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.

http://everyone.savethechildren.net/articles/every-one-pakistan-glance-2013

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