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 Inácio 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 http://everyone.savethechildren.net/articles/malnutrition-pakistan-crisis-long-overlooked  and also appeared as an Op-Ed in The News on Sunday on October 06, 2013   http://jang.com.pk/thenews/oct2013-weekly/nos-06-10-2013/pol1.htm#5

 

 

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.

Undernutrition: An unfinished agenda

“Nutrition is crucial to both individual and national development. The evidence in the Lancet Series on Maternal and Child Nutrition furthers the evidence base that good nutrition is a fundamental driver of a wide range of developmental goals. “The post 2015 sustainable development agenda must put addressing all forms of malnutrition at the top of its goal” was a unanimous agreement at the launch of the Lancet Series in Pakistan. Lancet is a pioneer medical research journal which focuses on health issues. The launch ceremony was well attended by representatives of the federal and provincial governments, UN agencies, donors, academia, media and civil society.

While there has been a tremendous increase in a global political commitment to improve nutrition; yet this has translated into a modest impact. This presents a substantial unfinished agenda i.e. to address the cause of 45% (3.1 million) of all under 5 child deaths due to malnutrition said the President and CEO of Save the Children US, Carolyn S. Miles observed in her opening remarks at the launching ceremony in Islamabad. In Pakistan alone, 35% of all under five deaths can be attributed to the menace of malnutrition observed Ms. Miles. 

She further noted that the national and international momentum to address human nutrition and related food security and health needs has never been higher but we have to seize this opportunity and take concrete actions. Carolyn Miles reaffirmed Save the Children’s commitment to the cause of addressing malnutrition and assured that Save the Children will remain a frontline ally for responding to nutrition issues in Pakistan.

One of the leading global experts on nutrition and a lead author of the Lancet Series Dr. Zulfiqar A.  Bhutta from the Agha Khan University presented the key finding of the four papers. Breastfeeding practices are far from optimum, despite improvements in some countries said Dr. Bhutta. Sub optimum breastfeeding results in an increased risk for mortality in the first 2 years of life and results in 800,000 deaths annually. Furthermore, nearly 15% of deaths of children younger than 5 years can be reduced (i.e. 1 million lives saved), if the ten core nutrition interventions identified in the Lancet Series are scaled up.

“If we want to address issues of malnutrition we would need long term sustained initiatives. This includes food security, child protection, gender dynamics which calls for nutrition sensitive interventions such as programs aimed at poverty alleviation, empowering women, targeted agriculture safety nets and early childhood development programs” recommended Dr. Bhutta.

“Pakistan has made insufficient investments in nutrition sensitive interventions that are critical to produce policy change and impact” lamented Dr. Bhutta and called for a collective societal approach, whereby all segments of society such as media, government, civil society and public work in collaboration to provide an enabling environment which puts the issue of malnutrition at the center stage.

“The Lancet Series in 2008 identified the need to focus on the crucial period from conception to a child’s second birthday-the 1000 days in which good nutrition has lasting benefits throughout life”.

“In Pakistan, about one quarter of the new borns are born at a low birth weight. Whereas, one half of the children suffer from chronic malnutrition. This seriously undermines the prosperous development of Pakistan as consequences of malnutrition cut the nations GDP by up to 4%” said Mr. Dan Rohrmann, Country Representative UNICEF Pakistan. “Despite the economic development of the nation, we are facing a silent crisis of malnutrition with indicators amongst the worst in the world and no improvements in recent four decades regretted Mr. Rohrmann and emphasized that if this issue is prioritized, malnutrition can be ended in a life time of a generation.

The Development Partners for Nutrition (DPN) group is involved in advocacy for considering nutrition as a priority at the national development agenda, policy and strategy support and strengthen nutrition in implementation shared Ms. Silvia Kaufmann, Chief Nutrition, UNICEF Pakistan. The DPN is supporting the development of provincial nutrition guidance notes and provincial inter-sectoral nutrition strategies she informed.

Mr. Aslam Shaheen, Chief Nutrition, Planning Commission of Pakistan lauded the efforts of Save the Children in launching the Lancet Series in Pakistan and observed that recommendations highlighted in the lancet paper will build into the Vision 2025 and government’s 5 year development plan. He also informed the participants that the Government of Pakistan will formally launch the National Nutrition Survey 2011 in the coming few weeks.

