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 may be extended beyond that of other sectors;  Activities that promote the prevention of acute malnutrition must be implemented with treatment of acute malnutrition programs;  Disaster Risk Reduction (DRR) principles underpin the response, by supporting the most vulnerable people within a community, supporting community resilience and coping strategies, and improving capacities through improved nutrition and wellbeing.  Response planning must take into account 2010, 2011 and 2012 flood impact and coping mechanisms utilized by vulnerable populations (especially women);

3 National Nutrition Cluster 3 July 2013

 Insecurity will challenge the response to any crisis;  Access constraints can hamper humanitarian response such as limited access to affected areas due to standing water, freedom of movement due to No Objection Certificate (NOC) requirements.

3. Nutrition Cluster Goal and Objectives

Goal To reduce mortality and morbidity by the timely identification and appropriate management of acutely malnourished children (6-59 months) and pregnant and lactating women (PLW).

Objectives I. To ensure the provision of lifesaving nutrition services for acutely malnourished children (boys and girls 6-59 months of age)

II. To ensure the provision of lifesaving nutrition services for acutely malnourished PLW;

III. To control and prevent micronutrient deficiencies among children aged 6-24 months and PLW;

IV. To protect and promote appropriate infant and young child feeding (IYCF) practices through strengthening caring capacity of family members, and health care providers both at community and facility levels;

V. To protect breastfeeding by prevention of donation and distribution of breast-milk substitutes in emergency affected areas;

VI. To strengthen capacity for effective implementation of nutrition interventions and ensure effective and timely implementation of nutrition interventions through enhanced coordination and information management, and monitoring of trends including the status of malnutrition in the affected population.

The planned preparedness and response actions to achieve the objectives and contribute to the overall goal are outlined in sections 9 and 10.

Guiding principles The Nutrition Cluster is guided by the following principles:

 Humanitarian Principles  Principles of Partnership  Sphere Standards  National CMAM guidelines  Global Nutrition Cluster guidelines

4. Nutrition Cluster Members and Structure

The National Nutrition Cluster is represented by 29 organizations including the National Disaster Management Authority (NDMA), International and National Non-Government Organizations (I/NGOs), UN Agencies, and donors. The Cluster Lead Agency (CLA) UNICEF chairs the Nutrition Cluster, and the NDMA focal point for nutrition is co-chair during a declared emergency.

4 National Nutrition Cluster 3 July 2013

In May 2013 there are active clusters in KP/FATA, Balochistan and Sindh Provinces. In Punjab, a nutrition coordination mechanism is in place that can transform into the Nutrition Cluster in the event of a declared disaster by the NDMA/PDMA.

On March 31, 2013, the NDMA withdrew as co-chair of the national clusters. This date coincided with the conclusion of the 2012 Monsoon Humanitarian Operation Plan for the flood response in Punjab, Balochistan and Sindh Provinces. At the Provincial Level, the PDMA and the Department of Health (DoH) remain active members of the Nutrition Clusters.

There are a number of challenges relating to disaster management in Pakistan and the structure of the Nutrition Cluster. The National Disaster Management system is largely decentralized from the NDMA to the PDMAs and DDMAs, and there is nascent capacity within the disaster management authorities for nutrition. The DoH in each Provence has established a nutrition cell that contributes to the nutrition cluster in a technical capacity. However, there is no line ministry that is directly involved in the Nutrition Cluster at the National Level, since the devolution of the central Government and the abolishment of the MoH in 2011. The result is a nutrition cluster structure that is largely independent in each Provence, working with a number of Government counterparts from the DoH and the PDMA. The National Cluster provides technical oversight and operational support to the Provincial Clusters as required, while leading strategic direction, standards and guidelines development.

The full contact list for the Nutrition Cluster is attached in annex 1.

Figure 1: Nutrition Cluster Structure in Pakistan

National Nutrition Cluster, Islamabad Co-chaired by NDMA

Punjab Nutrition Khyber Pakhtunkhwa NC. Sindh NC, Balochistan NC, Coordination, Co-chaired by DoH/PDMA Co-chaired by DoH and PDMA Co-chaired by DoH Co-chaired by DoH

5. Nutrition Cluster Management and Coordination

5.1. Nutrition Cluster Roles and Responsibilities

5.1.1 Government

The NDMA co-chairs the Nutrition Cluster only when there is a declared emergency resulting from a natural disaster, for example during the 2012 floods and for the duration of the Monsoon Humanitarian Operational Plan (MHOP). In the event of a declared disaster in 2013 the NDMA focal point will resume the role of co- chair.

5 National Nutrition Cluster 3 July 2013

5.1.2 Cluster Coordinators and Information Management Officers

The Nutrition Cluster Coordinators (NCCs) are responsible for leading the Nutrition Cluster in Pakistan, facilitating a timely and effective nutrition response and ensuring that the capacity of Government and other Nutrition Cluster Partners is strengthened. Further, the NCCs must ensure that the specific concerns and challenges that cannot be solved within the Nutrition Cluster are raised and properly discussed at the HCT, and that ensuing strategic decisions are shared and acted upon at the operational level.

In Pakistan there is currently one dedicated NCC at the National Level, on a six month standby-partner deployment. Four Provincial level NCCs are double-hatting as UNICEF programme staff. In the event of an emergency affecting 5 million people, surge support NCCs at the Provincial level with a number of affected districts will be required.

The Information Management Officers are responsible to facilitate and guide the Nutrition Cluster towards a reliable and predictable response through the provision of evidence based strategic and operational information. The IMO compiles inventories of needs and response that lead to a repeatable situational analysis of service gaps. The IMO facilitates coordination, information sharing, and reduces duplication through technical standards.

There is currently cluster IMO’s in Balochistan, KP, Sindh and Islamabad. The IMOs undertake UNICEF programme tasks concurrently. In Balochistan, the IMO is housed within the Nutrition Cell of the DoH. Surge IMO support will also be required in the event of a large scale disaster. The Cluster IMO at the National level is tasked with providing capacity building to the Provincial IMOs, based on a capacity development plan.

