Intersectoral Nutrition Strategy Sindh

Striving for Intersectoral

solution of Malnutrition

to have Healthy Children and

Mother

Careful management of the well-being of population is the essence of good government. Health is always a

provincial priority and government’s prime responsibility. Nutrition is an integral part of social sector development and improvement in its indicators would promote the much desired economic development through a healthy population.

Targets of MDGs strongly warrant that we must take some strategic steps and make efforts towards improved results. Therefore Planning and Development department has embarked on a historical achievement of formulating an Intersectoral Nutrition strategy for the Province of Sindh involving all the concerned departments, academia, Civil Society and Development Partners, a milestone in itself. We all know that both resources and skill are there, but what is lacking is a whole hearted effort. There is a need for proper utilization of all that is available, by competent and dedicated people.

Government of Sindh will provide full administrative support for implementation of this Strategy. The aim would be improvement of nutrition and socio- economic status of the people of province. Simply put, better nutrition advances human development, and poor nutrition constrains it. The former is obvious choice.

I am assured that Intersectoral Nutrition Strategy for Sindh not only provides a clear direction for all stakeholders and serves as a framework for consensus and convergence but also provides basis for

sustainable results and actions to address malnutrition.

I hope this Strategy will contribute to the socio economic & health status of poor masses of province. It should provide a base line to build upon leading towards progress. I also wish success to all the program personnel in the achievement of the goals set out for them in this effort.

Syed Qaim Ali ShahChief Minister

Mr. Arif Ahmad KhanAdditional Chief SecretaryPlanning & Development

It is a recognized fact that population of Sindh province especially women & children suffer from some of the

highest rates of malnutrition in the country. There is also an undeniable link between malnutrition and human development.

In the context of malnutrition the underlying causes are the prevalent poverty in the Sindh (about 31% of population lives below the poverty line), landlessness, food insecurity, gender imbalances and level of woman empowerment. These factors place Sindh at a serious disadvantage to meet the Millennium Development Goals (MDGs).

The National Nutrition Survey (NNS) 2011 reveals alarming malnutrition rates in Sindh. Natural disasters coupled with insufficient public sector investment; and limited awareness among individuals, families, policy makers and communities has a major impact on the current nutritional status. Responding to malnutrition requires a multisectoral approach to tackle these short comings.

An issue like this needs a very precise intersectoral strategy to arrest the malnutrition situation in the province. Therefore, development of a robust strategic plan with involvement and recognition from all line departments is a major challenge for Government. We appreciate the efforts of UNICEF for its support in formulation of this vital document together with the hard work put in by relevant officers of Planning & Development Department.

This Strategy has been formulated after a comprehensive and participatory approach.

Technical inputs have been obtained from all stakeholders i.e. the departments of health, population welfare, education, agriculture, food, livestock, women development and social welfare. Development partners, academia and civil society organizations have also made significant contribution.

I expect that the Government of Sindh’s policy makers and executives would benefit from this document and undertake rational and practical implementation plans to achieve the intended objectives.

Ms Rehana Ghulam Ali MemonSecretary (Development)

Malnutrition is an obstacle to human development, and without much more elective interventions it will

continue to inflict irreversible damage to individuals, early in life and large economic and social losses on countries for years to come.

Although, MDGs gave us direction with sequential milestones, for improving significant demographic, health and social indicators, yet for want of allocative efficiency and smart planning, we are terribly far away from reaching our targets to promote sustainable development and protecting the most vulnerable and disadvantaged segments from the disturbing effects. Therefore, it is strongly warranted that we must take more determined steps to achieve the targets of MDGs.

Evidence shows that fragmented actions, governance, financing and weak capacities are the core issues in Public Sector. Increasing budgetary allocations have not borne the desired outcomes unless we have clear strategic direction to trounce these issues.

The Intersectoral Nutrition Strategy has been formulated, based on Policy Guidance Notes prepared earlier. The hard work and strong commitment of Planning and Development Officials and focal person on nutrition made this incredible task tangible.

This strategy on nutrition has been developed through a consultative process by the Steering Committee and Technical Working Group on Nutrition, which includes representatives from line departments, academia, civil society and

development partners under the lead role of Planning and Development Department and aegis of UNICEF.

Intersectoral Nutrition Strategy proposes approaches, to address the major nutrition problems in the province. It aims to support in establishing and implementing action in accordance with current situation and resources.

This strategy emphasizes support for the most vulnerable groups, and alleviation of poverty and hunger, the root causes of malnutrition. Every effort has been made to direct the focus of all stakeholders for results on ground; particularly in health and nutrition system strengthening; and to support the leadership of government to achieve the Millennium Development Goals.

Intersectoral Nutritional Strategy For Sindh

Table of contentsAcronyms .............................................................................................................................................0

Overview

Introduction ...........................................................................................................................................1

Background information........................................................................................................................ 1

Overview of the nutrition status in Sindh .............................................................................................. 2

Review of the past initiatives ................................................................................................................ 4

Causality framework .............................................................................................................................5

Intervention framework ......................................................................................................................... 6

Goal of the INSS...................................................................................................................................8

Operational objectives .......................................................................................................................... 8

Underlying assumptions ....................................................................................................................... 8

The guiding principles........................................................................................................................... 8

Target group .......................................................................................................................................10

Rationale for the investment in nutrition ............................................................................................. 11

Organization analysis ........................................................................................................................ 11

Oversight coordination, monitoring and evaluation ............................................................................ 19

AnnexuresAnnexure one: Logical framework presentation .................................................................................. i

Annexure two: Sectoral recommendations

Health Sector ........................................................................................................................................ ii

Education sector .................................................................................................................................. ix

Agriculture/Fisheries/Livestocks .........................................................................................................xiii

WASH and PHED ...............................................................................................................................xix

Cross Sectoral RecommendationCSO .................................................................................................................................................. xxiii

BISP ..................................................................................................................................................xxv

Women Development Department ...................................................................................................xxix

Annexure three: maps of high risk districts for malnutrition ........................................................... xxxii

AcronymsADP Annual Development ProgramBCC Behavior Change CommunicationBHU Basic Health UnitCBA Child Bearing AgeCBO Community Based OrganizationCCT Conditional Cash TransferCHWs Community Health WorkersCMAM Community-based Management of Acute MalnutritionCMWs Community MidwivesDHIS District Health Information SystemDOH Department of HealthEPI Expanded Program on ImmunizationFANS Flood Affected Nutrition SurveyGAIN Global Alliance for Improved NutritionGAM General Acute MalnutritionGDP Gross Domestic ProductGoS Government of SindIDA Iron Deficiency Anemia IMR Infant Mortality RateIYCF Infant and Young Child FeedingLBW Low Birth WeightLHW Lady Health WorkerM&E Monitoring and EvaluationMAM Moderately Acute MalnutritionMI Micronutrient InitiativeMNCH Maternal, Neonatal and Child HealthMOU Memorandum of UnderstandingMTDF Medium Term Development FrameworkNGO Non-Governmental OrganizationNIDs National Immunization DaysNNS National Nutrition SurveyNPS Nutrition Program for SindNWFFP National Wheat Flour Fortification ProjectPC-1 Planning Commission-pro forma 1PDHS Pakistan Demographic and Health SurveyPHC Primary Health CarePLW Pregnant and Lactating WomenPSLSM Pakistan Social and Living Standards MeasurementRUTF Ready to Use Therapeutic FoodSAM Severely Acute MalnutritionSC Stabilization CenterSFP Supplementary Feeding ProgramTORs Terms of ReferencesWFP World Food ProgramWHO World Health Organization***

0

1

Sindh – Intersectoral Nutritional Strategy1. IntroductionNational nutritional survey has highlighted alarmingly high level of malnutrition in Pakistan. One fourth of the population (24%) is undernourished and two out of every five children malnourished. The national stunting prevalence among children under five is 43.7%1,2. The findings indicate that Pakistan has the second highest number of severely wasted children next to India3. According to the most recent esti-mates by the United Nations Food and Agriculture Organization (FAO) 37.5 million people in Pakistan are not receiving proper nourishment4.

Nutritional status has huge implications at individual and societal level. At individual level, poor nutrition affects health and survival, physical and cognitive functioning, and work capacity thus decreasing the income of households and national economy. According to the United Nations Standing Committee on Nutrition’s5 (SCN) fifth report on the world nutrition situation, just three types of malnutrition are respon-sible for 3-4 percent of GDP loss in Pakistan in any given year.

Under-nutrition has huge implications for women and children as is evident from the high rates of infant and maternal mortality which is reported as 87 per 1000 live births for infants (Sindh MICS 2009-10.) and 314 maternal deaths per 100,000 live births (Sindh PDHS 2006-07) for mothers in Sindh.

In order to respond to this grave and urgent situation, Government of Pakistan and developmental partners have committed to address the issue of malnutrition on war footing. Following document is the output of the long series of dialogues and consultations and inputs by various partners.

2. Sindh – Background InformationSindh is the 2nd largest province of Pakistan and is divided into 23 districts, 113 talukas/ tehsils and 1,703 Union Councils with current estimated population of 43 million in 2011 (Sindh HSS Report). Sindh’s growth rate is highest in the country6. Population demographic analysis indicates 15% of the population under five years of age. Sindh’s contribution to the national economy has been substantial – between 30 and 33 percentage of the country’s GDP with a population that is nearly 50% urban. The province’s GDP per capita is roughly three times that of the country as a whole. The rural population of Sindh is scattered over large distances and infrastructure is poor. Rural households face livelihood issues due to decreasing agricultural productivity and heavy devasta-tion caused by recent floods7.

According to the Benazir Income Support Program (BISP), 45.7 percent people (Approximately 82 mil-lion) in Pakistan are living below the poverty line. And out of these 45.7 percent people 36.5 percent (Approximately 65 million) of the total population are living in chronic poverty8. The rural-urban poverty

1 All data is from the Pakistan National Nutrition Survey (NSS), 2011 unless otherwise indicated. The 2011 survey is the first to provide repre-sentative data for each of the provinces.2 By comparison, India = 48%; Nepal = 45%; Bangladesh = 43%; D.R. Congo = 43%; Sri Lanka = 17%3 Policy guidance notes Sindh4 http://www.tbl.com.pk/malnutrition-in-pakistan-the-hidden-hunger/5 United Nations Standing Committee on Nutrition (SCN). Fifth Report on the World Nutrition Situation: Nutrition for Improved Development Outcomes, March 2004.6 Pakistan Economic Survey of 2011-12 7 TRF (2011). Situational analysis for post devolution health sector strategy of Sindh province. November, quoted in Road Map for Health systems strengthening in Sindh province Province to support USAID/Pakistan’s RMNCH programs in Pakistan. DRAFT, October 2012, USAID8 Adnan M.Crossing the poverty line. “The News” Sunday, 10th June 2012, Islamabad

2

gap in Sindh is high compared to the other provinces. Women and children (out-of-school/work), dis-abled, and the elderly, are the most vulnerable groups.

Sindh has a large network of primary, secondary, diagnostic, pharmacy and ambulance services being provided in many parts in collaboration with private sector. Around 22% of public sector offers tertiary care services to low income groups. Issues of staff retention particularly of female staff, frequent drug stock-outs and poor maintenance of building and equipment are major challenges faced by the public health sector. MNCH, LHW program, EPI and other vertical programs operate under the rubric of the Department of Health. Population welfare department is separate but aims to work very closely with the health sector. The districts that present most challenging health profiles are Thatta, Tharpakar, Jacoba-bad, Badin, Mirpurkhas, Kambar and Kashmore. Karachi, Hyderabad and Sukkur are comparatively the most developed districts while other districts of Sindh are middle ranking. Almost one third of mothers in Sindh have had six or more pregnancies. Sindh has a very low literacy rate of 46%9 with female literacy level of only 12%10. 73% of urban compared to 50% rural have ever attended school.

NNS indicates that a very small proportion (32%) of the population in Sindh have access to pipe water. In addition, according to NNS, 85 percent respondents stated that they “never treat water in any way to make it safer for drinking”. The situation in rural area is even more alarming where 92% population never treated water. One-third of the population of Pakistan defecates openly in the fields. In rural Sindh, the people are poor and lack sanitation facilities. .According to PSLM 2010-2011, 62% house-hold in Sindh have flush toilet facility compared to 66% national. There are a lot of disparities with in the districts (7% for Tharparkar Vs. 97% for Karachi).

Women in Sindh have low social status as evident from the poor education and literacy indicators in females (46% females compared to 71% for males).The society is patriarchal with fathers and brothers responsible for decision regarding women’s health, marriage and family size. It is a cultural norm to serve meal to men first (NNS 2011).

Sindh has successful models of public private partnership for health care delivery such as People’s Primary Health Care Initiative which is now operational in 21 districts of Sindh. The Basic Health Units, Dispensaries, Mother and Child Healthcare Centers have been transferred to PPHI, Sindh. PPHI is now looking after 1137 facilities which include 647 BHUs, 9 RHCs, 34 MCHs, 435 dispensaries and 12 others (Unani Shifa Khana)11.

3. Overview Of Nutrition Status In Sindh National Nutrition Survey 2011 highlights that, directly or indirectly, “the concurrent vicious life cycle of malnutrition contributes to almost 35 per cent of all under-five deaths in the country”. It argues that over the past 20 years, “there has been little change in the prevalence of malnutrition in the population”, despite greater food availability and an overall increase in caloric intake per capita12.

Analysis of NNS 2011 indicates that Sindh is the most food deprived province of Pakistan where only 28 percent households are food secure (21.1% food insecure without hunger, 33.8% food insecure with moderate hunger and 16.8% food insecure with severe hunger).

The survey indicates that unlike many other areas in South Asia, there are no significant differences in the nutritional status of young girls and boys. . Problems emerge for females however in adolescence and adulthood. Only 52.5% of women in Sindh have body mass index which is normal, while 23.7% are underweight and 24.0% are overweight or obese.

9 Pakistan economic survey 201110 Policy analysis of education in Sindh, UNESCO, 201111 Monthly bulletin PPHI Sindh, monthy performance review, Dec 2012 , vol 1 , issue 3, pg # 1 and 1012 Situation analysis of children and women in Pakistan, 2012

3

Prevalence, consequences and causes of malnutrition in Pakistan

Nutrition statistics2011

(Pakistan)2011

(Sindh)2001

1. Nutritional situation of children:l Chronic malnutrition (about 10 million children, 2011)l Acute malnutrition (about 3.5 million children, 2011)l Severe acute malnutrition (about 1.4 million children,

2011)l Chronic malnutrition is significantly higher in rural than

urban in areasl Chronic malnutrition is slightly higher for boys than for

girlsl Iron deficiency anemial Vitamin A deficiencyl Vitamin D deficiencyl Zinc deficiencyl Low birth weightl Early initiation of breastfeedingl Minimum acceptable diet for children 6 to 24 months

43%15%5.6%

46% (urban) 37% (rural)44% (boys) 42% (girls)

62%42.1%40%39%22%41%8%

49.8%40.5% (underweight)

17.5% (Wasting)

73%35.4%43%

38.6%-

51%3%

42%14%

51%13%

37%

26%

2. Nutritional situation of women:l Underweightl Maternal iron deficiency anemial Vitamin A deficiencyl Vitamin D deficiencyl Zinc deficiencyl Household using Iodized salt

15%51%42%67%41%69%

27%13

59%47%71%45%52%

29%5.9%

3. Underlying causes:l Heads of household illiteratel Food insecurel Food insecurity, poverty and lack of education for women

are major contributing factors to child malnutrition

56%58%

13

Recent nutritional survey has also highlighted the prevalence of “Hidden Hunger” or micronutrient de-ficiency as a major challenge for the development of a healthy population. Anemia in mothers in the form of iron deficiency, and stunting was found to be significantly high amongst mothers and children-a direct result of the micro nutrient deficiency. Of the 40 essential nutrients, four are in chronically short supply: iron, zinc, iodine and vitamin A. NNS 2011 indicates that Vitamin A deficiency affects 37.1% of women and 53.3% of children, both figures are the highest in Pakistan. Vitamin A is responsible for enhancing immune functions of the body (e.g., Sommer et al., 198414; 1986; see Beaton et al., 199315) and maintenance of primary functions including eyesight. Vitamin A status affects not only the incidence of diarrhoea but also its duration, severity, and fatality rate.

Other micronutrient deficiencies have resulted in high levels of moderate and severe anaemia which affects 59.7% of pregnant women and 72.5% of children in the province. Iodine deficiency disorders (IDD) are the single most common cause of preventable mental retardation and brain damage and are associated with cognitive loss affecting approximately 35% of school age children.

13 PDHS 2006-200714 Sommer, A; J. Katz; I.Tarwotjo, (1984). Increased Risk of Respiratory Disease and Diarrhoea in Children with Pre-existing Vitamin A Defi-ciency. American Journal of Clinical Nutrition 40:1090-95.15 Beaton, G.H.; R. Martorell; K.J.Aronson; B. Edmonstron; G.McCabe; A.Ross; B.Harvey, (1993). Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries. Toronto: International Nutrition Program, University of Toronto.

4

Only 52% of the households use iodized salt in the province. The survey also underscored the fact that although stunting is significantly higher in food insecure households; it is not uncommon in food secure households.

Review Of The Past InitiativesReview of the past initiatives indicates a general tendency towards developing “nutrition specific” interven-tion mostly in health sector indicating the general perception that nutrition is the mandate of the health sector. Review also indicates that within the health sector, primary focus has been on implementing CMAM activities which is probably in response to onslaught of cases that ascended to surface after flood that struck the Sindh province. On the prevention and promotion side, health sector has been active in implementing IYCF and preventing micro-nutrient deficiency through initiatives like Wheat Flour Fortification and Universal salt iodization. 125 Wheat Flour Fortification plants were successfully built. In the absence of legislation to restrict sale of unfortified products in the markets, the micronutrient fortification initiatives always faced prob-lem of sustainability. Health sector has successfully integrated nutrition and breast feeding counseling in the curriculum of LHWs and CMWs; these components would however benefit from more focus on competency building for managing the cases of malnutrition and problems faced during breast feeding. Models of baby friendly hospitals have also been instituted but these also failed to get institutionalized in the absence of leg-islation. Analysis of MIS reports indicated that it is mostly department specific such as nutrition, MNCH, EPI. There is a tremendous opportunity to harmonize the information to develop a comprehensive understanding of the nutrition situation In Sindh.

Malnutrition is a multidimensional issue. The recognition of the role of other sectors has been nebulous and hardly any model of inter-sectoral action is available for analysis. Hence, while social protection packages such as Bailtul Maal and Benazir income support program have been introduced, opportunities to use its database to reach out to the ultra-poor population with social development interventions have not been exploited; while agriculture sector showed remarkable success in increasing agriculture produce, it did not delve into food security issues or invested significant efforts in exploring ways to augment bio-diversity and bio-availability of the crops. Similarly, harmful effects of bio-engineered seeds and chemical pesticide and its impact on the nutrient quality have not been raised as a concern to the extent needed. Similarly, in the livestock sector, focus has been on producing more milk or meat without enough understanding and hence control measure to discourage use of hormones did not receive much attention.

Inter-sectoral action is critical to addressing nutritional problem but there is a serious dearth of any suc-cessful inter-sectoral initiative even for demonstration or piloting purpose in the country. In the social protection arena, the country has introduced cash transfers to families through BISP but the opportuni-ties to synchronize this activity with other sectors have not been fully exploited. TAWANA – a model of school feeding programs strived to adopt inter-sectoral approach by striking a tripartite agreement between ministry of social welfare, ministry of education and ministry of women development. TAWANA however faced a lot of problems and failed to achieve its desired outcomes. Analysis of the underlying reasons for this tendency to work vertically can be categorized into the following:

a) Vertical nature of the program funding that lacked any incentive to work horizontally in inter-sectoral approach;

b) Lack of vertical integration as a result of centrally controlled organizational structure;c) Lack of political will to establish coordinating bodies to provide space for inter-sectoral action;d) Lack of donor harmonization that resulted in fragmentation of initiatives;e) Lack of human resources capacity to unfold the technical aspect of the issue and build capacity to

address the issue using inter-sectoral approach.

INSS has strived to learn from the past experience within the country and international experience documented in “scaling up nutrition intervention”. A series of consultation and inputs have guided the INSS developmental proves.

