Author: jawahir, July 17 2013

(The name of the non-government organization (NGO) involved here and the official mentioned here have been kept confidential upon their request.)

“Two year old Meeran lay idle in his mother’s lap at a therapeutic center in Sibi, His bones could be seen easily through his pale skin, and he could hardly breathe. It was the first time I saw a case of severe acute malnutrition,” said the Deputy Chief Executive Officer of an NGO [non-governmental organisation] mainly working in the health sector in Balochistan.

“The mother, weak and feeble herself, seemed concerned. They had to walk for kilometers to get to the center,” added the Deputy CEO [Chief Executive Officer]. Meeran is among five million children suffering from malnutrition in Pakistan’s largest but poorest province of Balochistan. Pakistan shares 6 percent of the global burden of malnutrition and Balochistan is its worst affected region.

This organization is one of the few NGOs working in Balochistan to fight malnutrition. The NGO workers in Balochistan have been facing security threats from militants, who suspect that the workers are Western spies. “Our staff members were threatened. Many left, but we hired more. Finally, we completed the project, although not in the way we wished,” the NGO representative said.

“One in every two children in Balochistan is chronically malnourished, which is irreversible” says Dr. Amjad Ansari, Health and Nutrition Specialist of UNICEF [United Nations Children's Fund]. Dr. Ansari further explained that the situation in Balochistan is categorized as an emergency, as 16 percent of children in the province suffer from acute malnutrition, far above the World Health Organization emergency threshold level. 

The National Nutrition Survey 2011 reveals a grim picture of the situation in the province: 52 percent of children in Balochistan are stunted (too short for their age due to chronic irreversible malnutrition) and 40 percent of children are underweight.

Moreover, the situation of women in the province is equally appalling, with nearly half of the women in Balochistan being anemic and Vitamin A deficient.

“Impact of childhood malnutrition is beyond an individual and over a lifetime,” says Dr. Ansari. Malnutrition impacts health, cognitive development and has catastrophic consequences on productivity, income and education. Economic effects of malnutrition are also enormous; the current situation of malnutrition in Pakistan is said to cost the country’s economy 3 percent of its GDP [gross domenstic product].

Explaining the long-term effects, Dr. Ansari said: “Malnutrition entraps children in a vicious cycle where a malnourished child is physically and cognitively underdeveloped, thus more prone to disease. So he’ll be less productive in adult life resulting in low human capital.”

The World Health Organization estimates that malnutrition is the underlying cause of an estimated 300,000 deaths of children in developing countries. Balochistan already has one of the highest child mortality rates in the region, where every 89 of 1000 children die before their fifth birthday.

“You can’t blame this situation on some specific factor. Security situation, government’s lack of commitment, displacements caused by floods, poverty and lack of awareness all are to be blamed,” says the Deputy CEO of the local NGO.

War-torn Balochistan is home to a number of conflicts with separatist nationalists waging an insurgency in the Baloch-dominated areas while radical Islamists holding sway in Pakhtun areas of the province. Thousands of people displaced due to conflict and floods in recent years now live in makeshift camps with little, if any, availability of food and other necessities of life.

Experts are on agreement that malnutrition has multi-sectoral and complex causes, including insufficient access to food, poor feeding practices, inadequate maternal and child care, and poor water and sanitation conditions.

Availability and access to adequate food throughout the year is one of the major challenges faced by the province. Around 63 percent of households in Balochistan province do not have availability of or adequate access to food and half of the worst food insecure districts in Pakistan are located in Balochistan.

“They are too poor to buy food,” says Imdad Baloch, a community worker in Balochistan. Imdad has been involved in nutrition projects for the past six years in different parts of the province. “Even if they have some money, it is never enough for the typically large families. And women are often the last one to receive food,” he adds.

Despite being the least populated but richest province in Pakistan in terms of mineral resources, half of the population in Balochistan is living below the poverty line. This situation is worse in rural areas where 74 percent of the population is suffering from poverty. The population in Balochistan is highly dispersed, mostly with no formal employment and only a small number of people earning a living through agriculture and livestock.

In a disintegrated health system such as that of Balochistan, the multi-sectoral and complex causes of malnutrition are difficult to address. The Government focuses its efforts mostly on awareness raising and programs for community-based management of acute malnutrition through provision of supplements. “I wish I could help them, but the only thing I can do is provide them nutrition supplements which is never enough,” says Imdad.

Despite of the enormous scale of malnutrition crisis, nutrition has been a low priority for Pakistan bureaucracy and government. The country lacks a comprehensive policy on nutrition, and ranks as a low commitment country on the Hunger and Nutrition Commitment Index (HACI).

Dr. Nasir Bugti, the Coordinator of the Provincial Nutrition Program, admits that the problem cannot be overcome with the current resources. “We are carrying out a few nutrition interventions in the province which unfortunately have a very little impact on nutrition indicators as the emergency is at such a large scale,” he said.

During the recent National Election in May 2013, almost all of the mainstream political parties, including the recently elected Pakistan Muslim League-Nawaz, ignored addressing malnutrition in their party manifestos.

However, Dr. Ansari sees recent devolution of governance and financial authority to provinces from Federal Government through 18th constitutional amendment as an opportunity to address malnutrition. “Balochistan, as a result, can formulate its own nutrition-specific policy and strategies specially tailored to the needs and context of the province,” he said.

Nonetheless, Balochistan Intersectoral Nutrition Strategy is being developed to improve the nutrition status. “The new strategy will chalk out the roles of different line departments including Food, Health, Education, Water, Agriculture, and Social Welfare to combat malnutrition in the province,” says Dr. Bugti.

The newly elected government brings new hope for Balochitsan. However, it has to overcome daunting challenges, such as multi-sectoral complex causes, limited resources and a deteriorating security situation, to save its future generation from malnutrition.

Disclaimer: (Views and opinions with this Blog represent my own and not those of people, institutions or organizations I am affiliated with unless stated explicitly. My Blog is not affiliated with (neither does it represent) the views, position or attitudes of my employer).