Livelihood and Food Security Assessment (LFSA)

Jamshoro, Sanghar, Umerkot and Tharparkar (Sindh-Pakistan)

November 2017

Livelihood and Food Security Assessment (LFSA)

Jamshoro, Sanghar, Umerkot and Tharparkar (Sindh-Pakistan)

November 2017

©Food Security Cluster, Pakistan 2017 All right reserved. This Material is copyright, however, it may be reproduced for educational purposes. The Food Security Cluster Pakistan should be informed of any such reproduction.

Disclaimer This interpretations and observations expressed in this publication do not necessarily reflects the position of all Food Security Cluster partners.

All photographs used in this publication are courtesy of © FAO/ Ajmal

Contents Acknowledgment ...... i Executive Summary ...... ii 1. Introduction ...... 1 1.1 Objectives of the Assessment ...... 2 2. Methodology ...... 4 2.1 Sampling Methodology ...... 4 2.2 Training on LFSA Questionnaire ...... 4 2.3 Data Collection ...... 4 2.4 Data Entry and Analysis ...... 5 2.5 Limitations of the analysis ...... 5 3. Regional, Demographic and Economic Profile of the Surveyed Households ...... 6 3.1 Regional Profile of Surveyed Households ...... 6 3.2 Demographic and Economic Profile of Surveyed Households ...... 8 4. Agriculture ...... 10 4.1 Land Ownership and Cultivation ...... 10 4.2 Status of Ownership of Cultivated Land ...... 11 4.3 Sufficiency of Own Produced Cereals for Household Consumption ...... 12 4.4 Availability of Water for Agricultural Activities ...... 14 4.5 Support Required by Households to Improve Crop Production ...... 15 4.6 Livestock Ownership ...... 16 4.7 Livestock Losses ...... 17 4.8 Livestock Sales ...... 19 4.9 Livestock Support Needed by Livestock Owners ...... 20 5. Household Assets Ownership, Livelihood/Income Sources and Food Expenditure ...... 22 5.1 Household assets ownership ...... 22 5.2 Household Livelihood, Income and Expenditure, Loans and Assets ...... 23 5.2.1 Primary and Secondary Income sources ...... 23 5.2.2 Women’s Livelihood Sources ...... 24 5.2.3 Monthly Income and Food Expenditure Share ...... 24 6. Food Consumption and Dietary Diversity ...... 25

6.1 Food consumption Score (FCS) ...... 25 6.1.1 Sources of Food...... 25 6.2 Household Dietary Diversity ...... 26 6.3 Food-based Coping Strategies ...... 27 6.4 Livelihood-based Coping Strategies ...... 27 6.5 Dietary Diversity among Women and Children ...... 28 7. Markets ...... 30 8. Food Insecurity...... 31 8.1 Prevalence of Moderate and Severe Food Insecurity ...... 31 8.2 Household Hunger Score (HHS) ...... 32 9. Shocks and Coping Strategies ...... 34 9.1 Shocks ...... 34 9.2 Debt ...... 36 9.3 Migration ...... 39 10. Health and Nutrition ...... 41 10.1 Access to Healthcare ...... 41 10.2 Disability ...... 42 10.3 Malnutrition ...... 43 10.3.1 Child Malnutrition ...... 43 10.3.2 Malnutrition among Pregnant and Lactating Women (PLW) ...... 45 11. Housing, Water and Sanitation ...... 47 11.1 Housing ...... 47 11.2 Access to Water ...... 50 11.3 Access to Sanitation ...... 54 12. Assistance ...... 57 13. Conclusions and Recommendations ...... 60 13.1 Conclusions ...... 60 13.2 Recommendations ...... 62

Acknowledgment The Livelihoods and Food Security Assessment (LFSA) was designed and implemented by the Pakistan Food Security Cluster (FSC) in four districts (Tharparkar, Jamshoro, Sanghar and Umerkot) of Sindh.

We would like to express our deepest appreciation to all organizations and individuals especially the field enumerators and district team leaders for their contribution in this assessment. FSC would like to acknowledge the contribution of Provincial Disaster Management Authority (PDMA-Sindh), Sindh Bureau of Statistics, Provincial Nutrition Cell/Nutrition Support Programme and Agriculture and Livestock Departments of Sindh for their support, technical advice and inputs on design and execution of assessment, and write up of this report.

Food and Agriculture Organization of the United Nations (FAO) and World Food Programme (WFP) co-led this assessment. The FSC would like to extend its gratitude to senior management of FAO and WFP for their guidance and overall supervision. The technical support extended by Feroz Ahmed and Duaa Sayed (IPC Global Support Unit, FAO) in designing of tool is also highly appreciated.

The overall supervision of Angeliki Dimou (Former National FSC Co-Lead, FAO) and technical inputs of Thivan Hoang (Head, Vulnerability, Analysis and Mapping Unit, WFP) during the planning and execution phases of the assessment are highly acknowledged.

From FAO, the extensive contribution of Ajmal Jahangeer, Muhammd Afzal and Nasrullah Khan in questionnaire designing, training of enumerators, field planning and monitoring of data collection and of Mehwish Ali for preparation of maps is very much appreciated. The logistics and coordination support provided by Ahmed Khan, Ashraf Ali and Shahnwaz Shaikh is also highly acknowledged. From WFP, Qasim Shah and Aman-ur-Rehman provided support in designing of tools while Khadim Shah supported the training of enumerators and monitoring of the data collection, which is highly appreciated.

Data analysis was carried out by a team of four experienced data analysts: Ajmal Jahangeer (FAO,) Khadim Shah (WFP), Kazim Jafri (Bureau of Statistics, Sindh) and Feroz Ahmed (IPC GSU, FAO). Their support in data analysis is highly acknowledged. The inputs of Genevieve Hussian and Habib Wardag (FAO) and WFP-VAM colleagues for developing the first draft of this report were also very useful.

The FSC would like to express its gratitude to Ajmal Jahangeer (FAO) who has completed this report with support from Khadim Shah (WFP) and presented a comprehensive analysis on livelihood, food security and nutrition situation of communities in the focused districts.

The FSC would also like to acknowledge the financial support offered by the European Union Directorate-General for Humanitarian Aid and Civil Protection (ECHO) without which it would not have been possible to conduct this assessment.

Finally, and most importantly, we would like to thank those families who spent time in answering the survey questions, without them this report would not have been possible.

For feedback, queries or comments concerning any aspect of the survey or this report, please contact:

Ajmal Jahangeer (Statistician, Information Management Unit, FAO, [email protected]) Thivan Hoang (Head, Vulnerability Analysis and Mapping Unit, WFP, [email protected])

Executive Summary The Pakistan Food Security Cluster (FSC), co-led by FAO and WFP, conducted the Livelihood and Food Security Assessment (LFSA) in four districts in Sindh, namely, Jamshoro, Sanghar, Tharparkar and Umerkot in April/May in 2017. The detailed assessment was aimed at assessing the situation of food security and livelihoods in the targeted districts.

The assessment was conducted with the following specific objectives:

• Assess the situation of food security and livelihoods in four districts in Sindh; • Assess the dietary diversity, hunger, severity of food insecurity, malnutrition and access to water and sanitation in the surveyed districts; • Identify the shocks experienced by the households and coping mechanisms; • Provide evidence for Integrated Phase Classification (IPC) for Acute Food Insecurity and IPC Acute Malnutrition Analyses and informed decision making for improving household livelihoods and food security

A standard methodology was employed whereby a sample size of 400 households was estimated for each district and in total 1,573 interviews was conducted in the four districts. The assessment focused on both urban and rural and arid and non-arid areas of the targeted districts.

Agriculture

As per the survey findings, most of the households did not own land whereas women headed households reported less land ownership and cultivation in all surveyed districts. Cereals produced by households were not sufficient to meet household consumption, particularly for households in desert/arid areas and those headed by women. A significant number of households had no stock at the time of the survey. Most of the households reported ownership of small ruminants, particularly goats in desert/arid areas. A considerable number of livestock losses were reported, specifically in Sanghar and Tharparkar districts. Sale of livestock was also common due to disease and reduced availability of fodder and water. Further, inadequate crop production and livestock losses are likely to have adverse impacts on livelihood and food security of the surveyed households.

Household Assets and Livelihoods

Generally, ownership of domestic and productive assets was very low. Primary sources of livelihood include sale of crops/vegetables and labour including unskilled agriculture and non-agriculture labour. Households in non-arid areas were engaged in relatively more sustainable livelihood strategies than in the desert/arid areas.

Food Consumption

Based on the food consumption score, more than half of the households had poor food consumption. The diet of the people in desert/arid areas was poorer in terms of quality and quantity than the non-arid areas and Tharparkar had the lowest dietary diversity. Most of the households were dependent on markets for

ii acquisition of food on cash and credit basis. However, long distances to the markets from communities, particularly desert/arid areas, and cost of transportation and unavailability of transport were reported two main problems in accessing the markets.

Food Insecurity

Prevalence of food insecurity, based on Food Insecurity Experience Scale (FIES)-an indicator of Sustainable Development Goal (SDG) 2, was quite high in the surveyed districts as two-thirds of households had moderate and severe food insecurity, particularly around three-quarters in Sanghar and Tharparkar. Further, food insecurity was higher in rural, desert/arid, women headed, and households that had unsustainable and agriculture based sources of livelihoods. Very high prevalence of food insecurity could be associated with high malnutrition among women and children in the surveyed districts.

Health and Nutrition

Access to healthcare is an important issue and long distances to health providers, overall 13.2 kilometers (KMs) and 21.8 KMs in desert/arid areas, was the most common problem reported, particularly in rural and desert/arid areas. Overall, prevalence of malnutrition among children age 6-59 months was 20.1%---above the emergency threshold (GAM-MUAC based); significantly higher among children in desert/arid areas, women headed, very poor and households that had unsustainable and non-agriculture based sources of livelihood. Further, overall 15.1% of PLWs were malnourished (MUAC below 21.0 CM); higher in rural and desert/arid areas, women headed, and households having agriculture and unsustainable livelihood sources.

Water and Sanitation

Around two-thirds of households were accessing water from improved sources: this was highest in Sanghar (76%) and lowest in Tharparkar (50%). Distance to the water sources was a major impediment, particularly for children and women who generally fetch water from long distances, which is likely to affect their health, education and care including breastfeeding of young children. Further, overall, around half of the households and two-thirds in Tharparkar district had no toilet/latrine at home.

Assistance

Two-thirds of surveyed households received support from Benazir Income Support Programme (BISP) followed by nutritional support, food assistance, cash/food for work/training and agriculture/livestock support from multiple sources (Government, UN, I/L NGOs, relatives/friends/community members) during the six months preceding the survey.