The launch of the Lancet Series on Nutrition  is timely and relevant for Pakistan as recommendations could be used in the Integrated Provincial Nutrition Strategies being prepared in all the four provinces through a consultative process. Save the Children together with the DPN is committed to providing support to the federal and provincial governments to have the strategies in place and implemented. There is also a commitment for full support and cooperation to the government for implementing the Scaling up Nutrition (SUN) initiatives commitments in Pakistan. Together with the Development Partners for Nutrition and the civil society of Pakistan we are committed to work for improving the nutrition situation in Pakistan. However, for these initiatives to materialize political will and leadership is needed by the government both at the federal and provincial level.

The launch got excellent coverage from Pakistan’s leading newspapers and on social media including facebook and twitter. There was great resolve and commitment among the stakeholders to use the findings of the series in the ongoing efforts to improve the nutrition situation in the country and put nutrition on the agenda of decision makers, civil society and media and the national and provincial levels.

 

The was blog also published at:

http://www.healthynewbornnetwork.org/blog/undernutrition-unfinished-agenda

http://www.trust.org/item/20130827063530-lq9ek/

http://everyone.savethechildren.net/articles/undernutrition-pakistan-unfinished-agenda

 

 

 

 

The superfood with the potential to save hundreds and thousands of children’s lives

Imagine a food that is free, nutritious and has the potential to save thousands of children’s lives. Well there’s no need to imagine it, it already exists- a mother’s milk; breastfeeding is one of the most powerful weapons we have to fight child mortality. The teachings of Islam also strongly endorse that mothers should breastfeed their children for two years.

The Global Breastfeeding Week concluded with a number of advocacy and awareness raising events across the country and globally. The World Breastfeeding Week which, each year, presents an important opportunity to put the spotlight on the importance of breastfeeding for saving children’s lives. But this can’t just be a one week effort; we need strong leadership and political action all year round to promote it.

According to the medical journal, the Lancet, suboptimum breastfeeding results in more than 800,000 child deaths annually. If we can ensure that every newborn is given breast milk immediately after birth and is fed only breast milk for the first six months, we can greatly increase the chance that they will survive and go on to fulfil their potential. Around one in eight of the young lives lost each year could be prevented through breastfeeding, making it one of the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths.

It is estimated that 3.1 million children die from malnutrition each year. Breastfeeding is not only crucial for tackling malnutrition and saving children’s lives, it also has the potential to have tangible impacts on the economic and social development of countries likes Pakistan. Malnutrition can undermine future earning potential by as much as 20% and can inhibit growth of GDP by as much as 2-3%.  Today’s malnutrition will knock $125bn off the global economy by 2030, when these children reach working age. 

But breastfeeding is undervalued. Global rates of breastfeeding have remained below 40% for the past 20 years as breastfeeding has slipped down the list of political priorities. In some countries, particularly in East Asia and the Pacific, the number of breastfed children is starting to fall.

In Pakistan only 37 per cent of children are exclusively breastfed for the first six months meaning that too many children are missing out on the vital nutrients they need in the first months of life. Similarly, the early initiation of breastfeeding is only 29 per cent in the country. That needs to change.

If babies receive colostrum – the mother’s first milk – within an hour of birth, it will kick start the child’s immune system, making them three times more likely to survive. If the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases like pneumonia and diarrhoea.

So what needs to happen? We need to ensure that women have the support they need to breastfeed and overcome the main barriers preventing them from doing so. Those barriers include community and cultural practices which discourage women from breastfeeding, severe shortages of midwives and health workers meaning that too often the opportunity for new mothers to be supported to breastfeed in the first few hours is lost, lack of adequate maternity legislation and marketing practices by some breast milk substitute companies leading to infant formula being used unnecessarily and improperly, ultimately putting children at risk.

