Pakistan National Nutrition Cluster Preparedness and Response Plan
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National Nutrition Cluster 3 July 2013 Pakistan National Nutrition Cluster Preparedness and Response Plan The National Nutrition Cluster Preparedness and Response Plan is a common framework to guide the actions of all partners in the nutrition sector in the event of a disaster. It does not replace the need for planning by individual agencies in relation to their mandate and responsibilities within clusters, but provides focus and coherence to the various levels of planning that are required to respond effectively. It is envisioned that the Preparedness and Response Plan is a flexible and dynamic document that will be updated based on lessons learnt in future emergency responses. Each Provincial Nutrition Cluster will develop a Provincial Nutrition Cluster Preparedness and Response Plan, in cooperation with the Provincial Disaster Management Authority (PDMA) and the Department of Health (DoH). The Provincial Plans are stand-alone documents, however are linked and consistent with the National Plan. 1. Background The 2011 Pakistan National Nutrition Survey confirmed that Pakistan’s population still suffers from high rates of malnutrition and that the situation has not improved for several decades. Two out of every five (44 percent) of children under five are stunted, 32 percent are underweight and 15 percent suffer from acute malnutrition.1 Maternal malnutrition is also a significant problem; 15 percent of women of reproductive age have chronic energy deficiency. Women and children in Pakistan also suffer from some of the world’s highest levels of vitamin and mineral deficiencies. The malnutrition rates are very high by global standards and are much higher than Pakistan’s level of economic development should warrant. Moreover, the rate of decline in malnutrition in Pakistan appears to be slower than in other countries in the region. Based on current trends, Pakistan is not on track to achieve Millennium Development Goal of halving the 1990 level of malnutrition by 2015. Food insecurity and under nutrition are largely a problem of inequitable access by the poorest and most vulnerable to an adequate and diverse diet. Low nutrition indicators are also an outcome of poor education and low levels of knowledge about infant and young child diet and healthcare. Frequent childhood illness is also a contributing factor, especially illnesses such as diarrhea, measles and pneumonia. Of all the provinces in Pakistan, Sindh and Balochistan are the most vulnerable to food insecurity. Almost three quarters of families in Sindh and two thirds of those in Balochistan are considered food insecure.2 Emergencies exacerbate the underlying nutrition crisis in Pakistan. The 2010, 2011 and 2012 monsoon floods intensified malnutrition for populations that were already suffering from emergency levels of malnutrition 1 All nutrition figures from the draft National Nutrition Survey 2011. 2 Situation Analysis of Children and Women in Pakistan (October 2011) 1 National Nutrition Cluster 3 July 2013 before these disasters hit3 and will continue to be a significant factor in the high morbidity and mortality rates of children in Pakistan. In Khyber Pakhtunkhwa (KP) and the Federally Administered Tribal Areas (FATA), the NNS 2011 found a Global Acute Malnutrition (GAM) rate of 19.3 percent and 10.0 percent respectively. The nutrition situation of the approximately 1.1 million Internally Displaced People (IDPs) in this region is of particular concern. A Multi-Cluster Rapid Assessment Mechanism (McRAM) conducted in March 20104 of IDPs residing with host communities in Kohat and Hangu Districts found a very high GAM rate of 18.2 percent and a Severe Acute Malnutrition (SAM) rate of 10.3 percent. Further, 21 percent of mothers had stopped breastfeeding, and 24 percent reported a reduction in the frequency and rate of breastfeeding and feeding practices since the displacement. Food insecurity indicators were poor: more than 70 percent of the IDPs reported non- availability of food stock and 27 percent reported having food stock for less than one week. In April 2013, a rapid assessment was conducted to assess the situation following a new influx of IDPs from the Tirah Valley, Khyber Agency. This assessment found a similar rate of women had reduced or stopped breastfeeding as to the 2010 McRAM assessment (21 percent); and 83 percent cited a reduction in breast milk as the primary reason for the change, potentially due to stress or sickness in the mother.5 Due to further vulnerabilities associated with IDP populations and their hosting communities including lack of safe drinking water and sanitation facilities, food insecurity, and inadequate health services, the acute malnutrition rate is expected