5.1.3 UN agencies

UNICEF is the Cluster Lead Agency (CLA) for Nutrition at the Global level, and has been designated the CLA by the Humanitarian Coordinator (HC) in Pakistan. UNICEF has the responsibility as the CLA to ensure inclusion of key humanitarian partners, establish and maintain humanitarian coordination, lead planning, strategy development, advocacy and resource mobilization within the nutrition sector. Further, UNICEF is responsible for acting as the provider of last resort (subject to access, security and availability of funding) to meet agreed priority needs. The TOR for the CLA can be accessed from the following site: Cluster Lead TOR

Operationally, UNICEF is responsible for the management of severe acute malnutrition (SAM) in the community through the Outpatient Treatment Program (OTP) and will provide therapeutic nutrition supplies, measuring equipment and essential drugs needed for systematic treatment.

World Food Programme (WFP) is responsible for the management of moderate acute malnutrition (MAM) through the Supplementary Feeding Programme (SFP) component of the CMAM and will provide the supplementary food for the target MAM children and PLW, including transportation and warehousing. Capacity strengthening on MAM management will be ensured. Additionally, where required, General Food Distribution (GFD) in food insecure areas will be undertaken to complement the emergency nutrition interventions. Further, WFP, together with FAO is co-chairing the Food Security Cluster.

World Health Organization (WHO) is responsible for the management of SAM children with complications who require in-patient management in a Stabilization Center (SC). Technical support is provided by WHO to the respective Department of Health of the provinces for the implementation of various activities of nutrition in the Provinces. Nutrition SCs are run by the health departments of the Provinces with the support of WHO. A Health and Nutrition Sentinel Site Surveillance System is also established in the provinces to monitor the trends of malnutrition in the population. Two sentinel sites are selected in the districts based on pre-specified criteria. Surveillance tools are completed by the Lady Health Workers and health care

6 National Nutrition Cluster 3 July 2013 providers and this data is analyzed and report of trend of malnutrition of the districts shared with relevant stakeholders.

Food and Agriculture Organization (FAO) is co-lead of the Food Security Cluster. In order to reduce vulnerability, improve food production, income generation, and increase resilience to shocks in rural communities affected by disaster and conflict affected districts of Pakistan, FAO is implementing various food security projects. The main activities include: horticulture (vegetable and fruit production), crop production, livestock support, fishery related activities, capacity building of farmers for crop, vegetable and livestock production and marketing, range land improvement and water harvesting and conservation.

5.1.4 INGOs and NGOs

INGO and NGO Nutrition Cluster partners implement the majority of emergency nutrition interventions in Pakistan. Independently or in partnership with UN Agencies or DoH, I/NGOs will implement the emergency nutrition interventions in areas with response gaps, with particular focus on the thematic areas of OTP, SFP and infant feeding in emergencies. I/NGOs will also manage SC’s where there is a need.

5.2 Intra-Cluster Coordination

The Nutrition Cluster meets each month, and more often as required during the emergency phase. The National NCC facilitates the meetings, held at different partner office locations each month. The meeting minutes are circulated to all partners and uploaded to the cluster webpage.

5.2.1. UN agencies The UN agencies responsible for supporting the components of the CMAM are tasked with ensuring that there is regular and effective coordination amongst the three UN partners to ensure that the operational challenges are addressed and that the processes that enable implementation of nutrition services by the implementing partners are both functional and facilitate timely implementation in an emergency situation. Senior nutrition staff from WFP, WHO and UNICEF will meet in Islamabad at minimum on a bi-monthly basis, with facilitation support from the NCC. This coordination meeting outputs will be shared with the nutrition cluster partners.

5.2.2 Nutrition Cluster Joint Actions

CMAM working group A small technical group, led by MERLIN is responsible for progressing priority tasks to improve the CMAM program. The priority tasks identified in April 2013 include updating the 2009 National CMAM guideline, supporting CMAM evaluations, and developing standardized tools and work-plans for joint monitoring of CMAM program sites. The CMAM group will meet on a needs-basis, starting in May 2013.

IYCF working group The IYCF working group, led by Save the Children, is tasked with progressing cluster IYCF initiatives. This will include documenting best practices in IYCF in emergencies, improving the IYCF component of the National CMAM Guideline and integrating agreed IYCF indicators into routine data collection in the NIS. The IYCF group will meet on a needs-basis, starting in May 2013.

NIS and IM working group The NIS working group, led by the UNICEF NIS specialist/Nutrition Cluster IMO is responsible for reviewing and improving the NIS, and ensuring that there is a pool of Information Managers from the Nutrition Cluster partners that are skilled in the NIS and can provide technical support to all Implementing Partners. The working group is also tasked with promoting complementarity and alignment amongst the NIS and other

7 National Nutrition Cluster 3 July 2013 sources/databases of nutrition information. The NIS working group will meet on a needs-basis, starting in May 2013.

Project Vetting Committee The project vetting committees are established, as required, at the Provincial level and are composed of the Cluster Government Counterpart, the National and Provincial Nutrition Cluster Coordinators, UNICEF, WFP, WHO and a representative from the NGO, and INGO’s. Organizations submit a concept note and budget to the committee, which are then reviewed and projects are awarded based on merit. A standardized project vetting template is used to assess the project proposals. Further, the NCC’s will be trained by OCHA in applying the gender marker in this process.

5.2.3 Coordination Linkages between the National and Provincial Levels The coordination between the National and the Provincial Level Nutrition Clusters is a primary responsibility of the National NCC. In times of preparedness, the NCC will communicate on a regular basis with the Provincial NCC’s, including monthly Skype/teleconference meetings. When there is an active emergency, the National NCC will be directly supporting the Provincial NCC as required and communicating daily.

