Sunday, February 23, 2014

EVERY ONE in Pakistan: A glance at 2013

In 2013, the EVERY ONE Campaign really increased its reach and impact in Pakistan. We saw many successes such as the introduction of laws on breastfeeding, meaning that mothers are encouraged to exclusively breastfeed their children for first six months of child life. The laws prohibits the promotion of any milk produced as partial or total replacement for mother’s milk or represented as a complement to mother’s milk to meet the growing nutritional needs of an infant.

Using TV talk shows, radio programmes and street theatre, we engaged the public on issues such as malnutrition, and the importance of health workers and immunisation. We produced a documentary on nutrition, which was shown on 2 national and 18 cable channels across Pakistan. We also hosted television talk shows with speakers from the federal and provincial governments, policy makers, experts including GAVI, campaign ambassadors and civil society organizations. The Ministers of Health from Balochistan and  KP also participated in these talk shows, where we discussed malnutrition, immunization and health workers and how these issues impact women and children. Through TV and radio commercials, a radio drama and short stories, we reached 11 million people with our messages.

In all four provinces, we worked with local actors who performed street theatre, informing the public about malnutrition, importance of health workers and immunization. Total 28,399 people including 16,280 male and 12,119 females were reached through street theatre performances.

Early in the year we launched the ‘Super food for babies’ report in a consultation where government, civil society and parliamentarians were present.

The launch was an opportunity to increase the advocacy around breastfeeding in Pakistan. At the event, Dr Sania Nishtar, the President and Founder of Heart file said that breast milk is not only free but also provides the best protection for infants to fight common diseases and prevent stunting. She committed to take forward the findings of the Save the Children’s Breastfeeding Report and stressed on the need for implementing the breastfeeding legislation in line with the International Code for Breastfeeding Violations Letters were sent to the Chief Ministers in all four provinces and the Minister for Health at the federal level, for effective steps for the implementation of the breastfeeding laws. The research report “Breastfeeding: A roadmap to promotion and protection” and a documentary on breastfeeding were launched in a National Conference on Breastfeeding in Islamabad with representation from all the four provinces from civil society, Government, UN agencies and media. Maiza Hameed Gujjar MNA (Member National Assembly), assured Save the Children she would play her role for the implementation of Breastfeeding laws at the national and Punjab level. Mr. Shaukat Yousafzai, Minister for Health Government of Khyber Pakhtunkhwa (KP) announced that the Provincial Government is soon going to enact the KP Protection of Breastfeeding and Child Nutrition Bill. Similarly Mr. Bugti Head of Nutrition Cell Government of Balochistan said that the Balochistan Protection and Promotion of Breastfeeding Bill will be placed before the Provincial Assembly for enactment in its coming session. The immediate result was notification of the Infant Feeding Board at the Federal level within a week.

Another major step towards highlighting the situation of under nutrition in Pakistan was the launch of the Lancet Series on Maternal and Child Nutrition, on 21st August 2013. Dr Zulfiqar Ali Bhutta was one of the key note speakers. The launch was covered by some of the leading newspapers of the country covered, while Express Tribune also did an editorial the very next day.

Throughout the year we have been regularly collaborating with the Development Partners for Nutrition (DPN), including national consultation on “The Role of Private Sector in Addressing Malnutrition in Pakistan” and five media roundtable discussions to engage media in highlighting the issue of malnutrition. This resulted in several contributions by media persons in leading English and Urdu newspapers. We also organized Multi-stakeholders’ workshops in Lahore & Quetta to accelerate the implementation of the UN Every Woman Every Child (EWEC) Strategy in Pakistan. To gather more support around the issue of malnutrition a number of sessions were organized at Islamabad, Karachi, Lahore, Peshawar and Quetta with human rights organizations. Our aim was to increase understanding and knowledge of nutrition which will ultimately lead to improved nutrition advocacy initiatives by civil society organizations.

