For
the past few years it has become a norm that a few hundred newborn babies and
infants will die in Sindh’s beautiful Tharparkar dessert every year.
Conflicting figures are quoted in the media and by the government functionaries
about the number of deaths and their causes. Even if one fully agrees with the
official version, unfortunately however, there are no visible actions on part
of the government of Sindh and the federal government, keeping in mind the
severity of the issue and without going into provincial or federal subject
debate, to tackle the deadly issue on sustainable basis. As a result, we see
the inhabitants of Mithi offering special prayers in temples amid rising death
toll of children and their helplessness. Irrespective of the fact whether 200
plus children died in the past 50 odd days or 75 newborns and infants breathed
their last in Tharparkar’s hospitals, even a single preventable death is
criminal. Why are we unable to respond to this situation?
Child
health and nutrition experts and child rights activists believe that it’s
because of the lack of understanding at the decision making level about the
issue and the lack of political will to respond to it. If someone is going to
look at it and try to resolve it from the health perspective only, then we will
continue to see such horrific figures of newborns deaths for the years to come
as is the case for the past few years. It should be understood that there are
multiple factors for the current situation in Tharparkar and there is a need
for multi sectoral interventions to address the social, economic and cultural
reasons behind this mayhem. Similarly, responding to malnutrition also requires
multi sectoral approach 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.
According
Lancet findings and leading nutrition and child health experts in the world
including Pakistani experts, 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. Poor nutrition for mothers during
pregnancy, too few calories, poor quality of food (e.g. micronutrients),
repeated infections (e.g. diarrhoea, malaria), poor feeding practices (e.g. not
feeding colostrum) etc. are some of the major causes of malnutrition in
Pakistan and Tharparkar is no different rather these issues are much severe
there because of poverty, poor water and sanitation resources, lack of
education, child marriages, lack of family planning and lack of health
facilities in far flung areas like Nangarparkar which makes the situation worse.
The
nutrition challenge facing Sindh is substantial. Sindh has a dangerously high
rate of nutritional stunting among children under age 5 (49.8%) as compared to
43.7% of the national average. The prevalence of underweight children is 40.5%
as compared to 31.5% of the national average, while wasting prevalence is 17.5%
as compared to 15.1% of the national average. As per World Health Organization’s
standards, a national average of 15% or above is labeled as an “EMERGENCY”.
These figures have not changed significantly in the past decade and require
special attention at all levels. I believe the figures in Thar region will be
even worse than the provincial figures for Sindh.
Since
the Tharparkar child deaths are viewed as something related to malnutrition and
health, the whole focus is on health response which is not something new. Traditionally,
in Pakistan, nutrition has been viewed as a problem to be looked after only by
the health sector planning commission or Ministry of Health at the federal
level and Department of Health at the provincial level. This narrow approach
then excludes those remedies which would cater to the wider economic and social
contexts which predispose a community to poor nutrition. Major findings of the
National Nutrition Survey 2011 clearly indicate the urgent need to address
malnutrition through an integrated approach, which addresses immediate,
underlying and basic causes of malnutrition. This is a challenge to mainstream
nutrition and to ensure that all relevant departments and stakeholders are
cognizant of their roles and have effective coordination.
The
fact to respond to malnutrition issues through a multi sectoral approach was
realized a few years back and the government of Sindh notified the Provincial
Nutrition Steering Committee and Inter Sectoral Technical Working Group in
December 2012. The Technical Working Group had a number of meetings with the
support of the Development Partners for Nutrition Group and Sindh became the
first province to adopt the Sindh Inter Sectoral Nutrition Strategy in late
2013.
The
Sindh Inter Sectoral Nutrition Strategy is ambitious and seeks to reduce chronic
malnutrition in children aged 0-24 months by 10 percentage points from an
estimated 49.8% to 39.8% by the end of 2016. Iron deficiency anaemia in
children from 73% to 62% and maternal anaemia from 59% to 49% through
sustainable, effective and inter-sectoral interventions by the end of 2016. The
target group for the nutrition in interventions includes pregnant and lactating
mothers with 1000 days plus approach with nutrition supplies and provision of
food vouchers and meal to women living in difficult situations.
The
strategy further focuses on introduction of incentives such as conditional cash
transfers and food vouchers to encourage enrolment and daily attendance of
children of Benazir Income Support Programme beneficiaries in schools, mid-day
meal through school feeding programme and introduction of policy and strategy
for introducing mid-day meal for all students in high risk areas. Now a simple
question could be that is there any difficult situation or high risk areas in
Sindh than Tharparkar? What has been done in Tharparkar so far when it comes to
the implementation of the Sindh Inter Sectoral Nutrition Strategy?
The
Sindh Inter Nutrition Strategy further calls for increased access to safe water
and sanitation through rehabilitation, improvement, extension and augmentation
of the schemes. Ensure provision of drinking water and sanitation facilities in
schools operating in prioritized districts in rural areas. Create an enabling
environment for improving food security. Increasing the ratio of female
agriculture extension officers and field assistants and building training centre
for them at district level.
Has
any steps been taken to implement these strategies? What has been done for
female empowerment and income generation opportunities for women in Tharparkar?
What’s the status of the implementation of the Sindh Right to Free and
Compulsory Education 2013, the Sindh Protection and Promotion of Breastfeeding
and Child Nutrition Act 2013 and the Sindh Child Marriages Restraint Act 2014? The
implementation of the Sindh Inter Sectoral Nutrition Strategy and all these
laws are also closely linked with improving the situation of child deaths in
Tharparkar.
The
government of Sindh should take concrete measures for the implementation of the
related strategies and legislation and make budgetary allocation for the
implementation of the Sindh Inter Sectoral Nutrition Strategy. Tharparkar could
be made a case study for a pilot multi sectoral intervention to respond to this
situation. Steps should be taken to promote women employment and income, social
safety nets such is BISP should focus on Tharparkar, increase the number and
enhance the skills of health care providers Lady Health Workers to promote
exclusive breastfeeding for six months. The private sector should be encouraged
as well to play their due role. They can support other sectors in development
and implementation of standardized messages through capacity building of their
outreach workers in the areas of nutrition promotion. The government of Sindh
should also promote tourism in the beautiful and scenic Tharparkar to increase
income generation opportunities.
The writer is a child rights
activist and development practitioner with a Masters in Human Rights from the
London School of Economics (LSE) and tweets at @amahmood72
The article was published in Express Tribune on March 02, 2015
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