Drive to eliminate malnutrition gains momentum

Islamabad 

Four Provincial Fortification Alliances (PFAs), which are the provincial chapters of the National Fortification Alliance (NFA) of Pakistan, were launched here Thursday for smooth coordination and oversight of fortification activities at the provincial level. With these bodies finally in place, it can now be hoped that efforts for elimination of micronutrient malnutrition or ‘hidden hunger’ will be better coordinated, eventually leading to reversal of at least some of the harrowing trends reflected in the National Nutrition Survey 2011.

Minister of State for Health Saira Afzal launched the PFAs in the presence of director nutrition and secretary of NFA Dr. Baseer Achakzai and representatives of various partner and donor organizations. Speaking on the occasion, Saira thanked donors and UN agencies for providing technical assistance for the programme and emphasized that it is now the responsibility of the government and the provincial health departments to carry the task forward by allocating resources to address malnutrition.

Pakistan has a high burden of under-nutrition. The NNS 2011 revealed continued high rates of micronutrient deficiencies in children and women. A total of 62% children are anemic, with iron deficiency among 43.8%; 54% are vitamin A deficient, 40% are Vitamin D deficient and 37% still have iodine deficiency. Similarly, 51% mothers are anemic, with iron deficiency among 24.7%; 42% are Vitamin A deficient and 68% Vitamin D deficient.

According to economic statistics, annual financial losses resulting from micronutrient deficiencies in Pakistan reached 2-3 percent of GDP due to its negative impacts on health status, and poor cognitive development in children.

Globally too, the fortification of staple foods and condiments with vitamins and minerals is seen as a powerful nutritional intervention that reaches hundreds of millions across the world. Fortification has gained global attraction. Over 150 countries, governments and industry, supported by civil society, are implementing salt iodization programmes; 82 countries have mandated at least one kind of cereal grain fortification and dozens have large-scale food fortification programmes focusing on fortifying edible oils and condiments.

The compelling case for food fortification as a public health strategy sets a strong rationale for scaling up support from governments, the food industry, consumer associations, donors and international agencies. The job is far from complete. In many countries, fortification programmes have not been scaled up to the point where they can deliver to their full potential.

As part of the National Action Plan for addressing micronutrient malnutrition, the NFA was constituted under the Ministry of Health in 2003 with the lead technical role taken up by the Nutrition Wing. The Alliance has quite a few programmes to its credit, including successful Universal Salt Iodization (USI) programme, Wheat Flour Fortification Programme in earthquake-affected area of Khyber Pakhtunkhwa and AJK, Commercial Wheat Flour Fortification Project for Wheat Flour Export to Afghanistan, and National Wheat Flour Fortification Project.

To effectively address the issue of micronutrient malnutrition as revealed by NNS 2011, after the re-notification of Ministry of National Health Services, Regulations and Coordination, the NFA was reconstituted and notified in October 2013, with Dr. Baseer Achakzai appointed as its secretary for coordination among UN agencies, nutrition partners and provincial health, food and education departments beside other stakeholders. NFA includes representation from all federal line ministries, provincial line departments, development sector organizations, UN agencies, academia and research institutions, civil society and industry.

The objectives of NFA are to support relevant multi-sectoral policy framework and develop/put into action, necessary legislative instruments; to act as a coordination body for partner-supported projects, guiding their development and implementation and ensuring cohesion with national priorities; to provide technical leadership for guiding research and identifying sustainable solutions; and to strengthen the quality control and regulatory monitoring system at all levels. The progress made by NFA since its activation last year is reassuring.

Expressing her views on the occasion, Australian High Commissioner Margaret Adamson said, “Australia is committed to support the government of Pakistan in its efforts to battle the crisis of malnutrition, Food Fortification is globally recognized as one of the most cost-effective interventions for improving the nutritional status of the population at a large scale. Fortification of routinely consumed foods, like wheat and edible oil with micronutrients and vitamins, is particularly effective as these are used in everyday meals throughout the country.” Australian funding is providing critical support, allowing the National and Provincial Fortification Alliances to work through a public-private partnership model working with multi-sectoral stakeholders for coordination, the development of policy frameworks and agreement on fortification standards.

Earlier, Dr. Baseer Achakzai shared figures related to malnutrition in Pakistan as reflected in NNS 2011. “These alarming figures not only shocked the government but also created opportunities for us to work together to target these. The provinces have prepared Integrated Nutrition Strategies and Provincial Nutrition programmes with the support of donors and development partners. Today, Provincial Fortification Alliances have now been constituted in all provinces,” he stated with a sense of pride.

“Food fortification is safe and cost-effective in the prevention of micronutrient deficiencies, has been widely practiced in many countries for well over a century, and could contribute to reduce those figures, if fully implemented in Pakistan,” Dr. Achakzai stated. Indeed, the consequences of micronutrient malnutrition have far-reaching effects on economies through secondary physical and mental disabilities and altered work productivity.