During the measles outbreak in Sindh and Punjab, we worked together with Child Rights Movement, to write letters to the provincial chief ministers and advocate for strengthening routine immunization. Around the same time, the EVERY ONE Campaign was made part of the Khyber Pakhtunkhwa Provincial communication Technical Committee on Immunization. We also supported the midterm and annual review of the Expanded Program for Immunization (EPI) in Khyber Pakhtunkhwa, which resulted in the inclusion of training for Lady Health Workers in the EPI manual.

Our engagements with the Technical Advisory Group continued throughout the year, where we regularly reviewed the mother and child health situation in each province. For the first time in Pakistan, the EVERY ONE Campaign engaged the Parliamentarians from both the ruling and opposition parties on the country’s achievement of MDG 4 and related issues of under nutrition in Pakistan, strengthening routine immunization and increasing the number of Lady Health Workers and Community Midwives.

The EVERY ONE Campaign also worked with 1,564 children from 12 children’s clubs at Muzaffargarh in Punjab and 62 children clubs of Sanghar in Sindh and educated them on the importance of immunization, nutrition and lady health workers. As part of engaging children in the campaign, we held a press conference with the Children group on Universal Children’s Day. During the press conference, children highlight the health and education related issues. The call for attention was that it is due time that the government took a proactive lead to change the lives of these children. The press conference got coverage by one of the leading English newspaper along with some Urdu papers.
Last year we focused on educating journalists around health reporting. We collaborated with MIISHAL (Media Agency) to identify 20 potential journalists from across Pakistan to train them on the situation of under nutrition among children and women in the country, its link with the under 5 mortality and the role of media. The training was followed by field visits to the various health facilities in Sindh, Balochistan and Khyber Pakhtunkhwa.  This training resulted in significantly more media coverage on malnutrition. To appreciate the efforts of the journalists, the EVERY ONE Campaign collaborated with Agahi Awards to award the best journalists in the health category.

The EVERYONE Campaign will continue to build on the momentum created in 2013 and strive for achieving results in 2014. We’ve begun 2014 with provincial consultation on Every Newborn Action Plan consultations in collaboration with UNICEF. We are going to launch “Ending Newborn Deaths” report in Islamabad involving the federal and provincial governments, civil society and media. We’ll hold Health Workers Awards with a focus on Lady Health Workers and Community Midwives and will launch our documentary on health workers during the week involving high level provincial government officials with a focus on increase in the number of LHWs and CMWs. The EVERYONE Campaign is in the final stages of producing a documentary on immunization which will be launched during the immunization week. We are also working on a research together with the Expanded Programme of Immunization (EPI) about the causes of poor immunization in low performing districts of Punjab. Findings of the research will be used during the immunization week and later for advocacy to strengthen routine immunization. Together with DPN we are working to establish the SUN CSOs network. We’ll continue with our advocacy for provincial inter sectoral strategies and budgetary allocation for nutrition and continue to follow up on the implementation of the breastfeeding code. The State of the World’s Mothers report will be launched, breastfeeding week will be celebrated and a national research about newborns will be conducted and launched during the year. We’ll continue to engage with Private Sector at provincial level. We’ll continue to engage with key stakeholders including children, parliamentarians, DPN, civil society, media and government.

Sunday, February 2, 2014

Breastfeeding: A key to save children's lives

Hooray, the Balochistan Assembly has finally enacted the Balochistan Protection and Promotion of Breastfeeding and Child Nutrition Bill 2014 on January 14 however; the real test is its implementation in letter and spirit. I am saying this because we know that the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002 is on the statute books since 2002 but its implementation has always remained a distant dream.

