PPHI SINDH - Karachi

Introduction

Malnutrition is defined as imbalance of intake of food as per body needs, it could be Over-Nutrition or Under-Nutrition. The province of Sindh is suffering from Under-Nutrition since long. The National Nutrition Survey (NNS) in 2011 revealed that in Sindh, the most effected province where forms of under-nutrition prevail critically, as per WHO guidelines Wasting (Acute Malnutrition) is 17.5%, Under-Weight is 40% and, most dangerously, Stunting (Chronic Malnutrition) is 50%. According to another National Survey “Multiple Indicator Cluster Survey” (MICS) conducted in 2014, the under-nutrition situation remains same. According to MICS-2014, “more than four out of ten children under the age of five in Sindh are underweight (42%) and 17% are classified as severely underweight. Almost half of children under five years (48%) are stunted or short for their age and one quarter (24 percent) children are severely stunted. The results also show that 15% of children are wasted or thin for their height. Similarly, iron deficiency, anaemia in women and children are at levels of severe public health significance in Sindh, 62% and 73% respectively. Additionally, more than 70% of mothers in Sindh are Vitamin D deficient.

Nutrition Support Program (NSP)

Considering the situation, Government of Sindh (GoS) launched the Nutrition Support Program (NSP) with financial support of World Bank (WB) through Planning Commission – I (PC-I). The program was launched in nine districts of Sindh i.e. Larkana, Qamber, Kashmore, Jacobabad, Tando Muhammad Khan, Badin, Sanghar, Umerkot and Tharparkar. In March 2016, PPHI Sindh signed an MOU with NSP to initiate the field activities. The initial agreement was of 30 months till September 2018 which is further extended for 13 months till December 2019. Under NSP, PPHI Sindh established OTP - a nutritional clinic where management of Severe Acute Malnutrition (SAM) is done - sites, provided treatment of SAM children with Ready to Use Therapeutic (RUTF) and nutrition specific sessions to the communities. Under NSP, PPHI Sindh established 270 OTP sites in the PPHI Sindh managed health facilities in 256 Union Councils of nine districts of Sindh. Till October, 2018 project has successfully cured 77,862 (86%) SAM children with only 4.9% default rate. Apart from SAM case management, 43,998 health & nutrition sensitive sessions and 40,338 session of IYCF (Infant & Young Child Feeding) conducted reaching 819,326 people.

Accelerated Action Plan

The action was further scaled up by GoS when it launched another multisector program ‘Accelerated Action Plan’ (AAP) in 2017, which comprises eight (8) departments of Sindh Government, the departments are Health, Education, Social Securities, Agriculture, Local government, Fisheries, Livestock and Public Health.

The successful implementation of NSP program by PPHI Sindh, the Department of Health, GoS, again approached PPHI Sindh to be partner in AAP. Due to the successful Nutrition Services (OTP) of PPHI Sindh, it was given the responsibility of providing nutrition services across PPHI SIndh districts irrespective of PPHI Managed Health Facilities. As per the initial agreement between PPHI Sindh and APP, signed on 24 May 2018, PPHI Sindh was to provide OTP services in two districts (Sukkur & Mirpurkhas) of Sindh.

The agreement was revised and PPHI Sindh was given additional districts of Khairpur, Naushero Feroze and Ghotki for provision of OTP services in December 2018. Under AAP, in Sukkur and Mirpurkhas 3,827 and 5,265 SAM children identified respectively, whereas, 1,824 & 2,534 SAM children were successfully cured from Severe Acute Malnutrition in these two districts. 1,442 health & nutrition sensitive sessions and 1,399 session of IYCF (Infant & Young Child Feeding) were conducted reaching 39,105 people.

European Union – Programme for Improved Nutrition in Sindh (EU-PINS)

The AAP was complemented with addition of EU-Programme for Improved Nutrition in Sindh (PINS) project (A grant of European Union, EU). The EU-PINS aims to reduce the burden of malnutrition through multisectoral approach in 10 districts of Sindh Province. The districts are Dadu, Shikarpur, Larkana, Qamber, Matiari, Tando Allah Yar, Tando Muhammad Khan, Thatta, Sujawal and Jamshoro. The field activities started in July 2018 and will end in June 2021.

United Nations World Food Programme (UNWFP)

Considering more serious problem in Umerkot and Tharparkar, United Nations World Food Programme (UNWFP) also started its interventions to manage the Moderate Acute Malnutrition (MAM) in under 5 years old children and pregnant and lactating women (PLW). The WFP interventions have been intermittent and are limited to management of MAM.

PHI Sindh’s Nutrition Program provides nutritional services to most susceptible community in 21 districts of Sindh.