|Year : 2012 | Volume
| Issue : 2 | Page : 98-100
Nutritional programmes in Pakistan: A review
Asfandyar K Niazi1, Shaharyar K Niazi2, Arsalan Baber1
1 Shifa College of Medicine, Islamabad, Pakistan
2 Islamic International Medical and Dental College, Islamabad, Pakistan
|Date of Web Publication||22-Sep-2012|
Asfandyar K Niazi
Shifa College of Medicine, Pitras Bukhari Road, H-8/4, Islamabad
Source of Support: None, Conflict of Interest: None
Malnutrition is a serious issue in Pakistani society. During the past few years, many nutritional programmes have been initiated by the governmental and nongovernmental organizations. Some of these programmes focus on raising awareness among the masses while others focus on either directly supplying nutrients to the people or fortification of dietary components. However, the root of the problem-illiteracy, poverty, and socioeconomic deprivation-is still being neglected. These programmes have not yet been able to take control of the situation and Pakistan is still far behind other countries when it comes to nutrition. This article reviews the nutritional programmes in place in Pakistan, analyses their limitations and suggests a way forward.
Keywords: Nutrition, nutritional programmes, Pakistan
|How to cite this article:|
Niazi AK, Niazi SK, Baber A. Nutritional programmes in Pakistan: A review. J Med Nutr Nutraceut 2012;1:98-100
| Introduction|| |
Malnutrition is a serious health concern. For a developing country like Pakistan, poverty, lack of governmental support, and illiteracy contribute toward the widespread malnutrition. The addition of war and natural disasters to the list also exacerbates the prevalent situation. Malnutrition in turn leads to disease morbidity and mortality especially in the pediatric group and places additional burden on the already limited resources of the country. In the bigger picture, it also leads to poor work performance and thus hindrance in the country's development and progress. Although there has been a general increase in awareness and concern regarding nutrition in Pakistan, still no major improvements have been seen over the past few decades.
The National Nutrition Survey (NNS) conducted jointly by the Government of Pakistan and UNICEF shows that 41.5% of children under the age of 5 years are underweight, 31% have stunted growth, 11.6% have wasting, and 50% are anemic.  A similar dismal condition is also seen in the female group with iron deficiency seen in 45% of the women and severe iodine deficiency seen in 20%. Similar studies, but on smaller scales, show that the same problems persist in older children as well.  A survey on school going children found 44% of the children to be malnourished. These surveys show that Pakistan desperately needs nutritional programmes for surveillance, awareness, food fortification, and integration of nutritional counseling as a part of regular medical checkups and outreach programmes.
There is no easy answer to this problem and specialists in any specific field cannot tackle the situation alone. Rather the need of the time is to use a multi-disciplinary, all-hands-on-deck approach employing professionals from a broad range of fields such as economists, nutritionists, doctors, nurses, community health workers, and agriculturists. However, below is a discussion of the various nutritional programmes being run in Pakistan by the government and nongovernmental organizations, their successes, failures, room for improvement, and way forward.
| School Health Programme|| |
School health programme is jointly managed by the Ministry of Education, Government of Pakistan and United Nations Educational, Scientific, and Cultural Organization (UNESCO).  Although the focus of this programme is not exclusively nutritional, however, an important component of this programme is the School Nutrition Programme, which provides relevant nutritional information to the students and makes healthy, balanced food available to students of schools located in poor areas. This programme runs on the concept that nutritional interventions among children will not only benefit their own health and educational performance but will also help spread awareness among their parents and relatives.
From the beginning of this programme, it has evolved significantly. It began back in the 1970s, when the doctors were deployed in the government schools and were asked to treat the sick children. During the 1980s, the programme moved on to screening for health problems among students and working to prevent and treat diseases. It was however only recently when a nutritional component was included in this programme. Since the addition of the nutritional component to this programme, it has reported an increase in the attendance of students and educational performance. However, the posting of doctors to small towns and villages has been a problem. Most doctors are reluctant to work in areas with lesser facilities and skipping duties is extremely common on their part.
| Micronutrient Initiative|| |
Micronutrient Initiative (MI) works with the government and the UN to eliminate deficiencies of micronutrients such as iron, iodine, folic acid, vitamin A, and zinc.  MI employs screening to identify areas deficient in micronutrients and donate vitamin A and zinc supplementation along with sprinkles containing common vitamins and minerals directly and indirectly through the government. It also provides its expertise to the government and trains the involved personnel for programmes involved in salt iodization and flour fortification.
The MI programme has achieved incredibly. This can be seen in the statistics where 60% of the women are currently being reached by iron and folic acid supplementation programmes and more than 95% of children under the age of 5 years are receiving vitamin A supplementation. Salt iodization has also increased to 70%. One of the reasons for the success of this programme is that it has managed to identify the already available government infrastructure which was not previously being put to optimal use and incorporate it into its own programme. Vast amounts of vitamin A capsules are distributed during the polio vaccination campaign being run by the government. The lady health workers programme, an outreach programme which consists of government employed midwives going house to house in villages to improve maternal and child health, is also being used especially for zinc supplementation.
| Tawana Pakistan Project|| |
This project is a governmental initiative of the Ministry of social welfare and special education focused on primary school girls. It aims at combating malnutrition and increasing school enrolment among the girls in primary schools in villages.  The project provided freshly prepared meals in the afternoon to 418,000 girls and trained women in the community to run nutrition awareness programmes. Almost 94,000 women were trained through this programme to spread nutritional awareness in their communities and a significant drop in malnutrition, stunting, and wasting was seen in the girls in target primary schools. There was also an increase in the attendance of girls at these schools. This programme brought together an academic institution, numerous nongovernmental organizations, and the government for its implementation.