Recommendations

Agriculture

• Agriculture/livestock related support during the lean period • Support on improving crop production, crop diversification, drought resistant crops, climate smart agriculture

iii

• Support in establishment of agro-forestry nurseries and promotion of agro/ farm forestry • Construction /rehabilitation of existing irrigation infrastructure, improvement of conventional irrigation system, water conservation, introduction of micro-irrigation system and water harvesting • Capacity building of farmers through Farmers Field Schools (FFS), Farm Business School (FBS) and Women Open Schools • Cash based interventions for provision of fodder during the lean period • Extending livestock related assistance (fodder/feed, medicines/vaccinations) to needy and vulnerable livestock/poultry rearers • Trainings on livestock and poultry rearing, Livestock Farmer Field Schools (LFFS), LEGS training

Food Security and Nutrition

• Cash plus interventions particularly focusing on women headed and other vulnerable households in collaboration with BISP • Integration of cash transfer programmes and social protection to address food security and nutrition • Training on kitchen gardening, diet diversity, food processing and food safety • Enhanced provision and integration of nutrition support programmes • Ensure provision of vitamin A supplementation • Provision of micronutrients through food supplementation and food fortification • Regular monitoring of food security, nutrition and livelihoods through seasonal surveys

Off-farm Livelihood

• Trainings on skills enhancement • Direct and indirect market support interventions

Water and Sanitation

• Support for construction of water tanks, installation of hand pumps, solar water purifiers • Improve and increase water storage at household and community level • Cash for work on improvement of water sources • Provision of water at subsidized rates during lean period • Improve access to safe sanitation facilities at household, community and institution level • Carry out hygiene promotion activities at household, community and institutional level

1. Introduction Pakistan is fraught with challenges of poverty, food insecurity and continuous natural and manmade disasters. As per the latest poverty estimates, 29.5% of the population in Pakistan lives below the national poverty line; 35.6% in rural areas and18. 6% in urban1. Further, nationally 38.8% of the population is poor based on multidimensional poverty index (MPI)2; 54.6% in rural and 9.4% in urban areas. The situation of food security also paints a bleak picture. The recently launched 2017 global report titled “Food Security and Nutrition in the World”, a joint publication of FAO, IFAD, WFP, UNICEF and WHO, reveals that 19.9% of total population in Pakistan was undernourished during the period 2014- 2016, which was above the regional average of 14.9% in South Asia. Although the prevalence of undernourishment has reduced compared to 23.3% in 2004-06, number of undernourished people has increased from 35.7 million in 2004-06 (28.7 million in 1990) to 37.6 million in 2014-16. Further, according to latest Global Hunger Index (GHI) report published by IFPRI in 2017, Pakistan ranked at 106 with a score of 32.6; only above Niger, Timor-Leste, Afghanistan, Sierra Leon, Yemen, Madagascar, Haiti, Zambia, Chad and Central African Republic3.

Sindh also has higher incidence of multidimensional poverty. Overall, 43.1% of the population in Sindh is multidimensionally poor; the rural population is 7 times poorer compared with the urban (75.5% in rural vs. 10.6% in urban areas). Sindh experiences high floods and drought concurrently and rainfall variability is very high. Drought has been a recurring phenomenon in Sindh province, mainly in South- East and West of the province. The Sindh Drought Needs Assessment (SDNA) conducted by Food Security Working Group (FSWG) in 2015/16 reveals that the arid zones in the West (Jamshoro and Dadu) and South-East (Tharparkar, Umerkot and Sanghar) were the most drought affected areas. These areas experienced moderate to severe drought during 2013-15 and reported loss of livestock and crop.

Further, in February 2017, a joint UN observation mission, comprising of staff members from the Provincial Disaster Management Authority (PDMA), Sindh, and UN agencies (FAO, WFP, UNICEF, IOM and OCHA), visited the desert areas of Sanghar, Umerkot and Tharparkar. The mission observed a poor food security and livelihoods situation in the desert areas. Additionally, the communities reported reduced crop production, livestock losses and limited availability of water for domestic consumption and agriculture activities.

More recently, an Integrated Phase Classification (IPC) for Chronic Food Insecurity analysis conducted for 18 districts in Sindh in Nov 2016-April 2017, found that 83% of the population in Tharparkar, 80% in

1 National poverty line is based on cost of basic needs approach (CBN), which include both food and non-food items. The latest national poverty line was computed from Household Integrated Economic Survey (HIES) data conducted in 2013-14. 2 MPI was calculated from 15 indicators related to education, health and standard of living. The latest MPI was based on Pakistan Social and Living Standards Measurement (PSLM) survey conducted in 2014-15. 3 The GHI score is based on four indicators: prevalence of undernourishment, wasting and stunting among children under 5 and under 5 mortality rate.

Jamshoro, 75% in Umerkot and 73% in Sanghar was experiencing at least one type of chronic food insecurity (mild, moderate or severe). Particularly, the proportion of population in level four (severe chronic food insecurity) was 27% in Tharparkar, 20% in Jamshoro, 17% in Sanghar and 15% in Umerkot4.

The drought-like conditions in the recent past were also prevailing in the south-eastern districts, particularly in the third quarter of 2016, as seen in the maps below5. The drought-like conditions were expected to affect the livelihoods and food security situation in the targeted districts.

Figure 1: Drought Severity Maps

Against this backdrop, to assess the current situation of food security and livelihoods, the FSWG co-led by FAO and WFP conducted a detailed assessment in four districts of Sindh, namely, Jamshoro, Sanghar, Tharparkar and Umerkot. The assessment was conducted in both urban and rural and arid and non-arid area in the targeted districts.

1.1 Objectives of the Assessment The assessment primarily aimed at assessing the current situation of food security and livelihoods in the drought prone districts in Sindh, Jamshoro, Sanghar, Tharparkar and Umerkot.

The assessment was conducted with the following specific objectives:

• Assess the food security and livelihoods situation of the households in four districts in Sindh; • Assess the dietary diversity, hunger, severity of food insecurity, malnutrition and access to water and sanitation; • Identify the shocks experienced by the households and the coping mechanisms adopted;

4 The IPC chronic analysis was conducted in collaboration with Government counter parts from both Federal and Provincial (Sindh) and other stakeholders on food security and nutrition. The findings of chronic food insecurity analysis have been submitted to both Federal and Provincial (Sindh) governments for endorsement, which is still pending. 5 The maps were produced by the Pakistan Meteorological Department (PMD) in the quarterly drought bulletins in 2016/17. 2

• Provide sound evidence for Integrated Phase Classification (IPC) for Acute Food Insecurity and IPC Acute Malnutrition Analyses and informed decision making for improving household livelihoods and food security

2. Methodology The assessment was carried out in April/May 2017 and used a household level multi-sector questionnaire. The assessment was conducted with the financial support of ECHO.

2.1 Sampling Methodology Sample size was calculated using the following parameters/formula:

Population size (N): (No. of households in each district)

Confidence level (z): 95%

Margin of error (e): 5%

Prevalence (p): Prevalence of food consumption in each district

Using the above elements and standard formula of sample size calculation, a sample size of 400 households was estimated for each district for LFSA.

Further, considering the share of population of the regions/sub-districts in each district, the sample households were surveyed from both urban and rural regions and sub-districts. In first stage, considering the proportional share of sub-district population (urban and rural) in the total sample size of 400 households for each district, number of union councils (2-3 for rural sample) and number of blocks (1-2 for urban sample) in each sub-district (Tehsil/Taluka) were calculated. In the second stage, two villages were selected randomly in each union council and one urban block in the urban sample. In third stage, 18 households (of which up to 3 were women headed) per village/urban block were selected randomly for interview. Women headed households were interviewed to compare the situation against male headed households.

2.2 Training on LFSA Questionnaire FAO and WFP jointly conducted a three-day orientation/training on the questionnaire and assessment methodology from April 20-22 in Hyderabad. A nutrition expert from WFP facilitated an extended session on MUAC measurement.

2.3 Data Collection The data collection started on April 23, 2017 and continued until May 06, 2017. For each district, a team of seven experienced enumerators including two-three females collected data which was supervised by a District leader who is an experienced professional from Bureau of Statistics, Sindh6. The District leader supervised the data collection process, and checked the filled questionnaires before sending it to the FAO office in Islamabad for data entry. In addition, staff of FAO, WFP and the Bureau of Statistics-Sindh also monitored the field teams to ensure good quality data collection.

6 List of enumerators and supervisors is attached in annex A. 4

2.4 Data Entry and Analysis Filled out questionnaires were entered into a database by experienced data entry operators under the supervision of FAO staff. Consolidated data was analyzed by a team of four data analysts, one each from Bureau of Statistics-Sindh, FAO, WFP and IPC Global Support Unit. The analysts prepared a tabulation plan and analyzed the data for both IPC Acute Food Insecurity analysis and report of LFSA survey, using SPSS and STATA software.

2.5 Limitations of the analysis Although around 400 households were surveyed in each district, in both urban and rural, desert/arid and non-arid areas of the sub-districts in each district; but due to lack of sampling weights, the findings of LFSA should not be generalized to all households in the district.

3. Regional, Demographic and Economic Profile of the Surveyed Households

3.1 Regional Profile of Surveyed Households Contrary to a target of interviewing 1600 households, field teams were able to interview 1573 households in the four districts. These households were interviewed in 20 sub-districts (Talukas/Tehsils) and 89 clusters/PSUs of which 17 were urban and 72 rural villages (located in 36 Union councils). These households were surveyed in both urban and rural regions and desert/arid as well as non-arid areas of the surveyed districts7. The distribution of surveyed households in each district is as follows:

Table 1: Distribution of surveyed households across the districts

Jamshoro (N=375) Sanghar (N=406) Tharparkar (N=395) Umerkot (N=397)

Sub-district Share in Sub-district Share in Sub-district Share in Sub-district Share in (taluka/tehsil) district (taluka/tehsil) district (taluka/tehsil) district (taluka/tehsil) district sample sample sample sample

Kotri 32% Jam Nawaz Ali 9% Chachro 18% Kunri 23%

Manjhand 19% Khipro 26% Dahli 9% Pithoro 9%

Sehwan 25% Sanghar 26% Diplo 18% Samaro 23%

Thana Bula Khan 24% Shahdadpur 13% Islamkot 9% Umerkot 45%

Sinjhoro 8% Mithi 27%

Tando Adam 17% Nagarparkar 18%

7 The list of surveyed UCs/urban blocks is provided in the annex B. Households from both urban and rural areas were interviewed in the following sub-districts: Koti, Sehwan and Thana Bula Khan sub-districts in districts Jamshoro; Sanghar, Shahdadpur and Tando Adam sub-districts in district Sanghar, Mithi sub-district in district Tharparkar and Kunri, Umerkot and Samaro sub-districts in district Umerkot. In remaining sub-districts, households were only interviewed from rural areas. 6

Figure 2: Map of Surveyed UCs/Urban Blocks

Of the 1,573 surveyed households, an overwhelming majority (81%) were interviewed in the rural areas. The proportion of households surveyed in rural and urban areas was highest in Tharparkar (91%) and Jamshoro (29%) respectively.

Further, 59% of the surveyed households (100% in Tharparkar and 71% in Jamshoro) were located in desert/arid areas, whereas 78% of the surveyed households in Sanghar and 61% in Umerkot were located in the non-arid areas.

Table 2: Regional Distribution of Surveyed Households across Districts

Overall Jamshoro Sanghar Tharparkar Umerkot 1573 375 406 395 397 Urban 19% 29% 21% 9% 18% Urban/Rural Rural 81% 71% 79% 91% 82% Non-arid 41% 29% 78% 0% 61% Desert/Arid Area Desert/Arid 59% 71% 22% 100% 39%

3.2 Demographic and Economic Profile of Surveyed Households To assess the livelihood and food security situation of women headed households, purposely up to 3 women headed households were interviewed in each village/urban block during the assessment. Overall, 14% of the surveyed households were headed by women (widows, divorced, separated or whose husbands were away from home for work). The proportion of women headed households was highest (lowest) in Sanghar (Umerkot) district.