The coordination of information management is overseen by the National IMO, who is in direct weekly contact with the Provincial IMOs for the collection of Nutrition Cluster data and information that informs the Nutrition Cluster IM products such as situation reports, 4Ws, maps, contact lists etc.

5.3 Inter-Cluster Coordination

The Nutrition Cluster participates in the Inter-Cluster Coordination Meetings (ICCM) chaired by OCHA Islamabad, the Humanitarian Country Team (HCT), chaired by the HC and relevant cross-cluster meetings such as the Assessment TWG. The Nutrition Cluster will coordinate closely with the Food Security, WASH, Health and Protection Clusters to ensure that there is high complementarity between the Nutrition Cluster and the Clusters most closely related to effective delivery of emergency nutrition interventions.

A working group between the Food Security and Nutrition clusters, first formed in December 2012, is tasked with progressing activities that promote alignment between food security and nutrition interventions, including mapping of intervention areas and collation of data between the two clusters. The working group will meet on a needs-basis, starting in May 2013.

5.4 Integration of Cross Cutting Issues

The Nutrition Cluster aims to integrate cross cutting issues in the emergency response through the timely identification of the most nutritionally at risk groups, based on vulnerability and need. The Cluster strives for effective referral mechanisms for other vulnerable groups not included in the Nutrition Cluster’s response programs, for example education and social services. The Nutrition Cluster will foster partnerships with the Food Security Cluster to strengthen and harmonize nutrition and food security linkages and integrate Disaster Risk Reduction strategies and activities for improved community resilience to disasters. Further, the Nutrition Cluster will seek training on mainstreaming gender into nutrition needs assessment, project design and monitoring and evaluation.

8 National Nutrition Cluster 3 July 2013

6. Information Management, Assessment and Reporting

6.1 Information Management To promote timely and effective Information Management (IM) and information sharing in a disaster, the National and Provincial IMO’s are responsible for close coordination with all cluster partners, the NDMA, PDMA, other line ministries, and the IMO TWG. The following table outlines the primary IM products developed and maintained by the IMO.

Table 1: Cluster Information Management Products

Product Updated Location/sharing Contact lists Weekly IMO and website Meeting minutes Monthly IMO and website 4W’s matrix Monthly IMO and website Needs gaps analysis Monthly IMO and website Funding status Monthly IMO and website Nutrition Cluster Bulletin Bi-monthly Emailed and website Maps of CMAM sites Monthly Emailed and website Success stories Quarterly Website Assessments and surveys As required Emailed and website

6.1.1 Nutrition Information System Nutrition Information System (NIS) is a tool use for the data collection, analysis and reporting of nutrition related activities like CMAM, IYCF, micronutrient supplementation and blanket distribution. This is a cluster tool used by all implementing partners. This system is being used in FATA, KP and Sindh Provinces for nutrition activities and around 700 people have been trained on this system so far in Pakistan. All implementing partners are responsible to update the system on a weekly basis and share with the Provincial cluster IMO. For accurate reporting, the cluster IMO is responsible for supporting the Implementing Partners and Government counterparts to use the NIS.

The NIS is being reviewed in the preparedness phase to address inconsistencies and small errors. This review is led by the NIS TWG. The short-term strategy for the NIS is as follows:

 The NIS will be a complete data source, inclusive of all relevant nutrition information in Pakistan.  The NIS will be accessible to all partners, and partners can use the NIS data to generate reports at any- time from any location.  The NIS will use the latest tools and technology to deliver a high quality product to the nutrition cluster partners.  The NIS maintenance will be sustainable, led by a group of technical specialists from at least four organizations that are responsible for maintaining, improving and training other partners in its use.  There will be a schedule for implementation of comprehensive training of the NIS to all Provinces, through a Master Trainer approach, and monitoring of the training implementation and capacity of staff trained in NIS  The NIS will have a flexible format, to cater to a range of capacity levels. For example the ‘NIS simple format’.  The NIS reporting formats will be developed to a very high standard before seeking up-take by the Government counterparts.

The longer term vision is for the NIS to be integrated into the Government health information system. The NIS TWG is meeting regularly, led by UNICEF.

9 National Nutrition Cluster 3 July 2013

6.2 Assessments

6.2.1 Rapid Assessment Information in the first 72 hours an emergency is critical to inform the initial response priorities, and enable the Nutrition Cluster Partners to access humanitarian funding. The HCT has endorsed the Multi-Cluster Initial Rapid Assessment (MIRA) methodology, which is designed to identify strategic humanitarian priorities in the initial emergency phase. OCHA, in cooperation with the NDMA and the Clusters will finalize a revised Rapid Assessment Tool in June 2013.

The collection of useful nutrition information in rapid assessments is limited due to the difficulty in obtaining potentially sensitive information about infant and young child feeding practices from male key informants. For various reasons, it is not always possible to include MUAC in a rapid assessment, which can provide an indication of the level of acute malnutrition in the affected population. Further, there is often a time-lag between the onset of an emergency and worsening indicators of malnutrition, depending on the pre- emergency nutritional status of the population and the speed and effectiveness of the emergency response to provide/restore essential services.

As such, it is of particular importance to the Nutrition Cluster to have reliable and readily accessible secondary data to inform the needs of the affected population in the first phase of the emergency. Information that is available is summarized in Table 2. A map of nutrition assessments that have been conducted from 2000-2013 is attached in Annex 3 and the assessment reports are available on the Nutrition Cluster website.

