plants
5
10
10
10
10
Subject to
political
ownership and
availability of
funds To ensure
availability of
facilities of
quality hygiene
and sanitation
practices at
100% schools by
2019
(especially in
girls school)
3.7 Provide WASH facilities, like
soap and toilets, in schools in
collaboration with School
Education Department (Policy
Level)
% of schools
having soaps in
toilets
TBD EMIS
50
%
70
%
10
0 %
10
0 %
10
0 %
% of schools
having soaps &
toilets
Strategy 4: Development and implementation of Policies and Strategies
Formulation of
nutrition and
gender sensitive
policies &
strategies of
WASH sector
4.1 Approval and dissemination of
Punjab Drinking Water Strategy
by 2015 (Policy Level)
Policy
notification &
direction issued
TBD
Policy
notification &
directive
available/
promulgation
material
available
√ √ √ √ √
Subject to
political
ownership and
subject to
implementation 4.2 Approval and dissemination
Punjab Sanitation Policy and
Strategy by 2015 (Policy Level)
4.3 Approval and dissemination
Behavior Change
Communication Strategy by
2015 (Policy Level)
Page 158
4.4 Approval, dissemination &
implementation of Punjab
Municipal Water Act 2013
(Policy Level)
4.5 Prioritize the preparing the
WASH sectoral Nutrition
Strategy & Operational plan
and its effective implementation
Page 159
Annex-7 Result Framework Analysis of Social Protection Sector
Strategy
Objective Strategy Action(s) Indicators
Base
Line
Means of
Verifications
TIME LINE (Years) Key
Assumptions Y
1
Y
2
Y
3
Y
4
Y
5
Strategy 1: Strengthen social protection sector to scale-up nutrition-sensitive interventions
Expedition of
approval,
dissemination,
and
implementation
of nutrition-
sensitive social
protection
related drafted
strategies and
act(s)
1.1 Establishment of Social
protection authority (Policy
level)
Notification &
direction issued to
establish authority Nil
Notification &
directive
available √
Subject to
political
ownership and
availability of
funds
1.2 Prioritize the preparing the
existing policies/ legislation of
Social Protection sectoral more
nutrition-responsive and its
effective implementation
(Policy level)
Amendments in
policies &
legislations TBD
Record
maintained
√ √ √
Subject to
political
ownership
1.3 Develop nutrition specific
legislations about Zakat, Bait-
ul-Mall, and PVTC (policy
level)
Revision of Rules
TBD
Notification &
directive
available √
Subject to
political
ownership and
subject to funds
available
Page 160
1.4 Increase coordination between
federation and federating units
on nutrition-sensitive social
protection (Policy level)
MoU signed with
other sectors
(governmental,
privates, NGOs etc.) TBD
Meetings and
record maintain
√ √ √ √ √
Subject to
political
ownership and
subject to
consent of other
sectors
To create
enabling
environment for
mainstreaming
Nutrition in
Sector &
improving
multi-Sectoral
coordination by
year 2015
1.5 Develop and strengthen
linkage with LHWs, SH&NS,
teachers, local NGOs for
promoting social aspects of
addressing malnutrition
(Develop a mechanism of
coordination to implement on
strategies)
(Implementation level)
Policy notification
& direction issued/
Mechanism of
coordination
developed
TBD
Policy
notification &
directive
available
√
Subject to
political
ownership and
subject to
consent of
partners
1.6 Initiate screening through
School Health and Nutrition
Supervisors, response in
coordination with health
department to integrate
nutrition intervention with
women and children focused
approach (Implementation
level)
# of visits of
doctor/physician and
School Nutrition
Health Supervisor
TBD
12 visits per
annum per
school √ √ √ √ √
Subject to
implementation
1.7 Mapping of districts through
impartial surveys, and
utilization of this data to
strengthen nutrition
interventions of social welfare
department (Implementation
level)
# of districts of
which survey
performed and map
developed TBD
Record
available/
Developed map 2
5
15
25
36
Subject to
political
ownership and
availability of
funds
1.8 Create linkages of livestock
department with BISPs program
Policy notification TBD Record available √ √ Subject to
political
Page 161
“Wasela-e-Rozgar” and
upcoming new social protection
schemes to support for ultra-
poor segment of the society by
up-scaling home based livestock
and backyard kitchen farming
(Implementation level)
# of families
provided with cattle
Record
available/
families with
cattle
50
0
10
00
50
00
50
00