Table 3: Characteristics of the Surveyed Households across the Districts

Overall Jamshoro Sanghar Tharparkar Umerkot 1573 375 406 395 397 Gender of head of Women 14% 18% 19% 11% 8% household Men 86% 82% 81% 89% 92%

Status of primary Unsustainable 86% 84% 87% 88% 85% source of livelihood Sustainable 14% 16% 13% 12% 15%

Primary source of Agriculture 38% 26% 45% 38% 41% livelihood Non-Agriculture 62% 74% 55% 62% 59% Very rich 16% 24% 13% 15% 14% Rich 19% 18% 18% 25% 16% Income Quintiles Middle 19% 21% 18% 19% 19% Poor 25% 24% 25% 24% 25% Very poor 20% 13% 25% 16% 25%

Further, an overwhelming majority (86%) of the surveyed households had unsustainable sources of livelihood8; and this was similar across the districts. No significant difference was found in unsustainable sources of livelihood between urban and rural, desert/arid and non-arid areas, and women and men headed households. The economic status of households (as depicted by income quintile) and unsustainable source of livelihood have an inverse association e.g. as the economic status of household improves, the proportion of households with an unsustainable source of livelihood reduces.

Overall, agriculture was the primary source of livelihood for 38% of the surveyed households; 45% in Sanghar and 41% in Umerkot, whereas non-agriculture based livelihood was most reported by surveyed households in Jamshoro (74%). Further, proportionally more households in rural and non-arid areas and households headed by men and with poor economic status had agriculture as their primary source of livelihood, whereas non-agriculture based sources of livelihood were common among women headed, rich and households in urban and desert/arid areas. A higher proportion of households with agriculture

8 Unsustainable sources of livelihood include agriculture-based sources of livelihood, non-agriculture wage labor, small businesses, remittances, zakat and BISP payments etc. 8 based livelihood source in Sanghar and Umerkot was also linked with a higher proportion of non-arid area in both these districts.

Table 4: Distribution of Surveyed Households by Sources of Livelihood

Status of primary sources of Primary sources of livelihood livelihood Non- Unsustainable Sustainable Agriculture Agriculture Urban 80% 20% 23% 77% Urban/Rural Rural 87% 13% 41% 59%

Non-arid 87% 13% 51% 49% Arid/Non-Arid area Desert/arid 88% 12% 34% 66%

Gender of head of Women 88% 12% 32% 68% household Men 86% 14% 39% 61% Very rich 62% 38% 22% 78% Rich 85% 15% 37% 63% Income Quintiles Middle 91% 9% 39% 61% Poor 93% 7% 38% 62% Very poor 92% 8% 49% 51%

The analysis in the forthcoming sections is based on following dimensions/characteristics of households: overall and by district, urban/rural, desert/arid and non-arid areas, gender of head of household, livelihood sources and by income quintiles. Although the surveyed households were located in urban/rural, arid/non-arid and different sub-districts (Talukas/Tehsils) of the surveyed districts, the statistics presented in forthcoming sections inform the situation of the surveyed households only, and should not be generalized to population of entire district.

4. Agriculture

4.1 Land Ownership and Cultivation Agriculture is amongst the major livelihood sources for households in the surveyed districts. The households were not only engaged in crop cultivation and agricultural labor, but also livestock rearing for subsistence and livelihoods. The surveyed households, on average, owned 1.6 acres of land, whereas they cultivated on average 3.1 acres of land, most of them as tenant/share croppers. The households reported cultivation of wheat, rice, maize, millet, cluster beans, pulses and vegetables. Rice cultivation was reported mainly in Jamshoro and Sanghar, whereas millet and cluster beans by households in desert/arid areas of Tharparkar and Umerkot districts.

Among the surveyed households, land ownership and cultivation were higher in desert/arid areas compared with non-arid areas. This indicates that although households attempt to produce by cultivating land in the desert/arid areas, production in fact depends on availability of water, and more importantly on rainfall, which may not be timely. Further, women headed households own and cultivate less land compared with men headed households.

Fig 3: Avg. No of Acres of Land Owned and Cultivated 6.0

3.1 2.6 2.5 1.9 1.6 1.7 1.5 1.3 .6

Overall Jamshoro Sanghar Tharparkar Umerkot Land Ownership (Number of Acres of Agricultural Land Owned) Land Cultivation (Number of Acres Cultivated)

Fig 4: Avg. No of Acres of Land Owned and Cultivated 3.9 3.2 2.1 1.9 1.9 1.6 1.2 1.4

Non-arid area Desert/Arid area Women Men Arid/Non-arid Area Gender of Head of Household Land Ownership (Number of Acres Owned) Land Cultivation (Number of Acres Cultivated)

In terms of distribution of ownership of agricultural land, overall, the overwhelming majority (around three-quarters) of the surveyed households do not own a single acre of agricultural land; 83% each in Sanghar and Umerkot, 68% in Jamshoro and 61% in Tharparkar. More households (80%) do not own land in non-arid areas, compared with 69% in arid/desert areas, whereas no significant difference was found between women and men headed households except those owning 5 acres of land or more.

Fig 5: Distribution of Land Ownership 5% 12% 9% 5% 9% 13% 4% 7% 13% 8% 23% 5% 16% 6% 8% 3% 7% 6% 8% 9% 7% 6% 7% 12% 8% 7% 8%

83% 83% 80% 76% 74% 68% 69% 73% 61%

Overall Jamshoro Sanghar Tharparkar Umerkot Non-arid Desert/Arid Women Men area area District Arid/Non-arid Area Gender of Head of 0 Acres 1-2 Acres 3-4 Acres 5+ Acres Household

4.2 Status of Ownership of Cultivated Land The low land ownership in comparison with land cultivation rates is also validated by the very high share of tenants/sharecroppers: two-thirds of the farming households (land cultivators) were tenants/share croppers, followed by owners (30%) and owner-cum-tenant (4%), whereas 2% of the farming households leased in the land or were engaged in another arrangement. Across the districts, the proportion of tenants/sharecroppers was highest in Sanghar (73%) and lowest in Jamshoro (48%). The tenants/sharecroppers often depend on landlords for supply of inputs and sale of crop production and usually have 50% share in costs of inputs and crop production.

Further, the proportion of tenants/sharecroppers was significantly higher in non-arid compared to desert/arid areas, whereas no significant difference was found between women and men headed households in tenancy/sharecropping.

Fig 6: Status of Ownership of Cultivated Land 1% 3% 3% 5% 3% 4% 9% 4% 1%

64% 48% 62% 73% 71%

39% 33% 30% 21% 25%

Overall Jamshoro Sanghar Tharparkar Umerkot

Owner Tenant/Sharecropper Owner –cum-tenant Leased in the land/other

Fig 7: Status of Ownership of Cultivated Land Men 30% 65% 4%1%

Headof Women 32% 60% 5%3%

Genderof Household

Desert/Arid area 35% 60% 5%

aridArea Non-arid area 22% 71% 3%4% Arid/Non-

Owner Tenant/Sharecropper Owner –cum-tenant Leased in the land/other

4.3 Sufficiency of Own Produced Cereals for Household Consumption Sufficiency of own produced cereals for household consumption contributes to food security through food availability dimension. However, the farming households in the surveyed districts had limited cereal production (wheat, rice, maize, millet) from the previous two seasons (Kharif 2016 and Rabi 2015-16), which was sufficient for household consumption for just 2.4 months overall, whereas only for 0.7 months in Tharparkar. Further, farming households mostly located in non-arid areas and those headed by men produce cereals sufficient for a longer period (4.4 and 2.5 months respectively) compared with those in arid/desert areas and women headed households (just 1.2 and 1.6 months, respectively).

Fig 8: Average Number of Months Owned Produced Cereals from Last Season were Sufficient for Household Consumption 4.4 4.0 3.9 3.4 2.4 2.5 1.6 1.2 0.7

Overall Jamshoro Sanghar Tharparkar Umerkot Non-arid Desert/Arid Women Men area area District Arid/Non-arid Area Gender of Head of Household

Further, overall 36% of farming households, around 60% each in Jamshoro, Sanghar and Umerkot, had relatively better cereal production (for more than 3 months) from last two seasons (Rabi 2015-16 and Kharif 2016). On the other hand, overall 45% of the households engaged in farming and 60% in Tharparkar did not have cereal stock at the time of the survey.

In addition, 59% of households engaged in farming in desert/arid areas had no cereal stock available at the time of survey compared with 23% in non-arid areas, whereas slightly more women headed households (52%) did not have any cereals stock compared with men headed households (45%). The insufficiency of own-produced cereals along with limited access to purchased food due to limited income opportunities are likely to aggravate the food security situation of households. The insufficiency of own- produced cereals is also linked with limited availability of water – a major input for crop production.

Fig 9: Sufficiency of Own Produced Cereals from Last Season for Household Consumption

Overall 36% 11% 7% 45%

Umerkot 57% 6%1% 37%

Tharparkar 7% 17% 16% 60%

Sanghar 60% 12% 28%

Jamshoro 60% 4% 35% >3 months 2-3 months 1 month No cereals stock available

Fig 10: Sufficiency of Own Produced Cereals from Last Season for Household Consumption Men 37% 11% 7% 45%

Headof Women 23% 15% 10% 52%

Genderof Household

Desert/Arid area 17% 13% 11% 59%

aridArea Non-arid area 68% 9% 23% Arid/Non-

>3 months 2-3 months 1 month No cereals stock available

4.4 Availability of Water for Agricultural Activities With frequent dry spells over the past 4 years, availability of water for agricultural activities has reduced compared with normal periods, as reported by the households engaged in farming. Overall, 44% of farming households reported water unavailability compared with normal periods, 30% reported less availability, 13% reported it was available to some extent while 13% responded it was mostly or fully available. Unsurprisingly, almost all households engaged in farming in Tharparkar reported ‘no’ or ‘very less’ availability of water, whereas around half in Jamshoro, Sanghar and Umerkot reported ‘no’ or ‘very less’ water availability. Further, unavailability of water was reported more commonly in desert/arid areas compare to non-arid; 94% of the household engaged in farming in desert/arid areas and 41% in non-arid areas reported ‘no/very less’ availability of water for agricultural activities compared with a typical normal period.

Fig 11: Availability of Water for Agricultural Activities Compared to Normal Period

Overall 44% 30% 13% 9% 4% Umerkot 20% 32% 22% 22% 3% Tharparkar 70% 29% 1% Sanghar 9% 41% 28% 10% 13% Jamshoro 31% 22% 25% 14% 8%

Not available Very less available Available to some extent Mostly available Fully available

Fig 12: Availability of Water for Agricultural Activities Compared to Normal Period Desert/Arid 66% 28% 3%1%1% area

Non-arid area 7% 34% 30% 21% 9%

Not available Very less available Available to some extent

4.5 Support Required by Households to Improve Crop Production

The farming households were also enquired about any support they required (in order of importance) to improve the crop production in the next cropping season. The farming households clearly indicated the need for quality seeds, fertilizer, new irrigation system, agricultural tools and credit to enhance crop production. Farming households in Sanghar mainly reported the need for quality seeds and fertilizers while repair/improvement of existing irrigation system was prioritized in Jamshoro. In Tharparkar, respondents indicated the need for credit and bullocks.