Table 2: Secondary Information Sources/Fundamental Operational Datasets Dataset Status Characteristics Source Populations Completed, 1998 Area /sex/household http://www.census.gov.pk statistics size disaggregation WHO Health and Monthly reports – District level Community level data Nutrition Sentinel vulnerable districts disaggregation Available from WHO Site Surveillance System National Nutrition Survey completed, Provincial level Soft copy available from the Cluster Survey, 2011 report draft disaggregation IMO

CMAM project Updated weekly UC level Nutrition Information System screening Data disaggregation SMART Surveys Completed Dependent on survey http://pak.humanitarianresponse.info /clusters/nutrition

Flood Affected Areas Completed in flood Dependent on survey FANS 2010 Report Nutrition Survey affected districts of http://pak.humanitarianresponse.info 2010 2010 /clusters/nutrition

4Ws Updated monthly UC levels http://pak.humanitarianresponse.info /clusters/nutrition

Districts Profile Updated District levels http://en.wikipedia.org * Contact list Updated monthly n/a http://pak.humanitarianresponse.info /clusters/nutrition

* In en.wikipedia.org, enter district name in search text field area and the complete profile of the particular district is available.

10 National Nutrition Cluster 3 July 2013

The IMO will be responsible for rapid analysis of the relevant secondary information, and triangulating other initial information from NDMA, PDMA, OCHA and Nutrition Cluster partners present in the affected areas.

6.2.2 Detailed Nutrition Assessment Following a disaster and where more detailed nutrition information in needed to inform the response, the Nutrition Cluster will implement a detailed nutrition assessment based on the Standardized Monitoring and Assessment of Relief and Transitions (SMART) Methodology. The SMART Methodology provides a basic, integrated method for assessing nutritional status and mortality rate in emergency situations, and provides the basis for understanding the magnitude and severity of a humanitarian crisis. The optional food security component provides the context for nutrition and mortality data analysis.

A number of Cluster partners have extensive experience in implementing survey using SMART methodology, including UNICEF, Merlin, ACF and Save the Children. Where there is need to conduct a detailed nutrition survey, the Nutrition Cluster forum will provide a forum for coordination of the assessment timing, areas and resources, analysis and reporting.

As much as possible, the Nutrition Cluster will coordinate closely with other clusters in the planning and implementation of the detailed assessment to promote resource sharing and reduce assessment overlaps.

6.3 Reporting

There is no dedicated reporting officer in the Nutrition Cluster. In the event of a disaster that affects multiple Provinces, the National NCC is responsible for providing information to OCHA on the needs, responses and gaps of the nutrition response for the Humanitarian Situation Report (SITREP). In the event of a disaster that affects one Province only, the Nutrition Cluster inputs for the SITREP will be sent directly from the Provincial NCC to the OCHA field office, with support as required from the National NCC.

It is the responsibility of the National NCC and IMO to develop a Nutrition Bulletin for reporting to Nutrition Cluster Partners and the donor community on the activities of the Nutrition Cluster. The Bulletin is released bi-monthly, and summarizes progress against targets, and Nutrition Cluster key activities in the previous months. In a disaster, the bulletin will be compiled and released on a monthly basis.

7. Human Resources

The Nutrition Cluster Partners report the following Human Resources available in Pakistan and available through surge support and other emergency recruitments.

Table 3: Human Resources and Capacity Mapping

Organization Availability in Pakistan Surge Capacity Additional Resources Needed7 UNICEF 5 NCCs, 4 IMOs Yes – Standby Partner At least 4 additional 3 Emergency Nutrition Programme Roster, Regional and programme staff to enable Staff HQ staff. the 4 CC’s who are double hatting to become dedicated CC’s. Two additional IMOs.

7 Additional resources needed for a disaster where 5 million people require humanitarian assistance

11 National Nutrition Cluster 3 July 2013

WFP 1 Nutrition Specialist, 5 Yes- 1 Programme 1 Emergency coordinator Programme Officer (Nutrition), 7 Advisor, 1 programme with 5 additional Programme Assistants (Nutrition), 1 Officer Nutrition, programme staff would be Programme Assistant M & E- Regional & HQ staff, required to cope the Database, 30 Field Monitors standby partners on emergency needs roster WHO 9 Nutrition Officers, Yes At least 4 additional staff 4 Data Assistants per each affected province FAO 1 Nutritionist, 1 Agronomist, 2 No No Training Officers, 1 Information Management Officer, 3 Information Management assistants Save the 1 Health & Nutrition Director Yes, Regional Nutrition Sufficient capacity in Children 1 Health & Nutrition Specialist, 1 Advisor and other Pakistan Nutrition Manager, 2 Senior Human Resources in Nutrition Coordinators, 4 Nutrition Pakistan Coordinators, 6 Nutrition Assistants, 2 IYCF Officers and Nutrition teams Merlin 1 National Nutrition Coordinator, 3 Yes 1 roving coordinator is District Nutritionist, 1 NIS required to cope with coordinator, 4 NIS Assistants, 1 emergencies as team lead. Senior health coordinator, 1 Community Outreach Monitoring officer ACF 1 Program Manager, Yes, a maximum of 2 ACF can respond to 3 CMAM Supervisors, 3 CMAM surge support from HQ, emergencies only within Nurses, 3 Community mobilizers dependent on funding existing intervention areas. Additional HR will be recruited based on availability of donor funding. MSF 1 Medical coordinator, 1 Deputy Yes, there is a roster of Capacity is created as need Medical coordinator, 1 assistant to medical staff available arises Medical Coordinator for training for medical activities during disasters, including nutrition. CDO Pakistan 1 Project Coordinator, 1 Yes, from CDO staff in Local staff will be needed Programme Officer, 2 Field Sindh & KP/FATA for project Monitors, 1 data entry operator implementation as per requirement. A new chapter in Gahkuch, District Ghizer will be opened by October 2013 World Vision 1 Integrated Health Specialist, 1 Yes- National & Funding for Nutrition Child Health Advocacy Manager, 3 International World Coordinator, OTP Health & Nutrition Coordinators , Vision Global Technical supervisors, Community 2 Nutrition Coordinators, 2 resource network Mobilisers and volunteers Nutritionists, 3 HMIS officers, 8 Health & Nutrition community

