PAKISTAN Information Sheet

Credentialing Verification Authorities: Though there is a visible strong demand from various professional groups for a national council for accreditation of Nutrition related education program and registration of nutritionist, there is no governmental credentialing body for Dietetics in Pakistan as yet.

Rana Liaquat Ali Khan Government College of home Economics Karachi, (RLAK CHE) initiated a program for establishing criterial for human nutrition professionals in 2008. Pakistan Nutrition and Dietetic Society also joined and shared professional expertise in the project. Together they established a qualification and test-based criteria for giving RD certificate in 2010 and PNDS has been holding RDN (Registered Dietitian Nutritionist) exam all over Pakistan giving certificate for period of 2 years on the basis of that criteria all. Renewals are either made on the basis of Continuing Nutrition Education (CNE) hours or to reappear in exam if unable to complete required CNE hours.

As number of institutions granting degrees in nutrition has markedly increased, graduates sometimes get certificate of eligibility to work as dietitian or certification as Registered Dietitians form other institution/organizations as well and there are strong emergent demands from multiple groups for a National Nutrition Council and Government regulated licensing of Nutritionists-Dietitians.

Official Language(s): Urdu and English

Ongoing Nutrition Activities in Pakistan

1. National Dietetic Association Pakistan Nutrition and Dietetic Society (PNDS) (Registered society) Has four Chapters all over Pakistan: PNDS Islamabad Chapter, PNDS Lahore Chapter, PNDS Faisalabad Chapter and PNDS KPK Chapter. http://www.pnds.org. (For Public) and www.rdn.pnds.org (For Professionals) [email protected] https://www.facebook.com/pndsorg/

Other related Organizations Nutrition Foundation of Pakistan (NFP) (Registered Trust) www.nutrition.org.pk, https://www.facebook.com/nfprh/

Nutritionist Association of Pakistan (NAP) http://nap.org.pk/

Nutrition Society of Pakistan (NSP) https://www.fans-nutr.asia/contentbypermalink/pakistan.html https://www.facebook.com/groups/179429666030539/

Khyber Pakhtunkhwa Society of Nutrition and Dietetics – (KPSND) https://www.facebook.com/KPSND/

Nutritionists & Dietitians Society – (NDS) https://www.facebook.com/Nutritionists-Dietitians-Society-NDS- 950480948321951/

Young Nutritionists Club – (YNC) https://www.facebook.com/YNCofficial/

2. National Nutrition Programmes/Projects:

Pakistan faces double burden of nutritional disorder i.e. Problems related to under and over consumption of energy. However, the focus of national nutrition programs has mostly been on maternal and child undernutrition. The information given below is taken from Government publications and thus does not include projects bring undertaken by private sector or NGOs.

Nutrition Interventions/Activities: In Pakistan, stunting, wasting and deficiency of micronutrients are endemic issue due to dietary deficiencies, poor maternal and child health and nutrition, and high burden of morbidity.

The following nutrition related activities are under way or recently undertaken:

NNS 2018 Under the National Nutrition Program (NNP) 2017-18, the largest survey has been initiated by Nutrition Wing at the Federal level. It includes 120,000 households and district specific data.

“Nutrition Awareness and Institutional Strengthening Program” is planned.

Utilization of specialized nutritious products for stunting prevention in commercial and social safety sectors through public private partnership”.

Federal Nutrition Program for ICT, AJK, FATA and GB, one district in each area sponsored by M/o. National Health Services, Regulation & Coordination (MNHSRC) is under approval process.

Pakistan Multi-Sectoral Nutrition Strategy has been prepared based on provincial multi-sectoral nutrition strategies and is ready for launch and implementation.

Pakistan dietary guidelines for better nutrition (PDGN) has been prepared to provide nutrition information for healthy living to the masses.

Food Composition Table (FCT) for 350 raw and cooked food items with 25 nutrients based on data from 12 agro zones is under preparation.

Task force for Early Childhood Development (ECD) has been established and Letter of Intent (LOI) is signed nutrition partner to formulate National Policy Framework.

Establishment of IYCF committees at provincial level for planning and promotion of IYCF practices including breastfeeding.

CMAM: revised Community Based Management of Acute Malnutrition (CMAM) Establishment of stunting prevention program through support of UN-WFP in Sindh, Baluchistan, Khyber Pakhtunkhwa and FATA and in AJK. Implementation of large stunting prevention program in Punjab Government.

