Nutrition Policy in the Post-devolution Context in Pakistan: An Analysis of Provincial Opportunities and Barriers*

Abstract

In this article we take a comparative look at strategic opportunities and barriers for action on nutrition in Pakistan's four provinces in the post-devolution context. Provinces have faced historically common constraints of lack of a comprehensive policy and minimal allocations by the state, driven by low visibility of nutrition, siloed working of sectors and weak coalitions. Provinces also face common contextual impediments of poverty, patriarchy, and inadequate health and WASH coverage, with two provinces also constrained by inequitable power structures. Recent focusing events have provided a window of opportunity to the provinces for action on nutrition leading to definite movement towards horizontal coordination for nutrition, upscaled funding and stronger vertical integration. However, there are variations in the extent of coalition building on nutrition, supportive leadership, governance and community outreach. The Pakistan experience shows that strategising for nutrition needs to move beyond a closely tailored national policy to accounting for sub-national potential and constraints.

Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks

“…These groups often vary in their expertise, available resources, advocacy strategies, and functional roles within NANs. Global actors, typically international organizations (eg, WHO, UNICEF, and World Bank), donor agencies (eg, USAID, DFID, JICA, and CIDA), and global initiatives (eg, SUN, GAIN, and MNI), were also often seen as important drivers of NANs . Several global initiatives (eg, SUN) have been explicitly designed to “foster country ownership and broad stakeholder engagement in policy development and implementation” and have been seen as important in galvanizing the formation of multisector nutrition networks .…”

“…The expansion of donor or government nutrition budgetary commitments, adequate funding, and effective financing have enabled many NAN activities . In contrast, inadequate financing, or the failure to effectively utilize or administer financial resources, is a major challenge for NANs . Inadequate nutrition budgets have undermined their human, technical, and administrative capacities.…”

“…A number of factors were found to reinforce food bias. This includes events (eg, drought, conflict, and economic crises) that stimulate food distribution responses but not longer‐term “development nutrition,” when food distribution or pricing was an entrenched electoral issue (ie, food and not nutrition‐related initiatives bring in more votes) or when food distribution schemes were strongly institutionalized and resistant to change . The agri‐food paradigm of “productivism” also appears to reinforce food bias.…”

“…Also when strong incentives have existed for coordinated multisector/multilevel action including well designed polices, operational plans and enabling legislation, shared and sector‐specific goals, performance measures, and performance or results‐based budgeting (ie, multisector/multilevel resource transfers) . Coordinating bodies were potentially less effective when having limited capacities and resources (often when responsibility was located within politically weaker line ministries, eg, ministries of health, agriculture, and gender), when overly‐focused on technical work but not on advocacy for sustained attention and resources, and when NANs have possessed limited capacities for managing conflicts during policy processes . For example, in Bolivia, despite the early successes of the Zero Malnutrition initiative at coordinating actions and mobilizing financial resources, a failure to advocate for sustained political attention and administrative commitment led to its demise …”

“…45,48,56,94 In contrast, inadequate financing, or the failure to effectively utilize or administer financial resources, is a major challenge for NANs. 44,45,61,65,88,[95][96][97] Inadequate nutrition budgets have undermined their human, technical, and administrative capacities. Major reported challenges have included a lack of training providers, trained nutrition professionals and administrators, as well as high staff turnover.…”