12 National Nutrition Cluster 3 July 2013

mobilisers, 1 Food Programme Manager, CTS Coordinator, 1 Food Assistance Officer Malteser 1 programme coordinator, 2 Yes, from regional and There is the possibility to International program officer for health and HQ offices. move staff to affected nutrition, 2 medical officers, 3 Lady areas from nearby Health Workers, 8 village health program activity areas promoters, 1 community liaison training officer SHIFA 2 CMAM Project Coordinators, 2 Yes in Sindh, KP and Depending on the size of Foundation Monitoring and Evaluation Officers Gilgit-Baltistan area covered and the location, SF will need to either hire staff locally or if available, mobilize teams from already existing field offices. National 5 CMAM project coordinators, 2 Yes- NRSP Head Office, New local project staff will Rural field monitors, 3 social mobilisers, 1 Regional and District be hired during Support NIS officer Offices in all provinces implementation of the Programme of Pakistan including project AJK The 1 Nutrition Coordinator, 2 Yes- Operational Additional local staff will Johanniter Provincial Technical Coordinators,3 coordinators in the be hired for International Nutrition Officers Provincial offices implementation of new Assistance projects depending on availability of funds. Relief 3 Nutrition Project coordinators for Yes, 2 staff from A Program coordinator International four Districts of KP regional/HQ level depending upon the /Relief resource availability Pakistan

International 1 District level Nutrition Manager None Funding for Nutrition Rescue and 1 IMO Coordinator, OTP Committee supervisors, Community (Sindh) Mobilisers and volunteers NGO 2 District level Nutrition Manager None Funding for Nutrition Development and 1 IMO Coordinator, OTP Society supervisors, Community (Sindh) Mobilisers and volunteers HANDS 1 District level Nutrition Manager Nutrition related staff Funding for Nutrition (Sindh) and 1 IMO in HQ Coordinator, OTP supervisors, Community Mobilisers and volunteers

13 National Nutrition Cluster 3 July 2013

8. Supplies

The responsibility for the procurement of nutrition supplies is designated as follows:

UNICEF supplies Ready to Use Therapeutic Foods (RUTF), F75 and F100, essential medicines, multi- micronutrient powder for children and MMN tables for PLW and anthropometric equipment. WFP supplies Wheat Soya Blend (WSB), Supplementary Plumpy/ACHA Mum, High Energy Biscuits and Vegetable Oil. WHO and INGOs can procure contingency stocks, if required.

The Nutrition Cluster has reported contingency stocks available in May 2013, and calculated quantity of supplies required to respond to the planning scenarios of populations ranging from 100,000 to 5,000,000. This spreadsheet is available on the following OCHA site: http://pakresponse.info/Preparedness.aspx

WFP has adequate contingency stock levels to respond to the highest planning figure of 5 million people affected. In case of any urgent needs, the available food stocks can be diverted; however, considering the lead time of at least three months, WFP would need the funds well in advance to replenish the diverted stocks to meet its regular programme requirements.

The current contingency supplies of UNICEF are low, consisting of limited RUTF, chloroquine syrup and ferrous sulphate oral solution drops only. However, there is possibility of transfer of program supplies to an emergency response if the need should arise. In the event of a large scale emergency, emergency supplies can be requested from the regional and global stocks. When supplies are ordered, the lead time is up to eight weeks for arrival, plus potential additional clearance time in Pakistan. Timely procurement of F75 and F100 is particularly difficult, due to low global supplies in 2013. As a contingency measure, WHO has conducted training to SCs for preparation of F75 and F100 from locally available ingredients.

Since 2012 UNICEF has encountered problems in importing several essential medicines. This has adversely affected both the importation of single commodities and whole kits, including kits for Lady Health Workers, Midwifery, Obstetrics, and the standard Inter-Agency Health Emergency Kit. There are three principal issues which have resulted in refusals to grant clearance for UNICEF to import a number of essential medicines and nutritional supplements required for our programme of support to Pakistan:

1. The commodity concerned is not marketed in its country of origin 2. Medicines or kits containing narcotics are banned from importation into Pakistan 3. Medicines manufactured in India are prohibited from importation into Pakistan

The following medicines and kits are currently restricted by the Drug Regulatory Authority (DRA): amoxicillin, iron folic acid tablets, ferrous sulphate (sol), new formula oral rehydration salts, paracetamol, zinc tablets, midwifery kits, IEHK2006, and the obstetrics surgical kit. The restriction on Vitamin A, and multi- micronutrients has been resolved.

9. Preparedness Activities

Due to the frequency and magnitude of disasters in Pakistan, and the highly vulnerable food and nutrition security situation across all areas of country, there is a need for strong focus on both disaster preparedness and disaster mitigation, to lessen the impact of the disaster on the affected community.

Table 4 summarizes the activities that have been identified as a priority by the Nutrition Cluster for disaster preparedness in 2013.

14 National Nutrition Cluster 3 July 2013

Preparedness Activities Lead Time line

1. Preparation of the Preparedness and Response Plan

Mapping of partner projects, capacities, human resources, contingency NCC and IMO and May 2013 supplies all cluster partners Compilation of Fundamental Operational Datasets for the Cluster, IMO May 2013 including demographic data, malnutrition prevalence disaggregated to the district level and recent nutrition survey findings Consultation on the Plan with Cluster partners and NDMA NCC May 2013

2. Contingency Stocks and Partner Agreements

Contingency stocks are made available All partners May-June

Develop contingency partner agreements UNICEF April-June

3. Capacity Building of Government Counterparts and Cluster Partners

Plan and conduct an Nutrition in Emergencies (NiE) training for NDMA UNICEF and WFP June-July and PDMA nutrition focal points, to raise awareness of nutrition 2013 interventions in an emergency and operational aspects of the response. Strengthen linkages between nutrition and food security, through the NCC May-July development of an operational guidance for linking food and nutrition 2013 implementation. Conduct regular trainings on CMAM and IYCF implementation for UNICEF, all IPs On-going implementing partners and district Government counterparts Disseminate a joint statement on Breast Milk Substitute NCC July 2013 distribution/Code in emergencies to all cluster members and DoH to raise awareness of BMS code breaches in an emergency 4. Nutrition Assessment and Monitoring