Fig 13: Support Required by Farming Households to Improve Crop Production 80% 70% 60% 50% 40% 30% 20% 10%

Tools Tools Tools

Bullock Bullock

Fertilizer Fertilizer Fertilizer

Quality seeds Quality Quality seeds Quality seeds Quality

Agriculture Credit Agriculture Credit Agriculture Credit Agriculture

Agricultural Services Agricultural Services Agricultural Services Agricultural

Repair of Tube of Wells Repair

Introduction of new irrigation… new of Introduction irrigation… new of Introduction irrigation… new of Introduction

Repair/Improvement of existing… of Repair/Improvement Repair/Improvement of existing… of Repair/Improvement existing… of Repair/Improvement First Second Third

Overall Jamshoro Sanghar Tharparkar Umerkot

Further, the need for quality seeds, fertilizer and repair/improvement of existing irrigation system was mainly reported by farming households in non-arid (irrigated areas) areas, whereas agricultural tools and credit, introduction of new irrigation system and bullock were needed mainly by farming households in desert/arid areas.

Fig 14: Support Required by Farming Households to Improve Crop Production 60% 50% 40% 30% 20% 10%

Tools Tools Tools

Bullock Bullock

Fertilizer Fertilizer Fertilizer

Quality seeds Quality Qualityseeds Qualityseeds

AgricultureCredit AgricultureCredit AgricultureCredit

Introductionof new… Introductionof new… Introductionof new…

AgriculturalServices AgriculturalServices AgriculturalServices

Repair/Improvement… Repair/Improvement… Repair/Improvement… First Second Third Non-arid Desert/Arid

4.6 Livestock Ownership Livestock is an important source for subsistence and food consumption. Overall, 67% owned goats, 28% owned cows, 18% owned poultry birds, 15% owned buffalos, 10% owned donkeys, 7% owned sheep and 6% owned camels. Goat ownership was highest in Tharparkar (92%) followed by Umerkot (72%), Jamshoro (58%) and Sanghar (47%). In the desert/arid areas, 88% of surveyed households owned goats compared with 60% in non-arid areas.

Fig 15: Ownership of Livestock/Poultry

92%

72%

67%

58%

47%

35%

34%

30%

28%

26%

21%

18%

17%

16%

15%

14%

13%

12%

10%

Overall

Sanghar

Umerkot

Jamshoro Tharparkar Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

Fig 16: Ownership of Livestock/Poultry

88%

76%

60%

33%

32%

28%

22%

16%

13%

12%

11%

10%

Rural

Urban

Non-aridarea Desert/Aridarea Urban/Rural Arid/Non-Arid

Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

4.7 Livestock Losses The livestock owners also incurred livestock losses; 22% each of goats and poultry birds, 19% of sheep, 13% of buffalos, and 9% each of cows, camels and donkeys perished in the surveyed districts during the past six months preceding the survey.

The livestock losses were reported mostly in Sanghar and Tharparkar districts, however, apart from buffalos, donkeys and poultry birds, no significant difference was found between loss of other animals in desert/arid and non-arid areas.

Fig 17: Percentage of Livestock/Poultry Lost During Past Six Months Preceding the Survey Overall Jamshoro Sanghar Tharparkar Umerkot 0

-10

-20

-30

-40

Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

Fig 18: Percentage of Livestock/Poultry Lost During Past Six Months Preceding the Survey Non-arid area Desert/Arid area

-6 -8 -8 -10 -9 -15 -16 -19 -18 -21 -21 -23 -27 Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

Overall, 52% of the surveyed households that kept livestock reported loss of goats, followed by sheep (43%), poultry birds (40%), buffalos (19%), cows and camels 16% each, and donkeys 14% during the six months preceding the survey. The households in Sanghar incurred the loss of cows, buffalos, sheep, donkeys and poultry birds the most, whereas loss of goats and camels was incurred mostly by surveyed households in Tharparkar and Jamshoro respectively.

Further, proportionally more households in desert/arid areas incurred loss of cows, goats, and sheep than in non-arid areas, whereas the reverse held true for buffalos, camels, donkeys and poultry birds. In fact, the difference between the proportion of households that reported loss of goats and sheep in desert/arid and non-arid areas is significant. Slightly more women headed households incurred loss of poultry birds, whereas livestock losses are reported more among men headed households.

Fig 19: Percentage of Households Where Livestock/Poultry Lost During Past Six Months Preceding the Survey

Overall Jamshoro Sanghar Tharparkar Umerkot

9% 9%

- -

10% 10%

11%

- -

14% 14%

15%

- -

16% 16% 16%

17%

- - -

19% 19%

20% 20%

- -

21%

- -

24%

25%

26%

30%

40% 40% 40%

41%

- - -

43%

47%

51%

52%

55%

60%

61%

- 74% Cows Buffalos Camels Goats Sheep Donkeys- Poultry birds

Fig 20: Percentage of Households Where Livestock/Poultry Lost During Past Six Months Preceding the Survey

Non-arid area Desert/Arid area Women Men

13%

14% 14% 14%

15% 15%

- - -

- -

17% 17% 17%

18% 18%

- - -

19%

- -

21%

25%

29%

33%

34%

35%

40%

45% 45%

46% 46% 46%

- -

- - -

52%

62% - Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

4.8 Livestock Sales The households also sold livestock/poultry birds to meet their food and other household needs and also due to occurrence/risk of disease, lack of water and fodder for livestock. Overall, around 53% of the households that kept livestock sold goats, 42% sold sheep, 25% each sold cows and buffalos, whereas 17%, 8% and 30% sold camels, donkeys and poultry birds respectively during the past six months.

Fig 21: Percentage of Households Sold Livestock/Poultry During Past Six Months Preceding the Survey

Overall Jamshoro Sanghar Tharparkar Umerkot

10%

14%

15%

17%

19% 19%

20% 20% 20%

- -

21% 21%

- - -

22%

- -

24%

25% 25% 25% 25%

- - - -

30%

31% 31%

- -

34%

36%

40%

41%

42%

47%

48%

51%

53%

60%

67%

68%

- -

Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

Fig 22: Percentage of Households Sold Livestock/Poultry During Past Six Months Preceding the Survey

Non-arid area Desert/Arid area Women Men

0% 0%

16%

17%

19%

20%

21%

23%

25% 25%

26% 26%

- -

27%

- -

30%

31%

32%

33%

35%

38%

41%

42%

44%

50%

54%

55%

- - Cows Buffalos Camels Goats Sheep Donkeys Poultry birds

Selling goats and sheep was reported mostly in desert/arid areas, whereas cows and buffalos in non-arid areas. Further, except camels and sheep, proportionally more men headed households sold livestock/poultry compared to women headed households.

4.9 Livestock Support Needed by Livestock Owners The top five items required by livestock owners (in order of importance) were water, straw/green fodder, concentrated feed, vaccines/medicines and livestock restocking to maintain the existing stock of livestock to meet their food and livelihood needs. However, there is no significant difference across the districts for specific support requirement.

Further, requirement for water, straw/green fodder and livestock restocking was mostly reported by livestock owners in desert/arid areas, whereas concentrated feed and vaccines/medicines were required in non-arid areas.

Fig 23: Support Required by Livestock Owners 70% 60% 50% 40% 30% 20% 10%

Water Water Water

feed feed feed

fodder fodder fodder

Livestock Livestock Livestock

Vaccines/ Vaccines/ Vaccines/

medicines medicines medicines

restocking restocking restocking

Straw/green Straw/green Straw/green

Concentrated Concentrated Concentrated First Second Third

Overall Jamshoro Sanghar Tharparkar Umerkot

Fig 24: Support Required by Livestock Owners 60% 50% 40% 30% 20% 10%

Water Water Water

feed feed feed

fodder fodder fodder

Livestock Livestock Livestock

Vaccines/ Vaccines/ Vaccines/

medicines medicines medicines

restocking restocking restocking

Straw/green Straw/green Straw/green

Concentrated Concentrated Concentrated First Second Third

Non-arid Desert/arid

5. Household Assets Ownership, Livelihood/Income Sources and Food Expenditure

5.1 Household assets ownership Assets ownership by the households is a proxy indicator for household economic access. Generally, assets ownership is very Table 5: Households Current Assets Ownership Assets Overall Jamshoro Sanghar Tharparkar Umerkot low among the surveyed Domestic assets9 households as around 80% Television 30% 42% 39% 15% 23% to 95% do not own Radio 7% 10% 6% 7% 6% productive assets. Washing Machine 12% 17% 16% 8% 8% Overall, the most owned Telephone 71% 77% 59% 74% 75% Fan 52% 74% 57% 32% 44% assets include telephones Heater 3% 3% 5% 3% 1% (70%), fans (53%), Cooking Stove 17% 25% 25% 12% 6% televisions (TV) (30%) and Refrigerator/Deep 12% 20% 12% 7% 10% irons (30%), whereas Freezer Iron 30% 34% 37% 27% 21% plough/agricultural tools Motorbike 19% 31% 12% 14% 20% (19%) and sewing Car/other vehicle 2% 3% 2% 1% 2% machines (18%) are the Computer 3% 4% 2% 3% 3% two most commonly 10 Productive Assets owned productive assets. Handloom 1% 2% 0% 2% 1% Sewing Machine 18% 20% 14% 15% 22% The overall domestic Grain Mill 3% 5% 4% 2% 2% assets ownership was Taxi/ Rickshaw 1% 2% 1% 1% 1% relatively lower in Cart 3% 2% 1% 1% 6% Tharparkar and Umerkot Oxen 0% 0% 1% 0% 0% districts compared to Tractor 1% 1% 1% 0% 1% Farm Machinery 0% 0% 0% 0% 0% Jamshoro. In case of Plough/ Agricultural productive assets, the 18% 6% 4% 30% 33% tools ownership of agriculture tools was found much lower in Jamshoro (6%) and Sanghar (4%) compared to Tharparkar (30%) and Umerkot (33%).

Further, there has been no significant reduction in the ownership of assets over the six months period prior to the survey, rather ownership for certain assets has slightly increased.

9 Domestic assets include: Television, Radio, Cooking stove, Cooking range, Washing machine, Refrigerator, Freezer, Microwave, Air conditioner, Air cooler, Geezer, Heater. 10 Productive assets include: Handloom, Sewing machine, Grain mill, Plough, Tractor, Motorbike, Rickshaw, Cart (Donkey, camel, bullock etc.), Car and Bicycle 22

5.2 Household Livelihood, Income and Expenditure, Loans and Assets

5.2.1 Primary and Secondary Income sources Livelihood sources across the surveyed districts were more or less the same and the households were heavily relying on unsustainable strategies for earning income/livelihoods i.e. daily wage labor (agriculture and non-agriculture), followed by self-employed small business ownership (shops etc.), or the raising and selling of livestock. According to the survey findings, for their primary source of livelihoods about 42% of the households were dependent on unskilled daily casual labor or unskilled daily agriculture labor, followed by 15% on small business/self-employed and 14% on sale of agricultural produce. Similarly, as a secondary livelihood strategy, about 32% were earning their livelihoods from unskilled daily casual labor or unskilled daily agriculture labor, followed by 11% from income support from Benazir Income Support Programme (BISP) while about 26% of the households reportedly do not have a secondary source of income. For households engaged in other small income earning activities, these included livestock (10%), government employment (6%) and handicrafts (2%).

