Social protection

Widespread under-nutrition, especially iron deficiency, determines a range of negative consequences impacting the welfare of individuals and families as well as the economic and social development of the nation.

This economic, social and human burden is clearly inevitable and can be considerably reduced by adopting evidence based, affordable and effective interventions. The underlying household and community causative factors are mainly attributed by poverty along with less education, awareness and knowledge.

As these factors are related to human, economic and organizational resources available at the household level, they reflect the degree of social justice in society and the status and autonomy of women. A recent study by the Lancet Maternal and Child Study Group establishes that the services of nutrition-sensitive programmes with iron supplementation through social safety networks have a major impact on the nutrition indicators of women and growing children.

Many developing countries show success stories in enhancing the nutrition status of women and young children by using social protection platforms to initiate conditional or unconditional cash transfer programmes or health insurance models and addressed poverty and malnutrition. India adopted the model to provide fortified wheat flour through social safety network programmes (SSNP) among beneficiaries to overcome micronutrient deficiencies.

According to the WHO, the programme is “highly cost-effective”. After the success of fortified wheat, the country is now introducing similar reforms to eliminate iron deficiency in the early childhood through the SSNP.

In Pakistan, the Benazir Income Support Programme (BISP) is the most significant social safety net programme with clear objectives of pacifying the negative impact of slow economic growth, food insecurity and inflation on marginalized communities, particularly women. Though the advancement of the programme is slow, the platform keeps on introducing new interventions to address malnutrition issues. It conducted many training workshops for its BISP Beneficiary Committee (BBCs) to create awareness and information regarding iron deficiency in early childhood.

However, there is a need to disseminate the concept of the first 1000 days, starting from conception till a child’s second birthday, offering an irreplaceable window of opportunity to form healthier futures. It is the time period when the foundations of maximum health, growth, and neurodevelopment for the upcoming lifespan are laid.

In developing countries, these foundations get weakened due to malnutrition hence it is quite significant to focus on this time period to achieve optimum health, growth, and neurodevelopment across the lifespan. Provision of iron through weaning food; which should be essentially started at six months, can surely enhance growth in early childhood development.

A great initiative by the government is the Ehsaas Programme. The aim of the programme is to reduce inequality, invest in people’s welfare and upgrade lagging districts. The platform can be utilized to reach marginalized communities to overcome iron deficiency, one of the most prevalent and alarming micronutrient deficiency in the country.

Cash transfer programmes for vulnerable groups, provision of subsidized iron fortified food and awareness sessions should be made an integral part of the programme for the welfare of the people. Moreover, using this forum for national preparedness plans and guidelines for incorporating nutrition objectives and interventions into emergency relief programs can have a huge impact. The capacity of health systems and other stakeholders including women should be developed so they can be effectively utilized to provide appropriate nutrition care to children and their families.

Evidence suggests that the nutritional situation in Pakistan has made little improvement over the decades. Even the latest National Nutrition Survey 2018 does not reflect any hopeful indicators for women and growing children.

Around 58 percent of the population in Pakistan is food insecure; per capita availability of calories and commodities is insufficient with limited availability of nutritional food including vegetables and fruits to the poor. The prevalence of anaemia has been consistently high and showing an alarming situation in infants.

With all these prevailing situations, it has become imperative for the government to explore different perspectives to address the issue and strongly link social protection platforms with nutrition interventions. Moreover, the government should explore opportunities for public-private partnerships and extend its support to the private sector by providing subsidies in the production of fortified food like cereals as a weaning food.

A recent study by the Aga Khan University on the cost-effectiveness of price subsidies on fortified infant food reveals it as a major intervention to overcome iron deficiency in early childhood. The need is to focus more on the poorest households with low social and economic status (SES), as iron deficiency is highly prevalent among them.

Platforms like the Benazir Income Support Programme under the Ehsaas flagship, Bait-ul Mal, and the newly established provincial level social protection programmes should be utilized to provide marginalized communities with a cost-effective weaning diet in the form of fortified iron food for early childhood development to eliminate the social and economic burdens of malnutrition in the country.

The writer is a public health consultant.

Email: fauziawaqar_28@hotmail.com