5

4. Causality Framework It is a recognized fact that malnutrition is inextricably linked to actions and condi-tions across many sectors, including food and agriculture, education, economics, and environment. The UNICEF multi cau-sality conceptual framework highlights in-adequate food and nutrient (consequent to inadequate access to food -food inse-curity), and “diseases” as the two most common causes of child under-nutrition in Pakistan. Such diseases often result from some combination of inadequate provision of health services and poor environment (water, sanitation and hygiene practices or WASH). The framework indicates that inad-equate food intake and poor health are the immediate causes of child malnutrition and is the outcome of underlying behaviours and factors i.e. unsafe maternal and child care practices, food insecurity and inad-equate provision of WASH and health ser-vices. Food security encompasses access, adequacy and availability to both quantity and quality of food - People are food secure when food is both available and accessible and when population is informed and is able to consume a balanced diet. When analysed in context to Sindh and as documented in NNS 2011, the underlying reasons for poor nutrition status became quite clear. Since 2006, the food insecure population in Pakistan has increased by 12 million while the number of the se-verely food insecure population (consuming less than 1,700 kcal per day) has risen from 9.6 million to 45.3 million people – 28% of the population. According to NNS 2011, two thirds of these new severely food insecure people live in rural areas. In context to Sindh, flood and drought, social status, gender and rapid urbanization have played a key role in causing food insecurity; food insecure families across Pakistan do not have choices of desired dietary intake16. Only 24% of the population has proper sanita-tion; 64% have access to safe water and 52% of households have electricity.

The framework indicates underlying social determinants of health including poverty, women social sta-tus and policy and political issues. Poverty rate in Sindh is 31% vs. 33% in Pakistan (SPDC, 2004). Highest poverty level is observed in small towns (40%) followed by rural Sindh (38%) and large cities (23%). Sindh also has a high unemployment rate of 5.08% vs. National 5.95% (Labour Force Survey 2010-11) which is one of the key reasons for poor economic status of the population in Sindh. Poverty and lack of opportunities for education, particularly for females have negative consequences on care practices, on the utilization of health services, on family hygiene and on food security. And all of these are affected by economic status, governance and other “basic causes.” These care practices are de-pendent upon the choices that a mother is able to make which are the results of education, economic autonomy and women’s social status.

16 Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life. Household food security is the application of this concept to the fam-ily level, with individuals within households as the focus of concern.

6

5. Intervention Framework For INSSIntegrated nutrition strategy for Sindh has adopted intersectoral approach at three levels of causes of malnutrition, identified in the causality framework of malnutrition, given in the previous section. To address immediate causes of malnutrition, INSS advocates adopting high-impact nutrition specific in-terventions primarily from health sector that has the potential to avert maternal and child mortality expected in such situation through prompt clinical life-saving treatment and management of acute mal-nutrition. These interventions require presence of a functional health system with trained and dedicated staff and adequate logistic support. The new global movement which is based on the thirteen proven nutrition interventions given below, claims to give the best value for money and when delivered at scale, could together reduce stunting by one third globally17:

a) Promoting good nutritional practices:i. Breastfeedingii. complementary feeding for infants after the age of six monthsiii. improved hygiene practices including hand washing

b) Provision of micronutrients for young children and their mothers:iv. Periodic Vitamin A supplementsv. Therapeutic zinc supplements for diarrhea managementvi. Multiple micronutrient powdersvii. De-worming drugs for children (to reduce losses of nutrients) viii. Iron-folic acid supplements for pregnant women to prevent and treat anemiaix. Iodized oil capsules where iodized salt is unavailable

17 Scaling Up Nutrition: What Will it Cost? Horton, et.al. 2009

7

c) Provision of micronutrients through food fortification for all:x. Salt iodizationxi. Iron fortification of staple foods

d) Therapeutic feeding for malnourished children with special foods:xii. Prevention or treatment for moderate under nutritionxiii. Treatment of severe under nutrition (“severe acute malnutrition”) with ready-to-use therapeutic

foods RUTF). Through these interventions the strategy will aim to reach more adolescent girls, pregnant women and children under five years of age. Community mobilization activities through LHWs to identify and treat severe acute malnutrition through clinical lifesaving interventions are vital for ensuring successful uptake of such intervention. In addition, the strategy envisages sectors to upscale and revitalize vari-ous models present on ground such as Infant and young child feeding program (IYCF), promotion of hygiene behaviors, Vitamin A supplementation and micronutrients and food fortification (wheat with iron and salt with iodine). Most of these interventions emanate out of the 2008 Lancet Series on Maternal and Child Under-nutrition and the revised interventions (Lancet Maternal and Child Nutrition series 2013).

In order to address underlying causes of malnutrition, INSS will adopt medium term strategies proposed in the malnutrition intervention framework. Potential areas of actions include:

i) continue to enhance research and access to bio-diversification and bio-fortified food through house-hold education,

ii) incorporate nutrition interventions in small holder agriculture and rural farmers for encouraging pro-duction of homestead food production and get access to livelihood support– e.g. food for training, food voucher scheme, micro-credit, etc.);

iii) Enhance production, availability and access to fortified food such as fortified flour, oil and other food items as well as access to and micronutrient powders through legislative measures, enforcement of legislation through civil society and Quality assurance department (PSQC) and incentivising private markets and sectors;

iv) improve access and use of safe drinking water and sanitation through the provision of water purifi-cation tablets, containers, soap and hygiene education) and iv) increase access to functional public and private health services in the rural areas to provide access vaccination, PHC, ANC, obstetric and new-born care

In order to address the basic causes, every sector has reviewed their existing sectoral policies and strategies and has identified the areas of synergies. The sectors will also identify the areas of policy coherence and identify and address any unintended negative consequence on nutrition of the popula-tion. The departments and P and D have committed to reassess their existing PC1s to ensure these are gender sensitive, nutrition sensitive and address the need to reach out to those most affected by the issues.

8

6. Goal Of The Intersectoral Nutrition InterventionIntersectoral nutrition strategy for Sindh aims to reduce chronic malnutrition in children aged 0-24 months by 10 percentage points (from an estimated 49.8% to 39.8% by the end of 2016.)18 iron de-ficiency anaemia in children from 73% to 62% and maternal anaemia from 59% to 49% by the end of 2016 through sustainable, effective and inter-sectoral interventions.

6.1. Operational objectivesi. Improve nutritional outcomes in the Sindh province with a focus on sustainable, effective intersec-

toral interventionsii. Strengthen the provincial capacity for developing, mobilizing and stewarding intersectoral interven-

tion developed through public private partnership;iii. Integration and mainstreaming of nutrition in agricultural education, agriculture services and com-

munity development programs;iv. Promote nutrition health of women and children through linking mother and child health with social

protection, and food security interventions to produce long term sustained results; v. Promote programmatic complementarities and geographical convergence through coordinating the

strategic sectoral plan vi. Provide a broad Monitoring and Evaluation Framework for monitoring of nutrition sector strategy by

DOH and partners

6.2. Underlying assumption1. There is commitment to rapidly scale up both domestic and external investment for intersectoral

nutrition intervention;2. Development partners will harmonize their external assistance and will aim to reduce fragmentation

and enhance mutual accountability;3. Government, non-governmental sector and elected representatives will own the strategy;4. There is readiness to move towards one integrated provincial and district level monitoring and

evaluation system;5. Key sectors i.e. health, agriculture, food/ livestock/poultry and water and sanitation are committed to

coordinate and collaborate intersectorally and cross sectorally to make their interventions pro-poor, gender and nutrition supportive.

7. The Guiding Principles

Principle One: Recognition of Right to foodThe right to food is the first fundamental principle underlying this strategy. It is defined as:

“The right to have regular, permanent and unrestricted access, either directly or by means of financial purchases, to quantitatively and qualitatively adequate and sufficient food corresponding to the cultural traditions of the people to which the consumer belongs, and which ensure a physical and mental, indi-vidual and collective, fulfilling and dignified life free of fear.”

Principle two: Evidence based interventionsNutrition interventions instituted globally with right policies and interventions have shown remarkably

18 Given that weight data on infants in the first months of life will also offer insights on the prevalence of low birth weight, the indicator as a whole can serve as a measure of nutritional status in the first 1000 days.

9

reduction in the rates of under-nutrition. In designing the strategy, the country experience will be studied by the stakeholders. There is much that Pakistan can learn from neighboring countries like Bangladesh where appropriate policies, strategies and evidence based interventions have reduced malnutrition. In Bangladesh, from 1996 to 2006, there was 20 % reduction in stunting and 10 % reduction in under-weight.

Principle three: Geographical convergenceSindh has 23 districts however the situation of chronic malnutrition varies across districts. Even within districts, there are UCs which are more deprived then the other where social determinants of malnutri-tion are to a great extent lacking. It is proposed that the strategy focuses on district levels and further on high risk UCs within those districts and other districts for implementation in a phase wise manner. It is also proposed that such districts become priority districts for all the sectors and the coherent plan of implementation is adopted. The maps of high risk districts have been given in Annexure III.

Principle four: Gender empowermentThe status of women and women has a direct role on reduction in under-nutrition. One study19 that shows improving the status of women in South Asia would reduce the level of underweight children un-der three years of age by approximately 12%. According to World Bank giving 100 girls one additional year of primary education would prevent roughly 60 infant deaths and three maternal deaths, while averting some 500 births.

Principle five: Plan inter-sectorally and implement sectorally The strategy advocates inter-sectoral actions. Each sector will analyze their sectoral strategies using nutrition lens. These multiple sectors through their combined and coordinate actions will reduce vulner-ability to malnutrition through preventing illness and promoting health by creating an enabling environ-ment for actions. The strategy although will adopt an intersectoral approach but for implementation will focus sectorally and improving their current operations. The strategy proposes an oversight planning committee at the provincial level and an intersectoral district level committee to ensure coherent inter-sectoral interventions.

Principle six: Encourage involvement of the civil societyThe strategy envisions a critical and constructive role of the civil society and non state actors. The study envisages encouraging civil society stakeholders to actively participate in social mobilization, gover-nance, service delivery, research, monitoring and advocacy for nutrition promoting actions.

Principle seven: Common targets and indicators Common targets and indicators will be instituted with an aim to reduce prevalence of child stunting and micronutrient deficiency in women and children. It is proposed that a oversight project monitoring structure be formed to ensure that the nutrition outcomes are showing improvement through carrying out mid-term and end term evaluation. The strategy recommends development of a common inter-department reporting format to be implemented at the UC levels. The reports would be submitted to the district level and then the provincial level inter-ministerial group for monitoring of the progress.

19 L. Smith, U. Ramakrishnan,A. Ndiaye, L. Haddad, and R. Martorell, The Importance of Women’s Status for Child Nutrition in Developing Countries,Research Report 131, IFPRI, 2003

10

8. Target Group For Nutrition Intervention

1000 days plus approach (Preconception, conception, pregnancy and lactating women)Maternal nutritional status is a determinant of chronic and acute nutritional status in children under 5 years old. Scientific evidence indicates that first 1,000 days after conception is the most critical period of a child development. However the boundaries are inexact and in particular, the critical importance of the preconception period is being recognized. Both the size and age of women at the time of conception as well as nutrition during pregnancy are important. Many children are born undernourished because their mothers have a poor nutrition status. Through this route the disadvantages incurred by poor nutrition are passed between generations20. The data from Pakistan indicates that a significant proportion of children are already stunted at six months of age indicating the critical contribution of fetal malnutrition and small for gestational age. When mothers are breastfeeding they require extra energy which they can get from the reserves they have built up during pregnancy and from eating extra food after birth. The data indicates that a significant proportion, almost half by some estimates, of growth faltering oc-curs between the ages of six and 24 months when the child is no longer protected by exclusive breast feeding and critically dependent on appropriate complementary foods for nutritional needs. In addition effects of under-nutrition are irreversible if intervention is delayed until the child is two years old. Even a child adequately nourished after 24 months of age is unlikely to recover growth ‘lost’ in the first two years as a result of malnutrition.

Childhood (2-5years): Poor diet and repeated episodes of infectious disease and parasites affects the nutritional status of 2-9 year old children. Vitamin A supplementation is unlikely to affect linear growth, but has an impact of diarrheal disease burden and morbidity21. Zinc supplementation has an impact on linear growth and the effect is greatest among children between 12-36 months of age at risk of zinc deficiency. Psychological development may improve with a combined preschool nutrition and stimula-tion intervention. While improved weight gain has been demonstrated among school age children after deworming, there is no evidence of benefits on linear growth in children under 5. Malaria control using bed nets can reducethe prevalence of anaemia in young children and improve growth.

20 Scaling Up Nutrition: The UK’s position paper on under nutrition, September 201121 Strategies, Policies and Programs to Improve the Nutrition ... - FANTAwww.fantaproject.org/.../StrategiesPoliciesPrograms_Nestel.pdf

11

Adolescent age groups Adolescent boys and girls are both the target for the INSS. This age group is particularly important for girls because of their reproductive role, impact it has on the baby and inferior social status needs priority attention. INSS aims to give priority to adolescents in both education and health sector. Evi-dence suggest that adolescents should be considered separately as two groups22 for programmatic purpose: the younger ones (10-14 years), when 80% of the growth takes place and need for nutrients is very high; and the older ones (15-19 years), whose rate of growth has slowed down but for whom micronutrient deficiency control, especially Iron deficiency anemia (IDA control), is important. Adoles-cent girls in the age group of 10-14 years can be reached through school if they are able to attend the secondary. 15-19 years of age group is very important because in rural communities girls are often married at a younger age and a therefore a poor pre-pregnancy nutritional status and iron stores have a greater effect on pregnancy outcomes than anything taking place during pregnancy. Girls in the later age group can be reached through preconception counseling. Community based outreach workers from various sectors can play a critical role in influencing family behavior towards nutrition in girls in this age group.

Rationale For Investment In Nutrition In Sindh“Nutrition Policy Guidance Notes for Sindh” very clearly indicates that malnutrition in the province re-sults in direct loss to the economy of 2.7 to 4.1% of GDP annually and places constraints on economic and social development in the province through three tier pathways:

l Direct losses in productivity from impaired physical status –l Indirect losses from poor cognitive function l Losses emanating from increased health costs resulting when malnutrition reduces immune re-

sponse to infection. The report has outlined in detail about the impact of malnutrition as a direct consequence of prevalence rate of stunting (under 5), wasting (under 5), IDD in school age children, Anaemia in under 5 year old children and Vitamin A deficiency (under 5)23.

9. Organization And Sector Analysis And Proposed Inputs

I. Planning and Development (P and D)Planning and Development Department has a key role in policy planning, coordination between provincial and federal governments and donor agencies, coordination of foreign aid and technical assistance from abroad through Economic Affairs Division. P and D Dept. process PC-1 for different departments; finalize Annual Development Plan and 5 years Development Plan for different departments in the province.

Headed by Additional Chief Secretary (ACS), Sindh P&D Dept. is manned by about 200 officers in vari-ous technical and administration sections. P &D has 4 wings and every wing has its own role, technical, administrative, development and procurement. P and D has a technical committee which is headed by the chief economist and initially approves projects to be further sent to Provincial Development Working Party (PDWP) for approval. P and D has a monitoring evaluation cell and (TPM) which performs the role of the third party monitoring cell as well.

After 18th amendment budget given by Federal Govt. is now with Provincial Govt. and channelized through provincial finance dept. on demand basis and according to agreed ADP to respective dept. If

22 Adolescent Nutrition: A Review of the Situation in Selected South-East Asian Countries23 Nutrition policy guidance notes Sindh, P and D, Government of Sindh.

12

any project’ budget crosses 1000 million it goes to ECNEC for approval and then to Federal Govt. ap-proval through Central Development Working Party (CDWP). Once approved from Federal CDWP then Sindh Govt. releases administrative approval.

Potential role in INSS:i. P&D is currently reviewing following PC1s which will have tremendous impact on improving nutri-

tional status of the population:a) PC1 –NPS on agriculture development of farmers through micro credit loans, improving the ir-

rigation system and building safe capacity for grain storage. b) PC1 for nutrition (NPS) is in its finalizing stages and focuses primarily on improving the nutri-

tional status of children under five years and pregnant/ lactating women. ii. Sindh P and D department has adopted leadership role in bringing together different sectors un-

der the aegis of steering committee chaired by ACS development and secretaries of relevant de-partments as members. Steering committee has technical working group that comprises of focal persons from department of health, education, women development, agriculture, food, livestock, fishery and social welfare.

iii. The secretariat of the inter-sectoral strategy implementation will be based in the P and D.

II. Health SectorHealth sector plays a key role in addressing the nutrition issue mostly through addressing immediate causes of malnutrition. Like other vertical department, health department has also been devolved. De-volution in principle is meant to empower provinces upto district level. Lack of adequate funding has compromised the provinces to achieve desired level of effectiveness of the program. In addition lack of proper preparation and provincial capacity has restricted the province from taking a full benefit of the change and maximize on the synergy that would have been an outcome of this change.

Following sub sectors of health are directly involved in nutrition activities:

Lady Health Workers (LHW): LHW program currently operates in 23 districts of Sindh. LHWs are responsible for screening babies with moderate to severe malnutrition using MUAC approach and administration of iron, folic acid to pregnant women (during the house visit) and administer deworming tablets to children. LHWs play a critical role in community awareness raising around the issue. The LHW collects information about nutritional status of the children in the community but there is limited sharing of this information with other subsectors of health.

MNCH Program: MNCH program aims to reduce maternal and neonatal mortality through promoting skilled birth delivery, safe delivery practices, exclusive breast feeding and complimentary feeding in hard-to-reach areas as well as to support BEMONC & CEMONC 24/7 at all levels as per WHO proto-cols. MNCH activities are focussed at expectant mother and children of less than 5 years of age with no or little

Access to health services24 (USAID report). Role of CMW in nutrition program is limited to distribution of vitamins and supplements, Iron & folic acid, Calcium, Vitamin D and Multi vitamins to women during pregnancy and after delivery.

EPI/Polio Program: EPI program primarily focuses on immunization of children up to 15 months of age. Polio eradication program is not under the umbrella of EPI but is an important initiative from nutri-tion perspective. Vitamin A supplements are administered to children up to 5 years during the campaign. When the Polio program is rolled up and Pakistan achieves “Polio free Pakistan” status, new strategies will be designed for continuation of administration of Vitamin A.

24 Road Map for Health, Systems Strengthening in Sindh Province to support USAID/Pakistan’s RMNCH programs in Pakistan. DRAFT, Octo-ber 2012

13

Health Education Units, Structure and FunctionsPresently, the Health Education Officers (HEOs) and health education service units are present at the provincial and district levels but these are weak and not functioning properly because of shortage of staff. Support staff is also not available in any health education service unit to carry out health educa-tion-related field activities. A proposal is under consideration to establish service structure, organiza-tional structure and operational funding for health education and cadre of HEOs and required support staff. With enhanced capacity, health education cell can play a key role in standardizing health education and communication messages to be promoted from different sectors

Nutrition Program Cell: Sindh has a provincial nutrition program cell which is headed by a Pro-vincial Nutrition manager along with two deputy program managers. The program relies completely on district health officers of various programs and CBOs for program implementation. It is being imple-menting following four components:

i. Community outreachii. Supplementary Feeding Programme (SFP)iii. Outpatient Therapeutic programme: for children suffering with SAM iv. Inpatient Care for malnourished children

Nutrition Support Programme Sindh (NPS) NSP envisaged for 2013 to 2016 will target 09 districts of Sindh. Its PC-1 is in its finalizing stages and focuses primarily on improving the nutritional status of children under five years and pregnant/ lactating women. The PC1 will be executed by Health Department, GoS with financial support by the World Bank and ADP allocation of Govt. of Sindh. The Provincial Nutrition Support Program and Health Department will be responsible for the operationalization of the PC1. The Nutrition Cell, Health Department will act as Program Implementation Unit (PIU) and provide oversight and leadership for effective implementa-tion of the programme at provincial and district level. Nutrition cell of the project will be responsible for ensuring regular program monitoring, annual assessments, mid and end term evaluations of the inter-ventions. NSP framework has been developed with reference to Medium Term Development Frame-work and MDGs1, 4, & 5. Project will be implemented by the provincial department of health at the Provincial level and will be implemented through District health office of health at the District levels esp. the service delivery part primarily through the Lady Health Workers, of the National Program for Family Planning and Primary Health Care, services of PPHI

The main focus of the NPS is on the following:

l Addressing malnutrition in Children (06 – 59 months) and Pregnant & Lactating Women through IYCF and CMAM services esp. to the rural areas

l Addressing Micronutrient Deficiency through provision of micronutrient powders (through LHWs and CMWs), iron folic acid tablets to pregnant women, vitamin A supplementation (EPI Program), supply of Zinc and ORS

l Communication for Development and Behaviour Change; l Strengthening Institutional Capacity, Research and M&E Systemsl Focus on micronutrient deficiency through Vitamin A campaigns, IFA supplements and counselling

of PLWs, ensuring continuous supply of Zinc and ORS and training of health workers to address de-worming of male and female children with a focus on poor and disadvantaged through UNICEF support

l Advocacy for fortified foods. NPS aims to advocate for enacting of law for fortification of foods, in-cluding salt and wheat flour, advocacy with private salt processors for expansion of salt iodization program and with policy makers and private industry for expansion of the wheat flour fortification program along with capacity building for monitoring and demand creation, system of sustainable supply of KIO3 (iodine fortification),etc.