Contribute to the development of the revised 2013 MIRA tool and NCC May-June methodology 2013 Develop and submit to NDMA a nutrition detailed assessment tool and NCC May-June methodology 2013 M&E tools that are standardized for the nutrition cluster for monitoring NCC June-July CMAM programs 2013 Continue and advance joint monitoring tools for CMAM activities CMAM working May 2013 group Establish a mechanism for reporting of BMS Code breaches during an NCC July 2013 emergency through the Nutrition Cluster and the DoH. 5. Improve Information Management

Review of different nutrition information management systems modify UNICEF IMO May-June to match the government’s capacity and requirements and ensure 2013 maximum ownership Implement expanded NIS training to Government and Nutrition Cluster UNICEF May-June Partners 2013 6. Improvement to Operational Guidelines

15 National Nutrition Cluster 3 July 2013

Preparedness Activities Lead Time line

Develop an operational guideline for IYCF as an substantial element of UNICEF and IYCF June 2013 community mobilization working group

Update CMAM guidelines, and translation to Urdu. CMAM TWG June-July 2013

10. Response Plan

To meet the goal of reducing mortality and morbidity by the timely identification and appropriate management of acutely malnourished children and PLW, the Nutrition Cluster will implement a complement of nutrition interventions under the CMAM programme. The interventions will encompass: community mobilisation (including identification and mobilisation or community networks, community leaders, conducting screening for acute malnutrition and sessions on IYCF, including protection of breast feeding); micronutrient supplementation; management of acute malnutrition through OTPs, SFPs and SC’s; integration and promotion of appropriate infant and young child feeding practices; strengthening the referral linkage between various components of CMAM continuum of care and community mobilization; improving the efficiency of the response information system; establishment of a strong surveillance system, and capacity development of health care providers for all these service areas.

The response plan is based on an estimated population of five million affected, and 60 percent coverage by the nutrition cluster. Table 5 outlines the target beneficiaries for a six month response. For the estimated caseload, 250 nutrition sites (OTP/SFP) will be established, and 25 Stabilization Centres. In May 2013, 517 nutrition sites are operational. The additional caseload will be partially absorbed into the existing sites, and new sites established based on the gap analysis.

Table 5: Estimated Targets

Population Affected of 5,000,000 60% 3,000,000

Children: % Basis Prevalence Incidence Target Screening: # of children 6-59 months of age (14% of total population) 14.0% 420,000 420,000

SFP: # of Moderate Acute Malnourished Children (10% of 6-59 months children) 10.0% 42,000 63,000 73,500

OTP: # of Severe Acute Malnourished Children (5% of 6-59 months children )-80% of SAM for OTP 4.0% 16,800 25,200 29,400

SC: # of SAM Children with Medical Complications (5% of 6-59 months children )-20% of SAM for SC 1.0% 4,200 6,300 7,350

Deworming: # of Children (24-60 months) (12 % of total population)-70% coverage 8.4% 252,000 252,000

MM Supplementation: # of Children (6-59 months) (14% of total population)- 70% coverage 9.8% 294,000 294,000

Pregnant/Lactating Women:

Screening: # of Pregnant and lactating women-PLW (8% of target population) 8.0% 240,000 240,000

SFP: # of PLW at risk of malnutrition MUAC < 21 cm (13% of total PLW) 15.0% 36,000 54,000 63,000

Table 6: Response Actions

Actions Lead Timeframe Coordination and Needs Analysis Call National Nutrition Cluster meeting and establish coordination within NCC and IMOs, Day 1 and nutrition clusters for quick mapping of the disaster response in terms of with information on-going needs, capacity, gaps and commitments and report to OCHA and NDMA from NC partners

Formulate the initial response plan, in partnership with cluster members NCC Days 2-7

16 National Nutrition Cluster 3 July 2013 and establish strong linkages to other sectors where possible Advocate for and mobilize initial funding for the nutrition cluster NCC, all partners Days 2 and response ongoing Release a joint statement on Breast Milk Substitute distribution/Code NCC, CLA, DoH Days 1-7 to the media and all clusters to try and prevent the influx of BMS Participate in the MIRA, to identify immediate emergency nutrition MIRA trained Days 3-14 requirements staff Refine the nutrition sector response strategy for the funding appeal, NCC, all cluster Week 2-4 based on MIRA findings, the pre-crisis information and secondary data. partners Vetting and selection of nutrition proposals for inclusion in the revised NCC Weeks 3-8 appeal Contribute in the consolidation and finalization of the operational plan or NCC Weeks 3-8 appeal document Initiate Nutrition Response Establish and maintain screening for acute malnutrition outreach and UNICEF, IP’s Week 1 and community mobilization ongoing Establish and maintain Supplementary Feeding Program (SFP) sites for WFP, IPs Week 1 and the treatment of MAM Children under 5 and acutely malnourished PLW ongoing Establish and maintain Stabilization Centers, to treat SAM children with WHO, IPs Week 1 and complications ongoing Establish and maintain Outpatient Treatment Program (OTP) sites, for UNICEF, IPs Week 1 and treatment of SAM children in the community ongoing Coordinate with the Food Security Cluster to link GFDs to CMAM NCC, WFP Week 1 and interventions as necessary ongoing Implement comprehensive IYCF interventions, including education UNICEF, IPs Week 1 and sessions and establishment of baby friendly spaces ongoing Provide multiple micronutrient supplement8 to children 6-24 months and UNICEF, IPs Week 1 and PLW combined with adequate counseling ongoing Response Monitoring Establish and maintain NIS in all CMAM sites UNICEF Week 1 and ongoing Conduct joint monitoring of CMAM implementation in Sindh, Balochistan NCC, all partners Week 2 and and Punjab). ongoing Routinely monitor all CMAM sites, Non-Food Item and food ration UNICEF, IPs Week 2 and distribution to prevent the distribution of breast milk substitutes, ongoing bottles, teats and other milk products Monitor and report on key performance indicators (table 6) NCC, all partners Monthly

11. Cluster Monitoring

Regular monitoring and follow-up of the Nutrition Cluster CMAM activities is essential to ensure the CMAM is being implemented to a satisfactory level of both quality and coverage. Reporting through the existing reporting channels and reporting through NIS to prepare cluster reports needs to be ensured, including strong data analysis and interpretation that result in adequate actions to adjust the CMAM where and when required.

