Scaling-up Nutrition (SUN) Proposal for DRT-F 2015 (under SPA 6)1
Outcome 6.2: (as in OP II Joint Work-plan) Nutrition security increased, especially for the vulnerable and excluded groups
Joint Output level: (as in Joint Work-plan, 6.2.1)
Provincial/regional governments have developed and
implemented nutrition policies, strategies, and plans to address
malnutrition among the most disadvantaged/vulnerable
population groups
Policy Initiative: Technical assistance for scaling-up nutrition
(SUN)3
UN Entities
FAO,WFP,
UNICEF, WHO
Annual Common Budgetary Framework (2015)2
Total (USD) Core/regular/
Nonassessed (USD)
core/other/e
xtra
budgetary
(USD)
3,969,862
38,577
921,107
To be
mobilized/
funding gap
(USD)
3,010,000
Key activities towards which the DRT-F will contribute (include UN Entities to implement)

Continued and expanded technical support to multi-sectoral nutrition coordinating mechanism and institutional structures at the federal,
provincial and regional level, including policy, strategy, surveillance and assessment units

Enhance support to review and institutionalize provincial strategies, prepare operational plans, budget plans and monitoring framework
For each Policy Initiative – Output level
1. How was the policy gap for this initiative identified by the UNCT and the government? Which international norms and standards will this
integrated policy initiative assist the government in better realizing?
Pakistan faces a high burden of malnutrition, including under-nutrition, micronutrient deficiencies, overweight and obesity. The National
Nutrition Survey conducted in 2011 highlighted that 43% of the children under five years of age are stunted, 32% children age are underweight
1
Strategic Priority Area 6 of One United Nations Programme II (2013 – 2017)
This shows the current funding status
3
The initiative is part of the Flagship Programme on SUN
2
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and 15% are wasted. With the exception of lowering of iodine deficiency, no improvements have been identified in the nutrition indicators in the
past decade. Anemia and zinc deficiencies remain at high levels indicating a serious public health concern. Poor infant and young child feeding
practices contribute to childhood under-nutrition. Moreover, the series of natural disasters in the recent past—including floods and droughts—
further deteriorated the nutrition status of the population especially for mothers and children. Studies show that levels of chronic malnutrition
were decreasing up until the early 90’s, but thereafter began and continued to trend upwards4. Low birth weight, another key indicator of
under-nutrition, showed a similar trend5 and the overall hunger indicators have also been increasing.
During the rollout (2011 and 2012) of OPII (2013-17), the results of the CCA/meta-analysis highlighted the need for focused attention to
nutrition. Similarly the federal and provincial consultations for the development of the 5 year UNDAF/ OPII also showed the government need
for UN technical and policy support on nutrition. The Government of Pakistan (GOP) has increasingly recognized the importance of nutrition
within the development agenda and has included this topic in national annual and five year plans. It is also highlighted under Pillar IV (Food
security) of the recently launched Pakistan Vision 2025 issued by the Planning Commission. The signing and the launch of the global movement
on “Scaling-up Nutrition” (SUN), which was followed by declaration of commitment, are important and significant steps in this process. The UN
together with other nutrition development partners are supporting the GOP at national and provincial levels to formulate multi-sectoral policies
and strategies fully aligned with the Scaling-up Nutrition approach, which promotes both the scaling-up of nutrition-specific and nutrition
sensitive interventions (food security, agriculture, education, social protection, water and sanitation, among others). This policy initiative will
assist the GOP to better perform with respect to global targets and strategies including World Health Assembly Indicators, the second goal of the
proposed Sustainable Development Goals, the global SUN movement and the Rome Declaration and Framework of Action endorsed by the
member countries of FAO in the International Conference on Nutrition in November 2014. The focus will be on the continuation and expansion
of initial activities having started in 2014 (under DRT-F 2014) plus an emphasis on the formulation of a national multi-sectoral policy to support
the provinces and regions.
2. Briefly describe the activities to be implemented above (with DRT-F fund contributions) and how they will contribute towards the country
achieving the desired change at the output and outcome level?
The proposed action contributes to improving the nutrition actions and systems at the federal and provincial levels, in order to address the
malnutrition especially among mothers, adolescent girls and children. It will lead to the overall Scaling-up Nutrition (SUN) Initiative in Pakistan by
strengthening the linkages and coordination between the provincial and federal governments, and establishing standards, and mechanisms for
policy coherence and evidence-based decision-making. The action will complement other Strategic Priority Areas of the One UN Programme II in
Pakistan. The table highlighting key activities and value addition to DRTF support 2014 is mentioned below:
4
National Nutrition Survey (NNS) 2011, Government of Pakistan
5
PDHS, 1985 and PDHS 2007
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Activities
Value addition and difference from previous DRT-F support
Continued and expanded technical support to
multi-sectoral nutrition coordinating
mechanisms and institutional structures at the
federal, provincial and regional level, including
policy, strategy, surveillance and assessment
units
Strengthening the support at national level and creation of SUN Units in Provincial Planning
and Development Departments of KP, Sindh, Punjab, Balochistan and AJK /GB
Enhance support to review and institutionalize
national and sub-national strategies, prepare
operational plans, budget plans and
monitoring framework
This is in line with the SPA 6 SUN Proposal and the activities will strengthen the sector-specific
annual work plans and budgeting along with sector-specific communication plans
Sector-specific policy alignment
Scope of the guidelines now includes fortification and the LNS type products standards and
revision of the Food Composition Table and dietary guidelines
Through the DRFT support, the activities will be delivered at provincial level by partners as a complete package. The work in Balochistan will be
led by FAO, KP-FATA and AJK will be led by UNICEF, WFP will support Sindh and National Level and will collaborate with WHO in Punjab. The
main activities foreseen are described as under:
1. Continued technical support to multi-sectoral nutrition coordinating mechanism and institutional structures at the federal, provincial and
regional level, including policy, strategy, surveillance and assessment units