14

l In country production of high density diet for treatment of severely malnourished children.

III. Sindh Education And Literacy SectorThe vision of the Education and Literacy Department25, Govt. of Sindh is “to instil moral values and pro-vide education to all citizens irrespective of gender, caste, creed, or race. The basic thrust of the reform agenda is to remove illiteracy and provide free and compulsory primary and secondary education to all within minimum possible period.”

Sindh has 49,605 institutions from primary till higher secondary level. The share of various sectors is as follows: primary – 90.8%; Middle – 5.4%; Secondary – 3.3% and higher secondary – 0.5%26. There are 4.5 million children at these various levels with bulk (62%) going to primary. There is huge decline in middle sector enrolment compared with primary and if the transition gets improved serious efforts would be needed to provide physical space and teachers for increased enrolment. Across all the levels, the student-teacher ratio stand at 1:30; student-school ratio stand at 1:147 and student classroom ratio stand at 1:44.

In accordance with the 18th amendment, the functions of federal education ministry has been devolved to the provinces which on one hand present many opportunities but on the other hand, also pose some challenges because of the lack of capacity to deal with this change. Sindh, does not have a formal poli-cy document available at the provincial level, there is discussion within the provincial education ministry on the issues of education policy and curriculum in post 18th Amendment scenario27.

The ideology of Pakistan lays down upon the Government the obligation to make education acces-sible to all citizens. Sindh already had Sindh Compulsory Primary Education Ordinance of 2001 in place without much impact on enrollment as evident from various surveys. On February 13th, 2013 Sindh has legislated compulsory free education free and compulsory for children between five and 16 years. Enforcement of the ordinance and legislation will pose huge challenge for the DoE. Under the new law, all private schools will be bound to reserve 10 percent admissions for disadvantaged and terrorism-affected children. Under the “Sindh Right of Children to Free and Compulsory Education Act, 2013”, children will fall into the disadvantaged criterion if their parents’ monthly income is less than the minimum wage – Rs8,000 – fixed by the government. The law also makes it compulsory for parents or guardians to send their children to school.

AGPES is the PC1 for fourth phase of “assistance to girls primary education in Sindh (AGPES)” with a major focus on school feeding as a means to increase girls enrolment has been approved for the period from July 2013 to 30th June 2014 with a budget of Rs. 780 million. Under this project, 500 Government Girls Primary Schools in five districts i.e. Jamshoro, Thatta, Badin, Dadu and Tharparkar has been targeted to increase the low enrolment ratio in these districts. The project is within the framework of Education for all (EFA)”.

Sector IV: Department Of Agriculture / Food / Livestock / Poultry And Fisheries Agriculture contributes to over 21% of GDP, and employment to 45% of the country’s labour force be-sides contributing to substantially to the country’s exports. Four major crops (wheat, rice, cotton, and sugarcane) on average, contribute 29 percent to the value added in overall agriculture and 6.0 percent to GDP28. The livestock sector contributes 11% of the country’s GDP, with an estimated 42 billion liters of milk produced per annum.Since the 18th Amendment to the Constitution of 1973, Ministry of Food

25 http://www.sindheducation.gov.pk/26 Policy Analysis of Education in Sindh, UNESCO, Pakistan27 Dr Eshya Mujahid-Mukhtar. “Situation Analysis of the education sector”. UNESCO.28 Agriculture - Ministry of Finance available on www.finance.gov.pk/survey/chapter_12/02-Agriculture.pdf

15

and Agriculture and federal ministry of livestock and dairy development have been devolved to prov-inces. In spite of this change, issues such as the import and export of agricultural inputs and products, price setting, standardization and quarantine issues, national research and inter provincial issues i.e. rehabilitation, operation and maintenance of primary irrigation structure come under the nexus of the Federal Government.

Dairy Industry And Livestock: On average a dairy animal in Pakistan yields 6-8 times less milk than a dairy animal of the developed world29; Small average animal holding herd size of 3 per household in the country is posing a major barrier to developing the dairy farming sector.30 Dairy farmers are therefore not motivated to feed their animals, good quality fodder or practice good farm management.

Development Of Livestock Sector: Livestock and fisheries play an important role in poverty reduc-tion in the rural areas particularly from women perspective and has been described as a priority area of investment strategy of the government of Sindh. Government in its future plan has undertaken a project to set up a dairy village and animal meat processing zones in district Thatta on a public private partnership basis which will have direct impact on the meat and dairy product enhancement which will reduce poverty as well as availability of nutrition food.

Development Of Fishery Sector: Development of fishery sector will have impact upon the poverty reduction and availability of nutritious food. Rs. 1.065 billion has been allocated for 10 schemes in fisheries sector, in which 5 are ongoing schemes and 5 schemes are new projects which are be implemented in the next fiscal year. A model village has been planned for fisherman at Hawks-bay, Zero Point Badin, Munchhar Lake and Keenjhar LakeThatta. Budget also incorporates introduction of culture of High value Brackish Water fish in Sindh, rehabilitation of Pilot Shrimp Farm Garho as Training & Research Centre.

Sector V: Water, Sanitation Hygeine And PHED DepartmentsBefore promulgation of Sindh Local Government Ordinance (SLGO) 2001, the local Government was declared a department under rule 1979 for providing and maintaining the water supply and sanitation services throughout the province through Metropolitan corporations, Municipal committees, town com-mittees and union councils. After promulgation of Sindh Local Government Ordinance (SLGO) 2001, sanitation functions have been devolved to taluka/town level and a body designated as taluka/town Mu-nicipal Administration (TMA) has been set up, to provide municipal services at a taluka/town level under the Department of Local Government in the provincial administration. Prior to the SLGO, the water sup-ply and sanitation facilities for rural and urban areas were provided through Public Health Engineering Department [PHED] including its operation and maintenance.

Public Health Eng. Department was initially created by Government of Sindh (GOS) as a Project Directorate in mid-sixties and worked as a wing of local Govt. Department. PHE was upgraded in mid-seventies as a department with restricted mandate for only construction of water and drainage schemes throughout the province except two cities i.e Karachi and Hyderabad for which KWSB & WASA got the mandate.

Sindh Government has issued “Sindh Sanitation Strategy (SSS)” in 201131 which is currently more hardware focussed. The strategy can be reviewed to promote health and hygiene practices in context to both rural and urban areas of the province through behavioural change approaches and adoption of innovative technologies under the rubric of National Sanitation Policy (NSP).

“Municipal Services Delivery Program” (MSDP) Sindh is a program initiated by Sindh Government in collaboration with USAID with an aim to provide safe drinking water, improved sanitation and solid

29 Dairy Industry of Pakistan at www.iiste.org/Journals/index.php/EJBM/article/.../326530 Dairy Industry of Pakistan, available on www.iiste.org/ Journals/ index.php/ EJBM/ article/.../326531 http://202.83.164.25/wps/wcm/connect/1354e5804189d3a695fb9f71b08de1d3/Draft+Sindh+Sanitation+Strategy+June+18+2008.pdf?MOD=AJPERES&CACHEID=1354e5804189d3a695fb9f71b08de1d3&CACHEID=1354e5804189d3a695fb9f71b08de1d3

16

waste management system. The project upon completion will be reduce the incidence of diarrhoea and other water related diseases in selected secondary cities/ towns in the province

Sindh Cities Improvement Program (SCIP) is a Government of Sindh and Asian Development Bank (ADB) $400 million program focussed on improving the urban infrastructure & services, urban en-vironment and public health. SCIP has the potential to reduce the incidence of diarrhoea and other water borne and water related for an estimated 4-5 million residents in participating secondary cities in Sindh.

Operation and Management is a vital element of any water and sanitation scheme. The responsibility of O&M for urban schemes was entrusted to Municipal committees and the understanding continues to date. Unfortunately, the issue of Operation and Management (O and M) for rural schemes persists to pose a challenge as no clear policy could be devised. This is reflected in the figures received from WASH sector that reveals that more than 80% of water and sanitation schemes in urban areas (Popula-tion more than 5000 persons) are functional. While dwellers of urban area have access to water, this is not necessarily safe clean drinking water if assessed on the internationally recommended criteria. In contrast in the rural areas, proportion of functional scheme is less than 25%.Most of the rural population does not have access to water.

Cross Cutting Sectors

I. Social Welfare And Social Protection ProgramPoverty and under-nutrition are very closely interlinked and is indeed been defined as a cross sec-toral agenda. Poverty-Nutrition Cycle is vicious in nature and lead to a very complex inter-relationship between the poverty-related causes and consequences of malnutrition. The conceptual framework of the United Nations Children’s Fund (UNICEF 1990) identifies poverty as an important basic cause of under-nutrition.

Pakistan has adopted National Social Protection Strategy (2007) that provides a unique oppor-tunity to strengthen its social protection. Consistent with the Poverty Reduction Strategy and Pakistan Vision 2030, the Strategy provides a sectoral framework to address poverty allevia-tion. Since 18th amendment in the constitution, social welfare has now been fully devolved to the provinces. Even though coordination of programs within each province is likely to improve as a re-sult of the devolution, it is feared that in the absence of a central, coordinating body, coordination among provinces might deteriorate. Provincial capacity to manage this portfolio is also questionable. In 2009, as a key element of this strategy, Pakistan introduced a national safety net program, the Benazir Income Support Program (BISP). The primary mandate of Benazir Income Support Program (BISP) is poverty alleviation. BISP has immense potential to reach out to poor women and children by making cash transfer conditional to certain health behavior which may ultimately improve the nutritional status of the target group.

In recent past 90 percent of Zakat funds were diverted to BISP. Enrolled families are paid cash assis-tance @ Rs.1000 per month on quarterly basis; apart from benefits provided under graduation strategy like: long term interest free returnable financial assistance, vocational & technical training, health & life insurance coverage. In 2010, about 7% of the country’s population was benefiting from the transfers. The BISP also includes microcredit financial assistance, and is pilot testing health and life insurance coverage and vocational skills training32

32 Channa A, 2012. Background Paper Social Protection in Pakistan: A Profile of Existing Programs and an Assessment of Data Available for Analysis, Asia Research Centre, London School of Economics.

17

BISP has also established a small Social Policy Research Unit in order to strengthen research activities related to social policy social protection and cash transfers.

Special initiatives of BISP include:

a. Waseela-e-Haq: To promote self-employment among women beneficiaries (or their nominees as in Balochistan, trainees are usually men to improve their livelihood. Soft loan of PKR 300,000 on 15 years terms for business+10 days fully covered training on entrepreneurship and business manage-ment are being offered.

b. Waseela-e-Rozgar: To empower female beneficiary or her nominee through acquiring a skill; be-come economically independent by acquiring vocational training through dynamic and Intersectoral technical education and vocational training service

Beneficiaries are given vocational training in one of 52 different trades (check for nutrition relevant!)

c. Waseela-e-Sehat: Health Insurance program with an annual maximum limit of Rs. 25,000 per family through Benazir Sehat cards , Conditional Social Transfers

BISP has also established a small Social Policy Research Unit in order to strengthen research activities related to social policy social protection and cash transfers.

Proposed Action

a) BISP is planning to expand its coverage to rural areas- an excellent opportunity to address basic cause of under-nutrition;

b) Education sector has proposed working with BISP to encourage daughters of BISP beneficiaries to enrol in schools which access to mid-day meal program

c) The BISP database is an immense resource and can be used to map out social welfare for women and disabled as it captures nationwide segment of the ultra-poor population. Through microfinance loans and waseela-e rozgar, BISP has expressed readiness to encourage small level food and mi-cronutrient products stores in rural areas that can provide access to diverse source of food at low cost upon showing BISP card or vouchers, e.g. multi-micronutrient powders, soap, water purifiers;

d) Health awareness around nutrition can be promoted through utilization of cell phones (owned by 56% of BISP’s beneficiaries) to provide/reinforce key information tailored to pregnancy or early childhood as appropriate.

e) BISP has expressed its commitment to work with agriculture and PHED program to assist skill de-velopment program in rural communities using expertise available for food processing and opera-tion and management of the water and sanitation network.

f) Other social safety net programmes with cash or food transfers to extremely poor households will be promoted

II. Women Development Department Women Development Cell was established in the Planning & Development Department, Government of Sindh in 1979. The objective of this cell was to address women’s issues through an institutionalized sys-tem in planning and development of Sindh. In 1995 a separate Women Development Department was formed with a broader scope than the previously established cell within the P&DD. However in 1998 the Department was merged with the Social Welfare Department at the secretariat level. In 2001 the Directorate of Women Development was abolished and a Women Development Wing was established under Directorate of Social Welfare. It was later put under the control of Population Welfare Depart-

18

ment. In 2003 a separate Women Development Department was re-established with a strong mandate focused towards women’s empowerment and gender equality. WDD aspires to enhance the status of women to promote women’s rights, ensure their active participation in national life at all levels on the basis of gender equality and to serve as an agent of change in the society, improved legal to economic resources and employment access.

The Women Development Department will achieve these role as a catalyst, lobbyist and advocate for gender related issues by providing a platform for women in anticipation. After the devolution of Ministry of Women Development , Government of Pakistan, responsibility and role of Women Development Department, Government of Sindh have been extensively enhanced. The Women Development De-partment, Government of Sindh comprises a Secretariat/Administrative department and a Directorate headed by a Secretary. Following are the roles of the WDD:

1. Formation of public policies and laws to meet special needs of women.

2. Protection and promotion of Women’s rights, gender equity and equality in public sector or in par-ticular and society in general.

3. Discharge of responsibilities with regard to status of women and girls.

4. Development projects for providing special facilities for women such at strategic initiative, innova-tions and special equalizing projects.

5. Coordination of women’s welfare programs with other concerned departments and agencies at District and local level for making conductive and safe work environment for working women and conducting research/surveys in the regard.

6. Improvement of working conditions of female labour both in urban and rural areas.

7. Promotion of cottage industry with special preference to participation of women in such industry.

8. Maintenance of a database of all women parliamentarians, councillors and members of civil society organizations working on gender issues.

9. Setting up of community/mohallah Schools and training centres for women on the basis of self-help community development.

10. Setting up of advisory legal centres to provide legal aid to women and to review laws considered to be discriminatory against women and formulate recommendations in respect thereof.

11. Implementation of National Women’s Welfare Policy as applicable to the Province of Sindh.

12. Registration and assistance of women Organizations.

13. Promotion and under taking of training and research on the condition and problem of women

14. Service matters, except those entrusted to the Services, General Administration and Coordination Department.

Civil Society Organizations Civil society is “an umbrella term for a range of non-state and non-market citizen organizations and ini-tiatives, networks and alliances operating in a broad spectrum of social, economic, and cultural fields. These include formal institutions, non-governmental organizations, trade unions, professional asso-ciations, philanthropies, academia, independent pressure groups, think tanks, and traditional informal formations, such as faith-based organizations, shrines, seminaries, and neighborhood associations.” Since the 1980s, health-related CSOs have proliferated in type, number and functions they perform, a development largely seen in positive terms. NGOs have mushroomed, however legal framework for recognizing CSO role is still absent. The CSOs with their independent transparent role will strengthen the governance and monitoring role during the implementation of intersectoral nutrition intervention

19

plan. In addition CSOs with technical expertise will extend their support in the research, documentation social mobilization activities.

l Internationally there are several examples available which indicates that with CSOs participation, advocacy objectives are rapidly adopted e.g. HIV, youth issues etc. With the devolution and district based health service delivery, the environment has become more supportive for CSO participation. Participation of CSOs is viewed as manifestation of democratic society

l During crises situation and emergency response, CSOs and NGOs have emerged as a powerful player in the Government for resource mobilization and for strengthening service delivery;

l Experience from other countries indicates that CSOs often are more effective in ensuring corporate role through appropriate regulation.

l In Pakistan, CSOs and NGOs have been actively involved in undertaking series of research and surveys particularly around issues of nutrition including anthropometric surveys.

“Pakistan Health and immunization CSO coalition” is an important platform that currently has a constitu-ency of 51 members and is planning to broaden itself. The coalition has expanded itself into an orga-nized platform and is working to strengthen Government in many social change agenda like vaccina-tion, social mobilization and strengthening service delivery in hard to reach population. Initially funded by GAVI, the platform today represents CSOs in NITAG and other dialogue fora. The coalition has plans to expand health, agriculture, environment and other sectors are organized under the rubric of coalition and on creating social awareness on various aspects of nutrition. CSO will also support Women devel-opment department and Social welfare in carrying out advocacy and social change activities

10. Oversight Coordination, Monitoring And Evaluation

10.1 Provincial Inter-Sectoral Nutrition Program Oversight CommitteeIntersectoral nutrition strategy is the first strategy which involves working across many departments working under the GoS. In order to have successful implementation of the strategy, it is important to establish an oversight “Provincial inter inter-sectoral committee” harmonizes plans and takes decisions to ensure implementation of coordinated and geographically convergent actions, tracks implementation of sectoral commitment, address any emerging red flag problems and limiting factors quickly and efficiently, and to assure accountability for results. It is proposed that the committee be chaired by Chief secretary or Additional chief secretary. Following departments will represent on the committee.

l Department of agriculture/ food/ livestock /poultry and fisheries

l Department of education (DoE)

l Department of health (DoH) and population welfare

l Public health engineering department (PHED) and local government

l Women Development Department (WDD) and social welfare

l Finance department P and D

l M and E Department

The committee would also have representation from following departments and sectors:

l Department of social welfare

20

l Women development department

l CSO coalition

ToR Of The Provincial Intersectoral Nutrition Committee:

a) Ensure that various departments are able to work in a coherent and coordinated manner;

b) Ensure the annual district based work plans have been produced in consultation with other sectoral partners;

c) Provide oversight during implementation to ensure that the province achieves its targeted objec-tives and activities;

d) Carry out arbitration and mediation role in case of any conflict and differences between various sec-tors

e) Ensure that an overarching, intersectoral MIS has been developed that reports key performance indicators by all sectors on a quarterly basis;

f) Provides support and approval for mid-term and end term evaluation.

g) Provide policy guidance and support in case it is needed.

g) Performing any other functions assigned to the intersectoral nutrition committee by Chief or assis-tant chief secretary.

10.2. District Based Inter-Sectoral Nutrition Program CommitteeDevolution has provided a unique opportunity to Pakistan and Sindh in particular to operationalize a “district based intersectoral nutrition program committee”. The committee would be responsible for identifying UCs for phase wise intersectoral implementation. The committee will have the representa-tion of various departments and will be guided by the strategic plan approved at the provincial level. A mechanism / platform called “inter-sectoral district nutrition group (IDNG)” or implementation of inter-sectoral nutrition intervention would be established in each district.

The DINPC will have representation from different departments. Following are the terms of reference of DINPC

Terms Of Reference Of District Based Intersectoral Nutrition Program Committee (DINPC)

DIPNC will be responsible for:

i. Prioritizing UCs in each high risk districts for phase wise introduction of the program;

ii. Ensure development and reporting of monitoring indicators for UC level inter-sectoral nutrition ac-tivities;

iii. To oversee the development of micro plans for implementation at the UC level;

iv. To resolve any red flag issue if it arises.