As most of us know, Pakistan is not on track to achieve Millennium Development Goal (MDG) 4 targeted to reduce under-five mortality rate by two-thirds between 1990 and 2015. We know that around 700 days have left only to achieve our target. Countries like Bangladesh and Nepal are on track to achieve the MDG 4. Remember that in 1990; Pakistan’s under-five mortality rate was 138 per 1000 live births as compared to those of Bangladesh (139 per 1000 live births) and Nepal (135 per 1000 live births). However over the past two decades there has been remarkable change, Bangladesh was able to lower its under-five mortality rate to 41 and Nepal to 42 which put them well on track to meet their MDG 4 targets for 2015 while Pakistan is still struggling at 86 per 1000 live births. With the World’s highest national number of newborn deaths (194 000 in 2010), the neonatal mortality declined by only 0.9% per annum between 2000 and 2010 in Pakistan; less than the global average (2.1%) and less than national maternal and child mortality declines.

A major source of killer diseases among Pakistani children is the lack of exclusive breastfeeding and the use of unhygienic bottles, formula milk and teats. Pakistan has failed to achieve any significant progress in increasing exclusive breastfeeding for six months in the last decade. “Exclusive Breastfeeding is defined as only breastfeeding and no additional food, water or other fluids for first 6 months of life”. Only 38% of infants in Pakistan are exclusively breastfed for 6 months according to the preliminary findings of the Pakistan Demographic and Health Survey (PDHS) 2012-13. This is indicative of the fact that there is hardly any improvement since PDHS 2006-07 when the exclusive breastfeeding for six months was 37%. The PDHS 2012-13 findings also shows increase in bottle feeding rates in Pakistan.

On the contrary, in Bangladesh the rate of exclusive breastfeeding for six months is 64% while in Nepal it is 70%. Bangladesh was able to increase the rates from 43% in 2007 to 64% in 2012 by commitment at all levels. This was also possible because of the active involvement of the civil society and media in the campaigns for the promotion and protection of breastfeeding.

Breast milk is a powerful intervention which can significantly reduce infant mortality. Save the Children’s Super Food for babies report refers to breastfeeding as the closest thing to a ‘silver bullet; in the fight against malnutrition and newborn deaths. This is apparent from the fact that an estimated 22% of newborn deaths could be prevented if breastfeeding started within the first hour after birth.

“Babies who are not exclusively breastfed in the first six months are at 14 times higher risk of dying than exclusively breastfed infants” said renowned Paediatrician and President of the Advocacy and Advisory Network on Newborn (AANN) Dr. Tabish Hazir during an event. He further stated that Pakistan has the highest bottle feeding rates in South Asia which calls for the strict implementation of the breastfeeding and marketing code, capacity building of the healthcare providers at all levels for improved breastfeeding counselling skills and revision of the undergraduate curriculum with greater emphasis on good Infant and Young Child Feeding practices including exclusive breastfeeding.

Research shows that early initiation of breastfeeding benefits the immunity of a baby, reduces the risk of neonatal sepsis and respiratory infections and is also associated with higher rates of breastfeeding and lower rates of diarrhea throughout the first six months of life. According to a new study in Greece, children who were breastfed for more than six months scored the highest on cognitive, language and motor development tests as toddlers.

According to the findings of a qualitative assessment done to explore factors responsible for the violation of the Code in Pakistan many healthcare providers are unaware of laws related to the protection of breastfeeding.

To be able to witness in our lifetime that no child will be born to die from a preventable disease, it is imperative to put breastfeeding at the centre of our efforts. This means not only the involvement of the government and the health system, but also of the media and the community. Steps to eradicate major barriers such as community and cultural pressures; the shortage of frontline health workers i.e. Lady Health Workers who cover only 60% of the population; lack of maternity legislation and inappropriate promotion of breast-milk substitutes are also important to ensure that every infant receives the life-saving protection that breastfeeding can offer. Similarly, the breast milk substitutes producing companies should abide by the Code and dedicate 1/3 of all BMS packaging to a warning label stating that formula is inferior to breast milk.

