National Nutrition Survey (NNS) 2018-19 reveals a gloomy picture of malnutrition in children under 5 and women of reproductive age group in Azad Jammu and Kashmir. The survey indicates that about 39.3 % of children under 5 years are stunted (a very high prevalence) while 16.1 % have wasting (critical), 56.6 % children are anemic (Hb. level 7-10.9 mg/dL), 21.9% Zinc deficient, 64.3 % children have Vit. D deficiency, 31.7% has severe VAD and 30.8% Iodine Deficiency. 13% Women of Reproductive age are under weight, 56.4% are anaemic and 22.1% are facing deficiency in Vit. A.
Background & Achievement of CMAM (2013-2019) in AJ&K
According to National Nutrition Survey 2011, AJK was suffering from high rates of childhood and maternal malnutrition. Government of AJ&K could not address the situation due to financial constraints. UN partners (WHO, UNICEF and WFP) initiated the Community Nutrition Program in 03 District (Muzaffarabad, Neelum and Bagh) in 2013. Later on, two more administrative units upgraded as districts (Havieli and Jhelum Valley).
Pakistan National Guidelines for the Community- Based Management of Acute Malnutrition CMAM) had been launched in 2014. The approach aims to reach the maximum number of children with acute malnutrition and to ensure access and coverage by providing treatment at many decentralized sites instead of a few centrally located inpatient facilities. In 05 Districts of AJ&K this intervention continued in collaboration with UN partners through their implementing partners i-e Islamic Relief and AJKRSP. The implementing partners quit the program in Jun 2015. Department of Health took the responsibility of the ongoing program in the same 05 Districts. The DoH is providing services through LHVs in BHUs and RHCs designated for Nutrition Services, whereas the responsibility for provision of supplementary food and capacity building carried out by UN-partners, especially World Food Program. Activities being implanted. till March-2020.Due to some reason program was closed in March-20 and resume in Jan-22 in targeted 5 Districts.
Program Components in Implementing Strategy in AJ&K
UNICEF and World Food Program are assisting by providing Ready to Use Supplementary (RUS) and Ready to Use Therapeutic Feed (RUTF). The program is being implemented by a concrete mechanism of treating and managing malnutrition with its four main components as given under: –
UNICEF and World Food Program are assisting by providing Ready to Use Supplementary (RUS) and Ready to Use Therapeutic Feed (RUTF). The program is being implemented by a concrete mechanism of treating and managing malnutrition with its four main components as given under: –
a. Community Outreach: Community mobilization and health and nutrition education by LHWs
b. Supplementary Feeding Programme (SFP): Management of Moderately Acute Malnourished (MAM) children and PLWs through Supplementary Food provided by WFP (support not continued after Dec 2019).
c. Outpatient Therapeutic Programme (OTP): Management of Severely Acute Malnourished (SAM) children through Therapeutic Food provided by UNICEF (support not continued after Dec 2017).
d. Stabilization Centers (SC): Inpatient Care for complicated SAM children established at AIMS Muzaffarabad in collaboration with WHO (one time training and required instruments/equipment)
Background & Launching Ehsaas Nashonuma program (August 2020 onward)
A health and nutrition conditional cash transfer programme which aims to address stunting in children under 23 months of age. Stunting negatively impacts brain function, organ development, and immune system, ultimately limiting future productivity. Prime Minister Imran Khan launched this programme on August 13, 2020 in 14 districts of the country in the first phase including Bagh and Hattian Bala from AJK, selected on the basis of high stunting rate. 50 Ehsaas Nashunama Marakiz/Centers (including 05 in AJK) have been established at Tehsil level health facilities to provide all Nashonuma services under one roof. Ehsaas Nashonuma is fully funded by the government of Pakistan. World Food Programme has been hired as an implementing partner to carry out all the activities of the programme. In AJK DoH has provided space and facilitating implementation. Registration and provision of supplementary food and cash transfer lies with WFP.
Achievements of DoH in implementing CMAM Program
a. Nutrition Cell at DGH office is established comprising following: –
(1) DoH designated HR (Program Coordinator and support staff)
(2) 01 Nutrition Information System (NIS) Assistant sponsored by WFP
b. 138 LHVs trained for screening and management of malnourished target population at Primary Health Care level (BHUs/RHCs)
c. 138 BHUs and RHCs designated as SFP/OTP sites functional for screening and provision of supplementary food to children of 6-59 months of age and Pregnant and Lactating Women.
d. 01 Nutritional Stabilization Center established at AIMS Muzaffarabad
e. Enhancing Nutrition literacy (Health education) and dietary diversity through LHWs
f. Development and endorsement of Multi-sectoral Nutrition Strategy for AJ&K in collaboration with SUN (Scaling Up Nutrition) –P&DD AJ&K and other stakeholders
g . Awareness campaigns regarding Iodine Deficiency Disorders and impact of Iodized salt (UNICEF supported)