21

Financing Mechanisml A Nutrition section should be established in the province that will provide guidance, support, coordi-

nation and processing of nutrition sensitive intervention across all the sectors.

l Inter-sectoral strategy will be the central tool and will have the monitoring indicators to see progress on the nutrition status

n Every department will make their plans which are nutrition sensitive preferably using policy notes

n Every department will also review their existing plans in pipeline and will aim to make these nutrition sensitive

n P and D will ensure that every plan that is approved is nutrition sensitive

n Plans will be funded either by ADP or foreign assistance

i 

 

i

Ann

exur

e on

e

 

Cre

ate

enab

ling

envi

ronm

ent

Nut

ritio

n an

d fo

od s

ecur

ity p

olic

y ap

prov

ed

Legi

slat

ion

on m

icro

nutri

ent f

ortif

icat

ion

enfo

rced

Legi

slat

ion

of m

id d

ay fo

od p

rogr

am fr

om

scho

ols

enfo

rced

Exe

cutio

n, O

pera

tion

& M

aint

enan

ce o

f w

ater

and

san

itatio

n po

licy

appr

oved

Legi

slat

ion

on b

aby

feed

ing

prot

ectio

n en

forc

ed

Intra

-sec

tora

l tas

k fo

rce

has

ensu

red

harm

oniz

atio

n in

hea

lth a

ctiv

ities

Cod

e of

bre

ast m

ilk m

arke

ting

enfo

rced

Incl

usio

n of

cos

t of m

ilk a

nd th

erap

eutic

food

in

AD

P b

udge

t

MoU

sig

ned

betw

een

educ

atio

n an

d W

AS

H

for s

choo

l hea

lth e

nviro

nmen

t im

prov

emen

t

Tena

ncy

act e

nfor

ced

Stri

ct re

gula

tory

mea

sure

s im

pose

d fo

r sal

e on

ly c

ertif

ied

seed

s an

d pe

stic

ide

Adv

ocac

y fo

r est

ablis

hmen

t of f

ood

regu

lato

ry a

utho

rity

that

will

ens

ure

food

sa

fety

of t

he s

nack

s an

d ot

her f

ood

item

s be

ing

sold

in th

e m

arke

t

Cap

acity

dev

elop

men

t

Nut

ritio

n in

tegr

ated

in th

e cu

rric

ulum

of

outre

ach

heal

th, e

duca

tion

& W

AS

H

Sch

ools

and

com

mun

ity b

ased

pla

tform

s fo

r nu

tritio

n ed

ucat

ion

mob

ilize

d

Fem

ale

exte

nsio

n w

orke

rs in

duct

ed

Indu

ct a

nut

ritio

n sp

ecia

list i

n cu

rric

ulum

de

partm

ent

IYC

F in

clud

ed in

pre

-ser

vice

and

med

ical

co

llege

cur

ricul

um

Pub

lic a

war

enes

s ca

mpa

igns

aro

und

harm

ful e

ffect

s of

pes

ticid

e

Cap

acity

of L

HW

sup

ervi

sors

in s

choo

l he

alth

che

ck u

p bu

ilt

Sur

veill

ance

for e

nsur

ing

iodi

ne c

onte

nt o

f sa

lt en

sure

d

Aw

aren

ess

abou

t whe

at fl

our f

ortif

icat

ion

amon

gst p

rodu

cer e

nhan

ced

Vit.

A s

uppl

emen

tatio

n en

sure

d

Trai

ning

cen

ter f

or fe

mal

e ag

ricul

ture

ex

tens

ion

wor

kers

est

ablis

hed

Hom

e ba

sed

grai

n st

orag

e fa

cilit

y es

tabl

ishe

d

Cap

acity

for g

row

ing

hom

e ba

sed

vege

tabl

e

Legi

slat

ing

“Exe

cutio

n, O

and

M o

f wat

er

and

sani

tatio

n po

licy

Env

ironm

ent s

peci

alis

t at e

ach

dist

rict l

evel

fo

r qua

lity

assu

ranc

e en

sure

d

Cad

re o

f com

mun

ity li

vest

ock

heal

th fe

mal

e w

orke

r

Fiel

d ba

sed

inte

rven

tion

Con

ditio

nal c

ash

trans

fers

inst

itute

d

Food

vou

cher

pro

gram

for f

amili

es o

f poo

r ch

ildre

n

Com

mun

ity w

ater

sys

tem

s st

reng

then

ed

Hou

seho

ld la

trine

s co

nstru

cted

in h

igh

ride

com

mun

ities

Hou

seho

ld in

com

e th

roug

h in

com

e ge

nera

tion

activ

ities

enh

ance

d

Mic

ro-c

redi

t pro

gram

s re

ache

s ou

t to

hard

to

reac

h po

pula

tion

Est

ablis

hmen

t of b

aby

frien

dly

wor

k pl

ace

Pre

vent

ing

and

Trea

ting

SA

M a

nd o

ther

di

sord

ers

CM

AM

pro

gram

impl

emen

ted

Hom

e ba

sed

poul

try a

nd c

attle

rais

ing

capa

city

thro

ugh

BIS

P w

asee

l-e-ro

zgar

pr

ogra

m in

stitu

ted

Sus

tain

able

fish

farm

ing

thro

ugh

capa

city

bu

ildin

g of

mas

ter t

rain

er fo

r tra

inin

g of

fish

fa

rmer

s in

stitu

ted

New

s W

AS

H s

chem

es la

unch

ed in

pr

iorit

ized

are

as

WA

SH

sch

emes

reha

bilit

ated

, im

prov

ed a

nd

augm

ente

d

Cap

acity

of w

omen

in h

ome

base

d fo

od

proc

essi

ng, c

onse

rvat

ion,

pre

serv

atio

n an

d m

arke

ting

enha

nced

Res

earc

h an

d de

velo

pmen

t

i. Im

pact

of i

nter

-sec

tora

l int

erve

ntio

n on

ed

ucat

ion

outc

omes

.

ii.

Gap

s in

the

curr

icul

um.

iii.

Impa

ct o

f CC

T an

d M

id-d

ay fo

od

prog

ram

on

scho

ol p

erfo

rman

ce

Res

earc

h to

:

i. de

velo

p w

omen

orie

nted

m

echa

niza

tion

ii.

impr

ove

tech

nolo

gica

l met

hods

in

dairy

farm

ing

indu

stry

to in

crea

se

anim

al m

ilk p

rodu

ctio

n.

iii.

prod

uce

high

pro

tein

fish

es.

iv.

prod

uce

vacc

ines

and

bio

logi

cal

supp

lem

ents

for p

reve

ntio

n of

di

seas

es in

live

stoc

k an

d po

ultry

.

v.

enha

nce

nutri

tive

valu

e of

the

crop

, di

vers

e fo

od p

rodu

ctio

n, a

gron

omic

re

quire

men

t suc

h as

qua

lity

of s

eeds

, fe

rtiliz

ers

and

biol

ogic

al p

estic

ides

etc

.

i. C

ost e

ffect

ive

and

sust

aina

ble

tech

nolo

gy fo

r wat

er p

urifi

catio

n.

ii.

Cos

t effe

ctiv

e an

d su

stai

nabl

e ap

proa

ch to

mai

ntai

ning

.

iii.

Cau

salit

y an

alys

is o

f san

itatio

n w

ith

mal

nutri

tion.

iv.

The

dist

ribut

ion

of s

anita

tion

rela

ted

heal

th b

urde

n by

wea

lth q

uint

ile.

Inte

r-se

ctor

al N

utrit

ion

Res

ults

Fra

mew

ork

Goa

l: To

redu

ce u

nder

-nut

ritio

n in

wom

en a

nd c

hild

ren

in a

cces

sibl

e po

pula

tions

In

ter-

sect

oral

Nut

ritio

n R

esul

ts F

ram

ewor

k G

oal:

To re

duce

und

er-n

utrit

ion

in w

omen

and

chi

ldre

n in

acc

essi

ble

popu

latio

ns

Res

earc

h an

d de

velo

pmen

t Fi

eld

base

d in

terv

entio

n C

apac

ity d

evel

opm

ent

Cre

ate

enab

ling

envi

ronm

ent

ii 

 

ii

Ann

exure tw

o 

INSS

Hea

lth a

nd p

opul

atio

n w

elfa

re d

epar

tmen

t /Se

ctor

Act

ion

Plan

(Jun

e 20

13 to

Dec

201

6)

A

ctio

n O

utpu

t Ind

icat

or

Tim

e Le

ad

Dep

t.

Supp

ort

Dep

t. Pr

iorit

y

Bud

get

A

ctio

n A

rea

1: E

nabl

ing

envi

ronm

ent,

polic

y fr

amew

orks

, str

ateg

ies

1.1.

An

evi

denc

e ba

sed

polic

y w

ith

a se

t of g

ende

r sen

sitiv

e in

ter-

sect

oral

inte

rven

tion

with

pa

ve th

e pa

th fo

r int

rodu

cing

go

od p

rogr

ams

DoH

with

oth

er s

take

hold

ers

wou

ld d

raft

the

prov

inci

al

nutri

tion

polic

y an

d w

ill g

et it

ap

prov

ed

With

the

intro

duct

ion

of th

e po

licy,

follo

win

g pr

iorit

y ar

eas

wou

ld g

et th

e fo

cus

in th

e pr

ogra

m d

evel

opm

ent a

nd im

plem

enta

tion:

-1

000

days

plu

s fo

cus

on n

utrit

iona

l hea

lth

to in

clud

e ad

oles

cent

girl

s/P

regn

ant a

nd

lact

atin

g w

omen

and

wom

en in

chi

ld

bear

ing

age

- Adv

ocac

y to

incr

ease

mat

erni

ty le

ave

from

3 m

onth

s to

6 m

onth

s to

pro

mot

e ex

clus

ive

brea

st fe

edin

g -R

eviv

al o

f bab

y fri

endl

y ho

spita

ls

-Dis

sem

inat

ion

of I

YC

F m

essa

ges

such

as

early

initi

atio

n of

bre

ast f

eedi

ng, e

xclu

sive

br

east

feed

ing

Hea

lthy

com

plem

enta

ry

feed

ing

for b

abie

s m

ore

than

six

mon

ths

old

- Adm

inis

tratio

n of

nut

ritio

us fo

od

supp

lem

ents

from

hig

h ris

k sc

hool

s - A

nnua

l scr

eeni

ng o

f sch

ool c

hild

ren

to

prev

ent n

utrit

iona

l pro

blem

at a

n ea

rly

stag

e -E

stab

lishm

ent o

f the

rape

utic

feed

ing

prog

ram

in th

e re

ferra

l car

e fa

cilit

ies

Mar

ch 2

014

DoH

Al

l sta

keho

lder

s I

TBD

1.2

Est

ablis

h a

intra

-sec

tora

l tas

k fo

rce

to id

entif

y lin

kage

s an

d

area

of m

utua

l rei

nfor

cem

ent

and

ther

eby

redu

ce in

tra-

sect

oral

frag

men

tatio

n

Man

agem

ent p

roto

cols

ens

ures

con

tinui

ty

of c

are

acro

ss d

iffer

ent s

ub s

ecto

rs o

f he

alth

Stan

dard

ized

and

har

mon

ized

indi

cato

rs

2013

(upo

n ap

prov

al o

f th

e In

ter-

sect

oral

nu

tritio

n

DoH

Popu

latio

n W

elfa

re

All

Sup

port

Sec

tor L

HW

s,

CM

Ws,

EP

I, N

utrit

ion,

HS

RU

, P

WD

, (M

SU

and

1 TB

D

A

ctio

n O

utpu

t Ind

icat

or

Tim

e Le

ad

Dep

t.

Supp

ort

Dep

t. Pr

iorit

y

Bud

get

A

ctio

n A

rea

1: E

nabl

ing

envi

ronm

ent,

polic

y fr

amew

orks

, str

ateg

ies

iii

  

iii

amon

gst H

ealth

sub

sect

ors

such

as

MN

CH

, LH

Ws,

N

utrit

ion

and

Iden

tific

atio

n of

lin

kage

s be

twee

n di

ffere

nt

sect

ors

for m

onito

ring

and

eval

uatio

n su

ch a

s co

ntra

cept

ive

prev

alen

ce ra

te, e

xclu

sive

br

east

feed

ing,

mal

nutri

tion,

ana

emia

pr

eval

ence

am

ongs

t wom

en a

nd c

hild

ren

supp

lem

enta

tion

Har

mon

ized

and

com

plim

enta

ry

inte

rven

tions

Stan

dard

ized

aw

aren

ess

mes

sage

s

stra

tegy

) FW

W),H

ealth

Ed

ucat

ion

Cel

lTB

Con

trol

Pro

gram

, M

alar

ia C

ontro

l, H

epat

itis

Con

trol

Pro

gram

, AID

S

Con

trol P

rogr

am,

DH

Os

wou

ld b

e co

-opt

ed o

n ne

ed b

asis

1.

3 P

rom

ote

early

initi

atio

n of

br

east

feed

ing

thro

ugh

legi

slat

ion

of th

e “c

ode

of

mar

ketin

g of

bre

ast m

ilk

subs

titut

e”, r

egis

terin

g ho

spita

ls a

nd B

HU

/F

WC

/MS

U/R

HC

in b

aby

frien

dly

initi

ativ

e

Enha

nce

emph

asis

on

early

in

itiat

ion

of b

reas

t fee

ding

th

roug

h in

tegr

atin

g it

in th

e pr

otoc

ol o

f BeM

ON

C a

nd

IMN

CI

At l

east

90

% o

f hos

pita

ls, B

HU

and

priv

ate

sect

or fa

cilit

ies

wou

ld b

e re

gist

ered

and

im

plem

entin

g ba

by fr

iend

ly p

roto

cols

M

essa

ges

for a

dvoc

atin

g an

d im

plem

entin

g ba

by fr

iend

ly in

itiat

ive

inte

grat

ed in

to p

re-

serv

ice

prim

ary

care

faci

lity

and

CM

W

initi

ativ

e”

Pre

-ser

vice

cur

ricul

um o

f doc

tors

, nur

ses,

C

MW

, LH

W a

nd F

WW

will

be

expa

nded

to

incl

ude

not j

ust c

ouns

elin

g on

bre

ast

feed

ing

but

als

o m

anag

emen

t of b

reas

t fe

edin

g pr

oble

ms

and

mal

nutri

tion.

June

201

6 H

ealth

PW

D

Wom

en/

/Med

ia/C

SO

1

TBD

1.4

Adv

ocat

e fo

r inc

lusi

on o

f cos

t of

milk

and

ther

apeu

tic fo

od

in A

DP

bud

get a

s es

sent

ial

drug

to

ensu

re s

eam

less

su

pply

of m

ilk a

nd th

erap

eutic

fo

od fo

r tre

atm

ent o

f m

alno

uris

hed

child

ren

By

the

end

of 2

014,

bud

get f

or m

ilk a

nd

ther

apeu

tic fo

od in

clud

ed in

AD

P a

nd

cont

inuo

us s

uppl

y of

milk

and

ther

apeu

tic

feed

will

be

ensu

red

June

201

4

DoH

Popu

latio

n W

elfa

re

CS

Os

Fina

nce

depa

rtmen

t

P an

d D

I TB

D

iv

  

iv

1.5

Prom

ote

early

hea

lth s

eeki

ng

beha

viou

rs a

mon

gst p

aren

ts

and

teac

hers

of m

alno

uris

hed

child

ren

thro

ugh

prom

otin

g m

essa

ges

abou

t ear

ly s

igns

an

d sy

mpt

oms

of m

alnu

tritio

n/

child

hood

dis

ease

s us

ing

com

mun

ity a

nd s

choo

l pla

t fo

rm a

nd in

tegr

atin

g th

e st

anda

rdiz

ed m

essa

ges

in th

e ou

treac

h w

orke

rs c

urric

ulum

.

KA

P s

urve

y in

dica

tes

at le

ast 2

0%

impr

ovem

ent i

n kn

owle

dge

and

prac

tice

abou

t pre

vent

ion,

sig

ns a

nd s

ympt

oms

and

impo

rtanc

e of

tim

ely

seek

ing

of c

are

for

mal

nutri

tion

and

com

mon

chi

ldho

od

2014

on

war

ds

Hea

lth

Edu

catio

n /

Popu

latio

n W

elfa

re/ W

omen

D

evel

opm

ent/

CS

O

II TB

D

1.6

Adv

ocat

e fo

r the

enf

orce

men

t of

legi

slat

ion

of “b

aby

frien

dly

wor

k pl

ace”

to e

nabl

e m

othe

rs

to b

reas

t fee

d th

eir b

abie

s fo

r at

leas

t tw

o ye

ars

afte

r birt

h an

d en

sure

hea

lthy

grow

th o

f th

eir b

aby

25%

pub

lic a

nd p

rivat

e se

ctor

faci

litie

s w

ill

be re

gist

ered

as

baby

frie

ndly

wor

kpla

ce

and

will

hav

e “E

arly

Chi

ldho

od C

ente

rs”

esta

blis

hed.

The

se c

ente

rs w

ould

be

man

ned

by p

rope

rly tr

aine

d st

aff t

hat

unde

rsta

nd th

e va

lue

of n

utrit

ion

for b

abie

s an

d ch

ildre

n

2016

H

ealth

Popu

latio

n W

elfa

re

WD

D/L

egis

lato

rs/P

WD

/Lab

our

Dep

artm

ent/

Trad

e U

nion

/ Lo

cal C

ham

bers

an

d C

omm

erce

II TB

D

A

ctio

n A

rea

2: C

apac

ity D

evel

opm

ent a

nd C

oord

inat

ion

2.1

Hea

lth s

ecto

r wou

ld c

arry

out

fo

llow

ing

task

s to

stre

ngth

en th

e ca

paci

ty o

f var

ious

sec

tors

and

en

ablin

g th

em to

sup

port

in th

e di

ssem

inat

ion

of th

e ke

y m

essa

ges

and

carr

y ou

t fo

llow

ing

func

tions

:

a)

Par

ticip

ate

in th

e re

view

an

d st

reng

then

ing

of th

e nu

tritio

n co

mpo

nent

of t

he

curri

culu

m a

nd c

apac

ity

build

ing

of th

e Ag

ricul

ture

ex

tens

ion

wor

kers

, sch

ool

curr

icul

um, W

AS

H w

orke

rs

Stan

dard

ized

key

mes

sage

s w

ill b

e in

tegr

ated

in th

e cu

rricu

lum

of a

gric

ultu

re,

WA

SH

, Edu

catio

n;

All

the

sect

ors

invo

lved

in IN

SS

im

plem

enta

tion

will

be

diss

emin

atin

g an

d re

info

rce

the

key

heal

th m

essa

ges

thro

ugh

orga

nizi

ng o

r par

ticip

atin

g in

di

ffere

nt a

ctiv

ities

June

201

6 H

ealth

Ag

ricul

ture

/

WA

SH

/

Edu

catio

n

I TB

D

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

v

  

v

curr

icul

um a

nd W

DD

w

orke

rs

b)

Par

ticip

ate

in th

e se

rvic

e de

liver

y fro

m v

ario

us

plat

form

c)

C

reat

e m

odel

s of

Pub

lic

Priv

ate

Par

tner

ship

pa

rticu

larly

to re

ach

out t

o th

e po

pula

tion

in th

e LH

W

unco

vere

d ar

eas.