Tackling these barriers demands a new and concerted effort from many different groups of people; governments, local communities and business. For example, governments and local communities need to take action to empower women to make their own decisions about breastfeeding, governments need to invest in strengthening health systems to protect, promote and support breastfeeding and introduce nationwide breastfeeding-friendly policies and legislation. Finally, businesses need to act responsibly in their marketing on Breast Milk Substitutes and governments need to ensure that national regulation of Breast Milk Substitutes is strengthened and enforced. This issue is increasingly important in emerging economies, where some companies are aggressively marketing their products, despite the threat that this undermines support for breastfeeding.

In the last two decades there has been huge global progress in reducing child mortality with five million fewer children dying in 2011 than in 1990. The world is nearing a tipping point, the time at which the eradication of preventable child deaths becomes a real possibility.  But there is still a lot to do to reach that point - breastfeeding is key to unlocking further progress and saving hundreds and thousands of children’s lives.

Pakistan, voted in favour of adopting the International Code of Marketing of Breast-milk Substitutes during the World Health Assembly in May 1981, and promulgated “The Protection of Breastfeeding and Young Child Nutrition Ordinance 2002” to enforce the code. The ordinance 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. The ordinance requires from health workers to encourage, support and protect breastfeeding. Following the devolution, earlier this year, the Sindh Assembly enacted the local legislation by Sindh “The Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013”. Similarly, last year the Punjab Assembly also adopted the law as the Punjab Protection of Breastfeeding and Young Child Nutrition (Amendment) Act 2012.

“It’s heartening to know that Sindh and Punjab have enacted laws for the Protection and Promotion of Breastfeeding. However, the real test is its implementation in letter and spirit”. “Despite the Protection of Breastfeeding and Child Nutrition Ordinance on statute books since 2002, its implementation has always remained a distant desire.” Similarly, Punjab and Sindh have not been able to notify the rules and Infant Feeding Boards to monitor implementation of the law.

Keeping in view, the importance of breastfeeding in preventing fatal childhood diseases and neonatal mortality it is important that Balochistan and Khyber Pakhtunkhwa also enact laws on the pattern of Sindh and steps are taken for the effective implementation of these laws in all provinces. This will ensure safe nutrition for infants by promoting and protecting breastfeeding.

Similarly, the federal government should also take practical steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002 for the Islamabad Capital Territory and Federally Administered Areas. Infant Feeding Boards require to be notified immediately in Islamabad, Sindh and Punjab to monitor the implementation of the respective laws.

There is also a need to put promotion of breastfeeding on the agenda of civil society including NGOs, print and electronic media and academia to play their role in its promotion at all levels and create widespread awareness in the society which will ultimately lead to reduction in preventable infant and under 5 mortality in Pakistan.

The writer is a child rights activist and tweets at @amahmood72

 

Child domestic labour in Pakistan

Almost every month or two we hear about a new case of torture to death of a child domestic worker in Pakistan and then forget until a new case surface. The recent cold blooded torture to death of 10 year old Jamil in Multan by the wife of his employer show the seriousness of the problem in Pakistan.

Jamil's cruel torture to death is not the first case of murder of a child domestic worker in Pakistan. Approximately 42 cases of cruel violance against child domestic workers were reported in media since Shazia Masih's torture to death in January 2010 in Lahore. Jamil is 20th child domestic worker tortured to death and majority of these cases have been reported in Punjab.

If someone has any doubts, please google Shazia Masih (Lahore), 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 Chief Minister of 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 2012. I understand that policing may not be an effective way to respond to the situation however, banning child domestic labour can be a good deterance particularly for parliamentarians and government servants.

For resolving the issue of child labour on sustainable basis in Pakistan, the federal and provincial governments should make serious efforst 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.

Children’s place in manifestos

FORMER prime minister Raja Pervez Ashraf declared 2013 the year of the rights of the child in Pakistan on Nov 20, 2012 while speaking at a function to commemorate Universal Children’s Day. Unfortunately, however, his government couldn’t take any tangible steps in the first two and half months of 2013 except the last-minute approval of the Prohibition of Corporal Punishment Bill 2013 by the National Assembly and the approval of the Criminal Law Amendment (Child Protection) Bill 2013 by the federal cabinet in its last meeting.

