Pakistan

Background: The Pakistan case presents assessment of integration of evidence based nutrition interventions into the existing public MCH system. The activity was undertaken in two impoverished districts – Naushero Feroz, and Matiari of rural Sindh. The activity is intended to demonstrate feasibility of operationalizing nutrition services using the public health program (LHW). Till inception, following activities have taken place-
 
Activities:

Desk review: Appraisal of current services to identify a package of evidence based nutrition interventions. Assessment of IYCF knowledge and practice in the community. Appraisal on acceptability of community base micronutrient intervention, e.g. sprinkles.
 
Development of intervention package and IEC materials: Intervention package and IEC materials have been adapted and modified for public and private sector. Iron-folate supplementation to pregnant mothers, micronutrient (sprinkles) for school aged children; BCC, nutrition education, breast feeding promotion strategies, complementary feeding strategies through individual and group discussion; promotion of baby friendly hospital initiative, GMP etc.
 
Curriculum & guideline: Training curriculum for the LHWs (Lady Health Worker) on maternal nutrition education, educational package on Breast Feeding and Complementary Feeding support and technique was developed. BCC material regarding use of sprinkle, and iodized salt was developed.
 
Baseline cross-sectional survey: Baseline survey was conducted in Naushero Feroz and Taluqa districts covering a total population of 583,378. Baseline information on knowledge, attitude, and practice on nutrition issues, infant and young child feeding, food preparation, hygiene, health seeking behavior was obtained. Hemoglobin status of young children was recorded
 
End-line biochemical evaluation of sprinkle supplementation reveals that the project was effective in improving iron status of children aged 6-18 months. Feasibility of micronutrient supplementation for young children in the form sprinkles is achieved by the capacity of the existing public health systems (LHW program).
 
Validation of a household food insecurity instrument: Focus group discussions have taken place to assess the information on household characteristics, eating and cooking patterns, ideas about good and adequate food, management and coping strategies and concerns and local views about food.

Achievements:

Policy environment: Impetus has been created within Ministry of Health to address policies related to nutrition. The Government agenda to include national level coverage of salt iodization and edible oil fortification is making progress. Dialogue continues with relevant sectors and partnerships to try and address issues regarding barriers to accessing health and nutrition services, growth monitoring and promotion, challenges to scaling up exclusive breast feeding promotion programs, and targeting of complementary feeding as well as micronutrient supplementation.

Launching of national sprinkles program: On the backdrop of successful assessment by MNI of feasibility of distribution and effectiveness in reducing child anemia by providing Micronutrient Sprinkles has lead to official launch of the Sprinkles program.

Development of national Complementary Feeding Guidelines: The guidebook on improved feeding practices and recipes for Pakistani children and mothers is almost near completion. The target audience for this guidebook would be community health workers, literacy teachers, community mobilizers, health professionals, nutritionists, and NGOs.