This well-designed programme has the potential of exponentially improving the nutritional situation in poverty stricken regions of Pakistan. The direct training of such a large number of women in running nutritional awareness programmes is certainly a big achievement. Not only can these women improve their own nutrition, but they also hold the potential of improving the situation of their children, families, and societies. Even though focusing on girls and women is a start, however it should grow to include boys and men in their domain as well.
| National Programme for Family Planning and Primary Health Care|| |
This programme was initiated by the government in 1994 with the aim of providing primary health care services at the doorstep and improving the health conditions in rural areas.  This programme has employed more than 100,000 trained lady health workers who live in rural communities. Their task is to visit different homes in their localities and provide various primary health care services with special focus on maternal and child health. In addition to the health services, these workers also provide nutritional advice to the community and provide iron and folate supplementation at the doorstep.
This programme reaches to more than 65% of the inhabited area of Pakistan and provides free of cost services to 90 million people. The workers are well-trained and have access to all the available public infrastructure and play an enormous role in supporting the rural healthcare system in Pakistan due to its size and efficiency.
| Nutrition Wing, Ministry of Health|| |
In addition to supporting nongovernmental organizations by way of public-private partnership, the nutrition wing of ministry of health also conducts various programmes of its own including screening and evaluation for various nutritional deficiencies, vitamin A supplementation programme, flour fortification, and food safety and quality control.  It also runs the national nutrition programme. This extensive programme targets all aspects of nutrition including maternal and child, infant, adolescent, adult, and elderly nutrition. The major foci of the programme's work are low birth weight babies, preschool malnutrition, iron deficiency in mothers and children. In addition it also works to promote awareness regarding breastfeeding and maternal nutritional status and iodized salt.
| Other Programmes|| |
Many academic institutions, especially medical schools, and nongovernmental organizations run small level nutritional programmes which work by providing free healthy food or creating nutritional awareness among the masses. Most of these programmes work in collaboration with either the international organizations like United Nations, World Health Organization, UNICEF, or with the government.
| Limitations of the Existing Programmes|| |
The existing nutritional programmes in Pakistan are facing the iceberg tip phenomenon. Even though these programmes focus on creating nutritional awareness, conducting screening tests for nutritional deficiencies, and providing micro- and macro-nutrients to the masses, but the actual root of the problem-illiteracy, socioeconomic deprivation, and poverty-is often ignored. These measures are appreciable efforts for fast but expensive and temporary positive results regarding nutrition, but the permanent solution is tackling illiteracy, socioeconomic deprivation, and poverty.
An effective nutritional strategy should work at all levels of the community. Most programmes work either for awareness or provision of nutrients directly. However an effective, large scale programme is urgently required, which would incorporate all the strategies including screening for deficiencies, raising nutritional awareness among the masses, training locals to manage nutritional programmes in their communities, and direct provision of nutrients.
The involvement of the agricultural society and media in these programmes has been poor. Every industry has a role to play in countering this situation and unless every industry does play its role, the situation cannot be improved. The private-public partnership, as seen in many nutritional programmes, holds its own problems. Issues about red-tape while handling governmental organizations and the ill-defined ownership of such programmes seriously hamper their functioning.
| Way Forward|| |
Better coordination between the different programmes is required so the tasks and workload could be divided between them. Formulation of a new nutritional policy is the requirement of the hour so that the root of the problem could be reached. Implementation of the nutritional programmes should be multidisciplinary; utilising the services of professionals from all fields. The programmes focusing on any specific gender or age group should be broadened to include all individuals. Policies regarding improvement of literacy level and socioeconomic conditions of the masses should be formulated and implemented.
| References|| |
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|2.||Mian RM, Ali M, Ferroni PA, Underwood P. The nutritional status of school aged children in an urban squatter settlement in Pakistan. Pak J Nutr 2002;1:121-3. |
|3.||UNESCO. School health programme. Available from: http://unesco.org.pk/education/documents/publications/School%20Health%20Programme.pdf. [Last accessed on 2012 Mar 15]. |
|4.||Micronutrient initiative. Pakistan. Available from: http://www.micronutrient.org/english/view.asp?x=606. [Last accessed on 2012 Mar 15]. |
|5.||Badruddin SH, Agha A, Peermohamed H, Rafique G, Khan KS, Pappas G. Tawana project-school nutrition program in Pakistan-its success, bottlenecks and lessons learned. Asia Pac J Clin Nutr 2008;17:357-60. |
|6.||Ministry of health. National programme for family planning and primary health care. Available from: http://www.phc.gov.pk/site/. [Last accessed on 2012 Mar 15]. |
|7.||Nutrition wing, Ministry of Health. Projects. Available from: http://nwpk.org/projects.html. [Last accessed on 2012 Mar 15]. |