In terms of income sources, minor disparities were noticed among the districts, nonetheless daily wages (agriculture and non-agriculture) 30.0% Fig 25: Household Sources of Income remained the top most source for livelihood across the districts. After 25.0% daily wage labor, in districts Umerkot and Sanghar, 27% and 20.0% 14% of households respectively,

15.0% were relying on the sale of agriculture produce while in

10.0% Tharparkar about 18% were relying on sale of animals or animal

5.0% products or livestock for their livelihood. Income support from

0.0% BISP was the secondary source of Primary Secondary Primary Secondary income for about 27% of Current 6 months ago households in Jamshoro, 4% each in Non-agricultural wage labour Small business/self-employed Sanghar and Tharparkar and 8% in Agricultural wage labour Sale of agriculture produce Sale of livestock Government employee Umerkot district. Since the sample NGO/private employee Handicrafts of the survey included non-desert areas as well, therefore, compared to the desert areas the livelihood strategies were somewhat different in the non-desert areas. The households in non-arid areas are engaged in relatively more sustainable livelihood strategies than households in the desert areas.

Further, findings reveal no significant change in the current livelihood strategies and those employed six-months-ago, prior to the survey dates, by the households. For instance, the proportion of households

23 who were previously involved in unskilled daily casual labor or unskilled daily agriculture labor decreased from 47% to 42%, similarly a decrease of 4% has also been observed in the sale of livestock.

5.2.2 Women’s Livelihood Sources In the surveyed districts, women are usually very active and provide full support to their male members of household in earning of livelihood. As per the survey’s findings, on average one female per household was engaged in livelihood earning activities. The main sources of women’s livelihood included handicrafts (27%), agricultural wage labor (24%), BISP support (18%) and non-agriculture wage labor (10%).

5.2.3 Monthly Income and Food Expenditure Share Households were asked about their total monthly income earned during the last month - cash income from all sources and also income earned from the seasonal sales of agriculture/other produce prior to the survey. Similarly, the survey also looked into the households’ expenditure incurred on food and non- food items in the same month11. The findings show that the mean monthly income of a household was PKR 10,895. The highest mean income was observed in Jamshoro (PKR 12,223), while the lowest in Sanghar (PKR 10, 070). Similarly, a significant differential has been seen in the monthly income of urban areas (average PKR 14,203) and rural (PKR 10, 104). No significant difference in the current and income level from six months ago of the households was observed.

The households were also asked Fig 26: Households's Expenditure Share on Food about their monthly household OVERAL 4% 22% 23% 51% expenditure, especially food UMERKOT 4% 19% 20% 57% expenditure, which is a proxy indicator on assessing households’ THARPARKAR 3% 20% 22% 55% access to food. The findings SANGHAR 4% 29% 29% 38% suggest, overall more than half JAMSHORO 2% 22% 19% 57% (51%) of the households spent Below 50% 50% to below 65% 65% to below 75% Above 75% more than 75% of their total expenditure on acquiring the household’s food. While the mean monthly food expenditure proportion was 83% of the total expenditure, this pattern was the same across the surveyed districts. Such high expenditure on food indicates that the households have to compromise on other basic needs (health care, education, others) to meet their immediate food needs.

11 The share of food expenditure of total household expenditure is a proxy indicator on household food access. The higher the share of food expenditure, the greater the likelihood that a household has poor food access and economical vulnerability. The commonly used thresholds for the share of food expenditure are used to classify households into 4 food expenditure groups i.e. Low equivalent to food secure (<50%); Medium, equivalent to marginally food secure (50 to 64.9%); High equivalent to moderately food insecure (65 to 74.9%); Very high equivalent to severely food insecure (=>75%). 24

6. Food Consumption and Dietary Diversity

6.1 Food consumption Score (FCS)

The FCS12 is a proxy indicator that helps establish a household’s current food security situation. FCS is a composite score based on dietary frequency, food frequency and the relative nutrition importance of the different food groups. The Fig 27: Food Consumption Score FCS is based on the frequency of different food groups consumed Poor Borderline Acceptable over a period of seven-day recall OVERALL 30.5% 26.1% 43.5% period, and does not capture UMERKOT 20.2% 24.7% 55.2% the quantities consumed and THARPARK… 45.6% 30.4% 24.1% number of calories gained. SANGHAR 36.0% 24.1% 39.9% JAMSHORO 19.5% 25.1% 55.5% According to the findings of the survey, overall about 44% of households had acceptable food consumption, approximately one third fell under poor food consumption category while the remaining had ‘borderline’ food consumption. Across the districts, Tharparkar had the worst food consumption with 46% of the surveyed households having poor food consumption and 31% being on the borderline, followed by Sanghar with 36% of the surveyed households having poor food consumption and 24% on the borderline. Jamshoro and Umerkot were found relatively better with 20% having poor food consumption and 25% on the borderline.

6.1.1 Sources of Food

Generally, all the desert/arid zone is very low on food production, in fact it has characteristics of a mono- cropping zone, with Fig 28: Two Main Sources of Food Consumed at Household households heavily own production (crops, animal) market dependent on markets for Sugar .4% 97.8% sourcing their food. As per Oil/fats .7% 97.4% the findings of this survey, Fruits 2.0% 94.4% except for milk and other Vegetables 2.6% 79.8% dairy products, more than Meats 5.7% 88.0% 90% of households were Milk 47.9% 47.0% Pulses 3.5% 93.1% sourcing the entire food Cereal 13.0% 81.7% basket from markets either with cash or on credit. For

12 FCS Consumption Score (FCS) is an acceptable proxy indicator giving an indication of food security status of the household if combined with other household access indicators. Based on a seven-day recall of the food groups consumed within a household, the FCS measures food diversity (types of foods consumed), food frequency (the number of days each food group is consumed), and the relative nutritional importance of different food groups. The score for each food group is calculated by multiplying the number of days the commodity was consumed and its relative weight. The FCS is a weighted sum of food groups. Based on FCS standard thresholds, households are categorized into three groups: “poor” food consumption (FCS= 1-28), “borderline” food consumption (FCS = 28.1 – 42), and “acceptable” food consumption (FCS>42). 25 milk, about half (48%) of the households were dependent on “own production”. Similarly, own production accounted for about 13% of households for cereals, 6% for meat and 3% for vegetables. About 14% of households reported “gathering” as the source for vegetable consumption. Such high dependency on the markets indicates that households are highly susceptible to market price fluctuations, especially when the livelihood strategies are mostly unsustainable.

6.2 Household Dietary Diversity Dietary diversity13 has important implications on overall health and wellbeing of individuals. A high proportion of energy derived from staple cereals is an indication of poor dietary diversity, while those with better diversity are likely to have a balanced proportion of their total energy from staple cereals as well as other nutritious foods. The food consumption pattern also indicates food diversity (the number of food groups consumed) by households during the past one week prior to the survey.

Fig 29: Dietary Diversty Groups Generally, the diet of the people in Low (1 to 4.5) Medium (4.5 to 6) High (Above 6) the surveyed districts was not only

Overall 70.8% 29.2% inadequate in terms of quantity, but also of poor quality and was Umerkot 67.5% 32.5% heavily cereal-based, thus poor or Tharparkar 83.5% 16.5% low dietary diversity remains a problem across the districts. Sanghar 68.5% 31.5% Overall, a very high proportion Jamshoro 63.2% 36.8% (71%) of surveyed households had low dietary diversity (<4.5 food groups) while the remaining had medium dietary diversity (4.5 to 6 food groups). Among the districts, none of districts had higher dietary diversity (>6 food groups). The highest percentage of households with low dietary diversity was reported in district Tharparkar (84%), followed by Sanghar (69%); whereas medium dietary diversity was found in district Jamshoro (37%), followed by Umerkot (33%).

13 The Diet Diversity Score (DDS) measures how many food groups out of 7 groups (i.e. excluding sugar/sweet from 8 groups used in FCS module) are consumed on average over a 7 days period. DDS is not an average for one day. The indicator results in the sum of the number of consumed food groups (from 0 to 7). Based on DDS, dietary diversity is ranked in 3 groups: Low diet diversity (DDS is less than 4.5), Medium (DDS = 4.5 - 6), and High (DDS is above 6).

6.3 Food-based Coping Strategies In the event of food shortfall or Fig 30: Reduced Coping Strategies Index lack of money to buy/access Overall 46% 24% 30% food, immediately households employ number of food based Umerkot 40% 27% 33% coping strategies, which are Tharparkar 39% 23% 38% measured by reduced coping 14 Sanghar 46% 28% 26% strategy index (rCSI) . Change in food consumption of the Jamshoro 61% 18% 22% household such as eating less

No or Low coping (0-5) Medium coping (6-10) High coping (>10) preferred or less expensive food, borrowing food from others, reducing the number of meals or portions, adults eating less in order to provide sufficient food for the children, are all considered as food-based coping strategies. Responses are thus weighted according to their severity and summed. According to the findings of the survey, Tharparkar had the highest (10) mean rCSI, whereas it was almost 8 in the remaining three districts. This indicates almost all households in the surveyed areas were employing ‘medium coping strategies’. Proportionately, overall about 46% of the households were employing ‘no or low coping strategies’, whereas 30% were employing ‘high coping strategies’, while 24% were employing medium level coping strategies.

6.4 Livelihood-based Coping Strategies Besides food based coping mechanisms, households use a variety of livelihood-based coping strategies in the case of food shortfall or Fig 31: Livelihood Coping Strategies lack of money to access food. HH not adopting coping Stress coping Crisis coping Emergencies coping Employing such strategies could Overall 15% 26% 22% 37% seriously undermine the ability Umerkot 17% 32% 19% 32% of households to make their livelihoods in the medium to Tharparkar 10% 15% 23% 53% long-term. Such strategies are Sanghar 23% 22% 26% 30% categorized according to their

Jamshoro 10% 37% 19% 35% severity e.g. a) stress strategies such as borrowing money, purchase food on credit, spent savings; b) crisis strategies such as selling household or productive assets, or withdrawing children from school); and c) emergency strategies such as consuming seed stock held for the next season, selling house or land or last female animal, or begging). The livelihood-based strategies are analysed based on their occurrence in the past 30 days prior to the survey.

The findings suggest overall 37% of the households across the districts employed ‘emergency strategies’, 22% ‘crisis strategies’, and 26% ‘stressed coping strategies’ to meet their food related needs. Among the

14 Food –based coping strategy is measured by Reduced Coping Strategy Index (rCSI). It is based on the short list of 5 food-related coping strategies applied in the case of lack of food or lack of money to buy food, during the past 7 days, prior to the survey. Generally, the higher the rCSI, the more severe the coping is applied by a household. Based on Pakistan’s context, the rCSI is determined and classified into three categories: No or low coping (rCSI= 0-5), medium (rCSI = 6 - 10), high coping (rCSI >10). 27 districts, the highest proportion (53%) of households resorting to emergency coping mechanisms was in Tharparkar, followed by Jamshoro, Umerkot and Sanghar.