The current year is also the year of elections in Pakistan and in the coming days and weeks we’ll be hearing political parties share their programmes and manifestos with the masses. This article has attempted to review the manifestos of Pakistan’s major political parties, specifically with reference to the rights of children to health and protection.

The PPP in its manifesto of 2008 referred more to what the party has done during earlier periods in power. While referring to health, the party declared it a high priority and committed that “it will further consolidate the Lady Health Workers Programme”.

The PTI highlighted “the present dismal state of women and children in terms of their access to healthcare, nutrition, and education”. The party plans to revamp and upgrade the public healthcare system in Pakistan in line with its slogan “healthy people, healthy nation” by putting in place reforms such as doubling state spending on health, achieving 100 per cent immunisation of children against preventable diseases, policy emphasis on preventive healthcare etc.

The PML-Q while referring to health commits to investment in hospitals to provide better treatment to patients and special incentives for doctors to serve in rural areas.

The PML-N while highlighting the importance of health made commitments to modernise main teaching hospitals both in the federal capital and provincial headquarters and equip these with state of the art medical equipment and facilities. The PML-N also committed to increase overall expenditure on health to 2% of the GDP, achieve 100% vaccination of children and 50% reduction in maternal and infant mortality by 2018.

The MQM committed to increase public expenditure on health from 0.6 per cent to five per cent of the GDP during the next five years. Interestingly, in its 2008 manifesto, the MQM had committed to increase it from 0.6 per cent to four per cent of the GDP and while drafting their manifesto for 2013 they were aware that it’s still at 0.6 per cent. The MQM further committed to ensure full coverage of the Expanded Programme of Immunization (EPI) and to establish hospitals in every district and healthcare centres in every village of the country. In its manifesto the MQM also committed for effective legislation against social ailments like gender discrimination, sexual harassment, domestic violence, child abuse, rape, honour killings, child marriage, karo kari, vani, marriage to the Quran, bonded labour and child labour. The party also committed to repeal all discriminatory laws against women and religious minorities.

The ANP committed it would strive to provide health facilities to all citizens. The party aimed to allocate at least six per cent of the GDP to health. It emphasised child and mother care, provision of clean drinking water and preventive medicine. ANP is the only political party that has included section on child rights in its manifesto and has vowed to review, legislate and implement child labour laws to ensure that child labour under the age of 16 years is prohibited in all formal and informal sectors including domestic sector. The ANP is committed to implementation of the Juvenile Justice System and will establish exclusive juvenile courts and introduce exclusive prisons with immense rehabilitation possibilities for the children. The ANP has also committed to make efforts to prohibit all forms of violence against children such as corporal punishment, sexual abuse, rape, kidnapping and ensuring punishment as per law.

The ANP also made commitments about bringing changes in FATA however, no child rights specific recommendation was made to ensure children of FATA equal rights without any discrimination as per the UN Convention on the Rights of the Child and other international human rights instruments.

While reviewing the manifestos of political parties it was observed that the content of most of the manifestos has minor changes from the 2008 elections. It was also observed that most of the commitments made regarding the right to health are of a general nature and there has been little focus on large-scale health reforms linking this right with achieving our international commitments such as the Millennium Development Goals (MDGs), Convention on the Rights of the Child and International Covenant on Economic, Social and Cultural Rights etc.

Similarly, except the PTI little attention has been paid to the prevention aspect highlighting areas like child and maternal health, infant and under-five mortality, immunisation and budgetary allocation.

The ANP and MQM have made specific recommendations related to budgetary allocation for health. However, one fails to understand what steps they took to increase budgetary allocation for health during their time in power.

According to the findings of the Draft National Nutrition Survey 2011, malnutrition has become a key concern for the country. Approximately 400,000 children die in Pakistan every year before their fifth birthday and 35 per cent of these deaths are attributed to malnutrition. However, none of the political parties have shared any vision about how they will address this important issue. Similarly, no specific agenda has been shared about what steps they would take to put Pakistan or their respective provinces on the right direction towards achieving the MDGs.

Health workers and immunisation are of immense importance towards achieving the MDGs. However, these important areas are not that visible on the agendas of political parties except the PPP and PTI, and that too without clear objectives and strategies.