This has also been made mandatory under the Protection of Breastfeeding legislation in Pakistan. The Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013 has made it mandatory for the BMS companies to include a warning in Urdu and Sindhi languages that formula is inferior to breast milk. An Infant Feeding Board has been notified at the federal level to monitor the implementation of the federal law. Punjab requires to effectively implement the Punjab Protection of Breastfeeding and Young Child Nutrition (Amendment) Act 2012 while Khyber Pakhtunkhwa has committed at the highest level that soon it will also enact a legislation for the protection and promotion of breastfeeding.

The writer holds a Masters in Human Rights from the London School of Economics is working for the promotion and protection of child rights. He tweets @amahmood72





Friday, January 24, 2014

Innocence lost: Child domestic labour

The murder of a 10 year old child domestic worker Irum by her employers in Lahore made headlines last week. I’d like to share with readers however, that Irum’s cruel torture to death is not the first case of torture to death of a child domestic worker in Pakistan. Approximately 45 cases of violence against child domestic workers were reported in media since Shazia Masih’s tragic and cruel murder in January 2010 in Lahore. Irum is 22nd child domestic worker tortured to death and majority of these cases have been reported in Punjab. Iram’s murder was the first case of torture to death of child domestic workers in 2014 followed by two other such cases of 16 year old and 12 year old Fizza Batool all from Lahore.

If someone has any doubts, please google Shazia Masih (Lahore), Jamil (Multan) Yasmin (Okara), Shehzad (Gujranwala) Tehmina (Islamabad) to name a few. All these cases show that child domestic labour is one of the deadliest form of child labour in Pakistan. However, the federal and provincial governments in Pakistan have failed to respond to the situation. The problem with Pakistani society is that we have short memories and forget about such cases after a few days. We don’t have any follow up mechanism and such cases remain in the limelight till media keep following it. Once media loss its interest, everyone forget about it until the new reported case in a few months’ time.

Similarly, the Government is constantly in denial mode despite the fact that it has been proved by the brutal torture to death of 22 child domestic workers. A much higher number got injuries including lifelong injuries and a number are missing. There are organized gangs who are involved in internal trafficking of children and are providing children as domestic servants in big urban centers. The federal government is required to put an immediate ban on child domestic labour by adding child domestic labour in the schedule of banned occupations under the Employment of Children Act (ECA) 1991 through a notification in official Gazette.

The only argument from those in the government against putting child domestic labour in the schedule of banned occupations under the ECA is that it wouldn’t be possible for Labour Inspectors to conduct inspections of houses. In my opinion even where labour department can conduct inspections, what achievement has been made by them or what positive impact is created as for as labour rights in Pakistan is concerned? Agreed that policing is not a solution however, the ban will send a signal to those educated people, bureaucrats, parliamentarians and common people that this is something against the law. Extensive awareness raising campaigns by civil society will help reduce the number of child domestic workers and will also put the employers on an alert against torturing innocent children.

Similarly, I’ll also request Chief Minister Punjab to take a proactive action and immediately ban child domestic labour under the schedule of banned occupations of the Punjab Employment of Children (Amendment) Act 2011. This is important as almost twenty of the twenty two child domestic workers’ torture to death cases have been reported from Punjab. The Government of Punjab should wake up now and respond to this situation.

For resolving the issue of child labour on sustainable basis in Pakistan, the federal and provincial governments should make serious efforts to implement Article 25-A of the Constitution of Pakistan about right to free and compulsory education for children 5 to 16. The Government of Punjab should immediately enact the Right to Free and Compulsory Education Bill and make sufficient budgetary allocation for the implementation of the law.

This blog first published in Tribune Blogs on January 06, 2014 

Our unsung heroines

Our frontline health workers including Lady Health Workers (LHWs), Community Midwives (CMWs) and Vaccinators are the real heroes in Pakistan’s fight to prevent child and maternal mortality in the country to be able to achieve Millennium Development Goals (MDGs) 4 & 5. MDG 4 is about two third reduction in child mortality and MDG 5 is about three quarters reduction in maternal mortality ratio by 2015. The progress towards achieving MDGs remains a challenge and an elusive dream for Pakistan where 352,400 children under-5 die of preventable causes every year. The national under 5 mortality rate is 87 per 1000 live births and the maternal mortality rate is at an alarming 276 deaths per one 100,000 live births. There is a need to accelerate the efforts to be able achieve MDGs 4&5.