6.5 Dietary Diversity among Women and Children

Dietary diversity is very important; particularly the proteins based part of the diet, for reproductive age women and young children. According to the survey findings, surveyed households lacked in providing diversified food to reproductive age women and young children. Overall only 30% of surveyed women of reproductive age, and just 17% in Tharparkar, were meeting the minimum dietary diversity (MDD-W) i.e. they consumed 5 or more food groups out of 10 in past 24 hours recall period. The MDD-W is considerably lower among women of rural, and desert/arid areas, men headed, unsustainable, agriculture and poor households than among women of urban, non-arid areas, women headed, sustainable, non-agriculture and very rich households.

Fig 32: Minimum Dietary Diversity of Women (MDD-W)

40% 39% 30% 25% 17%

Overall Jamshoro Sanghar Tharparkar Umerkot

Fig 33: Minimum Dietary Diversity of Women (MDD-W)

38% 37% 35% 29% 29% 23%

Urban Rural Non-arid area Desert/arid Women Men Area Urban/Rural Arid/Non-Arid Gender of head of household

Fig 34: Minimum Dietary Diversity of Women (MDD-W)

49% 43% 34% 33% 31% 28% 28% 25%

21%

Rich

Poor

Middle

Veryrich

Verypoor

Agriculture

Sustainable

Unsustainable Non-Agriculture Status of primary Primary sources of Income Quintiles sources of livelihood livelihood In case of minimum dietary diversity (MDD) among children age 6-23 months, overall 20% children (just 12% in Umerkot) met the minimum dietary diversity (MDD) based on a 24-hour recall period. The low dietary diversity among women of reproductive age and young children could be attributed to the poor health and nutrition situation in the surveyed districts.

Fig 35: Minimum Dietary Diversity (MDD) of Children Age 6-23 Months

29% 25% 20% 16% 12%

Overall Jamshoro Sanghar Tharparkar Umerkot

7. Markets In view of the crucial role of the markets in the households’ food security and households’ high dependency on markets to meet their food needs, the survey also looked into the households’ access to the nearest functional markets along with the status of food availability in the markets. Generally, the markets mechanisms are not very strong in these districts and markets are mainly located in the tehsil headquarters, far away from most communities, particularly in the desert/arid areas. Nonetheless markets were functioning well and reasonably connected to the bigger markets at Hyderabad and Mirpurkhas districts. There were almost no markets at the UC level in the desert/arid belt.

On average the nearby functional markets were about 15 kilometers away from the communities. The markets were relatively further (on average 25 km) from the communities in district Tharparkar, compared with an average of 14 kilometers in district Sanghar. Overall the distance to the nearest market ranges from one to a hundred kilometers. Households in Tharparkar and Jamshoro travelled a maximum of 100 kilometers to access a market, whereas in Sanghar and Umerkot the maximum distances reported were about 90 and 65 kilometers respectively. Further according to the findings, for about half of the surveyed households (49%), the markets were20+ kilometers away.

Table 6: Households Access to Market Districts Mean Availability of Main problems while accessing market Distance to food items Market is far Transport is not Cost of transportation markets (Kms) (Plenty) away often available is very high Jamshoro 11 90% 68% 25% 47% Sanghar 14 84% 51% 39% 28% Tharparkar 25 88% 67% 45% 30% Umerkot 12 90% 41% 35% 51% Overall 15 88% 58% 37% 37%

Generally, food availability in the markets does not seem to be an issue, as overall 88% of the households reported plenty of food availability in the markets they access. Besides remoteness, households face a number of problems while accessing the markets. For instance, overall about 58% of surveyed households reported “the market was too far away” as the main issue followed by “transport was not often available” and cost of transportation was very high” by 37% each.

Even though, food is generally available, Fig 36: Households with Enough Resoruces to Buy Food (%) the household’s ability to afford food Yes NO remains a challenge. More than half (54%) Overall 45.8% 54.2% of surveyed households reported having Umerkot 45.1% 54.9% no resources to buy food from the local Tharparkar 51.9% 48.1% markets. Among the districts, the Sanghar 37.7% 62.3% Jamshoro 47.2% 52.8% proportion of such households was relatively higher (62%) in district Sanghar followed by 55% and 53% in districts Umerkot and Jamshoro respectively. 30

8. Food Insecurity

8.1 Prevalence of Moderate and Severe Food Insecurity

The Food Insecurity Experience Scale (FIES)15 developed by FAO is used to compute Sustainable Development Goal (SDG) indicator 2.1.2: the prevalence of moderate or severe food insecurity in the population. The analysis16 revealed that overall 67% households had moderate and severe food insecurity in the surveyed districts, whereas 11% had severe food insecurity. Across the surveyed districts, Tharparkar had the highest prevalence of moderate and severe food insecurity (74%) followed by Sanghar, Jamshoro and Umerkot. The prevalence of severe food insecurity was significantly higher in Sanghar (23%) compared to other districts. Further, surveyed households in rural and desert/arid areas had higher prevalence of moderate and severe food insecurity than households in urban and non-arid areas.

Fig 37: Prevalence of Moderate or Severe Food Insecurity (%)

71.0 74.0 72.0 67.0 69.0 64.0 63.0 57.0 58.0

23.0 11.0 11.0 11.0 13.0 10.0 8.0 8.0 6.0

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid Moderate and Severe Severe

Analysis by other dimensions indicates that the estimated prevalence of moderate and severe food insecurity was slightly higher among women headed and agriculture based households, whereas significantly higher among households that had unsustainable livelihood sources.

15 The FIES is a food security measurement scale composed of eight questions. The questions ask to report on the occurrence of experiences and conditions that are typically associated with food insecurity. Respondents are asked to report if each of the conditions has been experienced, over the past 12 months, because of a lack of money or other resources to obtain food 16 The analysis presented in this section qualifies the statistical tests performed before estimating the prevalence of moderate and severe food insecurity. 31

Fig 38: Prevalence of Moderate or Severe Food Insecurity (%) 74.0 69.0 70.0 65.0 64.0

49.0

16.0 11.0 12.0 12.0 11.0 7.0

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood Moderate and Severe Severe

8.2 Household Hunger Score (HHS)

Household Hunger Score (HHS) is a method developed by Food and Nutrition Technical Assistance (FANTA) based on perceptions of food insecurity at household levels. It assesses whether households have experienced problems in food access during the preceding 30 days (four weeks) based on three questions and measures the severity of food insecurity in the past 30 days, as reported by the households themselves.

Based on the HHS, around half (48%) of surveyed households had no hunger, 28% had slight, 23% had moderate, whereas only 1% had severe hunger. Across the surveyed districts, most of the surveyed households in Umerkot had no hunger (72%), whereas moderate and slight hunger were highest among households in Sanghar and Tharparkar respectively.

Fig 39: Household Hunger Score

1 1 3 1 10 23 23 15 18 43 28 33 47 17 72 48 44 37 38

Overall Jamshoro Sanghar Tharparkar Umerkot

% of households with HHS of 4-6 (severe hunger) % of households with HHS of 2-3 (moderate hunger) % of households with HHS of 1 (slight hunger) % of households with HHS of 0 (no hunger)

Further, slightly more households in non-arid areas had no and moderate hunger, whereas slight hunger was found more in surveyed households in desert/arid areas. Similarly, the proportion of women headed households with moderate hunger was two times of men headed households.

Fig 40: Household Hunger Score 1 1 2 1 25 22 20 41

21 35 30 19

52 49 42 39

Non-arid area Desert/arid Area Women Men Arid/Non-Arid Gender of head of household % of households with HHS of 4-6 (severe hunger) % of households with HHS of 2-3 (moderate hunger) % of households with HHS of 1 (slight hunger) % of households with HHS of 0 (no hunger)

Moreover, slight and moderate hunger were slightly higher among households with unsustainable sources of livelihood. Further, moderate hunger was inversely associated with income quintiles; with improvement in income, moderate hunger reduces.

Fig 41: Household Hunger Score 1 1 2 2 14 15 15 22 24 23 23 26 30 24 25 31 31 27 28 29 33 26

62 60 54

46 46 49 50 39 41

Rich

Poor

Middle

Veryrich

Verypoor

Agriculture

Sustainable

Unsustainable Non-Agriculture Status of primary Primary sources of Income Quintiles sources of livelihood livelihood % of households with HHS of 4-6 (severe hunger) % of households with HHS of 2-3 (moderate hunger) % of households with HHS of 1 (slight hunger) % of households with HHS of 0 (no hunger)

9. Shocks and Coping Strategies

9.1 Shocks The households in the surveyed districts also faced several shocks during the past six months prior to survey, which affected their livelihood and food security. Overall, around half of the surveyed households reported experiencing any shock; huge proportion of households (72%) in Tharparkar experienced any shock during the past six months. Significantly more surveyed households in desert/arid areas, whereas slightly more households with unsustainable and agriculture based sources of livelihood experienced any shock.

Fig 42: Households Experienced any Shock During Past Six Months

32% 34% 37% 46% 44% 42% 47% 55% 72%

68% 67% 63% 54% 56% 58% 54% 45% 28%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid No Yes

Fig 43: Households Experienced any Shock During Past Six Months

39% 42% 46% 46% 47% 51%

61% 58% 54% 55% 53% 49%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood No Yes

The three main shocks reported by surveyed households included ‘severe sickness’ or ‘death of a bread earner (33%), ‘livestock disease outbreak’ and ‘drought/dry spell’ reported by 48% each. Among these 34 shocks, ‘severe sickness or death of a bread earner’ was mostly reported by households in Umerkot, compared with livestock disease outbreak and drought/dry spell in Tharparkar. Further, a higher proportion of women headed, sustainable and non-agriculture based households experienced severe sickness or death of a bread earner, whereas livestock disease outbreak and drought/dry spell were experienced more by other groups of households.

Fig 44: Main Shocks Experienced by Households

74%

63%

58%

51%

50%

48%

47%

46%

45%

41%

40% 40%

40%

38%

37%

35%

33%

31%

29%

28%

26%

23% 17%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Severe sickness or death of breadwinner Livestock disease outbreak Drought/dry spell

Fig 45: Main Shocks Experienced by Households

59%

55%

50% 50%

49%

45%

44%

42%

41%

40%

36%

31% 31% 28%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood

Severe sickness or death of breadwinner Livestock disease outbreak Drought/dry spell

In terms of losses due to reported shocks, mostly households experienced losses related to crop production, livestock and livelihood, particularly in Tharparkar, and desert/arid areas of the surveyed districts. The losses were faced by both women and men headed households alike, whereas a higher proportion of households with unsustainable and agriculture based livelihood sources reported the losses.

Fig 46: Main Losses due to Shocks

64%

59%

52%

50%

49%

46%

44%

43%

37%

36%

34%

33%

26%

24%

22%

21%

20%

16%

15%

15% 13%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid Crop losses Livestock losses Loss of livelihood

Fig 47: Main Losses due to Shocks

61%

52%

50%

47%

45%

44%

41%

38%

34%

25%

22%

21%

17%

17% 9%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood

Crop losses Livestock losses Loss of livelihood

9.2 Debt Contracting debt is very common and an immediate coping mechanism to meet household’s food and non-food needs. Overall 71% of surveyed households, whereas 75% in Tharparkar had contracted debt to meet household needs during the past six months prior to survey. Proportionally more households in rural and desert/arid areas, women headed households, and households engaged in unsustainable and agriculture based livelihood strategies contracted debt.

