Program<\/a>me schemes<\/p>\nThe principle behind the initiative is simple: development spending can influence nutrition even when a project has nothing explicitly to do with food<\/p>\n
A water-supply scheme can reduce exposure to disease. An agricultural programme can affect dietary diversity. A road can determine how easily a pregnant woman reaches a health facility. Education can influence health and feeding practices. Social protection can determine whether a household can afford nutritious food<\/p>\n
The child experiences these interventions as one environment<\/p>\n
Government, however, often experiences them as separate departments<\/p>\n
Nutrition markers attempt to narrow that gap<\/p>\n
The idea is important because it shifts nutrition from being a specialised concern of health officials to becoming a consideration in the decisions that shape communities<\/p>\n
It is a small change in administrative procedure with potentially large consequences<\/p>\n
The battle against malnutrition begins before birth<\/p>\n
The province\u2019s health interventions continue to focus on the first 1,000 days\u2014from conception until a child\u2019s second birthday<\/p>\n
This period receives enormous attention in nutrition science because growth and development during these early years can influence a child\u2019s health and potential for years to come<\/p>\n
KP\u2019s Nutrition Cell at the Directorate General Health Services has been working across this window through maternal and child nutrition interventions, breastfeeding promotion, supplementation and treatment of acute malnutrition<\/p>\n
The province has introduced multi-micronutrient supplementation for mothers and weekly iron and folic acid supplementation for adolescent girls<\/p>\n
The latter is especially significant<\/p>\n
The nutrition of a future mother is not determined on the day she becomes pregnant. It is shaped during the years before pregnancy<\/p>\n
If nutrition policy begins only when a woman enters an antenatal clinic, it has already missed part of the story<\/p>\n
Making breastfeeding a community responsibility<\/p>\n
KP has also invested in making breastfeeding support more accessible<\/p>\n
With UNICEF support, 27 breastfeeding rooms and day-care centres have been established in hospitals and educational institutions<\/p>\n
The province is also implementing the Baby-Friendly Hospital Initiative and moving towards the Baby-Friendly Community Initiative, with the stated ambition of becoming the first province in Pakistan\u2014and among the first in the region\u2014to introduce the community-based model<\/p>\n
The distinction matters<\/p>\n
A mother can receive excellent advice inside a hospital and still struggle to follow it once she returns home<\/p>\n
Breastfeeding is influenced by family practices, workplace conditions, social expectations and the availability of support. Taking the initiative into communities acknowledges that healthy behaviour cannot be created by medical advice alone<\/p>\n
It has to be supported by the environment in which people live<\/p>\n
Building nutrition into the health workforce<\/p>\n
A policy can only be as strong as the people who deliver it<\/p>\n
KP has therefore worked with academia and UNICEF to harmonise nutrition curricula across BS\/MS and allied health sciences programmes<\/p>\n
The effort seeks to ensure that nutrition is not treated as a narrow specialisation, but becomes part of the professional knowledge of doctors, nurses and allied health workers<\/p>\n
The province has also established a Centre of Excellence for Nutrition and Child Development at Khyber Medical University, creating a platform for research and evidence generation<\/p>\n
This could prove particularly valuable<\/p>\n
Pakistan does not need only more nutrition campaigns. It needs more answers to practical questions: Which interventions work best in which communities? What reaches mothers in remote areas? Which approaches are affordable at scale? What survives a flood, an economic shock or a disruption in health services?<\/p>\n
Local research can turn those questions into evidence<\/p>\n
From programmes to learning<\/p>\n
That principle is visible in KP\u2019s operational research on multi-micronutrient supplementation in Swabi, undertaken with support from Nutrition International<\/p>\n
The importance of such research goes beyond one district or one supplement<\/p>\n
Public policy improves when governments are willing to test their assumptions<\/p>\n
A programme that looks effective on paper may encounter very different realities in the field. Mothers may face transport problems. Health workers may be overstretched. Supplies may arrive late. Families may have concerns about a particular intervention<\/p>\n
Research allows policymakers to see those gaps\u2014and, ideally, fix them<\/p>\n
The food people already eat matters<\/p>\n
Not every nutrition problem can be solved by asking families to change their diets<\/p>\n
For millions of households, affordability is part of the equation<\/p>\n
That makes food fortification an important part of KP\u2019s strategy<\/p>\n
The province\u2019s programmes include Universal Salt Iodisation, wheat flour fortification and oil fortification, targeting micronutrient deficiencies through foods already consumed by large sections of the population<\/p>\n
It is a different kind of intervention: instead of asking every household to acquire a new product or adopt an entirely new habit, essential nutrients can be delivered through commonly consumed foods<\/p>\n
The principle is particularly relevant in a province where poverty and food insecurity can limit the choices available to families<\/p>\n
Nutrition beyond the health department<\/p>\n
KP\u2019s approach has also moved into schools and social protection<\/p>\n