ownership/
Subject to funds/
Subject to
beneficiaries to
implement on
kitchen farming
(never sell out)
# of families
provided with layers
Record
available/
families with
layers
50
00
10
00
0
50
00
0
50
00
0
# of families
provided with
vegetables & fruits
seeds
Record
available/
families having
seeds
50
00
10
00
0
50
00
0
50
00
0
1.9 Advocacy with BISP for linking
BISP beneficiaries with
“Kitchen gardening Scheme”
(Implementation level)
No. of meetings held
with BISP
TBD
Minutes of
meeting
available
√ √ √ √ √
Subject to
political
ownership and
availability of
funding,
Subject to
change in
policy of BISP
Strategy 2: Improving the economic access to nutritional needs by poverty alleviation and social protection
By 2015,
introduce cash
transfer system
for improving
the economic
2.1 Link the cash transfer via
vouchers and assistance from
BISP with evident based
nutrition need (Implementation
level)
% of BISP
beneficiaries
receiving voucher
based on nutrition
need
TBD
Record
maintained/
Families
receiving
voucher
10
%
40
%
80
%
10
0 %
10
0 %
Subject to
political
ownership and
availability of
funds
Page 162
access to
adequate food to
meet minimum
nutritional needs
2.2 Link cash transfer amounts to
provincial food price indices so
that real value remains constant
(Implementation level)
% of BISP
beneficiaries
receiving amount
based on food price
TBD
Record
maintained/
Families
receiving
voucher
10
%
20
%
40
%
70
%
10
0 %
Subject to
political
ownership and
availability of
funds
2.3 Conduct research intervention to
assess the impact on improving
nutrition through cash transfer
scheme (BISP data could be
used), and implement impartial
program monitoring with third
party validation
(Implementation level)
Research conducted/
Dissemination of
knowledge
TBD
Reports and
research papers
available
√ √ √ √
Subject to
availability of
funds
By 2015,
introduce
conditional cash
transfer (CCT)
policies with the
intention of
targeted
approach
2.4 Introduce conditional cash
transfer (CCT) and make BISP
or any other such program
conditional for beneficiaries to
enroll their daughters in schools
(Policy level)
% of BISP
beneficiaries
families admitted
their daughter in
schools Nil
Certificates of
admission
received from
each family 15%
30%
50%
75%
100%
Subject to
political
ownership and
availability of
funding,
Subject to
change in
policy of BISP
2.5 Piloting of a conditional cash
transfer program using
vouchers and linked to the
utilization of health and
nutrition services by target
population groups, while being
particularly attentive to supply
side constraints which may be
encountered by these groups
(Policy level)
Pilot project
conducted/
Dissemination of
knowledge Nil
Reports
available
√ √ √ √
Subject to
availability of
funds
Page 163
2.6 Targeted and conditional food
subsidies for poor instead of
generic subsidies and will be
linked with inflation rate by
2014 (Policy level)
Availability of low
price food for poor
in market Nil
Price of food
√ √ √ √
Subject to
political
ownership and
availability of
funds
Strategy 3: Promote nutrition awareness for healthy dietary practices
To use Social
Protection
Sector platform
for promoting
nutrition
awareness for
healthy & safe
dietary
practices in
poorest
community of
Punjab
1.1 Seminars/ workshops in
industrial homes (1 day - 1 week
nutrition specific trainings in
Sanat-Zars) (Implementation
level)
# of events
conducted in each
districts per annum Nil
Reports
available
12
24
48
48
48
Subject to
political
ownership and
availability of
funds
1.2 Seminars/ workshops in PVTC
(1week-15days nutrition
module to Zakat families)
(Implementation level)
# of events
conducted in each
districts per annum Nil
Reports
available
12
24
48
48
48
Subject to
political
ownership and
availability of
funds
1.3 Seminars/ workshops in Rescue
homes (Darul-aman)
(Implementation level)
# of events
conducted in each
districts per annum Nil
Reports
available
12
24
48
48
48
Subject to
political
ownership and
availability of
funds
1.4 Enhance nutrition awareness
through distributing IEC
material poorest 2,50,000 zakat
families of Punjab using zakat
committees (25,000)
(Implementation level)
Development of IEC
material and its
distribution Nil
IEC material
developed and
distributed in
families
√ √ √
Subject to funds
and subject to
institutes
Page 164
Annex-8 Result Frame work for M&E
Results
Chain
Descriptive
Summary
Indicators of Work Performance Means of
