The federal government has approved a five-year plan for reducing stunting among children of up to five years in 67 districts across the country. Half of the cost of the Rs312 billion plan will, however, be sent in paying salaries.
In its technical appraiser of the Tackling Malnutrition Induced Stunting, the Planning Commission had raised serious questions about its efficacy terming it a “short-term measure, not sustainable and costly”.
The commission had also questioned the claim of reducing the stunting from 40% to 32% saying it would still be 36% after spending Rs312 billion.
The Central Development Working Party (CDWP) recommended Tackling Malnutrition Induced Stunting in Pakistan –July 2021-June 2026 project worth Rs312.4 billion to the Executive Committee of National Economic Council (Ecnec) for further consideration.
The CDWP meeting – presided over by Planning Commission Deputy Chairman Jehanzeb Khan – cleared three development projects with a cumulative estimated cost of Rs6.50 billion and recommended three projects worth Rs342 billion to Ecnec for further consideration.
The overall goal of the project is to significantly reduce malnutrition induced stunting among the children in the next five years and virtually eliminate it among the children born in 2023 by 2030.
In his first speech after becoming prime minister, Imran Khan had announced to reduce stunting.
The federal government would spend Rs162 billion in procuring nutrition sachets while the provincial governments would pay Rs150 billion to be spent on salaries. The federating units are already paying these salaries to the lady health workers.
The key goal of the plan is to reduce stunting from 40.2% to 32% in five years and to reduce acute malnutrition to 10% from 17.7%.
It will promote the intake of vitamins and minerals through provision of micronutrients for young children and their mothers. The maternal malnutrition will be reduced from 14.5% to 10.5%.
The Ministry of Planning has repeatedly raised serious observations over the five-year plan and had also returned the project in March this year.
Early this month, in a meeting of the stakeholders, it was decided that the Ministry of National Health Services and Regulations will submit a new PC-I to address all the observations.
But the CDWP took the decision on the basis of the old document, which a top official of the Planning Commission said would be revised before being submitted to Ecnec.
In its remarks the Planning Commission stated that the districts selected as high burden districts in terms of stunting in the PC-I do not match with the actual high burden districts. Only 41 districts are high burden districts out of selected 68.
The National Nutrition Survey 2018 findings showed that the average stunting of the actual 67 high burden districts is 51.1% as against the claim of 40%.
It said: “Proposed stunting reduction target set in the PC-I after five years, ie, 8% will bring down stunting from 51.1% to 43% rather 32% from 40%, which is mentioned in the PC-I”.
The Planning Commission said contrary to the claim of reducing stunting to 32% in five years, the average national stunting will still be 35.7% after five years despite spending Rs312 billion.
While explaining its argument, the Planning Commission said the health ministry has targeted 67 districts but is taking into account the results of 154 districts, which would inflate the actual progress.
“The project goal seems unrealistic [and] ambitious [as it aims at eliminating stunting] by 2030 among children born in 2023. No evidence exists globally for [achieving] such a huge target especially through nutrition specific interventions”.
The commission said the problem of malnutrition is related to the underlying drivers such as food systems, food security, social protection, health system, agriculture, climate change, livestock water and sanitation and education.
It argued that the issue cannot be resolved through provision of sachets.
The senior official of the commission said the CDWP cleared the project after seeking input from renowned health experts, who describe the sachets method as effective.