session 6 country 2 baseer enn pakistan presentation · provinces / administrative areas urban /...
TRANSCRIPT
CMAM/SUN ConferenceCMAM/SUN Conference1414--17 November 201117 November 2011
Addis Ababa, EthiopiaAddis Ababa, Ethiopia
Dr. Baseer Khan AchakzaiDr. Baseer Khan AchakzaiNational Program Manager, Nutrition Wing, NIHNational Program Manager, Nutrition Wing, NIH
Government of PakistanGovernment of Pakistan
Federal DemocraticRepublic of EthiopiaMinistry of Health
Provinces / Administrative
Areas
Urban /
RuralGender
Pakistan
Overall
%
BalochistanKhyber
PakhtunkhwaSindh Punjab AJK Urban Rural Male Female
Stunted 43.6 52.2 47.8 49.8 39.2 31.7 36.9 46.3 44.2 43.1
Wasted 15.1 16.1 17.2 17.5 13.6 17.6 12.6 16.1 15.9 14.3
Under
weight31.5 39.6 24.1 40.5 29.8 25.8 26.7 33.3 32 31
Total population:Total population: 18 million+ in 201118 million+ in 2011
6th most populous country in the World :6th most populous country in the World :
Background/country informationBackground/country information
Source:Source: Child Nutrition ( NNS 2011)Child Nutrition ( NNS 2011)
Indicators Pakistan Sindh Punjab KhyberPakhtunkhwa
Balochistan Cut off
11--AcuteAcutemalnutritionmalnutritionNNS 2001NNS 2001FANS 2010FANS 2010__________________22--StuntingStuntingNNS 2001NNS 2001FANS 2010FANS 2010NNS 2011NNS 2011
UnderweightUnderweightNNS 2001NNS 2001FANS 2010FANS 2010
Low BirthLow BirthWeightWeightPDHS 2006PDHS 2006
10.8%10.8%13%13%____________
31%31%37%37%43.6%43.6%
41.5%41.5%31.5%31.5%
31.1%31.1%
18%18%21.2%21.2%__________
44%44%51%51%----------------
------------
27.4%27.4%
12%12%13.9%13.9%____________
32%32%50%50%------------------
--------------------
24%24%
11%11%7.3%7.3%______________________
43%43%47.8%47.8%----------------------------
------------------------
34%34%
14%14%8.9%8.9%________________
39%39%59.1%59.1%----------------------------
--------------------
43%43%
>15%>15%CriticalCritical>10%>10%SeriousSerious
>40%>40%very Highvery High3030--39%39%HighHigh
15% SSA15% SSA27%27%AsianAsianRegionRegion
Story of CMAM Scale upNutrition Wing 2002Donors’ initiative 2006/7- Pilot projectsDecade of natural/manmade disasters: DoH
(LHWs, TFCs), NGOs (OTP) involvement largerscale
18th Constitutional AmendmentKey terminology – 4 components of CMAM- C-M-A-M!!!-SCs (WHO) – TFCs (UNICEF)!
Pakistan
Policy & Strategy EnvironmentSystems/structures to aid CMAM scale-up :National Disaster Management Authority,
Cabinet Division, Planning Commission,National Health Emergency PreparednessCentre
Cluster Approach: PartnersFinancing CMAM Through umbrella PC1 of NWDonors support: supplies, coordination and
capacity buildingCoordination Federal-Provincial-District; GO-INGO;
ClustersLinkages with other programmes LHW Program. CMW Program, People prog
HealthI, EPI, DOHGreater need to integrate in vertical programs and
initiatives such as IYCF
Pakistan
Future Architecture of Nutrition in Pakistan
National Level NutritionCoordination Structure
Provincial Level NutritionCoordination Structure
Pakistan
Children
(6-35 months)
Pregnant and
Lactating women
Blanket feeding for a month 180,000 160,000
Treatment given 9,000 severely
malnourished
At risk who received supplementary
food
30,000 moderately
malnourished
21,000
At risk who received multiple
micronutrient supplementation
120,000 160,000
Key messages on appropriate infant
and young child feeding practices,
hygiene/sanitation delivered
160, 000
Beneficiaries: Total 460,000 (23%
children and women representing of
the affected population),
300,000 160,000
•SAMrate Sind = 6.1% n 2.9%
Expected outcomes:
•More than 3,000 health care providers trained on emergency nutrition services, including infant feeding inemergency & CMAM
Progress made
Success 1: Leadership (Federal level)Success 2: Strategic planning (Punjab)Success 3: NGOs involvement (Khyber
Pakhtunkhwa)Success 4: Communication (Balochistan)Success 5: Research (Sindh)
Factors Contributing to Success
Pakistan
Major Challenges & Obstacles
Challenge 1: Resources ! (Finances, HR,Supplies)
Challenge 2: Co-ordination (Inter-provincial, Federal-Province,Vertical programs)
Challenge 3: Donors’ dilemma (Clustermembers roles undefined,war of mandates)
Pakistan
Learning point 1: Donor ‘s impression can bedeleterious (WB on PC1s-wrong message toother Potential donors that WB pledged allsupport!)Learning point 2: Active leadership andadvocacy is really effective- Quality of servicescan be compromised if a common monitoringmechanism is not operationalLearning point 3: MOUs between partners inthe beginning is necessarySpecial about our country that has enabledscale-up. Disasters proved blessing in disguise, ahuge number of NGOs skilled in CMAM servicesGovernment to be the main process owner
Pakistan
Key learning Points
Backdrop: Breast Feeding Rules 2010;Micronutrient Plan, IYCF Strategy
Plan 1: National CMAM Guidelines disseminationPlan 2: Development of SOPs for NGO selection for
LHW, non-covered areasPlan 3: Research in development of local RUTF
Obstacles: Poor investments in public health,dearth of HR with Nutrition Expertise, Interruptedsupply for RUTF, Low level communityunderstanding of malnutrition...National & international development AidEffectiveness !, two way accountability; Evaluate !,Building Long term vision
Pakistan
Next Step & Way Forward
Cabinet Division, Government ofPakistan;
Dr. Qazi Muhammad Suleman, (NutritionConsultant);Development Partners, WHO, UNICEF,
WFP, FAO, Merlin, World Vision, ConcernWorldwide, DoHs and other Clustermembers;ENN Ethiopia & UK;Government of Ethiopia
Pakistan
Acknowledgements
Lets fight against mal nutrition for the bright future ofthese children………
Dr. Baseer Khan AchakzaiDDG, Nutrition Wing, NIH
Government of PakistanFederal DemocraticRepublic of EthiopiaMinistry of Health
Emergency Network