2.2

Pro

mot

e ex

clus

ive

brea

st

feed

ing

up to

six

mon

ths

of a

ge

capa

city

bui

ldin

g of

hea

lth c

are

prov

ider

s to

pro

mot

e cl

ient

co

unse

lling

abo

ut im

porta

nce

of

IYC

F an

d its

incl

usio

n in

in p

re-

serv

ice

curri

culu

m

20 %

incr

ease

s in

ado

ptio

n of

IYC

F pr

actic

es fr

om th

e ba

selin

e gi

ven

in N

NS

At l

east

10%

incr

ease

d ad

optio

n of

ex

clus

ive

brea

st fe

edin

g

KA

P in

dica

tes

at le

ast 2

0 %

impr

ovem

ent

on k

now

ledg

e sc

ores

abo

ut im

porta

nce

of e

xclu

sive

bre

astfe

edin

g

Incr

ease

d aw

aren

ess

abou

t im

porta

nce

of e

xclu

sive

bre

ast f

eedi

ng fo

r firs

t six

m

onth

2016

H

ealth

Popu

latio

n W

elfa

re

Wom

en/P

opul

atio

n W

elfa

re/C

SO

I TB

D

2.3

Publ

ic a

war

enes

s ca

mpa

igns

la

unch

ed b

y va

rious

cad

res

of

heal

th o

utre

ach

wor

kers

and

so

cial

med

ia to

cre

ate

awar

enes

s ab

out h

arm

ful

effe

cts

of th

e us

e of

pes

ticid

es

parti

cula

rly a

mon

gst w

omen

th

roug

h in

clud

ing

key

stan

dard

ized

mes

sage

s in

the

curr

icul

um o

f LH

Ws,

CM

Ws

and

FWW

Legi

slat

ion

will

be

in p

lace

rega

rdin

g la

belli

ng (i

n U

rdu

and

Sind

hi la

ngua

ge) o

f pe

stic

ides

info

rmin

g ab

out i

ts d

ange

rs to

pr

egna

nt w

omen

KA

P s

urve

y of

rura

l wom

en w

ould

sho

w

at le

ast 2

0% i

mpr

ovem

ent i

n th

e aw

aren

ess

(from

the

base

line)

abo

ut

harm

ful e

ffect

s of

pes

ticid

es o

n pr

egna

nt

wom

en;

June

201

6 H

ealth

Ag

ricul

ture

/CS

O

II TB

D

vi

  

vi

2.4

Build

cap

acity

of L

HW

/LH

W

Sup

ervi

sor a

nd c

ompe

tent

pe

rson

from

CS

Os

in a

nnua

l sc

hool

hea

lth s

cree

ning

of

child

ren

and

refe

rral t

o th

e ne

xt

leve

l car

e fa

cilit

y

80%

Sch

ools

in th

e hi

gh ri

sk d

istri

ct w

ill

inst

itute

sch

ool h

ealth

ser

vice

che

ck-u

p of

chi

ldre

n an

d re

port

it on

an

agre

ed

form

at to

the

next

leve

l car

e fa

cilit

y

June

201

6 H

ealth

LH

W p

rogr

am,

CS

O

II TB

D

2.5

Bui

ld c

apac

ity o

f agr

icul

ture

ex

tens

ion

wor

kers

in n

utrit

ion

heal

th p

rom

otio

n th

roug

h in

clud

ing

stan

dard

izin

g he

alth

m

essa

ges

in th

eir t

rain

ing

curri

culu

m

100%

of t

he a

gric

ultu

re e

xten

sion

wor

ker

wou

ld b

e tra

ined

in th

e nu

tritio

n he

alth

pr

omot

ion

and

wou

ld c

ompe

tent

ly s

prea

d it

amon

gst t

he c

omm

unity

mem

bers

June

201

6 H

ealth

Ag

ricul

ture

II

TBD

A

ctio

n A

rea

3: C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n

3.1

Red

uce

prev

alen

ce o

f ana

emia

an

d lo

w b

irth

wei

ght b

abie

s am

ongs

t ado

lesc

ent g

irls

and

wom

an in

chi

ld b

earin

g ag

e th

roug

h ad

optin

g 1

000

days

pl

us fo

cus

on p

rom

otin

g nu

tritio

nal h

ealth

from

all

sub

sect

ors

of h

ealth

thr

ough

di

ssem

inat

ing

mes

sage

s ar

ound

he

alth

y co

okin

g, d

ieta

ry e

atin

g pr

actic

es th

roug

h LH

Ws,

CM

W

and

FWW

.

50 %

of P

rimar

y he

alth

car

e ce

ntre

s an

d PW

D c

linic

s w

ill b

e pr

ovid

ing

pr

econ

cept

ion

cou

nsel

ling

prog

ram

for

mar

ried

coup

les

from

LH

W, C

MW

and

FW

W p

latfo

rm

KA

P s

urve

y w

ould

indi

cate

that

> 5

0%

pare

nts

of s

choo

l goi

ng a

nd a

dole

scen

t gi

rls w

ill b

e aw

are

abou

t the

key

nut

ritio

n m

essa

ges

Sch

ools

in th

e hi

gh ri

sk a

reas

will

hav

e an

nual

de-

wor

min

g ba

sed

on th

e ep

idem

iolo

gica

l inf

orm

atio

n

Sch

ools

in th

e hi

gh-ri

sk a

reas

will

hav

e nu

tritio

us fo

od s

uppl

emen

tatio

n pr

ogra

m

from

edu

catio

n se

ctor

2016

Hea

lth,

Popu

latio

n W

elfa

re

(CM

W,

LHW

, FL

CF,

CS

O,

FWW

, Mal

e S

ocia

l M

obili

zers

fro

m p

op.

wel

fare

de

partm

ent

Mic

ronu

trien

t Im

itativ

e/P

opul

atio

n W

elfa

re/

Educ

atio

n D

epar

tmen

t/Wo

men

D

evel

opm

ent/B

IS

P/C

SO

/Rur

al

supp

ort

prog

ram

s

1 TB

D

Act

ion

Are

a 3:

Cap

acity

Dev

elop

men

t – P

rogr

amm

e Im

plem

enta

tion

vii 

 

vii

3.2

Cre

ate

awar

enes

s th

roug

h he

alth

out

reac

h w

orke

rs a

nd

mas

s ca

mpa

ign

in th

e po

pula

tion

abou

t the

nee

d to

co

nsum

e on

ly io

dize

d sa

lt

Incr

ease

d su

rvei

llanc

e of

sal

t co

nten

t of K

IO3

in th

e sa

lt at

the

hous

ehol

d le

vel t

hrou

gh

equi

ppin

g LH

Ws

with

cos

t ef

fect

ive

tool

s

100

% h

ouse

hold

s w

ill c

onsu

me

iodi

zed

salt

100

% o

f sal

t pro

duce

d is

iodi

zed

100%

sal

t ava

ilabl

e in

the

mar

ket w

ould

be

iodi

zed

2016

H

ealth

Po

pula

tion

Wel

fare

Food

D

epar

tmen

t Lo

cal

Gov

ernm

ent

PS

QC

I TB

D

3.3

Cre

ate

awar

enes

s am

ongs

t co

mm

unity

and

sm

all w

heat

flo

ur p

rodu

cers

thro

ugh

diss

emin

atin

g st

anda

rdiz

ed

mes

sage

s th

roug

h he

alth

ou

treac

h w

orke

rs a

nd m

ass

cam

paig

n ab

out t

he n

eed

and

impo

rtanc

e of

whe

at fl

our

forti

ficat

ion

with

iron

At l

east

70

% o

f the

flou

r mills

will

be

forti

fyin

g iro

n

50%

of c

hakk

is/fl

our p

rodu

cers

bud

gete

d w

ill b

e se

lling

forti

fied

flour

2016

H

ealth

C

MW

E

PI

LHW

M

SU

Food

D

epar

tmen

t Lo

cal

Gov

ernm

ent

I TB

D

3.5

Upt

ake

of V

itam

in A

inc

reas

ed

thro

ugh

awar

enes

s ra

isin

g ab

out e

atin

g he

alth

y di

et a

nd

supp

lem

enta

tion

prog

ram

ViA

defic

ienc

y w

ould

be

redu

ced

by 1

0%

com

pare

d fro

m N

NS

201

1 20

16

Hea

lth/

CM

W/

EP

I /LH

W

MS

U

Food

D

epar

tmen

t

I TB

D

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

4.1s

H

ealth

sec

tor w

ould

par

ticip

ate

activ

ely

in th

e fo

rum

est

ablis

hed

for

inte

r-sec

tora

l nut

ritio

n re

sear

ch w

ith

an a

im to

dev

elop

evi

denc

e ba

sed

polic

y an

d in

terv

entio

n

At l

east

thre

e re

sear

ches

wou

ld

be id

entif

ied

from

hea

lth s

ecto

r fo

r res

earc

h an

d ev

iden

ce

gene

ratio

n

Loca

lly p

rodu

ced

cost

effe

ctiv

e hi

gh d

ensi

ty fo

od w

ill b

e av

aila

ble

for t

reat

men

t of

mal

nour

ishe

d ch

ildre

n

2016

H

ealth

P a

nd D

Aca

dem

ic In

stitu

tions

/All

Sub

S

ecto

rs/A

gric

ultu

re/ W

DD

/ UN

A

genc

ies/

PH

ED

/ Edu

catio

n /C

SO

/M a

nd E

valu

atio

n

II TB

D

Act

ion

area

4: R

esea

rch

and

Dev

elop

men

t

viii

  

viii

A

ctio

n A

reas

5: P

roje

ct M

anag

emen

t, R

epor

ting,

Mon

itorin

g an

d Ev

alua

tion

(for n

utrit

ion

rela

ted

and

nutr

ition

spe

cific

inte

rven

tions

)

5.1

Rep

ort t

o In

ter s

ecto

ral n

utrit

ion

cell

thro

ugh

esta

blis

hing

a s

yste

mat

ic

plan

ning

and

repo

rting

sys

tem

to b

e im

plem

ente

d th

roug

h In

tra-s

ecto

ral

Mon

itorin

g an

d Ev

alua

tion

cell

Rep

ortin

g pr

oced

ures

will

be

inst

itute

d to

mon

itor t

he

follo

win

g:

a)

Inte

grat

ion

of n

utrit

ion

into

th

e re

leva

nt s

ub S

ecto

r’s

curri

culu

m

b)

Inte

grat

ion

and

repo

rting

on

the

nutri

tion

indi

cato

rs

c)

Impl

emen

tatio

n of

dis

trict

ba

sed

wor

k pl

ans

End

2014

on

war

ds

annu

ally

Pla

nnin

g,

mon

itorin

g ce

ll

Dev

elop

men

tal p

artn

ers

All

Sub

Sec

tors

i.e.

Agr

icul

ture

/ W

DD

/ U

N A

genc

ies

/PH

ED

/ E

duca

tion

/CS

O/ M

&E

I TB

D

5.2

Form

atio

n of

Tas

kfor

ce to

mon

itor

prog

ress

on

INS

S fr

om h

ealth

se

ctor

pla

tform

Ann

ual

revi

ew m

eetin

g to

as

sess

pro

gres

s on

INS

S

impl

emen

tatio

n

End

lin

e ev

alua

tion

to a

sses

s im

prov

emen

t on

NN

S, a

nd

MIC

S in

dica

tors

On

goin

g H

ealth

And

P an

d D

LHW

s, C

MW

s, E

PI,

Nut

ritio

n,

HS

RU

, PW

D, (

MS

U a

nd

FWW

),Hea

lth E

duca

tion

Cel

l TB

Con

trol P

rogr

am, M

alar

ia C

ontro

l, H

epat

itis

Con

trol P

rogr

am, L

HW

de

partm

ent

I TB

D

Act

ion

Are

as 5

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)

ix

  

ix

Ann

exur

e th

ree

SECT

OR II: IN

SS Edu

cation

 Sector Action Plan

 (Jun

e 20

13 to Dec 201

6) 

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le

Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

A

ctio

n A

rea

1: E

nabl

ing

envi

ronm

ent,

polic

y fr

amew

orks

, str

ateg

ies

1.1

Intro

duce

the

polic

y fo

r con

ditio

nal

cash

tran

sfer

(CC

T) to

enc

oura

ge

BIS

P /

any

othe

r suc

h pr

ogra

m

bene

ficia

ries

to e

nrol

l the

ir da

ught

ers

in s

choo

ls

80%

of t

he B

ISP

ben

efic

iarie

s w

ill h

ave

thei

r dau

ghte

rs e

nrol

led

in s

choo

ls

Sep

t 201

6 D

oE

BIS

P

1 TB

D

1.2

Intro

duce

the

polic

y an

d st

rate

gies

fo

r int

rodu

cing

mid

-day

food

for a

ll th

e st

uden

ts fr

om s

choo

ls in

hig

h ris

k di

stric

ts

- P

aram

eter

s fo

r hig

h ris

k sc

hool

s id

entif

ied

- Po

licy

endo

rsed

, dis

sem

inat

ed a

nd

enfo

rced

. -

Cap

acity

for m

anag

emen

t, pl

anni

ng

and

impl

emen

tatio

n of

the

mid

-day

fo

od a

dmin

istra

tion

prog

ram

bui

lt in

th

e ta

rget

ed s

choo

ls

- 7

0% o

f sch

ools

in th

e ru

ral a

reas

in

the

targ

et d

istri

cts

get a

gla

ss o

f milk

da

ily w

ith s

ome

dry

bisc

uits

or a

frui

t.

Sep

t 201

4 Ju

ne. 2

016

DoE

WD

Dt/

Soc

ial

wel

fare

/ C

SO

2 TB

D

1.3

Dev

elop

MoU

with

WA

SH

sec

tor f

or

exte

ndin

g te

chni

cal a

ssis

tanc

e ac

cord

ing

to a

pha

se w

ise

plan

for

impr

ovin

g sc

hool

env

ironm

ent i

n pr

iorit

ized

dis

trict

s

50%

of t

he p

riorit

ized

sch

ool’s

has

in

stitu

ted

acce

ptab

le s

tand

ards

of w

ater

an

d sa

nita

tion

hygi

ene

June

201

6 D

oE

WA

SH

i

TBD

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le

Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

Act

ion

Are

a 1:

Ena

blin

g en

viro

nmen

t, po

licy

fram

ewor

ks, s

trat

egie

s

x 

 

x

A

ctio

n A

rea

2: C

apac

ity D

evel

opm

ent a

nd C

oord

inat

ion

2.1

Act

ion

orie

nted

Inte

rsec

tora

l nu

tritio

n sp

ecifi

c m

essa

ges

will

be in

tegr

ated

in th

e cu

rric

ulum

an

d ca

paci

ty o

f pr

imar

y sc

hool

s/se

cond

ary

scho

ol

teac

hers

will

be b

uilt

in th

e de

liver

y of

thes

e ac

tiviti

es w

ith a

fo

cus

on s

treng

then

ing

nutri

tion

as a

n in

tegr

al p

art.

Ther

e w

ill b

e a

need

to in

duct

a

nutri

tion

spec

ialis

t in

the

curr

icul

um d

epar

tmen

t of t

he

scho

ol

80%

of

th

e sc

hool

s in

hi

gh

risk

dist

ricts

will

hav

e te

ache

rs tr

aine

d fo

r im

plem

entin

g a

ctio

n or

ient

ed h

ealth

an

d hy

gien

e ed

ucat

ion

curr

icul

um

June

201

5 E

duca

tion

Dev

. pa

rtner

s su

ppor

t A

DP

TA

from

su

ppor

t se

ctor

s H

ealth

an

d W

ASH

I TB

D

A

ctio

n ar

ea 3

: Fie

ld b

ased

impl

emen

tatio

n

3.1.

E

nsur

e an

nual

scr

eeni

ng a

nd

deliv

ery

of e

ssen

tial p

acka

ge o

f nu

tritio

n se

rvic

e to

sch

ool c

hild

ren

for p

reve

ntio

n, id

entif

icat

ion

and

refe

rral

for h

ealth

issu

e at

an

early

st

age

LH

W s

uper

viso

rs p

oste

d in

the

catc

hmen

t are

a of

the

scho

ol

wou

ld u

nder

take

the

heal

th

awar

enes

s ac

tivity

for s

choo

l co

mm

unity

, de-

wor

min

g of

ch

ildre

n an

d sc

hool

hea

lth

scre

enin

g.

DoE

will

coor

dina

te w

ith h

ealth

>90%

of s

choo

ls g

oing

chi

ldre

n in

hi

gh ri

sk d

istri

cts

will

rece

ive

six

mon

thly

de-

wor

min

g se

rvic

e, h

ealth

ch

eck-

ups

and

aw

aren

ess

rais

ing

activ

ities

to p

reve

nt a

gain

st

mal

nutri

tion

June

201

6 D

oE

Hea

lth/L

HW

pr

ogra

m,

CS

Os

I TB

D

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

Act

ion

area

3: F

ield

bas

ed im

plem

enta

tion

xi

  

xi

sect

or/L

HW

pro

gram

to h

ave

annu

al s

cree

ning

pro

gram

s by

LH

V /

LHW

for a

ll ch

ildre

n at

tend

ing

scho

ols.

LH

Ws

will

use

W

HO

road

to h

ealth

cha

rt fo

r sc

hool

chi

ldre

n an

d w

ill re

fer t

he

sick

chi

ldre

n id

entif

ied

for f

urth

er

treat

men

t to

the

next

leve

l car

e fa

cilit

y

Chi

ldre

n id

entif

ied

with

a p

robl

em

will

be

refe

rred

and

the

fam

ily w

ill

be c

ouns

elle

d fo

r see

king

car

e an

d ad

optin

g co

rrec

tive

mea

sure

at

hom

e.

3.

2 It

is p

ropo

sed

that

"foo

d vo

uche

rs

be is

sued

to th

e fa

mili

es o

f sch

ool

child

ren

to b

uy e

ssen

tial f

ood

item

s (r

ice,

forti

fied

flour

and

ed

ible

oil)

at h

eavi

ly s

ubsi

dize

d ra

tes

from

util

ity s

tors

are

su

bsid

ized

rate

s. It

is p

ropo

sed

that

syn

ergi

es b

e ex

plor

ed w

ith

WD

D /

CS

Os

for t

he p

rovi

sion

and

go

vern

ance

of s

uch

serv

ices

to

avoi

d bu

rden

ing

the

scho

ol

auth

ority

with

adm

inis

trativ

e re

spon

sibi

litie

s.

Mor

e th

an 5

0% o

f sch

ools

in th

e ta

rget

ed d

istri

cts

wou

ld in

trodu

ce

the

prog

ram

of f

ood

vouc

hers

.

 

June

201

6 D

oE

CS

O/

coop

erat

ives

/WD

D

II TB

D

xii

  

xii

Act

ion

area

4: R

esea

rch

and

Dev

elop

men

t

4.1

Edu

catio

n de

partm

ent w

ould

pa

rtici

pate

act

ivel

y in

the

foru

m

esta

blis

hed

for d

efin

ing

and

impl

emen

ting

inte

rsec

tora

l nut

ritio

n re

sear

ch w

ith a

n ai

m to

dev

elop

ev

iden

ce b

ased

pol

icy

and

inte

rven

tion

DoE

wou

ld u

nder

take

at l

east

one

re

sear

ch. O

ne p

ossi

ble

rese

arch

qu

estio

n w

ould

be

impa

ct

asse

ssm

ent o

f CC

T an

d M

id-d

ay

food

pro

gram

on

perfo

rman

ce o

f ch

ildre

n in

sch

ool.

DoE

wou

ld e

xten

d its

tech

nica

l su

ppor

t in

desi

gnin

g re

sear

ch fr

om

gend

er p

ersp

ectiv

e

June

201

6 H

ealth

re

sear

ch

foru

m/

P&

D/ D

oE

Aca

dem

ic

Inst

itutio

ns A

ll S

ub

Sect

ors

II TB

D

Act

ion

Are

as 5

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)

5.1

Par

ticip

ate

in th

e in

ter-

sect

oral

co

ordi

natio

n gr

oup

to m

onito

r IN

SS

as

pira

tions

and

pla

n

DoE

repo

rts w

ill in

dica

te >

70%

ac

hiev

emen

t on

its ta

rget

ed p

lan:

D

oE p

artic

ipat

e ac

tivel

y to

ens

ure:

•

Inte

grat

ion

of n

utrit

ion

into

the

rele

vant

sub

Sec

tor’s

cu

rric

ulum

•

Inte

grat

ion

and

repo

rting

on

the

nutri

tion

indi

cato

rs

• Im

plem

enta

tion

of d

istri

ct

base

d w

ork

plan

s •

Par

ticip

ate

activ

ely

in th

e jo

int

mon

itorin

g en

d li

ne e

valu

atio

n

Dec

. 201

6 D

OE

,

M&E

Dev

elop

men

tal

partn

ers

Oth

er s

ub

sect

ors

I

 Act

ion

area

4: R

esea

rch

and

Dev

elop

men

t

Act

ion

Are

as 5

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)

xiii

  

xiii

Ann

exure four 

SEC

TIO

N T

HR

EE- I

NSS

Agr

icul

ture

Sec

tor A

ctio

n Pl

an (J

une

2013

to D

ec 2

016)

Act

ion

Out

put I

ndic

ator

Ti

me

Res

pons

ible

D

epar

tmen

t Su

ppor

t Pr

iorit

y

Bud

get

A

ctio

n A

rea

1: E

nabl

ing

envi

ronm

ent,

polic

y fr

amew

orks

, str

ateg

ies

1.1.