The province is pursuing school-age deworming for children aged 5 to 14, while nutrition has been incorporated into the Integrated Health Project<\/p>\n
Through SUN-KP, the Scaling Up Nutrition platform, and the province\u2019s Multi-Sectoral Integrated Nutrition Strategy, nutrition is being connected with sectors beyond health<\/p>\n
The logic is straightforward<\/p>\n
A health department can treat a malnourished child. It cannot, by itself, determine the price of food<\/p>\n
A doctor can recommend handwashing. A doctor cannot build a water system<\/p>\n
An agriculture department can increase food production. It cannot guarantee that a poor family can afford a diverse diet<\/p>\n
Nutrition sits at the intersection of all three<\/p>\n
That is why the province\u2019s KP-SPRING\u2014Khyber Pakhtunkhwa Stunting Reduction Integrated Nutrition Gain\u2014and other nutrition-sensitive initiatives are significant not simply as programmes, but as attempts to make different parts of government work towards a common outcome<\/p>\n
Protecting children when crisis strikes<\/p>\n
For KP, emergency preparedness cannot be separated from nutrition policy<\/p>\n
The province has developed a Nutrition Emergency Response Plan and maintains an Emergency Nutrition Cluster Coordination mechanism<\/p>\n
It has been activated during major emergencies, including COVID-19 and the floods of 2022 and 2024<\/p>\n
This matters because disasters rarely affect all families equally<\/p>\n
A household already struggling with food insecurity can be pushed into severe nutritional vulnerability by a flood, displacement, disease outbreak or sudden loss of income<\/p>\n
For children, deterioration can happen quickly<\/p>\n
A nutrition response therefore cannot begin after a crisis has already disrupted food supplies and health services. It has to be designed before the emergency arrives<\/p>\n
Where social protection meets nutrition<\/p>\n
There is perhaps no clearer example of the connection between household economics and nutrition than the BISP Nashonuma Programme<\/p>\n
The programme links conditional cash transfers with maternal and child nutrition, targeting vulnerable BISP-registered pregnant and lactating women and children under two<\/p>\n
Its significance lies in the connection it makes between two issues that governments have often treated separately: poverty alle<\/p>\n
Cash support can help a family meet immediate needs. When that support is linked to maternal and child health and nutrition, it can also become an investment in the next generation<\/p>\n
The idea deserves attention well beyond nutrition policy<\/p>\n
The real test is reach<\/p>\n
There is, however, a point at which innovation must give way to implementation<\/p>\n
KP has developed a substantial architecture around nutrition. But a programme established in Peshawar is only as successful as its ability to reach a mother in a remote district<\/p>\n
The province\u2019s burden also remains high, particularly in the newly merged districts<\/p>\n
This is where the next chapter becomes more difficult<\/p>\n
Can these interventions be sustained?<\/p>\n
Can district-level health systems deliver them consistently?<\/p>\n
Can nutrition remain a priority when fiscal pressures increase?<\/p>\n
Can data tell policymakers not only what has been achieved, but who is still being left behind?<\/p>\n
And can successful experiments move from pilots and projects into routine government systems?<\/p>\n
These questions are more important than another announcement<\/p>\n
A different way of thinking<\/p>\n
Khyber Pakhtunkhwa is not the first place to discover that malnutrition is complex<\/p>\n
What is noteworthy is the range of mechanisms it is putting together to address that complexity<\/p>\n
Nutrition markers in development planning<\/p>\n
Nutrition in professional curricula<\/p>\n
A research centre focused on nutrition and child development<\/p>\n
Breastfeeding support in hospitals and communities<\/p>\n
Maternal and adolescent supplementation<\/p>\n
Community management of acute malnutrition<\/p>\n
Food fortification<\/p>\n
School-age deworming<\/p>\n
Social protection linked to nutrition<\/p>\n
Emergency nutrition planning<\/p>\n
And a multi-sectoral structure that attempts to bring different departments into the same conversation<\/p>\n
Taken individually, none of these measures can transform a province\u2019s nutritional profile<\/p>\n
Together, they suggest a more ambitious proposition: that nutrition should not be treated as a programme sitting inside government, but as an outcome that government as a whole must help produce<\/p>\n
That may be the lesson KP can offer the rest of Pakistan<\/p>\n
The province should not claim victory. The numbers do not permit it, and the unfinished work is too large<\/p>\n
But there is value in demonstrating that a different approach is possible<\/p>\n
The ultimate measure will not be the number of strategies written, centres opened or initiatives announced<\/p>\n
It will be whether a girl enters adulthood better nourished<\/p>\n
Whether a mother enters pregnancy healthier<\/p>\n
Whether a newborn receives the right start<\/p>\n
Whether a child grows without the invisible burden of chronic undernutrition<\/p>\n
And whether the institutions around that child are strong enough to protect those gains when the next crisis comes<\/p>\n
Malnutrition may begin before a child can speak<\/p>\n
The response, therefore, has to begin before the problem becomes visible<\/p>\n
That is the real promise\u2014and the real test\u2014of Khyber Pakhtunkhwa\u2019s nutrition experiment<\/p>\n
This content is produced in paid partnership with the Khyber Pakhtunkhwa (KP) government – a partner of DawnMedia\u2019s Act for Nutrition initiative<\/p>\n","protected":false},"excerpt":{"rendered":"
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