Fig 48: Households Contracted Debt During Past Six Months

64% 71% 71% 71% 75% 67% 73% 70% 72%

36% 29% 29% 29% 25% 34% 27% 30% 28%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area No Yes District Urban/Rural Arid/Non-Arid

Fig 49: Households Contracted Debt During Past Six Months

55% 74% 71% 74% 74% 69%

45% 26% 30% 27% 26% 31%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood

No Yes

Among the main reasons for contracting debt, ‘food needs’, covering ‘medical expenses’ and ‘debt reimbursement’ were the most reported reasons, particularly in Tharparkar and Umerkot, in rural and desert/arid areas.

Figure 50: Main Reasons for Contracting Debt During Past Six Months

92%

91%

89%

87%

85%

83%

81%

78%

77%

73%

69%

66%

65% 65%

65%

64%

59%

50%

23%

18%

14%

13%

12%

7% 6%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid Meet food needs Cover medical expenses Debt reimbursement

Overall, households had on average an outstanding debt of PKR 28,044 accumulated during the past six months prior to survey; households in Tharparkar had the largest amount of outstanding debt of PKR 37,429. The households in rural, desert/arid areas, women headed, with unsustainable and agriculture based livelihood sources had relatively higher amount of outstanding debt.

Fig 51: Amount of Outstanding Debt Contracted During Past Six Months (PKR)

37,429 37,429

31,706 31,706

30,559 30,559

30,346 30,346

28,044 28,044 25,951 27,864 19,758 25,509 28,574 25,890 27,410 28,305 26,263 24,253

Men

Rural

Urban

Overall

Women

Sanghar

Umerkot

Jamshoro

Tharparkar

Agriculture

Sustainable

Non-aridArea

Unsustainable

Non-Agriculture Desert/AridArea District Urban/Rural Arid/Non- Gender of Status of Primary Arid head of primary sources of household sources of livelihood livelihood

9.3 Migration

Seasonal migration in the desert areas is very common, households migrate to nearby water-rich districts for better livelihood opportunities and fodder/water for the livestock. Overall, 17% of the surveyed households (31% in Tharparkar), reported migration of at least one member during the past six months prior to survey. The low percentage of migration could be attributed to the lean period perhaps, as the survey was conducted at the outset of the lean season (April) where households had just finished the harvesting activities, and perhaps after this they would prepare for migration until Aug/Sept. Migration was slightly higher in rural and men headed households, and significantly higher in desert/arid areas and in households with unsustainable and agriculture based sources of livelihood.

Fig 52: Percentage of Households where Any Member Migrated During Past Six Months

31%

25% 21% 19% 17% 18% 18% 15% 15% 13% 13% 14% 10% 10%

Men

Rural

Urban

Overall

Women

Sanghar

Umerkot

Jamshoro

Tharparkar

Agriculture

Sustainable

Non-aridArea

Unsustainable

Non-Agriculture Desert/AridArea District Urban/Rural Arid/Non- Gender of Status of Primary Arid head of primary sources of household sources of livelihood livelihood

Three main reasons for migration reported by households were ‘fewer livelihood opportunities’ in the origin area, ‘loss of livelihood (crop/livestock loss)’ and ‘lack of fodder/grazing land’ for livestock. These reasons for migration were more pronounced in Tharparkar and Umerkot, in rural, desert/arid areas and in households with unsustainable sources of livelihood.

Fig 53: Three Main Reasons for Migration During Past Six Months

96%

92%

90%

89%

88%

87%

78%

77%

72%

67%

64%

54%

53%

52%

50%

40%

36%

30%

25%

21% 21%

21%

20%

18%

17% 10%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Less livelihood opportunities in the area Loss of livelihood Lack of fodder/grazing land for livestock

Fig 54: Three Main Reasons for Migration During Past Six Months

89%

88%

86%

85%

66%

64%

55%

53%

42%

22%

20%

17%

17% 0%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood

Less livelihood opportunities in the area Loss of livelihood Lack of fodder/grazing land for livestock

10. Health and Nutrition

10.1 Access to Healthcare Access to healthcare is a big issue in the surveyed districts; overall, surveyed households reported traveling 13.2 KMs (22.8 KMs in Tharparkar) to access healthcare. Compared to 2.2 KMs and 6.8 KMs in urban and non-arid areas, households in rural and desert/arid areas reported travelling 15.7 KMs and 21.8 KMs respectively to access healthcare. The most common problems reported by households while accessing healthcare, were ‘long distance’, ‘high cost of services’ and ‘lack/unavailability of transport’, particularly in Sanghar, Tharparkar, rural and desert/arid areas.

Fig 55: Avg.Distance to Mostly Accessed Health Facilities (KMs)

22.8 21.8

15.7 13.2 13.4 10.5 5.8 6.8 2.2

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/arid area area District Urban/Rural Arid/Non-Arid

Fig 56: Five Most Reported Problems in Accessing Health Care 70% 60% 50% 40% 30% 20% 10% 0% Overall Jamshoro Sanghar Tharparkar Umerkot Long distance High cost of services Transport not available Poor roads Medicines not available

Fig 57: Five Most Reported Problems in Accessing Health Care 60% 50% 40% 30% 20% 10% 0% Urban Rural Non-arid area Desert/Arid area Urban/Rural Arid /Non-Arid Long distance High cost of services Transport not available Poor roads Medicines not available

10.2 Disability Disability limits the capacity to access education and earn livelihood and subsequently impacts on food security Overall, 3% of the surveyed households had at least a disabled boy or a girl or an adult woman, whereas 5% had a disabled adult man. Across the surveyed districts, disability among both boys and girls was highest in Sanghar, whereas among men and women it was highest in Jamshoro and Tharparkar districts.

Fig 58: Percentage of Households Having Persons with Disabilities (PWDs) 12% 10% 8% 6% 4% 2%

Men

Rural

Urban

Overall

Women

Sanghar

Umerkot

Jamshoro

Tharparkar

Non-aridarea Desert/Aridarea District Urban/Rural Arid/Non-Arid Gender of head of household Boys Girls Men Women

Overall, the most common types of disabilities reported were related to vision, physical (lower limb) and mental retardedness. Vision related disability was more common among households in Tharparkar, whereas physical (lower limb) and mental retardedness was more prevalent among households in

Sanghar. Further, mental retardness, physical (lower limb) and vision related disabilities were significantly higher among households in urban, non-arid and desert/arid areas respectively.

Fig 59: Types of Disabilities

1% 2% 16% 17% 14% 23% 17% 7% 7% 7% 13% 16% 26% 28% 35% 7% 9% 30% 10% 14% 8% 10% 13% 12% 12% 47% 9% 30% 23% 23% 17%

Overall Jamshoro Sanghar Tharparkar Umerkot District Vision Speech Hearing Physical (Lower limb) Physical (Upper limb) Mentally retarded Others

Fig 60: Types of Disabilities 1% 1% 1% 14% 12% 15% 16% 17% 25% 4% 3% 7% 8% 8% 6% 23% 27% 42% 22% 22% 26% 10% 16% 10% 8% 13% 8% 9% 10% 10% 10% 9% 15% 31% 35% 32% 29% 25% 19%

Urban Rural Non-arid area Desert/Arid area Women Men Urban/Rural Arid/Non-Arid Gender of head of household

Vision Speech Hearing Physical (Lower limb) Physical (Upper limb) Mentally retarded Others

10.3 Malnutrition

10.3.1 Child Malnutrition High malnutrition among children and women is one of the big concerns in the surveyed districts. The poor food consumption, low dietary diversity, health issues and limited or no access to improved water and sanitation contribute to high malnutrition in the surveyed districts. Overall, based on Mid-Upper 43

Arm Circumference (MUAC) measurement, prevalence of Global Acute Malnutrition (GAM) among children age 6-59 months was 20.1% which was above the “emergency” threshold17. Overall, 3.3% children were severely acute malnourished (SAM), 16.7% were moderately acute malnourished (MAM). Among the districts, GAM prevalence was the highest in Jamshoro (22.3%), followed 17.8% in Umerkot and 18.6% in Tharparkar.

Further, the GAM prevalence was significantly higher among children in desert/arid areas and women headed households, and households with unsustainable and non-agriculture based livelihood sources and very poor households.

Fig 61: Prevalence of Malnutrition Among Children Age 6-59 Months

22.3%

20.9%

20.1%

18.6%

19.4%

17.8%

17.4%

15.7%

16.7%

15.8%

13.8%

11.5%

4.3%

4.0%

3.4%

3.3%

2..9% 2.8%

Overall Jamshoro Tharparkar Umerkot Non-arid Desert/arid District Arid/Non-Arid

Prevalence of SAM children Prevalence of MAM children Prevalence of GAM children

17 In total, MUAC readings of of 1137 children age 6-59 months were taken of which 681 were of age 6-23 months. Across the districts, MUAC data was collected from 355 children in Jamshoro, 428 in Tharparkar and 354 in Umerkot. MUAC data of 206 children in Sanghar was not included in the analysis due to data quality issues. 44

Fig 62: Prevalence of Malnutrition Among Children Age 6-59 Months

25.8%

23.5%

20.7%

20.2%

19.3%

18.8%

18.6%

17.1%

16.9%

16.0%

15.8%

15.5%

3.6%

3.5%

3.4%

3.1%

2.8% 2.3%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood

Prevalence of SAM children Prevalence of MAM children Prevalence of GAM children

Fig 63: Prevalence of Malnutrition Among Children Age 6-59 Months

22.9%

20.3%

19.6%

19.4%

18.3%

17.8%

17.5%

16.7%

16.3%

15.2%

5.1%

3.3%

3.0%

2.8% 2.6%

Very rich Rich Middle Poor Very poor Income Quintiles Prevalence of SAM children Prevalence of MAM children Prevalence of GAM children

10.3.2 Malnutrition among Pregnant and Lactating Women (PLW) Maternal nutritional status has important implications on health of young children during the pre-birth and post-birth periods. A high prevalence of malnourished pregnant and lactating women (PLW) is among the important factors of child malnutrition in the surveyed districts. Overall, 15.1% of PLWs were malnourished (MUAC below 21.0 CM) and prevalence of malnutrition among PLW was highest (16.6%) in Umerkot district18. Malnutrition among PLWs was significantly higher in women headed and

18 Data on MUAC of PLW in Sanghar was not included in the analysis. 45 unsustainable livelihood sources households, considerably higher in agriculture based households, whereas slightly higher in rural and desert/arid areas households compared to reference groups.

