I just returned from a trip to Islamabad to meet the GAIN team and some of our partners. I’m no expert on Pakistan, but compared to 2013, the commitment to accelerate reductions in malnutrition seems to have increased significantly.
In 2013 the Institute of Development Studies (IDS) and the Aga Khan Foundation released a collection of papers by Pakistani authors entitled “Seeing the Unseen: Breaking the Logjam of Undernutrition in Pakistan” it was edited by me, Zulfi Bhutta and Haris Gazdar. In the Introduction to that collection the editors noted “The coming together of three events: the massive flooding of 2010 and 2011, which exposed chronic as well as acute undernutrition; with the recent decentralisation of health services to the provinces; and the results from the 2011 National Nutrition Survey (NNS 2011), which show an increase in stunting, have created some momentum for nutrition”.
How have things moved on?
First, nutrition is reported to be much more prominent in the next 5 year draft National Development Plan which is waiting to be ratified by the new Government elected in late July.
Second, guided by the Ministries of Planning, Development and Reform and the National Health Services, and supported by the Scaling Up Nutrition Movement (SUN), the outgoing Federal Government has already committed 10 billion rupees (about USD 100m) to nutrition in this financial year, which represents a major boost.
Third, civil society is trying to replicate what was so successful in Peru—getting all the political parties to make SMART commitments to nutrition in their manifestos and then holding whichever one gets into power to those promises.
Fourth, the Provincial Food Authorities have become powerful forces for change in the Provinces. Starting out in the food safety space these Authorities are extending their interests into the nutrient dimensions of food.
Fifth, businesses really seem to be stepping up to the plate. The Sun Business Network (SBN) has revived with a new injection of resources and capacity and has 33 member businesses with plans to get to 100 in the next couple of years.
Sixth, the government officials I talked to in the Ministries of Planning, Development & and Reforms and in the National Health Services were all talking about food systems and how these systems frame the nutritious foods choices people have and how they make the choices.
Seventh, the adolescent and youth agenda is high on the development agenda with senior policy makers and development partners understanding that the current youth bulge can bring both a new set of opportunities (e.g. empowerment, entrepreneurship and a redefinition of what a healthy diet looks like) but also problems (unemployment and unrest) if the approach is not right.
Finally, the urban agenda is surfacing—with the World Bank a strong proponent of leveraging urbanization for nutrition.
Of course all of these opportunities present risks. There is “many a slip between cup and lip” when it comes to what is in development plans and what actually gets done (in all countries!).
Committing to spend USD 100m on nutrition is good, but what will it be spent on and what is the capacity to spend it (wisely)? Party political manifestos are often not worth the paper they are written on. A food systems framing can lead to action in new areas, but also to paralysis, as policymakers are overwhelmed with data and things they could do within the system. Provincial Food Authorities can be powerful agents of change, but less so if they do not align standards to make the work of business as seamless as possible over different geographies. And we know businesses can be as much a part of the affordable nutritious food problem as it is a part of the solution. Finally, a focus on urbanisation that is detached from rural transformation will run the risk of deepening divides.
But from a non-expert perspective, I detected a steely glint in the eye of all the public and private officials I met (most of them not nutritionists, by the way) and a determination that they are not going to let this moment slip to press home the advantage for nutrition. As a recent editorial by a former Finance Minister in a leading national newspaper put it “Pakistan is one of the emerging economies of the world with a notable economic growth potential that is threatened by the burden of pervasive malnutrition. Unless immediate action is taken, the crisis of malnutrition will continue to negatively affect Pakistan’s economic performance. It also has the potential to condemn future generations to a catastrophic future of deprivation and poverty.”
I couldn’t agree more and GAIN will do whatever we can to work with all stakeholders to make sure these opportunities are seized to accelerate reductions in malnutrition — in all its forms.