Verification
Responsiblity
Goal Improved human
capital, especially
among the poor
segments of society by
improved maternal and
child nutrition and
health status
Eliminate chronic under-nutrition by the year 2020 PDHS, MICS P&D
Purpose Strengthened
multisector
efforts
and other stakeholders
to improve access to
quality nutrition
services for
improved nutrition in
Punjab
By the end of 2020:
• % prevalence of stunting among children under -5
years reduced below 20%
• % prevalence of underweight among children under-5
years reduced below 15%
• % prevalence of wasting among children under-5
years reduced below 10%
• % of women with iron deficiency anemia reduced
below 30%
• % of babies born with low birth weight (<2,500
grams) reduced
• % of children and adolescents (boys and girls) not
completing primary and basic school education
reduced
PDHS, MICS, P&D
Outcomes 1: Policies, plans and
multi-sector
Coordination
improved at Provincial
& district levels.
By the end of 2020:
• Multi-sector commitment and resources for nutrition
are increased to at least 10% annually
• Nutritional information management and data
analysis strengthened and are used to track progress.
• Protocol established for nutrition profiles (as basis for
planning) at local level
Sectoral progress
reports
P&D all Sectors
2: Practices that
promote optimal use of
nutrition ‘specific’ and
nutrition ‘sensitive’
By the end of 2020:
• MIYC micronutrient status (Vitamin A, Iodine,
Anemia) improved
• % of children decreased with Vitamin A deficiency
Routine reporting Health,
Page 165
services improved,
leading to enhanced
maternal and child
nutritional status
% increase in households using iodized salt.,
% increase in use of zinc in management of
diarrhoea with new ORS)
• Comprehensive Training Package on Nutrition
adapted and rolled-out
• % of mothers and infant and young child feeding
practicing improved as per the recommendations
• % of children with SAM accessing services on Severe
Acute Malnutrition (SAM ) management as per
SPHERE standards increased especially in the most
affected districts
•Prevalence of infections (especially diarrhoea and
ARI) reduced
Adolescent girls awareness and behaviors in relation to
protecting foetal, infant and young child growth
improved
• Parents better informed with regard to avoiding
growth faltering
• Nutritional status of adolescent girls improved
(especially anemia)
• Primary and secondary school enrolment increased,
particularly for girls
Routine reporting Health
• All young mothers and adolescent girls use improved
sanitation facilities
• All young mothers and adolescent girls use soap to
wash hands at critical times
• All young mothers and adolescent girls as well as
children under 2 use improved drinking water
Routine reporting
of sectors
WASH, Health
• Food and nutrition security and agriculture strategy
aligned with nutrition objectives
• % women with heavy workload during pregnancy and
Post partum reduced.
Agriculture,
3: Strengthened capacity
of provincial and local
governments on
nutrition to provide
basic services in an
inclusive and equitable
Nutrition capacity of implementing Nutrition Strategic
Plan strengthened as per evidence-based capacity
building strategy
• Nutrition integrated into local planning and
monitoring
system
P&D, All participating sectors
Page 166
manner • Collaboration between local bodies’ health,
agriculture, social welfare, and education sector
strengthened at district and UC level
• Social protection measures designed and introduced
to prevent and reduce malnutrition in marginal
population groups with a focus on the critical window
of opportunity– from conception to two years of age
Outputs
Outcome 1: Policies, plans and multi-sector nutrition coordination improved at Provincial and district levels.
Output 1 Policies and plans
updated/reviewed to
incorporate a core set of
nutrition specific/
sensitive
Indicators at Provincial
and district levels.
By the 2014, annual and multiyear plan of all the
relevant sectors reflect indicators and targets on
contribution for reduction of malnutrition
• By the end of 2015, Nutrition related targets and
indicators incorporated in district level plans
Multisectoral
nutrition progress
report (quarterly,
annually)
P&D (Nutrition Cell at PSPU),
PMAC
Output 2 Multi-sector nutrition
coordination
mechanisms functional
at Provincial and
District levels.
