Breaking the cycle of poverty early: by Education & Nutrition

D.S AkramHon. Chairperson

Health Education & Literacy Program- Pakistan19th July 2015

Washington-DC

Outline of Presentation

• Insight into the issues related to nutrition and ECD in the developing world-Pakistan as an

example• UNICEF’s Conceptual Framework for

malnutrition• Possible solutions

• Scaling up Nutrition• What will we gain

World Map based onDeaths from All Nutritional Deficiencies*

Accessed at http://www.worldmapper.org/display_extra.php?selected=412 8/4/08

* Deaths from protein-energy malnutrition, iodine, vitamin A, iron deficiency in 2002. ICD 10 codes: D50-D53, D64.9, E00-E02, E40-E46, E50-E64.

What is causing malnutrition (Unicef’s analysis)

The “Window of Opportunity” for improving nutrition is very small…pre-pregnancy until 18-24 months of age

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0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

Age (months)

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Latin America and Caribbean

Africa

Asia

Repositioning Nutrition, 2006

• Over 162 million children <5 years are STUNTED• Maximum rates in South Asia are between 40-53%• Proxy indicator for reduced physiological capacity, work

output• Decreased educational achievement• Negative employability (Martorell R; 1996. Paper for WB)

Pakistan

Mountains

Plains

Desert

Scarcity of water

Urban Slum

Mapping Nutrition

Ref: “Mapping of Nutrition Initiatives” DS Akram ,et.al.TRF2013

Interventions that Affect Maternal and Child Under Nutrition

Newborn babies• Promotion of breastfeeding (individual and group counseling)

Infants and children• Promotion of breastfeeding (individual and group counseling).

• Behavior change communication for improved complementary feeding*

• Zinc supplementation

• Zinc in management of diarrhea

• Vitamin A fortification or supplementation

• Universal salt iodization

• Hand washing or hygiene interventions

• Treatment of severe acute malnutrition

*Additional food supplements in food-insecure populations.

(Sufficient evidence for implementation in all 36 countries)

www.thelancet.com Vol 371 February 2, 2008

Possible Solutions

Address Intermediate and underlying Causes

Infant and Young Child Feeding Early Child stimulation Indigenous Hi density foods for children, PLW Address food insecurity Micro – Credit / cash transfers Empower Women – 43% reduction in malnutrition

by educating women (Smith and Haddad, 2000) Land reforms – subsidized agriculture Alternate sources for power generation Employment POLITICAL AND SOCIAL SECURITY

Financing envelope

Health sector

Narrow nutrition lens

Multisectoral nutrition lens

Education sector

Agriculture sector

Private sector

Financial sector

Trade and tax policies sector

Transportation sector

Multiple other sectors

Incre

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ce fo

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sec

tors

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ew

pa

rtners

Environment sector

Go

ve

rnan

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er

Broadening the “nutrition lens”…

Po

vert

y a

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on

Scaling Up Nutrition (SUN)September 2010

Coordinated by U.N.

• Based on evidence based nutrition strategies from “Lancet Series 2008”

• Public-Private Partnership of 102 government and non-government global partners

Based on Three Principles:• Should be Country Based and “Owned”• Focus on “Window of Opportunity” priority to first

1000 days of life.• Multi-Sectoral approach with integration of nutrition

in related sectors.

Reaching the ‘Unreached’

• Conventional methods: face to face, interactive radio, television

• Peer counselors and child to child, child to parent teaching

• Using technology: alternate sources of power in schools and health centers

• Utilizing mHealth, voice messaging and visuals• Using skype for virtual classes and group counseling• CSOs partnering with governments

School in Tharparker & Solar Plant

What will we Gain?

• Investment in Nutrition of children will results in :– Decreased mortality (save 1 million deaths per year or 30

million life years).– Decreased morbidity.– Improved physical & mental growth.– Contribution to achieving ALL MDGs goals.– Increase in lifetime earnings.– Very high rates of return among the top 10 development

investments.

Convention of the Rights of the Child.

• Adopted by UN General Assembly on 20th Nov, 1989.• Total of 10. Principles.• Principle No 4: The child shall enjoy the benefits of social security. He shall be

entitled to grow and develop in health, to this end, special care and protection shall be provided both to him and to his mother, including adequate pre-natal and post-natal care. The child shall have the right to adequate nutrition, housing, recreation and medical services.

-Our Right – Food Security Good Governance