Pakistan Food Fortification Strategy has been revised to take up sustained actions to overcome micronutrient deficiencies (hidden hunger). Coordination with provinces and other relevant stakeholders for wheat flour fortification and universal salt iodization through National Food Agency (NFA and Provincial Fortification Alliances (PFAs)

Universal Salt Iodization (USI) To overcome Iodine Deficiency Disorders (IDD) Iodization (USI) continued in 110 districts through public private partnership with enhanced quality control and quality assurance

Food Fortification Program has started in 43 Oil/Ghee mills having vitamin A&D and 123 flour mills with Iron, folic acid, zinc and vitamin B12 in wheat flour, to overcome hidden hunger.

Fortification Assessment Coverage Toolkit (FACT) survey to determine the coverage and potential contribution of fortified foods is being conducted in all four provinces Bio-fortified wheat variety “Zincol 2016” zinc concentrated, about 20,000 tones seed will be provided to farmers for next crop

Cited Sources: • Govt. of Pakistan Ministry of Finance, Pakistan Economics Survey 2017- 18 Retrieved 25 May 2019 http://www.finance.gov.pk/survey/chapters_18/Economic_Survey_2017_1 8.pdf • Govt. of Pakistan. Planning Commission MDPR " Annual plan 2018 . (Government of Pakistan. Planning Commission. Retrieved 25 May 2019. https://www.pc.gov.pk/web/annualplan

3. Organizations working on Health & Nutrition a. National Organizations (Government)

Ministry of Health: Nutrition Wing 1st floor Taimur Chambers,10-D, West Fazal-e-Haq Road, Blue Area, Islamabad Phone: (92) 051-9214976 Fax: (92) 051 9215610

Nutrition Section, Planning and Development Division, Government of Pakistan P-Block, Pakistan Secretariat, Islamabad

National Institute of Health (NIH), Islamabad Chak Shahzad. Islamabad

3b. International Organizations

World Health Organization (WHO) PO Box 1013, Islamabad National Park Road, Chak Shehzad [email protected]

Micronutrient Initiative (MI) c/o CIDA Program Support Unit 18 Bazar Road, G-6/4 Pakistan Email: [email protected] Phone: + 92-51-282-4389 Fax: + 92-51-227-9137

UNICEF 90 Margalla Road, F-8/2, Islamabad Phone: +92-51h -2097700 Fax: +92-51-2097799 [email protected]

Save the Children Fund P.O. Box 1952, Islamabad, Pakistan Phone: 92-51-279211/2 Fax: 92-51-279210 [email protected]

Scaling Up Nutrition https://scalingupnutrition.org/sun-countries/pakistan/ c. Educational Institutes (Nutrition Education & Research)

Educational Institutions providing university level education in nutrition:

FEDERAL 1. Allama Iqbal Open University, Islamabad, https://aiou.edu.pk/ProgrammesList.asp?P=MASTER 2. Federal Government College Of Home Economics And Management Sciences, Islamabad, gcuf.edu.pk

SINDH. 3. Rana Liaqat Ali Khan Govt College of Home economics, Karachi, www.chek.edu.pk/department-of-nutrition-dietetics/ 4. Dow University Of Health Sciences, Karachi, www.duhs.edu.pk 5. University Of Sindh, Jamshoro, http://usindh.edu.pk/academics/faculties- uos/natural-sciences/institute-of-biochemistry/bachelors-degree-programs/

KPK. 6. Bacha Khan University BKU, Charsadda, https://pakeducareer.com/degrees/agricultural-sciences/ 7. Women University, Mardan, http://www.wumardan.edu.pk/program.php?q_id=Undergraduate 8. University Of Peshawar, Peshawar, www.uop.edu.pk 9. College Of Home Economics, Peshawar, http://www.uop.edu.pk/departments/?q=College-of-Home- Economics&r=Academic-Programs

BALUCHISTAN. 10. NIL.