A

dvoc

acy

for p

rom

ulga

tion

of

gend

er s

ensi

tive

and

pro-

poor

P

rovi

ncia

l foo

d se

curit

y po

licy

The

polic

y an

noun

ced

and

enfo

rced

, P

oor p

eopl

e ha

ve a

cces

s to

food

Ju

ne 2

014

Agric

ultu

re

Legi

slat

ors

CS

Os

I D

oes

not

requ

ire

budg

et

1.2.

A

dvoc

acy

for p

rovi

ding

ag

ricul

ture

land

to la

ndle

ss

fem

ale

poor

farm

ers

50%

of a

gric

ultu

re la

nd is

allo

cate

d to

fe

mal

e po

or fa

rmer

s Ju

ne 2

014

onw

ards

Ag

ricul

ture

W

DD

C

SO

s I

Doe

s no

t re

quire

se

para

te

budg

et

1.3.

A

dvoc

acy

for i

ncre

asin

g th

e ra

tio o

f fem

ale

agric

ultu

re

exte

nsio

n of

ficer

and

fiel

d as

sist

ant

At l

east

50%

of f

emal

e ag

ricul

ture

ex

tens

ion

wor

kers

and

fiel

d as

sist

ants

wou

ld b

e fe

mal

e,

Cre

ated

acc

ess

to fe

mal

e fa

rmer

s in

th

e fil

led

thro

ugh

stan

dard

ized

m

essa

ges

June

201

6 Ag

ricul

ture

Pa

nd D

W

DD

C

SO

s

i R

eallo

catio

n of

exi

stin

g bu

dget

1.4.

E

nfor

cem

ent o

f ten

ancy

act

Te

nant

s w

ould

be

able

to b

orro

w

smal

l loa

ns fo

r enh

anci

ng th

eir c

rop

prod

uctio

n

June

201

4 A

gric

ultu

re

Legi

slat

ors

CS

Os

I S

ame

as

abov

e

1.5.

E

nfor

cem

ent o

f leg

isla

tive

mea

sure

s ar

ound

mic

ronu

trien

t fo

rtific

atio

n of

food

thro

ugh

empo

wer

ing

food

mon

itors

and

P

SQ

C to

take

lega

l act

ions

‐ 10

0% o

f sal

t ava

ilabl

e in

the

mar

ket

is io

dine

for

tifie

d

‐ 10

0% o

f edi

ble

oil i

s fo

rtifie

d fo

r Vi

tam

in A

and

D

‐ 10

0% o

f the

flou

r is

forti

fied

with

iro

n

June

201

4 Fo

od

depa

rtmen

t P

SQ

CA

Legi

slat

or

CS

O

I Fu

nds

requ

ired

for

advo

cacy

ac

tiviti

es

1.6.

E

nfor

cem

ent o

f stri

ct re

gula

tory

m

easu

res

to c

ontro

l the

sal

e of

un

certi

fied

seed

s, h

arm

ful

Farm

ers

wou

ld u

se p

ure

seed

and

sa

fe p

estic

ides

for e

nhan

cing

cro

p pr

oduc

tion

that

will

resu

lt in

hig

h

June

201

4 Ag

ricul

ture

/ ac

adem

ia

Legi

slat

ors

CS

Os

II S

ame

as

abov

e

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le

Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

Act

ion

Are

a 1:

Ena

blin

g en

viro

nmen

t, po

licy

fram

ewor

ks, s

trat

egie

s

xiv

  

xiv

pest

icid

es a

nd m

edic

ine

with

ad

vers

e ef

fect

on

hum

an h

ealth

nu

trien

t and

goo

d qu

ality

cro

ps

Hor

mon

es a

dmin

iste

red

to a

nim

als

wou

ld b

e sa

fe

1.7.

A

dvoc

acy

for t

rans

ferri

ng th

e re

spon

sibi

lity

of m

edic

inal

in

puts

for t

reat

men

t, en

hanc

ing

milk

and

mea

t pro

duct

ion

to

prov

inci

al v

eter

inar

y dr

ug

regu

lato

ry a

utho

rity

Onl

y sa

fe a

nd a

ppro

ved

med

icin

es

are

adm

inis

tere

d to

live

stoc

k fo

r en

hanc

ing

milk

pro

duct

ion.

June

201

4 D

epar

tmen

t of

Live

stoc

k &

Fi

sher

ies

Aca

dem

ia/L

egis

lato

r

CS

Os

II TB

D

A

ctio

n A

rea

2: C

apac

ity D

evel

opm

ent a

nd C

oord

inat

ion

2.1

Coo

rdin

ate

and

supp

ort v

ario

us

sect

ors

in s

treng

then

ing

thei

r ou

treac

h w

orke

r cur

ricul

um

thro

ugh

incl

usio

n of

sta

ndar

dize

d m

essa

ges

and

broa

deni

ng th

e fo

cus

of th

e cu

rric

ulum

to m

ake

it m

ore

focu

ssed

aro

und

eatin

g he

alth

y fo

od s

uch

as fo

rtifie

d fo

ods

At l

east

20%

impr

ovem

ent i

n th

e K

now

ledg

e, a

ttitu

de a

nd p

ract

ice

surv

ey s

core

s of

the

outre

ach

wor

kers

wou

ld b

e ob

serv

ed

June

201

6 Ag

ricul

ture

de

partm

ent

Hea

lth

Educ

atio

n ce

ll

Hea

lth

Edu

catio

n W

AS

H

I TB

D

2.2.

A

dvoc

ate

for e

stab

lishi

ng a

tra

inin

g ce

ntre

s w

ith fa

cilit

y fo

r tra

inin

g w

omen

ext

ensi

on

wor

kers

and

fem

ale

farm

ers

at

ever

y di

stric

t lev

el

At l

east

five

out

of t

en 1

0 hi

gh ri

sk

dist

ricts

will

hav

e tra

inin

g ce

ntre

s eq

uipp

ed to

trai

n w

omen

ext

ensi

on

wor

kers

and

fiel

d as

sist

ants

June

201

6 Ag

ricul

ture

de

partm

ent

Acad

emia

P an

d D

Dev

elop

men

t pa

rtner

s

II TB

D

C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n

2.3.

D

evel

op h

ome

base

d gr

ain

stor

age

faci

lity

Com

mun

ity s

urve

y w

ould

sho

w

30%

of t

he h

ouse

hold

s ha

ve s

mal

l sc

ale

hom

e ba

sed

grai

n st

orag

e fa

cilit

y es

tabl

ishe

d,

June

201

6 Fo

od D

epar

tmen

t ag

ricul

ture

, lo

cal

com

mun

ity,

CS

O, R

SP

s

I TB

D

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

Cap

acity

Dev

elop

men

t – P

rogr

amm

e Im

plem

enta

tion

xv 

 

xv

Poo

r far

mer

s ha

ve a

cces

s to

food

,

2.4.

Ag

ricul

ture

ext

ensi

on w

orke

rs w

ill

sens

itize

and

bui

ld c

apac

ity o

f sm

all f

emal

e fa

rmer

s to

set

up

smal

l lev

el v

eget

able

gar

dens

on

a sm

all p

iece

of l

and

avai

labl

e to

th

em

By

the

end

of 2

016,

50%

of t

he

farm

ing

wom

en w

ill b

e gr

owin

g an

d co

nsum

ing

varie

ty o

f ve

geta

bles

by

adop

ting

the

skills

of

hom

e ba

sed

gard

enin

g ap

proa

ch

June

201

6 Fo

od d

epar

tmen

t Lo

cal

gove

rnm

ent

II TB

D

2.5.

A

dvoc

acy

for e

stab

lishm

ent o

f foo

d re

gula

tory

aut

horit

y th

at w

ill e

nsur

e fo

od s

afet

y of

the

snac

ks a

nd o

ther

fo

od it

ems

bein

g so

ld in

the

mar

ket

Ensu

red

food

qua

lity

and

food

sa

fety

thro

ugh

enfo

rcin

g ce

rtific

atio

n of

mos

t com

mon

ly

avai

labl

e fo

od it

ems

prio

r to

thei

r se

lling

in th

e m

arke

t

June

201

6 Fo

od d

epar

tmen

t Le

gisl

ator

s Lo

cal G

ovt.

CS

Os

I TB

D

2.6

Adv

ocac

y to

BIS

P, r

ural

sup

port

prog

ram

s an

d so

cial

wel

fare

de

partm

ent t

o in

clud

e sc

hem

e to

up

scal

e ho

me

base

d pr

oduc

tion

and

valu

e ad

ditio

n to

food

live

stoc

k da

iry a

nd p

oultr

y pr

oduc

ts u

nder

w

asee

la-e

rozg

ar p

rogr

am fo

r ultr

a-po

or

Was

eela

-e-ro

zgar

pro

gram

wou

ld

enab

le la

unch

ing

of a

t-lea

st o

ne

bene

ficia

ry in

eac

h vi

llage

and

at

leas

t 25

bene

ficia

ries

at e

ach

UC

w

ould

get

3 d

ozen

laye

r chi

cken

s w

ith c

ock.

The

sch

eme

will

als

o in

clud

e gi

ving

sm

all c

attle

of

exce

llent

gen

etic

pro

file

for r

earin

g an

d fu

ture

repr

oduc

tive

grow

th.

This

sch

eme

wou

ld b

enef

it in

pr

ovid

ing

acce

ss to

goo

d so

urce

of

pro

tein

as

wel

l as

will

incr

ease

ho

useh

old

inco

me

June

201

6 S

chem

es

incl

uded

Dep

artm

ent o

f Li

vest

ock

&

Fish

erie

s TA

BIS

P

WD

D

RS

P

II W

ill be

in

corp

orat

ed

in B

ISP

cu

rrent

sc

hem

es,

henc

e le

ss

depe

nden

cy

on b

udge

t

2.7

Live

stoc

k de

partm

ent w

ould

in

trodu

ce a

cad

re o

f com

mun

ity

lives

tock

hea

lth fe

mal

e w

orke

r al

mos

t in

line

with

con

cept

of t

he

com

mun

ity h

ealth

wor

kers

At l

east

one

loca

l com

mun

ity

wom

en/g

irls

from

eac

h vi

llage

with

so

me

educ

atio

n w

ill re

ceiv

e tra

inin

g as

com

mun

ity v

eter

inar

y he

alth

wor

ker

June

201

6 Ag

ricul

ture

W

DD

Ag

ricul

ture

U

nive

rsity

I TB

D

2.8

Impr

ove

capa

city

of w

omen

in

hom

e ba

sed

food

pro

cess

ing,

co

nser

vatio

n, p

rese

rvat

ion

and

25%

of h

ouse

hold

s id

entif

ied

thro

ugh

BISP

dat

abas

e w

ill

incr

ease

thei

r hou

seho

ld in

com

e th

roug

h so

me

hom

e ba

sed

skill

June

201

6 A

gric

ultu

re/fo

od/

lives

tock

/ pou

ltry

WD

D

Tech

nica

l ex

pert

1 TB

D

xvi

  

xvi

mar

ketin

g de

velo

pmen

t ini

tiativ

e w

ith

espe

cial

focu

s on

food

rela

ted

prod

uctio

n lik

e ce

real

s, m

ilk a

nd

mea

t by

prod

ucts

CS

Os

RS

P

2.9

Impr

ove

sust

aina

ble

fish

farm

ing

thro

ugh

capa

city

bui

ldin

g of

mas

ter

train

er fo

r tra

inin

g of

fish

farm

ers

and

ther

eby

enha

nce

acce

ss to

go

od p

rote

in a

vaila

bilit

y an

d in

crea

sing

the

yiel

d pe

r uni

t vol

ume

At l

east

10%

incr

ease

pro

duct

ivity

of

fish

es o

f nat

ural

wat

er b

odie

s fro

m th

e ba

selin

e A

lmos

t 100

% o

f the

sta

ff is

trai

ned

and

has

IEC

tool

to d

isse

min

ate

mes

sage

s ar

ound

goo

d fis

h fa

rmin

g pr

actic

es to

enh

ance

the

prod

uctio

n of

pro

tein

.

June

201

6 Li

vest

ock

&

Fish

erie

s de

partm

ent

BIS

P/R

ural

su

ppor

t pr

ogra

ms

1 TB

D

A

ctio

n ar

ea 3

: Coo

rdin

atio

n an

d C

oope

ratio

n

3.1

Est

ablis

h an

intra

-sec

tora

l co

ordi

natio

n fo

rum

of t

he

subs

ecto

rs w

ith re

pres

enta

tion

from

agr

icul

ture

, foo

d, fi

sher

ies

and

lives

tock

dep

artm

ents

to

coor

dina

te a

nd s

uppo

rt va

rious

in

tra s

ecto

ral i

nitia

tives

The

subs

ecto

r coo

rdin

atio

n gr

oup

will

und

erta

ke g

ap

anal

ysis

, dev

elop

dis

trict

inte

r-se

ctor

al p

lan,

tim

elin

es a

nd

mon

itorin

g m

echa

nism

Mar

ch 2

014

onw

ards

A

ll su

bsec

tors

i.e

. Dep

artm

ent

of A

gric

ultu

re,

food

, liv

esto

ck

and

poul

try

Dev

. Par

tner

s TA

I

TBD

3.2

Impr

ove

the

soci

o ec

onom

ic

stat

us o

f the

tena

nts

thro

ugh

linki

ng th

em to

the

publ

ic s

ecto

r se

rvic

e de

liver

y pl

atfo

rm

All

the

utili

ty s

tore

s, fo

od

vouc

hers

arra

ngem

ent a

nd

scho

ol fe

edin

g pr

ogra

m w

ill pu

rcha

se fo

od fr

om th

e sm

all

farm

ers,

milk

pro

duce

rs a

nd fo

od

supp

liers

June

201

4 on

war

ds

Tech

nica

l as

sist

ance

Te

nant

s, a

nd

smal

l foo

d pr

oduc

ers,

ba

ck y

ard

hom

este

ad

food

pr

oduc

ers/

W

DD

/ CS

Os

1 TB

D

3.3.

R

ehab

ilita

tion

of R

ural

pou

ltry

farm

ing

and

empo

wer

men

t of r

ural

w

omen

thro

ugh

supp

lyin

g of

3

doze

ns o

f lay

er c

hick

en to

the

bene

ficia

ries

of B

ISP

rura

l lad

y fo

r ba

ckya

rd fa

rmin

g

At l

east

50%

of t

he p

oor r

ural

w

omen

iden

tifie

d th

roug

h B

ISP

da

ta b

ase

or w

omen

de

velo

pmen

t pro

gram

will

hav

e ac

cess

to b

acky

ard

poul

try

farm

ing

whi

ch w

ill a

lso

incr

ease

June

201

6 D

epar

tmen

t of

agric

ultu

re/p

oultr

y

BIS

P

WD

D

CS

Os

RS

P

i TB

D

A

ctio

n ar

ea 3

: Coo

rdin

atio

n an

d C

oope

ratio

n

xvii

  

xvii

com

mun

ity a

cces

s to

hig

h qu

ality

pr

otei

n

3.4.

In

vest

in re

sear

ch to

incr

ease

milk

yi

eld

and

build

cap

acity

to re

duce

w

asta

ge o

f milk

thro

ugh

prod

ucin

g yo

gurt,

che

ese

and

butte

r for

se

lling

in th

e ne

ighb

ourh

ood

100%

of t

he ta

rget

for c

apac

ity

build

ing

of w

omen

wou

ld b

e im

plem

ente

d;

Prov

inci

al b

reed

impr

ovem

ent

prog

ram

will

be in

pla

ce th

at w

ill al

low

pro

duct

ion

and

avai

labi

lity

of g

ood

qual

ity o

f fod

der a

nd

impr

oved

farm

man

agem

ent

prac

tices

that

allo

ws

prod

uctio

n of

goo

d qu

ality

and

qua

ntity

of

milk

yie

ld.

June

201

6 D

epar

tmen

t of

lives

tock

In

stitu

te o

f an

imal

hea

lth

Res

earc

h in

stitu

tes

i tb

d

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

4.1

Advo

cacy

wou

ld b

e do

ne to

est

ablis

h re

sear

ch a

nd a

dvoc

acy

fund

. Agr

icul

ture

/food

/live

stoc

k/po

ultry

/fish

sec

tor w

ould

par

ticip

ate

activ

ely

in th

e te

chni

cal a

dvis

ory

grou

p sp

ecifi

cally

focu

ssed

to id

entif

y pr

iorit

y re

sear

ch a

reas

. Fol

low

ing

are

som

e of

the

area

s th

at h

ave

emer

ged

out o

f the

lit

erat

ure

revi

ew a

nd s

ituat

ion

anal

ysis

exe

rcis

e:

R

esea

rch

on th

e de

velo

pmen

t of n

utrie

nt ri

ch v

arie

ty

Res

earc

h to

dev

elop

wom

en o

rient

ed m

echa

niza

tion

(har

vest

ing,

thra

shin

g, c

hopp

ing,

hoe

ing

etc.

) to

enab

le h

er a

chie

ve b

ette

r res

ults

in le

ss ti

me.

Res

earc

h to

impr

ove

tech

nolo

gica

l met

hods

in d

airy

farm

ing

indu

stry

to in

crea

se a

nim

al m

ilk

prod

uctio

n

Res

earc

h to

pro

duce

hig

h pr

otei

n fis

hes.

R

esea

rch

is n

eede

d fo

r the

pro

duct

ion

vacc

ines

and

bio

logi

cal s

uppl

emen

ts fo

r pre

vent

ion

of

dise

ases

am

ongs

t liv

esto

ck a

nd p

oultr

y

One

Hea

lth: A

pplie

d re

sear

ch in

zoo

nosi

s, p

reve

ntin

g tra

nsfe

r of d

isea

se fr

om a

nim

als

to

hum

ans

espe

cial

ly in

chi

ldre

n an

d w

omen

like

bird

flu,

sw

ine

flu, b

ruce

llosi

s, tu

berc

ulos

is e

tc.

Res

earc

h to

enh

ance

nut

ritiv

e va

lue

of th

e cr

op, d

iver

se fo

od p

rodu

ctio

n, a

gron

omic

requ

irem

ent

such

as

qual

ity o

f see

ds, f

ertil

izer

s an

d bi

olog

ical

pes

ticid

es, e

tc.

Supp

orte

d by

: •

Acad

emia

•

CS

Os

• Ag

ricul

ture

sec

tor

• M

anuf

actu

ring

repo

rt •

Dev

. Par

tner

s, a

cade

mia

and

BC

C s

peci

alis

ts

• fo

od/fi

sher

y an

d liv

esto

ck

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

xviii

  

xviii

A

ctio

n A

reas

5: P

roje

ct M

anag

emen

t, R

epor

ting,

Mon

itorin

g an

d Ev

alua

tion

(for n

utrit

ion

rela

ted

and

nutr

ition

spe

cific

inte

rven

tions

)

5.1

Par

ticip

ate

in th

e in

ter-s

ecto

ral

coor

dina

tion

grou

p to

mon

itor

INS

S a

spira

tions

and

pla

n

Sec

tor w

ill re

port

nutri

tion

spec

ific

indi

cato

rs fr

om p

rovi

ncia

l and

di

stric

t lev

el o

n a

quar

terly

bas

is to

in

ter-

sect

oral

INS

S.

Th

e se

ctor

will

par

ticip

ate

activ

ely

to e

nsur

e th

e fo

llow

ing:

i)

Inte

grat

ion

of n

utrit

ion

into

the

rele

vant

sub

Sec

tor M

and

E

ii)

Inte

grat

ion

and

repo

rting

on

the

nutri

tion

indi

cato

rs

iii)

Impl

emen

tatio

n of

dis

trict

ba

sed

wor

k pl

ans

As

soon

as

esta

blis

hed

upon

the

appr

oval

of

INS

S

DO

E,

M&

E

Dev

elop

men

tal

partn

ers

Oth

er s

ub s

ecto

rs

I TB

D

5.2

Est

ablis

h in

tra s

ecto

ral

coor

dina

tion

to p

lan

and

impl

emen

t the

re

com

men

datio

ns o

f the

INS

S

Qua

rterly

mon

itorin

g re

port

will

in

dica

te p

rogr

ess

in li

ne w

ith th

e di

stric

t bas

ed a

nnua

l pla

n 70

% o

f the

pla

nned

mile

ston

es

achi

eved

and

impl

emen

ted

June

201

4 on

war

ds

June

201

6

Agric

ultu

re

sect

or s

enio

r m

embe

rs

DoE

/Lite

racy

/oth

er

fund

ed p

rogr

ams

I TB

D

A

ctio

n A

reas

5: P

roje

ct M

anag

emen

t, R

epor

ting,

Mon

itorin

g an

d Ev

alua

tion

(for n

utrit

ion

rela

ted

and

nutr

ition

spe

cific

inte

rven

tions

)

xix 

 

xix

Ann

exur

e fiv

e

SEC

TIO

N F

OU

R: I

NSS

(Inte

grat

ed N

utrit

ion

stra

tegy

for S

indh

) WA

SH S

ecto

r Act

ion

Plan

(JuL

Y 20

13 to

Dec

201

5).