It has emerged from the review of the manifestos that except ANP child protection is of no interest to any political party, except some highlights in the manifesto of the MQM without any solid plan about addressing the issues.

 

I need not remind anyone that millions of children are working as child labourers in Pakistan, including as part of the child domestic labour force, particularly in the homes of elites including politicians, while the number of children living and or working on the streets is increasing. Child marriage is still common, corporal punishment is widespread, internal trafficking of children, the use of children as child soldiers and suicide bombers and a poor criminal justice system for children are also some of the issues faced by minors.

The political parties in Pakistan need to come up with firm commitments about child rights, particularly children’s right to health and protection. Focus should be on areas which can bring solid changes in key indicators like child and maternal mortality, vaccination ratio, nutrition indicators, health workers’ coverage, protection of children from abuse, exploitation and violence against children, and above all policy, legislation and budgetary allocation for children.

The writer is a child rights activist. Twitter: @amahmood72

Published in Daily Dawn on April 9, 2013 http://dawn.com/2013/04/09/more-of-the-same-6/

 

 

 

Time to invest in routine immunization

It was a unanimous agreement among participants of the annual review of the Expanded Programme of Immunization (EPI), Khyber Pakhtunkhwa (KP) Province, to invest in routine immunization and that investment in routine immunization will help not only put Pakistan on the right track for achieving the Millennium  Development Goal 4 but will also ensure eradication of polio on sustainable basis. The review was held in Islamabad on March 22-24, 2013.

Dr Janbaz Afridi, Deputy Director EPI, highlighted the issues faced by the programme in KP including complicated security situation, difficult terrain, burden of Afghan refugees since 1979 and Internally Displaced Persons (IDPs) since 5 years, absence of a uniform and sustained quality of  coverage in critical districts, reporting and data management problems, weak technical capacity at district level and late compliance from some of the districts, limited number of female EPI technicians and no legislation concerning immunization to ensure 100% coverage of the target population.

While discussing the way forward it was agreed that the World Immunization Week to be celebrated in the last week of April 2013 with the theme “Stop Measles Now” shall be used as an opportunity to strengthen routine immunization in the province. Furthermore, service structure of staff involved in routine immunization, training of EPI staff in vaccine management, data management, communication and M&E, involvement of paramedics in routine immunization, evaluation of Lady Health Workers involvement in routine immunization, involvement of private sector and CSOs in EPI and legislation to ensure 100% coverage of target population were some of the areas require to be focused for greater immunization coverage and strengthening of the routine immunization system in the province.

A brief introduction of the EVERY ONE campaign was presented with its purpose and strategic objectives with a focus on immunization. It was highlighted that not enough children in Pakistan receive childhood vaccinations and children in rural areas are 1.4 times less likely to be immunized than children in urban areas. Highlighting the importance of immunization among the masses it was shared that 20% of the people in Pakistan have no knowledge about immunization and 14% think it’s unnecessary. It was emphasized that parental attitudes & knowledge and the quality of communication and outreach strategies directly affects the parental knowledge & attitudes – many parents of unimmunised children lack information about routine immunisation programme.

The EVERY ONE Campaign demanded that the provincial government should allocate specific resources to scale up routine immunisation targeting uncovered areas and children from poorest wealth quintiles. For this purpose, a policy should be adopted to train and expand the scope of work of LHWs to administer routine immunisation. Similarly, for KP to progress towards achieving universal standard for number of vaccinators (one vaccinator per 5,000 people) it is imperative to introduce a policy and make budgetary allocation. Furthermore, donors’ commitment was requested for responding to the needs of the province for universal coverage of routine and new vaccines.

It was discussed during the review that specific existing initiatives can be used to strengthen routine immunisation such as investments in LHWs and vaccinators, specific initiatives to reach out to every union council of the district as currently 110 of 1040 union councils of the province have no fix EPI Centre for immunization. It was also an undisputed agreement that there is a need for widespread awareness among the communities and their empowerment to demand services and hold the EPI accountable.