High Level Nutrition and Food Security Steering
Committee and coordination mechanisms functional
at Provincial level ( Already Functional in P& D)
• Technical Working Group functional at Provincial
level ( Already functional in PSPU )
By the end of 2014, Nutrition and Food security
steering committee functional at district level with
necessary resources
• By the July 2015, Majority of the planned nutrition
programmes coordinated and monitored by DSC at
district and sub district level..
• By the end of 2015, frequency of joint monitoring
visits by provincial level stakeholders ( Sectors, donors
& UN agencies ) increased.
Multisectoral
nutrition progress
report (quarterly,
annually)
P&D (Nutrition Cell at PSPU),
PMAC (all participating Sectors
Output 3 Bussiness
network/public private
partnership identified
and implaced
Establish Business Network for nutrition at provincial
level:
Nominate focal point or steering group
business network focal point reaches out to
Government Focal Point and other Networks and
liaises at provincial and district level
Organise multi-stakeholder convenings to define
potential contributions by the private sector and agree
on ways of working with all sectors
Multisectoral
nutrition progress
reports
P&D nutrition Cell, Bussiness
Network identified focal point,
all sectors
Page 167
Outcome 2: Practices that promote optimal use of nutrition ‘specific’ and nutrition ‘sensitive’ services improved, leading to enhanced maternal and
child nutritional status.
Output 3 Maternal and child
nutritional care service
utilisation improved,
especially among the
unreached and poorer
segments of society.
• By the end of 2014, Nutrition Communication
Strategy developed and in place to support
PINS
• % of pregnant women and mothers know the
importance of food diversity & eating three
times a day with animal source food at least
once a day
• Adolescents who report at least two
preventive/dietary nutritional measures
against anaemia increased
• Prevalence of roundworm among school
adolescent reduced
• Hand washing with soap practice increased at
critical times specially among adolescent girls
and young mothers
Multisectoral
nutrition progress
report (quarterly,
annually), surveys
(NNS/others)
P&D (Nutrition Cell at PSPU)
Health in lead with all
participating sectors,
Output 4 Adolescent girls’
parental education, life
skills
and nutrition status
enhanced.
By the end of 2020:
• Class attendance and class promotion rates among
adolescent girls increased
• Dropout rates among school adolescents decreased
• Adolescents who report at least two
preventive/dietary nutritional measures against
anaemia increased.
• Prevalence of roundworm among school adolescents
decreased
Routine reports of
participating
sector
Education
Output 5 Availability and
consumption of
appropriate foods (in
terms of quality,
quantity, frequency and
safety) enhanced.
By the end of 2020:
• Increased consumption of diversified food, especially
animal food or pulses , among pregnant women and
adolescent girls by increasing its production
• Food supply and distribution system strengthened –
food security ensured particularly in food deficit areas
• % infants initiated with breastfeeding within the first
hour and exclusively breastfed for six months
• % of children receiving immunisation and
micronutrient supplements as per the schedule
• Reduction in consumption of junk food by pregnant
mothers, children and adolescent girls
Multisectoral
nutrition progress
report (quarterly,
annually),
Surveys
(NNS/Others)
Health, Agriculture, Food,
Page 168
Outcome 3: Strengthened capacity of Provincial and local governments on nutrition to provide basic services in an inclusive and equitable manner.
Output 6 Capacity of Provincial
and district levels
enhanced to provide
appropriate support to
improve maternal and
Child nutrition.
By the end of 2020, knowledge on nutrition increased
among key identified staff at provincial and local level
by x% over the baseline of number of new nutrition
service outlets established or improved
• Starting from 2014, different sectors identify focal
persons for nutrition and execution of nutrition
interventions are reflected in their job descriptions
Multisectoral
nutrition progress
report (quarterly,
annually)
P&D (Nutrition Cell) all
Participating sectors
Output 7 Multi-sector nutrition
information updated
and linked both at
Provincial and district
levels.
By the end of 2015, access to the updated nutrition
information system made
available
• Nutrition information system available in all the
sectors
Sectoral progress
reports quarterly,
annually
P&D (Nutrition Cell) all
Participating sectors
Bussiness Network