PUNJAB. 11. University Of Home Economics Lahore, https://uhe.edu.pk/ 12. Government College for Women University, Faisalabad, gcwuf.edu.pk 13. University Of Agriculture, Faisalabad, www.uaf.edu.pk 14. Government College University, Faisalabad, https://gcuf.edu.pk/dept-home- food-science 15. Lyallpur Institute Of Management & Sciences (Lims), Faisalabad, lims.com.pk 16. Gift University, Gujranwala, www.gift.edu.pk 17. Government College of Home Economics, Gujranwala, http://pu.edu.pk/affiliation/collegeinfo/1098/Govt.-College-of-Home- Economics-Gujranwala 18. University Of Southasia, Lahore, https://usa.edu.pk/faculty-of-life-and-health- sciences/bachelor-in-food-nutrition/ 19. Minhaj University, Lahore, https://www.mul.edu.pk/english/department/food- and-nutrition/ 20. Institute Of Management Science, Lahore, http://www.pakaims.edu.pk/ 21. University Of Management And Technology, Lahore, https://www.umt.edu.pk/ 22. School of Food and Agricultural Sciences (SFAS)-UMT, Lahore, https://sfas.umt.edu.pk/ 23. University of Veterinary and Animal Sciences - UVAS, Lahore, www.uvas.edu.pk 24. Afro-Asian Institute, Lahore, afroasian.edu.pk 25. College Of Allied Health Sciences Akhtar Saeed Medical And Dental College, LAHORE, Lahore, www.amdc.edu.pk 26. University Of Lahore, Lahore, www.uol.edu.pk 27. The Superior University, Lahore, www.superior.edu.pk 28. Kaims International Institute, Multan, kaims.edu.pk 29. Times institute, Multan, www.t.edu.pk 30. Bahauddin Zakaria University, Multan, www.bzu.edu.pk 31. Comsats Institute Of Information Technology (Sahiwal Campus), Sahiwal, sahiwal.comsats.edu.pk 32. Department of Nutrition and Dietetics, Institute of Public Health, Birdwood Road Lahore https://iph.punjab.gov.pk/ 33. University of Health Sciences, Lahore www.uhs.edu.pk 34. Nutritionist Club, School of Nutrition - SON Pk, http://schoolofnutrition.pk/

Other institutions conducting research • Department of Home and Health Sciences, AIOU, Islamabad http://www.aiou.edu.pk • Home Economics Colleges (at Provincial level) • Department of Human Nutrition, NWFP Agriculture University • Department of Human Nutrition, Agriculture University Faisalabad • Nuclear Institute of Food and Agriculture (NIFA), NWFP • Department of Preventive Pediatrics, KEMC, Punjab • Shifa Medical Collage and Shifa International Hospital http://www.shifa.com.pk • Aga Khan University, Sindh

3d. Non-Governmental Organizations (NGO's)

Health Education & Literacy Programme (HELP) http://www.helpngo.org.pk/

Health Oriented Preventive Education (HOPE) http://www.hope-ngo.com/

Society for the Advancement of Community, Health, Education and Training (SACHET) http://www.sachet.org.pk HANDS www.hands.org.pk National Association of Diabetes Educators of Pakistan (NADEP) www.nadep.org.pk

Nutritionist Club, School of Nutrition – (consultancy firm) http://schoolofnutrition.pk/

4. Assessment of Training Quality of National Dietitians, their Professional Role and Prestige

Food, nutrition and diet related subjects are extensively studied in home economics and human nutrition department of various universities. Practical training in the hospital set up usually is done at a few hospitals. Recently, nutrition and dietetics graduates started working at hospitals as dietitians after completing internship at the established hospitals.

International organizations mostly prefer hiring medical officers, especially pediatricians and lady health workers for nutrition related jobs.

Number of working dietitians has been markedly increased in the current decade. Dietitians are working actively on in-patient as well as out-patient care. They are also educating the clinicians and creating the nutritional awareness among the people through seminars and via free nutrition camps.

The Nutrition Wing of the Ministry of Health in cooperation with the local community centers sometimes develop and implement community nutrition programs for the public.

Sources: http://nhsrc.pk/dashboards/nutritionselect.html https://www.nih.org.pk/nutrition-division/

5. Brief Description of National Healthcare System and Private Practice Pakistan has a mix of public and private health service delivery system.

In Pakistan the health care services are the obligations of provisional government except for the federal area. Free health care services are available through Government hospitals and primary, secondary and tertiary health care centers. The outreach primary health care services are delivered at the community level by Lady Health Workers (LHWs), Lady Health Visitors (LHVs), and Community Midwives (CMWs) who have earned success and trust in the communities.

Local small health centers and Basic Health Units are common especially in rural areas, but they can only provide limited services within the medical treatments.

In addition to public facilities, a variety of private health care services are also available and are used by more than 50% of the population. Few of them are well equipped but expensive so the services cannot be afforded by the common man. There are some insurance companies and panels for multinational organizations and private companies, as well as for some bureaucrats. This covers health, as well as nutrition charges. Traditional Ayurvedic and homeopathic medicine is also widely practiced.

Under 18th Constitutional Amendment, health service delivery has been transferred to the provinces, though, Pakistan Vision 2025, which was prepared in consultation with provinces provide a road map which includes reducing the widespread prevalence of communicable diseases, disease surveillance, addressing inadequacies in primary/secondary health care facilities, correcting rural/urban biases, bridging basic nutritional gaps and improving the pharmaceutical sector to ensure the availability, affordability and quality of medication drugs. The country’s ownership of the SDGs would be a prerequisite for health and development in future.