Dr Roohullah representing the Director General of Health Services reassured provincial government’s commitment for strengthening the routine immunization system in the province. He further committed that all issues raised in the review will be seriously considered and addressed.

It was agreed that such reviews should be held regularly both at the provincial and district levels to be able to identify and remove weaknesses and strengthen the routine immunization system in the province including in the poor performing and hard to reach union councils and districts. Based on the findings of the review, the Deputy Director EPI and Provincial Coordinator of LHW Programme agreed to review the Terms of Reference of the LHWs and formally include responsibilities related to EPI as they are now permanent government servants. It was also agreed that joint advocacy efforts should be made by the civil society, donors and UN Agencies for legislation and increased budgetary allocation for immunization in the province. 

http://everyone.savethechildren.net/articles/time-invest-routine-immunization  

 

SUPERFOOD for Babies

There was a unanimous agreement among the participants and speakers of the launching ceremony of Save the Children’s Global Breastfeeding report, ‘SUPERFOOD FOR BABIES: How overcoming barriers to breastfeeding will save children’s lives’, that breastfeeding is the most effective and tested method to protect children from killer diseases as soon as they are born.  

“The lives of 95 babies could be saved every hour - 830,000 a year, if new mothers around the world breastfed immediately after giving birth”, said Dr. Qudsia Uzma, Director Health & Nutrition at Save the Children, while sharing the salient features of the report. She highlighted that if babies receive colostrum – the mother’s first milk – within an hour of birth, it will kick start the child’s immune system, making them three times more likely to survive. If the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases like pneumonia and diarrhea.

It was only four days ago that Pakistan witnessed the adoption of the local legislation by Sindh to address breastfeeding violations. Serendipity perhaps, but the timing of this development in terms of the revealing of the Report could not have been better.  

“It’s heartening to know that the Provincial Assembly in Sindh has adopted the Sindh Protection of Breastfeeding and Child Nutrition (Amendment) Act 2013. However, the real test is its implementation in letter and spirit”, noted Save the Children’s Deputy Country Director in Pakistan, Mr. Ghulam Qadri: “Despite the Protection of Breastfeeding and Child Nutrition Ordinance on statute books since 2002, its implementation has always remained a distant desire.”

The EVERY ONE Campaign in Pakistan also recently saw the induction of its second champion, Haroon Rashid.

 “I would like to take this opportunity to pledge that as a Campaign Ambassador for Save the Children’s EVERY ONE Campaign, I will do all that is possible in my capacity to take forward the cause of maternal, newborn and child health in Pakistan” the singer proclaimed at the launch,  where he was formally introduced as the Campaign Ambassador. “When I was approached to become an Ambassador, I didn’t hesitate to take the assignment up as this is a subject very close to my heart.”

“The teachings of Islam strongly endorse that mothers should breastfeed their children for two years and I congratulate Save the Children for taking up such an important subject related to infant mortality”, said Dr. Donya Aziz, Member National Assembly of Pakistan, who was also part of the panel. With her proclamation of taking up the matter of implementation of the Ordinance with the Minister for Capital Administration and Development Division (CADD), it was clear that Dr. Donya recognized the value of such an intervention to ensure that every infant is given the life-saving protection that breastfeeding can offer. Referring to the report’s recommendation about lack of adequate maternity legislation which makes breastfeeding and returning to work a challenge, Dr. Donya Aziz, promised that if provided with a bill about adequate maternity legislation, she will place it before the National Assembly of Pakistan and endeavour to help ensure that the law is adopted.

“Legislation alone is not going to change the situation as numerous bills already exist in Pakistan; it is the implementation of laws that demand attention”, said Dr. Sania Nistar, a prominent right to health advocate in Pakistan and founder of the organization Heartfile.

“Equity statistics at all levels shows fundamental distortions in Pakistan. The Breast Milk Substitute production industry has to be brought to the table. If they are part of the problem, they should also be part of the solution.”

Dr. Sania rounded up the entire event by underlining that breastfeeding can have an impact on the bottom line because it costs nothing, thereby having a large scale impact on the improvement of newborn and child health By concluding that Save the Children has touched the heart of the problem with the new report, we knew that a potential partnership with Heartfile could be in the making.