The LHWs and vaccinators are not only playing a leading role in preventing thousands of preventable child deaths but are also our frontline force against the ongoing fight in the country for the eradication of polio. Unfortunately however, in the recent past we not only witnessed targeting of the LHWs and vaccinators by the terrorists but also a cold shoulder by the government towards resolving their issues.

The last approved PC-1 of LHW Programme has targeted the expansion of LHWs from existing number to 130,000 by 2015 with a focus on expansion to marginalize and disadvantageous uncovered areas. The 18th Amendment has implicated the expansion by bringing a standstill situation to the programme owing to lack of funds for meeting the operational cost of existing LHWs and barring the expansion. Lately, through judicial intervention the LHWs have been regularized throughout the country and their rewards have also been increased. However, we still see LHWs on the streets demanding documentation of their regularization and implementation of the decision in letter and spirit by the federal and provincial governments. 

Lack of frontline line health workers such as LHWs and Community Midwives is one of the major reasons of Pakistan’s slow progress towards achieving MDG 4 & 5 as currently there are 97,639 LHWs and 3,843 Lady Health Supervisors (LHSs) in the country covering only 60% of the population against the proposed target to increase this number to 130,000 by 2015. Following Supreme Court of Pakistan’s intervention, the previous government regularized the services of LHWs, LHSs and other staff of the Family Planning & Primary Health Care Programme with Federal Government’s full funding for this programme up to 7th NFC Award (FY-2015) as already decided by the Council of Common Interests.

While regularizing the LHWs, the previous federal government included a stringent condition; the posts that may become vacant as a result of resignation, losing jobs or otherwise shall stand abolished for the purpose of federal funding and new recruitment w.e.f. 1-7-2011 will be financed by the provincial governments. Likewise, any new creation of posts/appointments or future need will be financed by the provinces from their own budget/resources. This condition resulted in decrease in the number of LHWs instead of increasing their number i.e. in Punjab the number LHWs decreased from 49,000 to 47,300 and similarly in other provinces.

The incumbent federal government should intervene and reverse this decision by allowing the provincial governments to fill the vacant position i.e. 1,700 positions in Punjab to be filled immediately. Secondly, coordinate with the provinces and support them in recruiting more LHWs and making budgetary allocations for necessary supplies to reach to the uncovered areas and help Pakistan progress towards achieving MDGs 4 & 5. Similarly, the provincial governments should also take responsibility and start allocating resources for increase in the number of LHWs, CMWs and vaccinators in the respective provinces to be able to reach out to 100% population and achieve mother and child health related targets.

According to the findings of research studies by Professor Dr. Zulfiqar A Bhutta and others, in many countries, community health workers are now offering a wide menu of services to communities in different types of challenged settings. Their services include conducting deliveries, conducting counseling and health education, immunization, management of childhood illnesses at community level such as diarrhea, malaria and pneumonia and malnutrition. The community health workers’ services have led to decrease in child and maternal mortality in different countries.

The successive governments since 1993 have relied on LHW Programme for the delivery of health services to the far flung areas. The key policy instruments of development in Pakistan over this time period have included LHW Programme as a primary area of investment for meeting health challenges. Besides, non-governmental initiatives such bilateral projects, UN initiatives for child health etc have also heavily relied on LHW Programme for delivery of services targeting the achievement of MDGs.

The menu of services of LHWs include 20 key tasks related to maternal, newborn and child health care and the health indicators in LHW covered areas are significantly better than the national averages. Research has proved that the coverage of some key interventions for maternal and child health such as fully immunized children, knowledge of mothers about preparation of ORS, antenatal consultations, measures of exclusive breastfeeding  have improved in LHW covered areas. The children under 3 years of age in LHW covered areas are 15 percentage points likely to be fully immunized as compared to areas not covered by LHWs. When analyzed LHWs performance for difference in poor and rich, it has been found that the effects were larger for poorer households especially in maternal and neonatal health practices, immunization and growth monitoring according to Oxford Policy Management findings of 2009.