8 Excluding areas of WFP blanket supplementary food distribution

17 National Nutrition Cluster 3 July 2013

It was identified in the preparedness planning process that an active cluster led CMAM technical working group is required to provide supportive supervisions to improve program quality. To monitor the access and utilization of the CMAM, a coverage assessment using Semi-Quantitative Evaluation of Access and Coverage (SQEAC) will be conducted, and follow up nutritional surveys such as the Flood Affected Areas Survey (FANS) will be conducted if required.

Table 7: Key Programme Indicators

Key Indicators # Children and PLW screened for acute malnutrition (screening coverage) and % of total need # Children (boys and girls) treated at OTP, SFP, SC/ % of total identified % Children cured, defaulted and died (Sphere Standards Reference) # PLW enrolled in SFP and % of total identified # Children (boys and girls) and PLW receiving MMS # Breast feeding corners established and operational # CMAM sites/facilities monitored for breast milk substitution and other violations of the code # Sessions and people reached with IYCF interventions (disaggregated by gender) # Health care workers trained in facility based management of severe acute malnutrition # Health care workers and community workers trained in health and nutrition sentinel site surveillance system # Health care workers and community workers trained in CMAM (disaggregated by gender) # Health care workers and community workers trained in IYCF (disaggregated by gender) % CMAM programme coverage

The overall functioning of the cluster and the National Nutrition Cluster will be monitored and evaluated against the core functions of the NCC as specified by the Inter-Agency Standing Committee. A detailed survey was conducted in April 2013, based on the questions of the 2011 Nutrition Cluster Evaluation. This survey will be repeated in six month intervals. A monthly very brief monkey survey is also conducted on an on-going basis, to monitor the perceptions of the nutrition cluster by the partners.

12. Operational Constraints

The following operational constraints have been identified by the Nutrition Cluster:

 Delays in the procurement and clearance of essential medicines  Delays in F75/F100 procurement and clearance by the Ministry of Foreign Affairs  Potential delays in the Government declaring a disaster and requesting assistance  Delays in obtaining Non Objection Certificates (NOC)  Accessibility of the affected areas  Availability of skilled staff  Poor security resulting in reduced access to affected and high risk for project staff  Delays and limitation in rapid resource mobilization

18 National Nutrition Cluster 3 July 2013

13. Annexes

1. Nutrition Cluster Contact List, May 2013 2. Partner and project sites mapping, April 2013 3. List of supplies/contingency stocks for pre-positioning – this excel file is available upon request from the Nutrition Cluster and will be included in the overall matrix for the clusters. 4. Map of Nutrition Assessments 2000-2013, May 2013.

19 National Nutrition Cluster 3 July 2013 Annex 1: Nutrition Cluster Contact List

Nutrition Cluster Partners Contact List updated 24 May 2013

Name Organization Position/Title Contact Number Email

Shahid Fazal ACF Nutrition Coordinator 0303 5552116 [email protected]

Christopher Golden ACF DCD 0307 5550048 [email protected]

Najma Ayub ACF Deputy Nutrition coordinator 0334 8406586 [email protected]

Erin Rae Hutchinson ACF Country Representative 3018553089 [email protected] Kashif Ali ACF IMO ACF 0308-5599711 [email protected]

Saadia Shabbir AKF(P) Senior program Officer 0300 9546516 [email protected]

Dr. Yousaf Hayat Care International Health Coordinator To be completed [email protected]

Muhammad Arshad Care International Director of Programs To be completed [email protected]

Aliya Tayyaba CDO Executive Director 514901011 [email protected]

Musarat Jabeen CDO Documentation Officer 051 4901011 [email protected]

Aine Fay Concern Country Director 0300-8564479 [email protected]

Samiullah CRDO Program Manager 0345 9899368 [email protected]

Rehmat Yazdani ECHO Programme Officer 0308 5550531 [email protected]

Clementina Cantoni ECHO Technical assistant 0518357812 [email protected]

Nomeena Anis FAO Nutritionist 0346 8544210 [email protected]

Jehanzaib Singha GPP Project Manager 0345 4356577 [email protected]

Rabia Tabassum ILAP Liaison Officer 0334 8519785 [email protected]

Ahmad Ali Malik IMMAP PMC 0346 9199199 [email protected]

Ibrahim Abdella Johanniter Nutrition Coordinator 0306 5722779 [email protected] Louis Marinjnissen Malteser International Health Coordinator 345 500 48 49 [email protected]

Dr. Shahid Malteser International Program Manager Health 0300 8559226 [email protected]

Syed Shah Miran Merlin CHD 0303 5552033 [email protected] Mr. Wisal M Khan Merlin Nutrition Coordinator 3075555499 [email protected]

Khalid Nawaz Micronutrient Initiative NPM MI 0333 9127324 [email protected]

Dr. Shoaib MSF Medical Coordinator 0300 8504324 [email protected] Endashaw M Aderie MSF Deputy Medical Coordinator 300 852 6076 [email protected]

IrfanUllah Muslim Aid Health Nutrition coordinator 0300 9039983 [email protected]

Megan Gayford National Nutrition Cluster Islamabad 3008112794 [email protected]

20 National Nutrition Cluster 3 July 2013

Sabina Durrani NDMA DD/CoChair 0334 5066662 [email protected]