to continue to exceed emergency thresholds. A SMART methodology survey is planned for August and September 2013 to further investigate the prevalence of malnutrition in IDPs and their hosting communities in seven districts of KP and FATA. 2. Planning Scenario and Assumptions The planning scenario for the Nutrition Cluster Plan is aligned with the agreed approach by the Humanitarian Country Team (HCT) to use benchmarking figures for a non-defined disaster scenario where there between 100,000 to 5 million people affected6, to provide an estimation of the requirements to respond effectively with life-saving nutrition interventions in a timely manner to a disaster in Pakistan. The target caseloads of beneficiaries for the highest threshold of 5 million people affected is outlined in table 5, page 16. The main disaster scenarios are outlined below. Monsoon In 2010, the country experienced super-floods, which affected the country on the North-South and East- West axis. Then, in both 2011 and 2012, the impact of the Monsoon was most significant in Sindh and in some areas of Balochistan and Punjab, although all provinces and territory were affected. A number of hydrological threats are possible during the Monsoon season, such as riverine floods, flash floods, glacier melt outflow, glacier lake outflow (GLOF), and irrigation/drainage breaches. Cyclones & Tropical Storms Pakistan is prone to cyclones and tropical storms. This season lasts from May to August, and overlaps the Monsoon season. All coastal districts of Balochistan and Sindh are at risk, with the possibility of impact further inland also. Major port cities of Karachi and Gwador risk being heavily impacted. 3 Multi sector needs assessment (Nov 2011) 4 The Multi-Cluster Rapid Assessment Mechanism (McRAM) 2010 5 Inter-Organization Rapid Assessment, Displacement from Tirah Valley, Khyber Agency April 2013 6The five planning assumptions are affected population numbering: 100 000, 500,000, 1 million, 2 million and 5 million people. 2 National Nutrition Cluster 3 July 2013 Drought Traditionally, areas in Pakistan have suffered drought conditions. Extensive canals and irrigation channels throughout the country enable water flow to areas affected. However, lack of maintenance and repairs has rendered many of the smaller systems unusable and prone to overflow, breaching or blockage. In Pakistan a variety of crops (rice, wheat, cotton, vegetables, sun flowers) are grown, which are impacted by drought conditions. The livestock herds also bear an impact in drought conditions. Earthquakes Pakistan lies on a number of fault lines. There is a long history of tectonic activity, with the earthquake in Balochistan, 2007, and Muzaffarabad, 2005, the most significant in recent times. There are constant quakes, predominantly in the Balochistan area, which due to the lack of population concentration and depth of the epicentre have limited impact. However, this remains a constant risk. Conflict Since July 2008, Pakistan’s north-western areas of KP and FATA have experienced major displacements of populations as a result of insecurity. As the security context has fluctuated across different districts and agencies of KP and FATA respectively, so too have the patterns of displacement and return. Currently it is estimated that there are 1.1 million IDPs residing in communities in the districts of Peshawar, DI Khan, Tank, Hangu, Kohat, Nowshera and Kurram Agency. Pandemic Population concentration in Pakistan indicates a risk in public health terms. Vaccine preventable illnesses continue to cause significant impact, with cases of Polio and Measles still prevalent. Dengue and malaria peak seasonally, with areas such as northern Sindh and Punjab at most risk. Lack of sufficient health care services decreases the population’s ability to fight infection, and low vaccine uptake limits immunity. Planning Assumptions There are a number of important planning assumptions, including: Humanitarian contributions to the response will be determined as a consequence of coordinated planning with government counterparts, and only after the Government’s request for support; In the most likely scenario, the HCT will plan to support approximately 30 percent of the affected population; The Government will provide the initial response, and will call on the international community to assist, if needed and as appropriate; There is limited capacity of the Government to implement management of acute malnutrition services; Already existing instances of malnutrition, food insecurity and disease, as well as lack of proper basic infrastructure and facilities, will compound the impact of any crisis; There is often a time-lag for acute malnutrition to increase in a population following a disaster, thus the malnutrition levels must be closely monitored and the response phase