There are issues around LHWs coverage, remuneration and operational aspects of their programme. Currently LHWs cover only 60% of the population, nearly 25% of LHWs are low performing, there are delays in the salaries disbursements, the stock outs of medicines along with non availability and/or dysfunctional equipment is a continuous problem, the supporting referral system is not helpful due to staff absenteeism and other issues at the referral facilities.

It is imperative that LHWs coverage is expanded to un-served rural poor populations and urban slums and that will be possible only if their number is increased and all the current vacant positions are filled immediately. Similarly, it is important to ensure that they are provided with the required stock of medicines and equipment, their terms of reference are reviewed and routine immunization is formally incorporated; they are trained to be able to provide mothers with skilled support to improve child feeding practices, including breastfeeding and to contribute in maternal and newborn care. The monitoring mechanisms should be strengthened as well to ensure effective utilization of this vital human resource.

It is crucial that the provincial governments take a leadership role, with the support of the federal government, and strengthen the Programme at the provincial levels. The Programme should be structured in such a way that the staff is satisfied and are able to concentrate on performing their job which is critical for Pakistan’s acceleration of progress towards achieving MDGs.

This blog also published as an op-ed in The News on Sunday on October 13, 2013 

Monday, October 21, 2013

Malnutrition in Pakistan: A crisis long overlooked

“Well fed people can enhance their dignity, their health and their learning capacity. Putting resources into social programs is not expenditure. It is investment”, Luiz InĂ¡cio Lula da Silva, former President of Brazil

Finally the federal government has launched the long awaited National Nutrition Survey (NNS) 2011 in Islamabad in a high level ceremony where both the Federal Minister for Planning and Development and the Minister of State for Health Services Regulations and Coordination with the respective secretaries, representatives of the Provincial Governments and the Planning Commission of Pakistan, Donors, UN Agencies and civil society were present.

Findings of the NNS 2011 are depressing and clearly depicts how neglected the subject is in Pakistan. There has been no improvement in nutrition indicators for the last almost 4 decades and Minister Ahsan Iqbal rightly lamented the fact that the last decade following NNS 2001 has been totally lost as no tangible steps have been taken to improve the situation.

The NNS 2011 was the largest nutrition survey in the history of Pakistan conducted by the Agha Khan University’s Division of Women and Child Health, Ministry of Health and UNICEF with the financial support of AusAID and DFID. The NNS 2011 covered all provinces, Azad Jammu and Kashmir (AJK), Gilgit Baltistan and the Federally Administered Tribal Areas (FATA). This included 1,500 enumeration bocks (EBs)/villages and 30,000 households with a 49% urban and 51% rural distribution.

Results from the NNS 2011 indicated little change over the last decade in terms of core maternal and childhood nutrition indicators. With regard to micronutrient deficiencies, while iodine status had improved nationally, vitamin A status has had deteriorated and there had been little or no improvement in other indicators linked to micronutrient deficiencies.

The NNS 2011 revealed that the nutritional status has not changed much over the past decade. The anthropometry measurement of children under 5 revealed that 43.7% were stunted (too short for her/his age/low height for age) in 2011 as compared to 41.6% in 2001 NNS. Similarly, 15.1% children were wasted (weight that is too low for her/his height) compared to 14.3% in 2001. As per World Health Organization’s standards, a national average of 15% or above is labelled as an “EMERGENCY”.

The NNS 2011 indicates that stunting, wasting and micronutrient deficiencies are endemic in Pakistan. These are caused by a combination of dietary deficiencies; poor maternal and child health; a high burden of morbidity; and low micronutrient content in the soil, especially iodine and zinc. Most of these micronutrients have profound effects on immunity, growth and mental development. They may underline the high burden of morbidity and mortality among women and children in Pakistan.