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le

Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

Act

ion

Are

a 1:

Ena

blin

g en

viro

nmen

t, po

licy

fram

ewor

ks, s

trat

egie

s 1.

1 P

rovi

de

safe

dr

inki

ng

wat

er

and

good

sa

nita

tion

faci

litie

s th

roug

h:

Leg

isla

ting

“Exe

cutio

n,

Ope

ratio

n &

M

aint

enan

ce o

f wat

er

and

sani

tatio

n po

licy”

de

finin

g R

ole

of D

istri

ct

Cou

ncils

, Mun

icip

al

Com

mitt

ees,

Uni

on

Cou

ncils

and

PH

ED” a

nd

Pre

pare

a g

rand

stra

tegy

th

at p

riorit

ize

sche

mes

in

dist

ricts

that

are

hig

h ris

k fo

r mal

nutri

tion

At l

east

50%

of t

he h

igh

risk

dist

ricts

rece

ive

safe

dr

inki

ng w

ater

and

sa

nita

tion

in li

ne w

ith th

e ap

prov

ed p

rovi

ncia

l gra

nd

stra

tegy

June

201

6 LG

D

P

HE

D

I Th

roug

h Av

aila

ble

Gov

ernm

ent t

ools

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n 2.

1 En

hanc

e co

mm

unity

ow

ners

hip

for f

ollo

w u

p m

aint

enan

ce o

f the

new

sc

hem

es th

roug

h re

vivi

ng p

roje

ct

Impl

emen

tatio

n te

ams

(PIT

) in

high

risk

(PIT

co

nsis

ts o

f Com

mun

ity

Dev

. Offi

cer,

Assi

stan

t C

omm

unity

dev

. offi

cer

and

Hyg

iene

Edu

cato

r) o

PIT

in a

ll hi

gh ri

sk a

reas

w

ith n

ew s

chem

es re

vive

d E

very

new

sch

eme

has

th

e ov

ersi

ght c

omm

unity

m

onito

ring

team

Mar

ch 2

014

(revi

val o

f PI

T)

June

201

6

LGD

P

HE

D

CS

Os

Dev

. pa

rtner

I To

be

deci

ded

and

will

ne

ed re

sour

ce

mob

iliza

tion

2.2

Stre

ngth

en

capa

city

of

th

e s

ervi

ce

prov

ider

s Fo

rtnig

htly

re

port

will

be

pu

blis

hed

on

qual

ity

of

Mar

ch,2

014

LGD

P

HE

D

I

Early

at

th

is

stag

e to

es

timat

e

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le

Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

Act

ion

Are

a 1:

Ena

blin

g en

viro

nmen

t, po

licy

fram

ewor

ks, s

trat

egie

s

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

xx

  

xx

(Wat

er &

San

itatio

n) t

o en

sure

pro

visi

on o

f sa

fe

wat

er

on

WH

O

Stan

dard

s

Indu

ct

envi

ronm

ent

spec

ialis

t at

eac

h di

stric

t le

vel

for

ensu

ring

and

mon

itorin

g qu

ality

of

ex

istin

g an

d up

com

ing

WA

SH

fa

cilit

ies

by

follo

win

g W

HO

st

anda

rds

Est

ablis

h in

tra

sect

oral

m

onito

ring

cell

to e

nsur

e th

at w

ater

and

san

itatio

n sc

hem

es

mee

t th

e m

inim

um

WH

O

stan

dard

s.

wat

er

and

sew

erag

e di

scha

rge

that

in

dica

te

that

mor

e th

an 9

0% o

f the

fa

cilit

ies

are

supp

lyin

g w

ater

that

mee

ts th

e W

HO

st

anda

rds

In

tra

Sec

tora

l m

onito

ring

cell

will

ta

ke

rem

edia

l ac

tions

as

evid

ent

by t

he

min

utes

of t

he m

eetin

g

Mar

ch,2

014

LGD

PH

ED

1

Early

at

th

is

stag

e to

es

timat

e

C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n

2.3

U

nder

take

soc

ial

mob

iliza

tion

cam

paig

n to

pr

omot

e he

alth

and

hy

gien

e be

havi

our i

n th

e co

mm

unity

suc

h as

pr

otec

tion

of w

ater

so

urce

, fol

low

-up

mai

nten

ance

of s

chem

es

KA

P s

urve

y w

ill h

ighl

ight

20

% in

crea

se in

hea

lth

and

hygi

ene

prac

tices

June

, 201

6 LG

D

PH

ED

U

NIC

EF

Hea

lth

I

Re-

enfo

rcem

ent o

f env

ironm

enta

l hyg

iene

and

WA

SH m

essa

ges

by th

e ou

trea

ch h

ealth

wor

kers

sam

e fo

r all

sect

ors

1.4

Par

ticip

ate

in in

tegr

atio

n of

WA

SH

rela

ted

mes

sage

s in

the

curri

culu

m

Cur

ricul

um o

f out

reac

h w

orke

rs fr

om d

iffer

ent

sect

ors

cont

ain

WA

SH

re

late

d m

essa

ges

June

201

6 H

ealth

/PW

D

/agr

icul

ture

D

ev.

Par

tner

s LG

D

PH

ED

ii TB

D

C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n

xxi

  

xxi

Incl

ude

actio

n or

ient

ed m

essa

ges

on h

ealth

and

hyg

iene

in s

choo

l cur

ricul

um

1.5

Prov

ide

tech

nica

l as

sist

ance

and

sup

port

to

Dep

artm

ent o

f edu

catio

n,

liter

acy

depa

rtmen

t for

:

- inc

lusi

on o

f st

anda

rdiz

ed m

essa

ges

rela

ted

to e

nviro

nmen

tal

hygi

ene

in th

eir

curri

culu

m

- ens

urin

g th

e av

aila

bilit

y of

WA

SH

faci

litie

s in

sc

hool

env

ironm

ent

Prim

ary

scho

ol c

urric

ulum

w

ill h

ave

actio

n or

ient

ed

nutri

tion

mes

sage

s an

d ac

tiviti

es in

thei

r sch

ool

curri

culu

m

DoE

will

hav

e de

sire

d le

vel

of W

AS

H s

ervi

ces

in th

e sc

hool

s se

lect

ed fo

r in

terv

entio

n an

d as

per

the

plan

June

201

6 D

oE

Dev

. P

artn

ers

LGD

P

HE

D

i TB

D

A

ctio

n ar

ea 3

: Im

plem

enta

tion

(Fie

ld le

vel I

mpl

emen

tatio

n)

Im

plem

enta

tion

of p

roje

ct fo

r ava

ilabi

lity

of s

afe

wat

er a

nd g

ood

sani

tatio

n

3.1

intro

duce

new

WA

SH

sc

hem

es in

prio

ritiz

ed

area

s

50%

of t

he id

entif

ied

high

ris

k di

stric

ts w

ould

WA

SH

fa

cilit

ies

esta

blis

hed

July

, 20

14

LGD

& P

HE

D

Plan

ning

and

de

velo

pmen

t de

partm

ent/

Hea

lth/

UN

ICE

F/ D

ev.

partn

ers

/ C

SO

s

1 E

arly

at t

his

stag

e to

es

timat

e

R

evita

lize

non-

func

tiona

l sch

emes

3.3

Reh

abili

tatio

n,

Impr

ovem

ent,

Ext

ensi

on

and

augm

enta

tion

of

WA

SH

Sch

emes

Rev

italiz

e 75

% o

f non

-fu

nctio

nal w

ater

and

sa

nita

tion

sche

mes

June

20

16

LGD

P

HE

D

UN

ICE

F

I TB

D

Im

plem

enta

tion

of p

roje

ct fo

r ava

ilabi

lity

of s

afe

wat

er a

nd g

ood

sani

tatio

n

xxii

  

xxii

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

4.1

To p

artic

ipat

e ac

tivel

y in

th

e fo

rum

est

ablis

hed

for

gene

ratin

g ev

iden

ce to

in

fluen

ce p

olic

y th

roug

h re

sear

ch

Con

tribu

te to

rese

arch

es

aim

ed a

t mea

surin

g th

e im

pact

or s

tudy

ing

the

mod

el o

f wat

er a

nd

sani

tatio

n ac

tiviti

es.

Con

tribu

te to

initi

atin

g re

sear

ch to

find

loca

l so

lutio

n to

the

wat

er a

nd

sani

tatio

n is

sues

.

2016

LG

D /

PH

ED

P a

nd D

Acad

emic

In

stitu

tions

All S

ub

Sec

tors

/ Dev

. A

genc

ies

/ C

SO

/ M

and

E

II TB

D

Act

ion

Are

as 5

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)

5.1

Par

ticip

ate

in th

e in

ters

ecto

ral n

utrit

ion

coor

dina

tion

com

mitt

ee

The

com

mitt

ee w

ill

mon

itor t

he

impl

emen

tatio

n of

the

dist

rict p

lans

, int

egra

tion

of n

utrit

ion

indi

cato

rs in

to

the

rele

vant

sub

Sec

tor’s

cu

rric

ulum

, a s

yste

m fo

r in

tegr

atio

n an

d re

porti

ng

of th

e nu

tritio

n in

dica

tors

in

the

resp

ectiv

e de

partm

ent’s

Man

dE,

impl

emen

tatio

n of

the

dist

rict b

ased

wor

k pl

ans,

en

d lin

e su

rvey

s to

ass

ess

prog

ress

on

NN

S an

d M

ICs

End

2014

on

war

ds

Pla

nnin

g,

mon

itorin

g ce

ll

Dev

elop

men

t pa

rtner

s 1

TBD

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

Act

ion

Are

as 5

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)

xxiii

  

xxiii

Ann

exur

e si

x

CR

OS

S S

EC

TO

RS

:

CS

O R

OLE

IN

IN

SS

– 2

013

to 2

016 

 Action 

Outpu

t activity 

Timeline 

Prim

ary 

Sector  

Supp

ort 

sector 

Priority 

High: 1 

Low: 2

 

Budg

et 

 

 ARE

A 1: C

REATE

 AN ENABLING ENVIROMEN

T 1.1

Pr

ovide

the p

latfor

m to

Publi

c sec

tor pa

rtner

s to

appr

oach

CSO

s for

inter

-secto

ral in

terve

ntion

s in

vario

us pa

rts of

Sind

h

Carry

out m

appin

g of th

e CSO

invo

lved i

n inte

r- se

ctora

l asp

ects

of nu

trition

in S

indh;

Ju

ne 20

14

CSOs

Deve

lopme

ntal

agen

cies

Gove

rnme

nt De

pt.

1 Bu

dget

for

mana

ging

CSO

role

and

secre

tariat

1.2

Stre

ngthe

n adv

ocac

y thr

ough

exten

ding c

ivil s

ociet

y su

ppor

t to va

rious

secto

rs for

: - p

rovis

ion of

clea

n wate

r and

sanit

ation

facil

ities i

n sc

hools

and c

ommu

nity;

- Enfo

rceme

nt of

law on

brea

st fee

ding

-Beh

avior

chan

ge in

hard

to re

ach c

ommu

nities

More

scho

ols an

d com

munit

ies in

the h

igh ris

k ar

eas w

ould

have

acce

ss to

clea

n wate

r and

sa

nitati

on fa

cilitie

s Kn

owled

ge, a

ttitud

e and

prac

tice s

urve

y ind

icates

adop

tion o

f hea

lthy n

utritio

n beh

avior

in

the ta

rgete

d com

munit

ies

Depe

nds o

n the

proje

ct CS

O He

alth,

WAS

H,

Agric

ultur

e, Ed

ucati

on

1 Ba

sed o

n the

pr

oject

need

s

 Area 2: Cap

acity Develop

men

t / Program Im

plem

entation

  2.1

Re

duce

hous

ehold

pove

rty an

d sup

port

publi

c se

ctor t

hrou

gh sc

aling

up of

vario

us co

mpete

ncy

build

ing pr

ogra

ms th

roug

h tra

ining

comm

unity

mo

bilise

rs i.e

. : -H

ome b

ased

food

base

d pro

cess

ing te

chniq

ues

-Kitc

hen/h

ome b

ased

vege

table

gard

ening

-H

ome b

ased

cotta

ge in

dustr

ies.

- buil

ding h

ome b

ased

grain

stor

age f

acilit

y-

-comm

unity

base

d pro

ducti

on of

high

dens

ity di

ets

KAP

surve

y wou

ld hig

hligh

t that

at lea

st 25

%

of tra

inees

have

appli

ed ac

quire

d skil

ls to

impr

ove h

ouse

hold

incom

e, ac

cess

to di

verse

nu

tritiou

s foo

d sou

rce

.

Depe

nds o

n the

proje

ct

CSO

secto

r

Agric

ultur

e De

pt.

Healt

h Dep

t.

1 Ba

sed o

n the

sc

ale of

the

proje

ct

ACT

ION ARE

A 3: P

ROGRA

M IM

PLEM

ENTA

TION 

3.1

Assis

t GoS

in en

surin

g acc

ess t

o for

tified

food

thr

ough

socia

l mob

ilizati

on ca

mpaig

ns. a

nd fie

ld ba

sed s

urve

illanc

e of ID

D

Asse

ss ac

cess

and u

se of

iodiz

ed sa

lt inc

reas

es by

at le

ast 2

0% fr

om N

NS 20

11

2016

CS

O se

ctor

All S

ector

s inv

olved

in IN

SS

1

CS

O R

OLE

IN

IN

SS

– 2

013

to 2

016

ARE

A1:CR

EATE

ANEN

ABLINGEN

VIROMEN

T

Area2:Ca

pacity

Develop

men

t/Program

Implem

entation

  

ACT

IONARE

A3:PR

OGRA

MIM

PLEM

ENTA

TION

xxiv

  

xxiv

 ACT

ION ARE

A 4:RESEA

RCH AND DEV

ELOPM

ENT 

4.1

Exten

d CSO

supp

ort to

GOS

in M

onito

ring &

Ev

aluati

on of

field

base

d pro

jects

and i

nterve

ntion

CSOs

are p

art o

f var

ious m

onito

ring a

nd

evalu

ation

proje

cts an

d sur

veilla

nce

2016

CS

Os

INSS

1

4.2

Deve

lop an

d inn

ovate

low

cost,

indig

enou

s tec

hnolo

gies f

or nu

trition

impr

ovem

ent th

at mo

tivate

s com

munit

ies to

adop

t thes

e acti

ons

CSOs

will

unde

rtake

relev

ant r

esea

rches

to

deve

lop si

mple

low co

st so

lution

s suc

h as

prod

ucing

high

dens

ity di

et, ho

me ba

sed w

ater

filtra

tion p

lant.

2016

Re

sear

ch

org.

/ Ac

adem

ic ins

titutio

ns

/Univ

ersit

ies

(CSO

s)

CSOs

in th

e fiel

d 1

Depe

nds o

n the

proje

ct

 ACT

ION ARE

AS 5: PRO

JECT

 MANAGEM

ENT, REP

ORT

ING, M

ONITORING AND EVALU

ATION (FOR NUTR

ITION RELATED AND NUTR

ITION SPE

CIFIC INTERV

ENTIONS) 

5.1

Partic

ipate

in the

inter

secto

ral n

utritio

n coo

rdina

tion

comm

ittee

CSOs

will

monit

or im

pleme

ntatio

n of th

e dist

rict

plans

, integ

ratio

n of n

utritio

n ind

icator

s into

the

relev

ant s

ub S

ector

’s cu

rricu

lum, a

syste

m for

int

egra

tion a

nd re

portin

g of th

e nutr

ition i

ndica

tors

in the

res

pecti

ve de

partm

ent’s

M an

d E, e

nd lin

e su

rveys

to as

sess

prog

ress

on N

NS an

d MIC

s CS

O wi

ll sup

port

in th

e diss

emina

tion o

f in

form

atio

n ab

out

indi

cato

rs, r

esou

rces

, tar

gets

, and

ac

hiev

emen

ts th

roug

h w

ebsi

te a

nd

mak

ing

it ac

cess

ible

to th

e pu

blic

to

ensu

re tr

ansp

aren

cy

End 2

014

onwa

rds

Plan

ning,

monit

oring

ce

ll

Deve

lopme

ntal

partn

ers

1 De

pend

s on

the pr

oject

ACT

IONARE

A4:RE

SEARC

HANDDEV

ELOPM

ENT

ACT

IONARE

AS5:PR

OJECT

MANAGEM

ENT,RE

PORT

ING,M

ONITORINGANDEV

ALU

ATION(FORNUTR

ITIONRE

LATEDANDNUTR

ITIONSPEC

IFIC

INTERV

ENTIONS)

xxv

  

xxv

Anne

xure

sev

en

INSS

BIS

P /S

ocia

l wel

fare

Sec

tor A

ctio

n Pl

an (J

une

2013

to D

ec 2

016)

Act

ion

Out

put I

ndic

ator

Ti

me

Res

pons

ible

D

epar

tmen

t Su

ppor

t Pr

iorit

y

Bud

get

A

ctio

n A

rea

1: E

nabl

ing

envi

ronm

ent,

polic

y fr

amew

orks

, str

ateg

ies

1.1

BISP

will

see

k po

licy

appr

oval

for d

ata

shar

ing

of it

s in

divi

dual

ben

efic

iarie

s w

ith

the

rele

vant

dep

artm

ent i

mpl

emen

ting

INS

S

Nut

ritio

n sp

ecifi

c in

terv

entio

n w

ill b

e po

ssib

le to

intro

duce

th

roug

h B

ISP

clie

nts

Dec

201

3 B

ISP

A

ppro

ving

aut

horit

y I

TBD

1.2

BIS

P w

ill a

cqui

re a

ppro

val f

or e

xpan

ding

th

e pa

ckag

e of

voc

atio

nal t

rain

ing

to

enco

urag

e ca

paci

ty d

evel

opm

ent i

n th

e co

mm

unity

for n

utrit

ion

spec

ific

inte

rven

tion

At l

east

thre

e ne

w v

ocat

iona

l tra

inin

g in

clud

ed o

n ar

eas

rela

ted

to fo

od a

nd

agric

ultu

re, l

ives

tock

, fis

hery

an

d po

ultry

Dec

201

6 B

ISP

Ap

prov

ing

auth

ority

II

TBD

1.3

BIS

P w

ill a

cqui

re a

ppro

val f

or in

clud

ing

food

vou

cher

s in

its

pack

age

of s

ervi

ces

for d

augh

ters

of B

ISP

ben

efic

iarie

s en

rolle

d in

sch

ools

and

atte

ndin

g at

leas

t 20

day

s pe

r mon

th

100%

of e

ligib

le g

irls

will

ha

ve a

cces

s to

food

vo

uche

rs th

at w

ill s

erve

to

redu

ce p

reva

lenc

e of

m

alnu

tritio

n am

ongs

t the

ch

ildre

n of

BIS

P b

enef

icia

ry

June

201

6 B

ISP

Ap

prov

ing

auth

ority

I

TBD

1.4

BIS

P w

ill s

eek

appr

oval

to e

nsur

e th

at

com

mun

ity is

abl

e to

enc

ash

food

vo

uche

rs a

t an

outle

t in

thei

r com

mun

ity.

Suc

h ou

tlets

will

be

esta

blis

hed

or

enha

nced

thr

ough

BIS

P m

icro

finan

ce

sche

me

At l

east

one

food

reta

il ou

tlet

is e

stab

lishe

d in

eve

ry U

C

June

201

6 B

ISP

Ap

prov

ing

auth

ority

II

TBD

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le

Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

A

ctio

n A

rea

1: E

nabl

ing

envi

ronm

ent,

polic

y fr

amew

orks

, str

ateg

ies

xxvi

  

xxvi

1.5

BIS

P w

ill e

nfor

ce th

e co

nditi

on th

at th

e ou

tlet w

ill o

nly

prov

ide

appr

oved

bra

nd o

f iro

n fo

rtifie

d w

heat

flou

r, fo

rtifie

d ed

ible

oil

and

iodi

sed

salt.

