Dr Nadir Shah Technical Program Consultant Scaling Up

Dr. Nadir Shah Technical / Program Consultant Scaling Up Nutrition (SUN) Unit Planning & Development Department (P&DD) Government of Gilgit-Baltistan

GB Nutrition Status & SUN Progress Contents: Ø Ø Ø Conceptualizing Malnutrition & SUN Role GB Nutrition Status SUN GB Progress up date Challenges of Nutrition in GB Way forward

CAUSAL ANALYSIS OF MAL-NUTRITION

GB Malnutrition causal analysis Sector Wise Causal Mal-nutrition 1. 2. 3. 4. 5. WASH Food Insecurity Child-Care & Self-Care Education Poverty

SUN GB - Objectives 1. Strengthening advocacy & coordination among regional stakeholders responsible for nutrition promotion 2. Provide technical input to relevant sectors (including health, agriculture, food, education, local government, public health engineering, social welfare, industries and environment) on evidence based interventions pertaining to nutrition sensitive and specific strategies. 3. Liaise with development partners and other organizations to align nutrition related interventions with multi-sectoral integrated nutrition strategy

Country level SUN Approach: Multi-Sectoral Coordination & Intervention The multi-stakeholder platform Works to align and coordinate action across sectors. Health Women’s Empowerment Education Social Protection Agriculture Development, Poverty Reduction & Employment

Malnutrition Status of children IN GB (MICS 2016) 46. 2 50 Percentage of children under 5 -years 40 30 20 19. 4 10 3. 8 2. 9 0 Underweight Stunting Wasting Overweight Too less weight for Age Too short for their age Too thin for their height Too heavy weight for Age

GB m an g Sh ig Di ar am Gh er an ch Sk e ar du Gh ize Na r ga As r to re Gi lg it Hu nz a ar Kh Stunting Prevalence-District Wise Stunting 70 60 50 40 30 20 10 0

Children Micronutrient Deficiency Indicators Gilgit Baltistan 80% 72% 60% 41% 33% 20% 0% Anaemia Vitman A Deficiency Vitmain D Deficieny GB NNS 2011

Women Micronutrient Deficiency Indicators Gilgit-Baltistan 80. 0% 60. 0% 40. 0% 59. 4% 62. 9% Vitamin D Deficiency Zinc Deficiency 46. 7% 39. 2% 20. 0% Vitmain A Deficiency 40. 0% 30. 0% 20. 0% 10. 0% 33. 6% GB 23. 3% Anaemia Pregnant Woman GB Anaemia Non. Pregnant Women NNS 2011 Calcium Deficiency

Breast & Infant Feeding Gilgit-Baltistan Consolidated ( Ten Districts) 90 80 80. 7 70 60 63 50 50. 8 40 30 60 35 26. 7 20 27. 5 10 0 Early Initiation of Breastfeeding Exclusive Continued Introduction of Mininmum Breastfeeding at 1 Breastfeeding at 2 Semi-Solid or Soft Dietrary Diversity Under 6 Months years foods 6 mo From 4 Groups Bottle Feeding

Salt-Iodization, Low-Birth Weight, Vitamin-A Gilgit Baltistan Consolidated Indicators ( Ten Districts) 90 80 70 60 76. 9 68. 4 50 40 30 30. 5 20 22. 7 10 0 Iodized Salt consumption Salt Iodization Low-birth weight Infants weighed at Vit. A suppl. One infants birth Dose in 6 mo. Low-Birth Weight Vitamin A

100 90 80 70 60 50 40 30 20 10 0 WATER AND SANITATION CONSOLIDATED GILGIT-BALTISTAN (TEN DISTRICTS) 86 79 85. 5 50. 4 53. 2 Use of Imoproved Drinking Water Sources Water Treatment Use of Safe disposal Place of Availability of Improved of child's Handwashing Soap or Other Sanitation faeces Cleansing Agent Water & Sanitation

SUN, Multi-Sectoral Nutrition-Progress Forums for creating enabling environment 1. Political endorsement 2. Inter-sectoral-nutrition strategy in place 3. Provincial focal person 4. SUN Unit established 5. Sectoral Ministerial Forum 6. Steering committee 7. Sectoral TWGs 8. Multi-sectoral coordination committees 9. Sectoral Focal person of nutrition

SUN, Multi-Sectoral Nutrition-Progress B. Advocacy / Coordination 1. Parliamentarians 2. Civil society members 3. Academia 4. Women organizations 5. Media 6. Local Food business community 7. Line departments

SUN Multi-Sectoral Nutrition Progress C) Sectoral Nutrition Legislation Policies in place a) b) c) d) e) f) g) Inter-sectoral-Nutrition policy & strategy GB Water & Sanitation policy Drinking water policy Behavioral Change Communication policy Agriculture & Sub-sectoral policy Iodine Deficiency Disorder Control Act Pure Food Act Legislation in Process a) Food Fortification Act b) Breast Feeding Protection & Child Nutrition Act c) GB Food Authority

SUN Multi-Sectoral Nutrition Progress D. Sectoral Projects 1. Health Sector PC 1 a) Nutrition improvement program I. Improve nutrition status of under 5 children /mothers II. Promote healthy dietary habits in adolescent girls /adults III. Decrease micronutrient deficiency in mothers & children 2. Agriculture & subsectors Projects 3. Education 4. Food 5. WDD 6. LG & RD/ WASH

Key Challenges of Nutrition Agenda in GB Regional / Geographic 1. Difficult Terrain 2. Inaccessibility to health/nutrition care facilities 3. Scarcity of professional HR 4. Communication constraints Environmental 3. Short crops yield period Nutrition - a Marginalized Sector 1. Limited Donors involvement 2. Disaster risk area 3. High burden of chronic malnutrition 4. Limited provincial resources Poverty 1. Endemic deficiency for some 1. Limited job opportunities 2. Non existence of industries nutrients 3. Business scope 2. Cultural belief 3. Community non-awareness about nutrition Agriculture sector 1. Small cultivable land holdings 2. Paucity of viable irrigation channels

GB Multi-Sectoral Nutrition-Opportunities 1. Strong Political endorsement 2. Facilitative role of P & DD GB 3. Technical / Financial support of UNICEF 4. Sectoral coordination mechanism /Forums 5. Base line updated MICS nutrition data 6. Approval of Nutrition specific / sensitive PC 1 s 7. SUN unit coordination & technical consultation 8. Upgradation of Food and water testing laboratory 9. Legislation about food & nutrition

Way Forward 1. 2. 3. Community mobilization through mass media Financial tracking for nutrition investment Accelerated implementation of Nutrition specific / sensitive PC 1 s 4. Establishment of Food Authority >> Flour fortification 5. Protection of breast feeding and child nutrition act 20018 6. Consideration for Federal Nutrition Programs in GB 7. Promote Donor’s engagement in nutrition interventions 8. Strengthen Political Sensitization 9. Enhance Multi-sectoral Capacity Building 10. Adoption of National Level Monitoring Tools & Material

Key message for Sustainable Nutrition Improvement Let us Seek Multi-Sectoral Nutrition Solutions through Gender Sensitive Nutrition lens…. !! THANK YOU ALL !!!