Malnutrition plays a substantial role in Pakistan’s high child morbidity and mortality rates. Due to its correlation with infections, malnutrition in Pakistan currently threatens maternal and child survival and an estimated 35% of all under 5 deaths in the country are linked with malnutrition. It is imperative to respond to the situation if Pakistan has to be on track to achieve Millennium Development Goal (MDG) 4; about two third reduction in under 5 mortality.

More than 1.5 million children in Pakistan are currently suffering from acute malnutrition, making them susceptible to infectious diseases which may even lead to death. Long-term (chronic) malnutrition undermines both physical and mental development; nearly half of Pakistan’s children are chronically malnourished, and have their brain development and immune systems impaired, with life-long consequences.

Most of the irreversible damage due to malnutrition happens during conception and in the first 24 months of life meaning that risk begins from the day of conception to up to two years of age also referred to as the first 1000 days.

“Addressing malnutrition is one of the best investments Pakistan can make in its future”. There is a need to provide primary attention to nutrition-specific evidence-based interventions focused both on women and young children, while also addressing key malnutrition determinants.

It was encouraging to listen to the federal Minister for Planning and Development Ahsan Iqbal, during the launch of the NNS 2011, who was very clear that it is time for retrospection and that the issue is not going to be resolved through routine approach and all the stakeholders should respond to the situation as an emergency.

Besides, the launch of the NNS 2011 another positive development is Pakistan’s joining of the Scaling Up Nutrition (SUN) initiative at the global level in April 2013. More than 40 countries have joined the SUN Movement so far Pakistan being the largest country. SUN is an opportunity which the government should utilize effectively and gear up to improve the situation of nutrition in the country. Key donors, UN Agencies, National and International NGOs are there to support the federal and provincial governments to scale up efforts for nutrition in a coordinated and efficient manner.  

There is a need for multi-sectoral interventions to address malnutrition involving health, education, social protection, water and sanitation, agriculture and private sector with a high level commitment from leadership to plan and implement multi-sectoral interventions.

Recently during the launch of the Lancet Series on Maternal and Child Nutrition 2013 in Pakistan, prominent nutrition expert and lead researcher of the NNS 2011 Professor Dr. Zulfiqar A. Bhutta said that the NNS 2011 underscores the primacy of addressing maternal and child under-nutrition at scale through targeted effective interventions; the current coverage rates for many key interventions remain poor and must be prioritized for scaling up. A broad multi-sectoral concerted approach is needed with political ownership of the problem and its determinants at the highest level said Dr. Bhutta. He further stated that there is a need to focus on Infant and Young Child Feeding strategies, Exclusive Breastfeeding promotion and complementary feeding, an area that has received scant attention to so far.

Given the success of salt iodization in reducing deficiency, greater attention must be focused on large scale fortification strategies for staples and common commodities/weaning foods, including home fortification recommended Dr. Bhutta and said that there are clear opportunities for linking the current cash support program and social safety nets to key nutrition interventions targeting women and children (hence addressing food insecurity).

It is also imperative to support women and their families to practice optimal breastfeeding and ensure timely and adequate complementary feeding. Breast milk fulfills all nutritional needs of infants up to six months of age, boosts their immunity, and reduces exposure to infections. There is also a need for steps by the federal and provincial governments for the implementation of the respective breastfeeding laws i.e. the Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013for effectively monitoring the unnecessary promotion of breast milk substitutes. The rules of the 2013 Act require to be notified immediately and an Infant Feeding Board established and notified to ensure implementation of the law. Similarly, effective steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002should be taken at the federal level.