Com

mun

ity w

ill g

et a

cces

s to

fo

rtifie

d an

d sa

fe fo

od w

ith

good

nut

ritio

nal v

alue

June

201

6 B

ISP

C

SO

s Fo

od d

ept.

II TB

D

1.6

BIS

P w

ill d

evel

op a

n ag

reem

ent w

ith D

oE

and

CS

Os

to e

nsur

e th

at m

id-d

ay fo

od

prog

ram

(a g

lass

of m

ilk) a

nd ra

tions

etc

. is

pro

cure

d fro

m a

n ou

tlet s

uppo

rted

by

entre

pren

eur w

ho is

a B

ISP

bene

ficia

ry

With

the

impl

emen

tatio

n of

th

e ar

rang

emen

t, 50

% o

f the

B

ISP

sup

porte

d en

trepr

eneu

rs w

ill h

ave

enou

gh c

lient

ele

to e

nabl

e to

gr

adua

te o

ut o

f pov

erty

sca

le

Scho

ols

will

get

goo

d qu

ality

of

mid

-day

mea

l

June

201

6 B

ISP

D

oE

II TB

D

A

ctio

n A

rea

2: C

apac

ity D

evel

opm

ent a

nd C

oord

inat

ion

2.1

BIS

P w

ill si

gn M

oU w

ith W

DD

to s

eek

supp

ort i

n id

entif

ying

BIS

P b

enef

icia

ries

wom

en fr

om ta

rget

ed U

Cs

who

can

be

train

ed fo

r var

ious

hom

e ba

sed

food

and

ag

ricul

ture

rela

ted

inte

rven

tions

At l

east

one

BIS

P b

enef

icia

ry

hous

ehol

d in

eve

ry h

igh-

risk

UC

will

have

acc

ess

to

capi

tal t

o es

tabl

ish

hom

este

ad fo

od p

rodu

ctio

n/

lives

tock

etc

.

June

201

6 B

ISP

W

DD

II

TBD

2.2

BIS

P w

ould

dev

elop

an

agre

emen

t with

W

DD

to s

eek

thei

r fac

ilita

tion

in th

e id

entif

icat

ion

of v

ario

us n

utrit

ion

spec

ific

voca

tiona

l tra

inin

g pr

ogra

m a

nd th

ereb

y co

ntrib

ute

to b

oost

ing

up o

f hom

este

ad

food

pro

duct

ion

and

enco

urag

e w

omen

pa

rtici

patio

n in

eco

nom

ic a

ctiv

ity.

50%

of w

omen

trai

ned

in

vario

us s

kills

suc

h as

. dai

ry

food

pro

cess

ing,

bac

kyar

d ga

rden

ing,

com

mun

ity b

ased

ve

terin

ary

heal

th w

orke

r tra

inin

g an

d ho

ney

hive

es

tabl

ishm

ent,

back

yard

liv

esto

ck p

rodu

ctio

n in

clud

ing

youn

g ca

ttle’

s an

d sm

all

poul

try .

Poor

hou

seho

ld id

entif

ied

thro

ugh

BISP

dat

abas

e w

ill

June

201

6

BIS

P

WD

D

II TB

D

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

xxvii

  

xxvii

incr

ease

thei

r hou

seho

ld

inco

me

and

acce

ss to

nu

tritio

us a

nd d

iver

se fo

od

Dec

201

4 Va

rious

dep

artm

ents

un

der f

ood

and

agric

ultu

re

2.3

BIS

P w

ill s

ign

MoU

with

DoE

for :

•

shar

ing

of th

e de

tails

of t

he B

ISP

be

nefic

iarie

s w

ith D

oE h

ighl

ight

ing

the

dem

ogra

phic

pro

file

•

Sha

ring

of th

e sc

hool

atte

ndan

ce

reco

rds

of th

e da

ught

ers

of th

e B

ISP

be

nefic

iary

in o

rder

to fa

cilit

ate

BIS

P

in th

e di

sbur

sem

ent o

f con

ditio

nal

cash

tran

sfer

to e

ligib

le fa

mili

es.

• 70

% o

f the

sch

ools

in

the

high

risk

dis

trict

s w

ill ha

ve m

echa

nism

es

tabl

ishe

d w

ith B

ISP

for

shar

ing

info

rmat

ion

abou

t the

elig

ible

for

cond

ition

al c

ash

trans

fer

• 80

% o

f the

dau

ghte

rs o

f B

ISP

ben

efic

iarie

s w

ill

have

acc

ess

to fo

od

vouc

her s

chem

e

Dec

. 201

3 B

ISP

D

OE

1

TBD

A

ctio

n A

rea

3: C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n

3.1

BIS

P w

ill m

ake

nece

ssar

y ch

ange

s in

its

softw

are

right

s to

allo

w v

ario

us d

epar

tmen

t to

get

onl

ine

info

rmat

ion

arou

nd a

gree

d da

ta fi

eld

Vario

us d

epar

tmen

ts w

ill b

e ab

le to

retri

eve

prom

ptly

the

requ

ired

info

rmat

ion

June

201

4 B

ISP

IT

A

ppro

ving

aut

horit

y I

TBD

3.2

BIS

P w

ill m

ake

nece

ssar

y ch

ange

s in

its

cash

tran

sfer

sch

eme

to m

ake

it co

nditi

onal

to c

erta

in p

reco

nditi

ons

CC

T pr

ogra

m w

ill b

e in

trodu

ced

in a

tim

ely

man

ner

to e

ncou

rage

girl

par

ticip

atio

n in

sch

ool

June

201

4 B

ISP

IT

dep

artm

ent

DoE

I

TBD

3.3

Oth

er s

ocia

l saf

ety

nets

thro

ugh

cash

or

food

tran

sfer

s to

ext

rem

ely

poor

ho

useh

olds

will

be

prom

oted

Num

ber o

f hou

seho

lds

havi

ng re

ceiv

ed c

ash

or fo

od

trans

fer f

or in

crea

sed

diet

ary

inta

ke

June

201

6 S

ocia

l Wel

fare

D

epar

tmen

t D

evel

opm

ent

partn

ers

I M

ap

fund

ing

of

partn

ers

wor

king

in

this

ar

ea

C

oord

inat

ion

and

Coo

pera

tion

3.4

Par

ticip

ate

activ

ely

in th

e in

terd

epar

tmen

tal i

nter

sect

oral

nut

ritio

n gr

oup

for t

he i

mpl

emen

tatio

n of

the

BIS

P is

abl

e to

pla

y a

faci

litat

or ro

le in

im

plem

entin

g th

e re

com

men

datio

n of

the

task

June

201

4

BIS

P

Mem

bers

of t

he

INS

S c

omm

ittee

I

TBD

A

ctio

n A

rea

3: C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n

C

oord

inat

ion

and

Coo

pera

tion

xxvii

i

  

xxviii

reco

mm

enda

tions

of t

he IN

SS

fo

rce

3.5

BIS

P w

ill s

eek

supp

ort o

f civ

il so

ciet

y in

en

surin

g tra

nspa

renc

y of

its

prog

ram

s th

roug

h cl

ose

mon

itorin

g

BIS

P w

ith s

uppo

rt of

CS

Os

and

loca

l com

mun

ity

repr

esen

tativ

es w

ill b

e ab

le

to e

nsur

e th

e re

liabi

lity

of th

e in

form

atio

n re

ceiv

ed a

bout

sc

hool

atte

ndan

ce a

nd fo

od

vouc

her i

nitia

tive

May

201

4 B

ISP

C

SO

3.6

BIS

P w

ill s

eek

supp

ort o

f CS

Os

in

diss

emin

atin

g th

e in

form

atio

n ab

out C

CT

to c

omm

unity

and

mob

ilizin

g th

em to

sen

d th

eir d

augh

ters

to s

choo

ls

CS

Os

will

act

as

a br

idge

to

BIS

P fo

r ach

ievi

ng it

s ob

ject

ives

.

May

201

4 B

ISP

C

SO

II

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

4.1

BIS

P w

ill s

uppo

rt re

sear

ch a

imed

at

mea

surin

g th

e im

pact

of t

he s

ocia

l pr

otec

tion

mec

hani

sm o

n nu

tritio

nal h

ealth

Res

earc

h fin

ding

s w

ill

influ

ence

and

ena

ble

BISP

in

repo

sitio

ning

its

prog

ram

.

May

201

6 B

ISP

R

esea

rch

partn

ers

II

A

ctio

n A

reas

5: P

roje

ct M

anag

emen

t, R

epor

ting,

Mon

itorin

g an

d Ev

alua

tion

(for n

utrit

ion

rela

ted

and

nutr

ition

spe

cific

inte

rven

tions

)

5.1

BISP

will

partic

ipate

in the

inter

secto

ral n

utritio

n co

ordin

ation

comm

ittee

BISP

will

contr

ibute

to the

dis

cuss

ion th

roug

h pro

viding

mo

nitor

ing re

ports

on th

e agr

eed

indica

tors,

imple

menta

tion o

f the

distric

t leve

l BIS

P co

mmitm

ents,

sh

aring

of in

forma

tion a

bout

the

impa

ct of

vario

us in

terve

ntion

s on

nutrit

ional

and p

artic

ipatin

g in t

he

end l

ine su

rveys

to as

sess

prog

ress

on

NNS

and M

ICs

2014

onwa

rds

Plan

ning,

monit

oring

ce

ll

Deve

lopme

ntal p

artne

rs BI

SP

WDD

and o

ther s

ector

s

1 De

pend

s on

the

proje

ct

A

ctio

n ar

ea 4

: Res

earc

h an

d D

evel

opm

ent

A

ctio

n A

reas

5: P

roje

ct M

anag

emen

t, R

epor

ting,

Mon

itorin

g an

d Ev

alua

tion

(for n

utrit

ion

rela

ted

and

nutr

ition

spe

cific

inte

rven

tions

)

xxix

  

xxix

Anne

xure

eig

ht

INSS

Wom

en d

evel

opm

ent d

epar

tmen

t (Ju

ne 2

013

to D

ec 2

016)

A

ctio

n O

utpu

t Ind

icat

or

Tim

e R

espo

nsib

le D

epar

tmen

t

Supp

ort

Prio

rity

B

udge

t

Act

ion

Are

a 1:

Ena

blin

g en

viro

nmen

t, po

licy

fram

ewor

ks, s

trat

egie

s

Par

ticip

ate

activ

ely

in th

e di

scus

sion

fro

m v

ario

us fo

rum

s to

faci

litat

e th

em

in th

e de

velo

pmen

t of g

ende

r sen

sitiv

e an

d pr

o-po

or p

olic

ies

and

stra

tegi

es

All

the

sect

oral

nut

ritio

n an

d ot

her p

olic

ies

wou

ld b

e ge

nder

se

nsiti

ve a

nd re

alis

tic

Sep

t 201

4 W

DD

A

ll su

b se

ctor

s 1

Not

ne

eded

Parti

cipa

te in

the

polic

y di

alog

ue f

or

intro

duci

ng c

ost e

ffect

ive

mid

-day

fo

od p

rogr

am f

or g

irls

and

boys

from

sc

hool

s in

the

high

risk

dis

trict

s

Polic

y en

dors

ed, d

isse

min

ated

an

d en

forc

ed fr

om a

ll sc

hool

s in

the

high

risk

are

as

Sep

t 201

4 W

DD

D

oE

1 TB

D

To g

et th

e po

licy

endo

rsed

follo

wed

by

the

budg

et a

ppro

val f

or fo

od

supp

lem

ent t

o w

omen

at w

omen

co

mpl

aint

cen

tres

and

shel

ter H

ome,

D

arul

Am

an

All

nine

com

plai

nt c

entre

s di

spen

se fo

od s

uppl

emen

ts to

w

omen

clie

nts

Dec

201

4 W

DD

S

ocia

l wel

fare

CS

Os

III

TBD

Eng

age

in d

ialo

gue

with

oth

er s

ecto

rs

i.e. B

ISP

to id

entif

y an

d e

nsur

e in

clus

ion

of w

omen

spe

cific

act

iviti

es

in th

eir p

acka

ges.

Wom

en s

peci

fic h

ealth

and

nu

tritio

n ac

tiviti

es in

corp

orat

ed

in v

ario

us p

acka

ges

of B

ISP

ongo

ing

WD

D

BIP

S

CS

O

II

tbd

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

Par

ticip

ate

in th

e re

view

and

st

reng

then

ing

of s

choo

l nut

ritio

n cu

rric

ulum

to e

nsur

e it

is g

ende

r se

nsiti

ve

Gen

der s

ensi

tive

and

nut

ritio

n se

nsiti

ve c

urric

ulum

dev

elop

ed

by th

e gr

oup

of s

take

hold

er

April

201

5

DoE

H

ealth

/ Tec

hnic

al

assi

stan

ce

I I

TBD

Act

ion

Out

put I

ndic

ator

Ti

me

Res

pons

ibl

e Dep

artm

ent

Supp

ort

Prio

rity

B

udge

t

Act

ion

Are

a 1:

Ena

blin

g en

viro

nmen

t, po

licy

fram

ewor

ks, s

trat

egie

s

Act

ion

Are

a 2:

Cap

acity

Dev

elop

men

t and

Coo

rdin

atio

n

xxx

  

xxx

Act

ion

area

3: C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n (s

uppo

rt a

nd fa

cilit

atin

g ro

le)

WD

D w

ill s

uppo

rt D

oE in

de

velo

pmen

t and

impl

emen

tatio

n of

sc

hool

feed

ing

prog

ram

from

70%

of

scho

ols

in th

e hi

gh ri

sk a

reas

WD

D w

ill p

lay

a fa

cilit

atin

g ro

le

plan

ning

, im

plem

enta

tion

(if

capa

city

aug

men

ted)

and

third

pa

rty m

onito

ring

role

of t

he

food

sup

plem

enta

tion

prog

ram

June

201

6 D

oE

TA

WD

D

Hea

lth

WA

SH

I TB

D

WD

D o

ffice

rs w

ould

faci

litat

e ag

ricul

ture

dep

artm

ent i

n id

entif

ying

w

omen

from

rura

l are

as fo

r tra

inin

g in

liv

esto

ck/h

ortic

ultu

re c

are

train

ing

to

the

Wom

en/ g

irls

at v

illage

leve

l.

At l

east

85%

of w

omen

id

entif

ied

WD

D w

ill re

ceiv

e th

e tra

inin

g or

gani

zed

by li

vest

ock,

ho

rticu

lture

, agr

icul

ture

and

fis

herie

s.

Mar

ch 2

016

Agr

icul

ture

Dep

t.

Loca

l G

over

nmen

t/LB

D

WD

D o

ffice

rs

II

WD

D o

ffice

rs w

ould

faci

litat

e B

ISP

th

roug

h id

entif

ying

des

ervi

ng a

nd

train

ed B

ISP

ben

efic

iary

thro

ugh

agric

ultu

re p

rogr

am fo

r app

lyin

g fo

r

was

eela

-e-ro

zgar

loan

for p

urch

asin

g

Chi

cken

, Goa

ts, f

ishe

s an

d in

set

ting

hone

y m

anuf

actu

ring

busi

ness

75 %

Wom

en tr

aine

d in

liv

esto

ck w

ill b

ecom

e ec

onom

ical

ly a

ctiv

e 75

% W

omen

trai

ned

in o

ther

sk

ills w

ould

get

the

requ

ired

finan

cial

sup

port

to b

ecom

e ec

onom

ical

ly a

ctiv

ity

June

201

6 W

DD

Li

ve s

tock

s ,

fishe

ries,

and

Fo

rest

Dep

artm

ent,

Coo

pera

tion

depa

rtmen

t

BIS

P

CS

O

II TB

D

Coo

rdin

atio

n an

d C

oope

ratio

n

Par

ticip

ate

in th

e in

ters

ecto

ral n

utrit

ion

coor

dina

tion

com

mitt

ee a

nd c

ontri

bute

to

enh

anci

ng w

omen

’s p

ersp

ectiv

e in

va

rious

initi

ativ

es

WD

D e

nsur

es w

omen

’s in

tere

sts

are

refle

cted

in s

ecto

ral n

utrit

ion

plan

.

Qua

rterly

in

form

atio

n sh

arin

g

DoE

/L

itera

cty,

/ B

ISP

‘/Soc

ial

wel

fare

,/M&

E,

Dev

. Par

tner

s,

CS

O

Rel

evan

t do

nors

/UN

ICE

F/U

NE

SC

O

I

WD

D d

istri

ct o

ffice

rs w

ill m

onito

r de

liver

y of

con

ditio

nal c

ash

trans

fer t

o el

igib

le fa

mili

es (B

ISP

ben

efic

iarie

s w

hose

dau

ghte

rs a

re a

ttend

ing

scho

ols)

Tran

spar

ent m

echa

nism

for t

he

cond

ition

al c

ash

trans

fer

impl

emen

ted

from

all

the

targ

et

scho

ols

(in a

ll 10

hig

h ris

k di

stric

ts) b

y B

ISP

Dec

. 201

4 B

ISP

D

oE

WD

D

I

Act

ion

area

3: C

apac

ity D

evel

opm

ent –

Pro

gram

me

Impl

emen

tatio

n (s

uppo

rt a

nd fa

cilit

atin

g ro

le)

Coo

rdin

atio

n an

d C

oope

ratio

n

xxxi

  

xxxi

Act

ion

area

4: R

esea

rch

and

Dev

elop

men

t

WD

D w

ould

par

ticip

ate

activ

ely

in

the

foru

m e

stab

lishe

d fo

r in

ters

ecto

ral n

utrit

ion

rese

arch

with

an

aim

to d

evel

op e

vide

nce

base

d po

licy

and

inte

rven

tion

WD

D w

ould

lead

at l

east

one

re

sear

ch o

n de

velo

ping

a b

ette

r pe

rspe

ctiv

e on

the

caus

es o

r im

pact

of

mal

nutri

tion

on g

irls

and

wom

en.

WD

D w

ould

ext

end

its te

chni

cal

supp

ort i

n de

sign

ing

rese

arch

from

ge

nder

per

spec

tive

2016

H

ealth

re

sear

ch

foru

m/ W

DD

/ P

and

D

Aca

dem

ic In

stitu

tions

All

Sub

Sec

tors

II TB

D

Act

ion

Are

as 4

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)

Est

ablis

hmen

t of a

sys

tem

atic

pl

anni

ng a

nd re

porti

ng s

yste

m

Rep

ortin

g pr

oced

ures

to m

onito

r the

fo

llow

ing:

a)

In

tegr

atio

n of

nut

ritio

n in

to th

e re

leva

nt s

ub S

ecto

r’s c

urric

ulum

b)

In

tegr

atio

n an

d re

porti

ng o

n th

e nu

tritio

n in

dica

tors

c)

Im

plem

enta

tion

of d

istri

ct b

ased

w

ork

plan

s

End

2014

on

war

ds

annu

ally

Pla

nnin

g,

mon

itorin

g ce

ll

Dev

elop

men

tal

partn

ers

I I

Form

atio

n of

Inte

r-sec

tora

l M

onito

ring

and

Eva

luat

ion

Task

forc

e to

mon

itor p

rogr

ess

on IN

SS

, car

ry

out p

erio

dic

eval

uatio

ns a

nd ta

ke

timel

y co

rrect

ive

mea

sure

s

Qua

rterly

ev

alua

tion

of IN

SS

im

plem

enta

tion

at p

rovi

ncia

l and

di

stric

t lev

el

End

line

eval

uatio

n to

ass

ess

prog

ress

on

NN

S, a

nd M

ICS

in

dica

tors

On

goin

g H

ealth

P a

nd D

All

Sub

Sec

tors

/ A

gric

ultu

re /

WD

D /

UN

A

genc

ies

/ PH

ED

/ E

duca

tion

/ CS

O

M a

nd E

valu

atio

n

I 1

Act

ion

area

4: R

esea

rch

and

Dev

elop

men

t

Act

ion

Are

as 4

: Pro

ject

Man

agem

ent,

Rep

ortin

g, M

onito

ring

and

Eval

uatio

n (fo

r nut

ritio

n re

late

d an

d nu

triti

on s

peci

fic in

terv

entio

ns)