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