The writer is Director Advocacy and Child Rights Governance, Save the Children Pakistan Country Programme and tweets @amahmood72
This blog was also published at  and also appeared as an Op-Ed in The News on Sunday on October 06, 2013


Friday, September 20, 2013

Unite for child rights in Pakistan

By Arshad Mahmood

More than 40 child rights activists from across the country gathered in Islamabad to review the state of child rights in Pakistan and plan that how will they respond together as Child Rights Movement (CRM) Pakistan to improve the situation. CRM Pakistan is a coalition of more than 100 civil society organizations working for the promotion and protection of child rights across Pakistan having its national and AJ&K, Balochistan, Khyber Pakhtunkhwa (KP), Punjab and Sindh chapters.

The CRM Pakistan planned policy advocacy initiative focusing on child rights at the federal and provincial levels and called upon the federal and provincial governments to take serious and committed steps to improve the deteriorating state of child rights in Pakistan.

It was agreed that CRM will engage extensively with the new federal and provincial governments and parliamentarians to ensure that all pending legislation related to child rights i.e. The Prohibition of Corporal Punishment Bill, the Criminal Law Amendment Bill, the Child Marriages Restraint Amendment Bill and the National Commission on the Rights of Children Bill at the federal level are enacted during 2013 which has also been declared as the Year of the Rights of the Child in Pakistan.

The CRM meeting noted with concern that a number of children related legislations are pending at the provincial level and urged the provincial governments to enact the Balochistan Child Protection and Welfare Bill, the Punjab Commission on the Rights of the Child Bill, the Right to Free and Compulsory Educations Bills in Balochistan, KP and Punjab and the Prohibition of the Employment Children Bills in the all the four provinces. It was also decided that advocacy campaigns will be launched at the federal and provincial levels using various means to put pressure on the parliament for the enactment of all pending bills.

The CRM Pakistan also called upon the Government of Sindh and KP to notify rules of the Sindh Child Protection Authority Act 2011, the KP Child Protection and Welfare Act 2010 and the KP Borstal Institutions Act 2012 and make proper budgetary allocation for the effective implementation of these laws.

CRM noted with concern that there is no child protection system in the Islamabad Capital Territory (ICT) which makes the children living in the capital more vulnerable. The CRM decided that there will be targeted advocacy at the federal level so that the government should introduce a proper child protection system for ICT. It was also discussed and agreed steps should be taken for the implementation of the Right to Free and Compulsory Education Act 2013 in ICT and the Federally Administered Tribal Areas (FATA) where the laws has recently been extended by the President of Pakistan.

It was agreed that CRM will continue with its advocacy for increase in budgetary allocation for children in health including nutrition, education and child protection sectors at the national and provincial levels and will continue follow up for the implementation of Pakistan’s international obligations such as recommendations of Human Rights Council (UPR Process) and Concluding Observations and Recommendations of the Committee on the Rights of the Child etc.

The CRM also decided to get involved in debate related to Pakistan’s achievement of the MDGs and the post 2015 agenda for sustainable development. The coalition has planned to develop a Child Protection Monitoring Mechanism and regularly generate research reports and quarterly or bi-annual situation reports /newsletters and factsheets etc. It was also decided that meaningful child participation in CRM’s advocacy initiatives will be ensured.

The CRM Pakistan also discussed the situation of children in emergencies in Pakistan and called upon the government of Pakistan to take steps for the rehabilitation of children and their families affected by manmade and natural disasters in FATA and across the country. It was also decided that CRM will be involved in advocacy to keep highlighting the plight of the children affected by emergencies.

The Child Rights Movement called upon the federal government to ratify the Optional Protocols to the UN Convention on the Rights of the Child on the Involvement of Children in Armed Conflict and Communications Procedure for Children and decided to launch a campaign in this regard.

There were exclusive sessions on advocacy, the use of social media for advocacy and monitoring of child rights violations mechanism development. The CRM planning meeting concluded with a resolve to unite for child rights in Pakistan. There was a unanimous agreement that working as coalition in an organize manner has more potential to achieve great results for the children of Pakistan particularly at the policy, legislation and budgetary allocation level.

The writer is among the founding members of CRM Pakistan and Director Advocacy and Child Rights Governance with Save the Children Pakistan Program.