Daily Times

Balochistan is the poorest province of Pakistan with a poverty incidence of 48 per cent. It has water shortages across the region except for a few districts where water canals are providing water for agriculture. Overall, only three per cent of the land is agriculturally productive, while livestock contributes about 40 per cent of Pakistan’s total livestock population, where 70 per cent of the local population of Balochistan depends on livestock. The persistent draught starting from 1998 has adversely affected the agriculture and livestock sectors. According to studies, 20 of the 33 districts of Balochistan have faced severe drought where over 100,000 families and 1.7 million livestock have been affected. The drought has resulted in serious health and nutrition issues throughout the province. Moreover; in 2022, heavy monsoon floods caused devastations, resulting in heavy damages and the negative impacts on the health and nutrition status of the communities may aggravate in the years to come if drastic interventions are not timely taken. One of the major challenges for the government of Balochistan is malnutrition.

Malnutrition, in Balochistan province, is attributed to the aforementioned factors, where; according to the Pakistan Demographic Health Survey (PDHS) 2017-18, 73.7 per cent of adolescent boys and girls are suffering from anaemia; while 39.5 per cent of children aged 6 to 12 years are iodine deficient. The National Nutrition Survey(NNS) 2018 has reported vitamin D deficiency in 80.7 per cent of non-pregnant women, who are also suffering from haemoglobin deficiency. Moreover; according to the PDHS 2017-18, stunting, wasting and underweight children also occupy a considerable number wherein 18.9 per cent are wasted, 46.6 per cent are stunted and 14.4 per cent are with low birth weight. Both the NNS and PDHS depict very alarming situations of malnutrition and poor health indicators in Balochistan.

It is generally reported that lack of handwashing is also a serious factor that results in diseases and ultimately in malnutrition. According to the PDHS 2017-18, only 29 per cent of children are fully immunized, while 29 per cent are vaccinated against diseases. With this low vaccination in Balochistan, women and children are at higher risk of diseases that may ultimately add to Malnutrition. Major causes for low vaccination in Balochistan are lack of vaccinators, lack of proper cold chain maintenance in the districts and the community level, absenteeism, lack of monitoring, lack of awareness among the communities to accept and cooperate for vaccinating their children and, above all, poor performance of the Expanded Program on Immunization. Moreover, poverty, scattered population and cultural unacceptability of vaccination also contribute to low vaccination that ultimately results in diseases and malnutrition, especially among children.

Balochistan Food Authority, as per the law, has the mandate to enforce the legislation and regulate all the mills in the province to make sure only fortified flour, oil/ghee and slat are supplied to the market.

Since a full-ranged, well-structured and multifaceted system has not yet been in place, the nutrition indicators have not improved. Some interventions such as salt iodization, and preventive measures through the national program for LHWs and through the project: Balochistan Nutrition Program for Mothers and Children have been in place. The polio eradication Initiative through the Emergency Operation Centre working in coordination with the Health Department and other key stakeholders including technical and operational support provided by WHO and UNICEF has helped greatly in vitamin A supplementation in the province. Moreover, the low exclusive Breast breastfeeding rate shows that still a large number of children up to 6 months are deprived of a very essential source of nutrients, meaning they are at risk of malnutrition and diseases. Poor feeding practices are another factor contributing to poor health and nutrition deficiencies in children.

RECOMMENDATIONS: Though there is little realization about nutrition in Balochistan, much more is needed to sensitize the political leadership and the stakeholders. The Scaling Up Nutrition(SUN) Secretariat, established at the Planning and Development Department, Government of Balochistan should take the lead to advocate for pooling up of resources under a robust policy to be formulated taking all the stakeholders on board.

Nutrition should be made a regular part of the institutional set-up duly funded through the regular budget. In the Department of Health and the Balochistan Food Authority, the posts of nutritionists, dietitians and health & nutrition officers and food experts should be created. The multispectral approach is the only response the world has recognized to address the issue of malnutrition as malnutrition is a multifaceted phenomenon. The policy and action plan to be formulated shall contain a multi-sectoral approach involving all the government departments, the NGOs, civil society organizations and the market. The strategy to be devised by the government of Balochistan should cover both nutrition-specific and nutrition-sensitive interventions.

The Government of Balochistan has passed the Balochistan Food Fortification Act, which declares wheat flour fortification, edible oil fortification and salt iodization mandatory. The Government, in partnership with the donors and partners, shall provide support to the Mills in the province to establish infrastructure for fortifying the product. The Balochistan Food Authority, as per the law, has the mandate to enforce the legislation and regulate all the mills in the province to make sure only fortified flour, oil/ghee and slat are supplied to the market. Policy and plan for creating awareness among the communities about the importance of nutrition and food fortification need to be devised in consultation with all the stakeholders. All the vertical programs, under the Department of Health, working on mother health, child health and nutrition should be impetrated for efficient service delivery. Moreover, vaccination programs should be scaled up to ensure maximum vaccination coverage.

The writer is a Provincial Civil Servant, currently posted as Secretary Population Welfare Department Balochistan – Pakistan, and a policy analyst.