Sources: • Kumar, S., & Bano, S. (2017). Comparison and analysis of health care delivery systems: Pakistan versus Bangladesh. Journal of Hospital & Medical Management, 3(1), 1-7. • Pakistan Today. English daily. Shortage of equipment, staff affects • Pakistan’s health system BY PPI, (LAST UPDATED JUNE 30, 2018) https://www.pakistantoday.com.pk/2018/06/30/shortage-of-equipment- staff-affects-pakistans-health-system/

6. Employment Opportunities Profile

Graduates from food technology often work in food factories and food organizations. Number of hospitals having one or more posts of dietitians have increased in many big cities but is still far from being a norm. They deliver nutrition services to inpatients, takes part on the nutrition support as a clinical dietitian/nutritionist. They also work at private clinics and centers, e.g. diabetes clinics, cardiology clinic, slimming clinic, etc. Working as a lecturer at the college is a common and preferred job for many nutrition related professionals.

Mostly research is done in the teaching medical hospitals, the universities and under the set-up of international organizations.

7. Obtaining Work Permits

Pakistan Missions abroad are authorized to grant entry Work Visa to foreign expatriates on the recommendations of Board of Investment for one-year (Multiple) validity, extendable on yearly basis in Pakistan. Board of Investment will process work visa applications expeditiously within four weeks and recommended to the Ministry of Interior for authorization of visa to concerned Mission.

Visa Committee under the Chairmanship of Secretary Board of Investment approves the work visa cases received in BOI through the companies working in Pakistan. Visa advice is however issued by Ministry of Interior to Pakistan Mission abroad as per recommendation of BOI, in case of fresh entry visa and to Regional Passport Offices (RPOs) in case of visa extension.

Extension of three months provisional work visa, on application, recommended by BOI would be endorsed by the RPOs instead of Ministry of Interior. Work Visas are granted to foreign technical and managerial personnel for the purpose of imparting technical know-how and skills to the local population. The duration of work visa is one to two years. As per Visa Policy cases of grant and extension of Work Visas are processed within 4 weeks by BOI.

Source: https://www.emergingpakistan.gov.pk/travel/visa/work-visa/

8. Local Food Customs and Culture

In the Pakistani diet cereals remain the main staple food providing 62% of total energy. The diet is wheat based, eaten mostly with lentils and legumes, which is called “pulses”. The consumption of fruits and vegetables, fish and meat remains very low. The consumption of fruits and fresh vegetables, which are highly dependent on local seasonal availability, is also limited by the lack of organized marketing facilities throughout the country. Fluctuations in the availability of these foods are likely to be one of the factors responsible for the micronutrient deficiency, such as Zinc, Iodine, and Iron, which is frequently observed in Pakistan.

Milk is available in every house. It is also used for butter (Ghee). Tea is commonly used beverage which is mixed with milk all the time.

Usually three meals are taken daily. Each meal consists of flat bread (roti, paratha or chapatti) eaten with pulses, or thoroughly cooked vegetable or small amount of meat/chicken/fish.

There are great regional variations in serving size (e.g. weight of roti can vary from 30 g to 300 g), composition of prepared foods (e.g cooked pulses could be watery thin to think like cookie dough) and the way foods are eaten (e.g amount of curry eaten with one 100 gram chapatti can range from 20 gram to 200 gram). Pakistani curries are usually spicy and oily. In general, people eat the food mostly by hand without using fork and spoon.

9. CE Opportunities

Continuing Nutrition education session are arranged by PNDS, NFP and several educational institutions and hospitals. Occasionally these are also endorsed by international transitions.

CPE opportunities are provided through IAAND professional development activities such as IAAND conferences and webinars, through the Academy distance learning programs, the Journal of the Academy of Nutrition and Dietetics and the Academy Foundation resources.

10. IAAND Volunteer Opportunities

Opportunities to assist IAAND with your time are probably endless. Learn as much as you can about IAAND and where your skills and interest would be of most benefit both to you and to IAAND. You could: ▪ Assist IAAND in spreading awareness about nutrition and dietetics globally and advocating for nutrition issues in your local communities. ▪ Support IAAND’s growth by recruiting new members and assisting fund- raising team. ▪ Be a member on the IAAND leadership team ▪ Assist in organizing conferences ▪ Submit articles to the IAAND newsletter ▪ Be a Kids Eat Right International volunteer.

For further information please contact the Country Rep for Pakistan: [email protected]

Written by: Rubina Hakeem (2019)