Farhat Munir NRSP Senior program Officer 0321 5102238 [email protected]

Atta Ur Rehman Relief International Country Representative 0345 5566171 [email protected]

Asif Iqbal Save the Children Nutrition Manager 0343 8929066 [email protected]

Kamran Mohyudin Shifa Foundation Program Officer 0333 5483633 [email protected]

Asmat Ali Gill STC/Consultant Associate Consultant 0346 7892646 [email protected]

Umar Farooq STC/Consultant Consultant 0341 5187753 [email protected]

Silvia Kaufmann UNICEF Nutrition Manager 0345 5006546 [email protected]

Teshome Feleke UNICEF Nutrition Specialist 0345 5006539 [email protected]

Qutab Alam UNICEF Nutrition Cluster IMO 03333 9196471 [email protected]

Dr. Syed Saeed Qadir UNICEF Nutrition Program Officer 0300-9591579 [email protected] Uzma Khurram Bukhari UNICEF NCC, Lahore 0321 9800095 [email protected] Dr. Qurrat-ul-Ain Ahmed UNICEF NCC, Lahore 042 35315807-8 [email protected] Aien Khan Afridi UNICEF NCC, Peshawar 0300-5002598, [email protected] Dr. Muhammad Faisal UNICEF NCC, Quetta 0332-3536493 [email protected]

Abdul Rehman USAID Islamabad 3085551081 [email protected]

Naveed Shehzad Welt Hunger Hilfe PM&E Officer 0300 9044929 [email protected] Daniel Rupp Welt Hunger Hilfe Project Manager 0347 5250458 [email protected]

Mona Shaikh WFP Nutrition Specialist 3468564303 [email protected]

Tahir Nawaz WFP Program Officer 0300 8566209 [email protected]

Ghulam Abbas WFP Program assistant 0300 8520232 [email protected]

Khizar Ashraf WHO NPO 0300 4005942 [email protected]

Ali Musaddiq Khan WHO Nutrition Officer 3035552282 [email protected]

Enest Shoniwa World Vision Commodities Manager 345856 7550 [email protected] Adnan World Vision HMIS Officer 3339255148 [email protected]

Rasheed Ahmed World Vision Health Nutrition Manager 0345 8599935 [email protected]

21 National Nutrition Cluster 3 July 2013

22

National Nutrition Cluster 3 July 2013

Implementing Partners, Nutrition Cluster May 2013 District Tehsil/ Taluka Implementing Partner (IP) Naseerabad Johanniter Badin Merlin Qambar Qamber Johanniter Golarchi Taluka ACF Shahdadkot Warah Taluka Johanniter Matli Merlin KHANPUR National Programme Shaheed Fazil Raho Merlin LIAQUAT PUR National Programme Talhar Merlin RahimYar Rahim Yar Khan National Programme Badin Tando Bago Merlin Khan SadiqAbad National Programme Bhakkar National Programme Jam Pur National Programme Darya Khan National Programme JamPur National Programme Derya Khan National Programme Rajan Pur National Programme DG Khan National Programme Rojan National Programme Kaloor Kot National Programme Rajanpur Rojhan National Programme Kalor Kot National Programme Sanghar KHIPRO TALUKA PNFWH Mankera National Programme Alpurai CERD Sairay Mohajar National Programme Shangla Puran CERD Bhakkar Taunsa National Programme Garhi Yasin Taluka Save the children DG Khan National Programme Lakhi Taluka Save the children D.G.Khan Taunsa National Programme Shikarpur Shikarpur Taluka Save the children Dadu Merlin New Sukkur Johanniter Dadu Taluka ACF Pano Aqil Taluka Johanniter Johi Merlin Sukkur Rohri Taluka Johanniter Johi Taluka ACF Barikot CERD K.N.Shah Merlin Kabal CERD Khairpur Nathan Shah TalukaACF Khwazakhela CERD Mehar Merlin Matta CERD Dadu Mehar Taluka ACF Swat Swat CERD Dera Ismail Khan FPHC Tando Chamber HANDS Dera Ismail PRIME Foundation Allah Yar Jhando Mari HANDS Khan Prowa MDM Tando dg Layyah National Programme Bulri Shah Karim ACF Doaba MDM Muhamma Tando Ghulam Hyder ACF Hangu CDO Chachro Taluka Merlin CERD Tharparkar Nagar Parkar Taluka Merlin Hangu Tall CDO Ghorabari Merlin Jacobabad Taluka Save the children Jati Merlin Jacobabad Thul Taluka Save the children Mirpur Bathoro Merlin Jhatpat Nutrition Cell Thatta Sujawal Merlin Jhatpat, Sohbat Pur GMCW Jhatpat, Sohbat Pur, Usta MuhammadMSF Jafferabad Usta Muhammad,Gandakha,PAOBK Jhatpat, Sohbat Pur Kandhkot Johanniter Kashmore Taluka HANDS Tagwani Johanniter Kashmore Tangwani Johanniter Kohat MDM Kohat Lachi MDM Kurram Lower Kurram PEACE Bakrani NGODSS Dokri NGODSS Larkana Ratodero NGODSS Chobara National Programme Choubara National Programme Karor National Programme Layyah Layyah National Programme Adenzai CERD Khal CERD Samarbagh CERD Lower Dir Timergara CERD Isa Khail National Programme IsaKhail National Programme Mianwali Mianwali National Programme Mohmand Bezo FPHC Agency Safi FPHC Alipur National Programme jatoi National Programme Muzzafarga Kotadu National Programme rah Muzaffargarh National Programme Chatter, Murad jamali MSF Dera murad jamali MSF Dera murad jamali, TambooGMCW Naseeraba Murad Jamali GMCW d Murad Jamali, Tamboo, ChaterGMCW Nawabshah Sakrand Taluka HANDS Pabbi CDO Nowshera MERLIN Peshawar Town-4 Pehawar MERLIN 23