Strengthen SUN coordination system at national and sub-national level
The SUN coordination system at the national, provincial and regional level will be strengthened along with continuation of ongoing SUN
efforts in Pakistan. This will be achieved by making coordination mechanism more effective and efficient at federal and provincial levels by
providing technical and other necessary support. This will include formulation of a national nutrition task force, the secretarial and technical
assistance to the Ministry of Planning and Development at national level and support to planning and development departments at
provincial and regional levels. In addition, it will be tasked for the necessary coordination with the departments in charge of health, food,
agriculture, education, water, sanitation and hygiene (WASH), social welfare as well as local governments. It will ensure the alignment of the
multi-sectoral strategies within all networks and sectors to scale-up nutrition efforts. Dedicated staff will be deployed at these SUN units to
support project coordination and provide technical assistance. The following flow chart describes the coordination flow between the
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national and provincial SUN Secretariats and Units respectively and the other government structures. Already the support is being provided
to the National Fortification Alliance Secretariat and to the SUN Secretariat at national level. However, the coordination in provinces is a
missing link. It is important to consider this issue since following the adoption of the 18th Amendment,6 enforcement of strategies and
subsequent legislation is now a provincial subject. Therefore, this coordination at provincial level is crucial for achieving the results.
Flow Chart of Coordination between National and Provincial SUN Units
Ministry of National
Health Services
Regulations and
Coordination
Ministry of Planning
Development and Reforms
Chief Nutrition / SUN Focal
Person
Provincial
Departments of
Planning and
Development
Secretary and DG
Health
Director Nutrition
/ Secretary NFA
Provincial
Departments of
Health
Secretary and
DG Health
Services
SUN
Secretariat
Provincial SUN
UNITS working
with provincial
Nutrition
Steering
Committees
NFA
Secretariat
Director /
Nutrition
Focal
Person
SUN UN Network’s
Technical support

Policy coherence and sector-specific alignment
The provincial multi-/inter-sectoral policy guidance notes on nutrition followed by sector-specific strategic directions are already endorsed.
However, their internal collaboration and alignment is a missing link, which needs to be addressed by harnessing all relevant sectors. With
6
Devolution
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DRTF support, the said link will be established with planning and development departments to lead and support all relevant sectors in order
to further streamline their strategies and align them accordingly. In this regard, technical support will be furnished to P&D and other
departments at provincial and regional levels on need basis. Furthermore, a national nutrition strategy needs to be devised at the federal
level in light of the provincial policy guidance notes and inter-sectoral nutrition strategies. This will be carried out through DRFT policy
support, aligned to the Pakistan Vision 2025, the Pakistan Country Paper on Nutrition for ICN 2014 and the Rome Declaration and
Framework on Nutrition 2014. It would not only guide the nutrition action at the federal level but also contribute to greater allocation of
budgets, while preparing national and provincial action plans, and projects along with the mobilization of resources through different
channels.

Assist in the development of guidelines, normative guidance, standards and protocols
As part of the Scaling-up Nutrition Approach, the country needs to develop, revise and adopt national guidelines, standards and protocols on
nutrition. This normative work will help the departments at the federal and provincial levels in devising policies and implementing nutrition
activities and programmes. It will guide the public as well as the private sector to strategize their work in the field of nutrition. Food
composition tables and dietary guidelines are essential tools for providing information about the nutrient composition of selected food and
beverages regularly consumed in a given country. It serves as a guide to the population on recommended portion sizes of food and drinks
from each food group, which are necessary to maintain an optimal nutritional status and health. The nutrient composition of food and drinks
are influenced by soil fertility, environmental factors and agricultural practices, which vary from country to country and within country. A
review consultation of Pakistan’s Food Composition table (last revised 2001) and National Food Based Dietary Guidelines (last prepared
2005) has already been undertaken by the Planning Commission and FAO with the support of DRTF 2014, involving relevant national and
provincial universities in the country. It has identified various gaps, highlighted the need to update the Food Composition Table and
proposed recommendations for revising the dietary guidelines. This would entail the analysis of regional variations in the macro- and
micronutrients of key foods according to agro-ecological zones, dietary value of raw and cooked foods and an analysis of different commonly
prepared recipes at the household level.
The standards related to premixes for wheat flour in Pakistan are yet to be aligned with WHO recommendations globally. Apart from that,
the production of lipid based nutrient supplements has been initiated in Pakistan with the support of the private sector and WFP. However
the policy cover and the setting up of national standards in line with codex recommendations need to be done. Under the current proposal,
discussion will be initiated at the SUN secretariat involving the National Fortification Alliance and the SUN business networks to ensure that
this work critical work is initiated and completed.

Strengthen surveillance and analytical capacity of public sector at national and sub-national level
While health and nutrition surveillance is a highly important tool, it loses its relevance if there are delays in disseminating crucial data or if it
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suffers from lack of ownership by provincial and district governments. There is also an inherent risk common to all reporting systems that
the data may be treated routinely, that they are not aligned across the different data sources in the health and nutrition sectors and that are
not treated with the urgency it deserves. Through the DRTF, necessary technical support will be provided resulting in capacity building of
staff and in strengthening the system to render decision-making in nutrition a high priority for the policy makers at the provincial level.
Through DRT-F support, the provincial governments will be assisted through the nutrition surveillance in viewing the entire nutrition
problem along holistic lines and link surveillance results to decision-making on a perpetual basis. This will enable the government to view an
investment in nutrition as a major leap towards economic growth in the long term by addressing the adverse impacts of the current dismal
indicators. By drawing attention to the surveillance findings, the provincial and district governments will be advised on the most costeffective ways of rectifying the situation based on international best practices and UN current experience in the country.
2. Enhance support to appraise and institutionalize national and sub national strategies, prepare operational plans, budget plans and
monitoring framework

Support and strengthen sector-specific action plans
Alignment of nutrition interventions within different sector-specific action plans is necessary to ensure that an multi-sectoral approach is
implemented to address under-nutrition holistically. The relevant sectors like health, WASH, agriculture, education and social protection
need to develop nutrition sensitive plans for better-integrated actions. Under this proposal, efforts will be taken to develop sector-specific
plans with budgetary estimations and linked monitoring frameworks. It is important to note, that—without having done this effectively—
the true essence of multi-sectoral strategies will not be achieved.

Develop and consolidate sector-specific national and provincial communication and media strategies
To address under-nutrition comprehensively and to get concrete outcomes, nutrition-specific and sensitive sectors such as WASH, health,
agriculture, food security and social protection need comprehensive communication strategies in order to raise nutrition awareness among
the general population, in particular with regard to mothers, caregivers and families. Hence, under this proposed action, integrated national
and provincial communication and media strategies will be developed and aligned in a multi-sectoral manner.

Technical support to public sector for multi-sectoral Public Sector Development Plan
Sector-specific operational plans will need the thrust to be translated into actions, once public sector allocations to Annual Development
Program schemes are significantly increased at the provincial level. While the World Bank supported nutrition program secured sizable
government counterpart funding, there is a need for much greater public sector spending in the sector vital to human progress and
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economic development. Capacity gaps in this regard are foreseen and would therefore be matched with provision of assistance to all the
relevant sectors such as WASH, health (the main implementers), agriculture, information, education and social protection.

Formulation of a comprehensive inter-sectoral monitoring framework
This proposal will address the formulation of sectoral plans based on the approved inter-sectoral strategies and the comprehensive
monitoring framework. Furthermore, a plan will be needed to gauge the nutrition actions. In addition, an appropriate and comprehensive
inter-sectoral plan will be developed for the monitoring of implementation of sectors plans. A monitoring framework will be based on
result-based framework, which will address programmatic and financial aspects.
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