Fig 64: Prevalence of Malnutrition among Pregnant and Lactating Women (PLW) 16.6% 15.4% 15.1% 14.8% 14.7% 15.3% 13.9% 13.8%

Overall Jamshoro Tharparkar Umerkot Urban Rural Non-arid Desert/arid area area District Urban/Rural Arid/Non-Arid

Fig 65: Prevalence of Malnutrition among Pregnant and Lactating Women (PLW)

19.6% 17.1% 15.9% 14.5% 14.1%

10.2%

Women Men Unsustainable Sustainable Agriculture Non-Agriculture Gender of head of household Status of primary sources of Primary sources of livelihood livelihood

11. Housing, Water and Sanitation

11.1 Housing Housing structure is one of the indicators of wealth status of households. Overall, 33% were living in non-cemented (kacha) houses, 25% in Chonra19/wooden houses while 22% of surveyed households each were living in cemented (Pakka) and semi-cemented houses (kacha/pakka mixed). Across the surveyed districts, around two-third of the households in Tharparkar and Umerkot, whereas half in Sanghar were living in kacha/wooden houses. Significantly higher proportion of households were living in kacha/wooden houses in rural, desert/arid areas and households with unsustainable and agriculture based livelihood sources. Further, an inverse association is found between household economic status reflected by income quintiles and living in kacha/wooden houses.

Fig 66: Type of Housing

13% 18% 15% 13% 25% 21% 26% 37% 45% 19% 30% 37% 29% 33% 50% 36% 25% 28% 26% 21% 23% 21% 27% 13% 20% 18% 18% 41% 31% 27% 22% 23% 15% 20% 18% 17%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Area Arid/Non-Arid

Pakka hosue Semi pakka house Kacha House Chonra/Wooden/Other

19 Chonra is made of bamboos and bushes. 47

Fig 67: Type of Housing 11% 20% 10% 24% 25% 27% 24% 27% 31% 30% 19% 33% 18% 29% 27% 37% 32% 35% 26% 28% 36% 38% 35% 43% 23% 20% 21% 22% 20% 23% 44% 17% 45% 21% 14% 23% 29% 29%

17% 18% 11% 14% 14% 14%

Rich

Men

Poor

Middle

Women

Veryrich

Very poor Very

Agriculture

Sustainable

Unsustainable Non-Agriculture Gender of head of Status of primary Primary sources of Income Quintiles household sources of livelihood livelihood

Pakka hosue Semi pakka house Kacha House Chonra/Wooden/Other

Further, living in a small house with a big family is also an indication of household’s poor wealth/economic status. Around half (45%) of households were living in one-room houses, whereas 37% were living in two-room houses. Umerkot had the highest proportion of households living in one room houses followed by Jamshoro, Sanghar and Tharparkar. Overcrowding has adverse health implications particularly for young children.

Fig 68: Number of Rooms in House 2% 2% 3% 2% 2% 4% 2% 2% 2% 5% 5% 3% 6% 6% 5% 5% 4% 6% 9% 11% 10% 11% 11% 14% 11% 14% 13%

37% 35% 41% 34% 36% 37% 36% 40% 36%

45% 46% 48% 46% 47% 43% 41% 37% 42%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

1 2 3 4 5 or more

Further, access to electricity was also quite low; as only 61% of surveyed households overall, whereas just 41% in Tharparkar reported access to electricity. Households in rural and desert/arid areas, with unsustainable and agriculture based sources of livelihood and those very poor had significantly lower access to electricity.

Fig 69: Access to Electricity

87% 78% 70% 66% 61% 57% 54% 51% 41%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Fig 70: Access to Electricity 86% 78% 70% 63% 61% 66% 58% 55% 55%

47% 50%

Rich

Men

Poor

Middle

Women

VeryRich

VeryPoor

Agriculture

Sustainable

Unsustainable Non-Agriculture Gender of head of Status of primary Primary sources of Income Quintiles household sources of livelihood livelihood

Similarly use of unimproved sources of fuel for cooking could also lead to health complaints, particularly among women who are mainly engaged in cooking. Collection of firewood also has adverse implications for safety of women and children. An overwhelming majority (87%) of surveyed households reported use of unimproved sources (firewood, dung cakes, crop residues/others) for cooking purposes; highest in Tharparkar (91%) and lowest in Sanghar and Jamshoro. Significantly more households in rural and desert/arid areas were using unimproved sources of fuel compare to ones in urban and non-arid areas.

Fig 71: Sources of Fuel for Cooking

2% 2% 1% 1% 4% 1% 7% 2% 7% 4% 5% 7% 3% 6% 6% 2% 6% 7% 21% 4% 8% 13% 17% 9% 32% 19% 22%

91% 87% 89% 77% 77% 81% 63% 67% 55%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Fire Wood Gas Dung Cake Crop residue/others

11.2 Access to Water Limited access to improved water sources contributes to health issues, poor food consumption and subsequently poor nutrition. Overall, 65% of surveyed households access water from improved sources; highest in Sanghar (76%) and lowest in Tharparkar (50%)20. Unsurprisingly, the proportion of households accessing water from improved sources is significantly higher in urban and non-arid areas, whereas considerably higher among households having sustainable and non-agriculture based livelihood sources. Surprisingly, regardless of income status, indicated by income quintiles, no major difference was found in households’ access to improved water source.

20 Improved water sources include: Piped water/public tap, tube well/borehole, protected well, hand pump, treatment/filtration plant, RO plant, bottled water and protected spring water.

Fig 72: Access to Water

21% 21% 31% 24% 35% 38% 39% 50% 51%

79% 79% 69% 76% 65% 62% 61% 50% 49%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Improved Non-improved

Fig 73: Access to Water

24% 23% 35% 32% 36% 37% 37% 42% 37% 37% 43%

76% 77% 65% 68%

63% 63% 58% 63% 63% 57% 64%

Rich

Men

Poor

Middle

Women

Very Rich Very

VeryPoor

Agriculture

Sustainable

Unsustainable Non-Agriculture Gender of head of Status of primary Primary sources of Income Quintiles household sources of livelihood livelihood

Improved Non-improved

Amongst the sources of drinking water, hand pump was the most reported source followed by piped water/public tap and unprotected well. Piped water/public tap was the major source in Jamshoro; hand pumps in Sanghar and Umerkot and unprotected wells in Tharparkar. Further, hand pumps and unprotected wells were the major sources in non-arid and desert/arid areas respectively. 51

Fig 74: Sources of Drinking Water

Desert/Arid Area 18% 9% 6% 12% 1%3%1% 8% 9% 30% 1%3%

-Arid Non-arid Area 19% 6% 3% 46% 2%2%2%2% 8% 1% 8%1% Arid/Non

Rural 16% 7% 5% 30% 1%3% 5% 6% 21% 1%5%2% ral

Urban 30% 8% 4% 31% 3%3%2% 6% 10% 1%3% Urban/Ru Umerkot 16% 7% 3% 33% 3%1%4%1% 15% 15% 3%

Tharparkar 16% 4% 11% 13% 1%4% 6% 9% 34% 1%

Sanghar 14% 2%1% 54% 2%3%1%5% 4% 10% 3%1% District Jamshoro 27% 17% 3% 19% 1%2%1%3% 8% 15% 2%3%

Overall 19% 7% 4% 30% 2%3% 5% 6% 19% 1%4%1% Piped water/public tap Tube Well/ borehole Protected Well Hand Pump Treatment/ Filtration Plant RO Plant Bottled Water Protected Spring Water Water Tanks/ bladders Water Tanker Unprotected Well Unprotected Spring Water River/ Canal Rain Water/other

Apart from the quality of water, distance to the main water source is another issue in the surveyed districts where mostly children and women have to walk a long way to fetch water. Time spent on collection of drinking water reduces time for child education, and care for young children by the women. The use of women’s time on fetching water from far distance is also likely to have adverse impact on breastfeeding during the 182 days when the child needs to be exclusively breastfeed. Overall, 22% of surveyed households, 34% in Tharparkar, reported walking for more than 30 minutes to collect drinking water. As expected, significantly more households in desert/arid areas (34%) than in non-arid areas (11%) and in very poor households (27%) reported walking for more than 30 minutes to collect the drinking water.

Fig 75: Access to Water

22% 21% 18% 15% 17% 11% 34% 23% 34% 13% 19% 18% 15% 29% 22% 14% 25% 12% 21% 27% 23% 26% 18% 24% 18% 12% 12% 49% 46% 57% 47%

38% 27% 32% 34% 29%

Rural

Urban

Overall

Sanghar

Umerkot

Jamshoro

Tharparkar

Non-aridArea Desert/AridArea District Urban/Rural Arid/Non-Arid In the house/comound Less than 10 minutes walk 10-30 minutes walk More than 30 minutes walk

Despite limited access to improved water sources, overall only 59% households (81% in Tharparkar) were using any measure, mostly cloth filtration, to improve the quality of drinking water. Significantly more households in desert/arid areas (70%) reported use of any measure to get the water quality improved than in non-arid areas (48%).

Fig 76: Households Use Any Measure to Improve Quality of Drinking Water

81% 70% 59% 60% 54% 55% 50% 50% 48%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Fig 77: Measures Taken to Improve Quality of Drinking Water

94%

93%

92%

90%

87%

82%

77%

76%

67%

27%

24%

20%

17%

15%

13%

10%

5% 5%

4% 2%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Chlorination Cloth Filtration Boiling

11.3 Access to Sanitation

Access to improved sanitation is essential for good health as households with poor sanitation facilities are likely to have poor health. Access to improved sanitation facilities was very low, as overall half of the surveyed households, and two-thirds in Tharparkar reported ‘no toilet/latrine’ at home, hence, using ‘open fields’ for defecation. Overall only 29% households had access to ‘flush toilet’ at home; just 17% households in Tharparkar, 24% in rural and 20% in desert/arid areas. Unavailability of ‘toilets/latrines’ was more common in Tharparkar, rural, desert/arid areas and households with unsustainable and agriculture based livelihood sources and very poor households. Low access to improved sanitation facilities might be linked with low availability of water in the areas as with limited water availability for drinking and cooking; households would be less concerned about absence of improved sanitation facilities at home.

Fig 78: Access to Toilet

32% 43% 41% 41% 51% 55% 62% 57% 61% 14% 3% 15% 18% 6% 16% 15% 5% 7% 5% 8% 9% 12% 15% 5% 5% 3% 15% 2% 14% 4% 4% 6% 3% 5% 8% 4% 7% 5% 14% 5% 2% 38% 7% 3% 26% 4% 26% 7% 18% 24% 11% 12% 13% 10%

Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Flush System (Linked to Sewerage Flush (Linked to Septic Tank) Flush (Connected to open drain) Dry raised latrine Pit Latrine Open Field

Fig 79: Access to Toilet

25% 30% 42% 51% 51% 46% 55% 55% 58% 60% 20% 65% 19% 3% 16% 1% 14% 15% 11% 18% 14% 5% 11% 15% 12% 8% 4% 4% 12% 5% 13% 9% 7% 5% 5% 5% 8% 4% 9% 7% 37% 34% 6% 7% 4% 23% 22% 5%

19% 18% 15% 11% 12% 15% 11%

Rich

Men

Poor

Middle

Women

VeryRich

VeryPoor

Agriculture

Sustainable

Unsustainable Non-Agriculture Gender of head of Status of primary Primary sources of Income Quintiles household sources of livelihood livelihood

Flush System (Linked to Sewerage Flush (Linked to Septic Tank) Flush (Connected to open drain) Dry raised latrine

Further, almost two-thirds of surveyed households were not connected to any drainage system; highest (75%) in Umerkot. Households in rural and desert/arid area, having unsustainable and agriculture based sources of livelihood and very poor ones were more likely to be not connected with any form of drainage (underground/covered/open) system.

Fig 80: Access to Drainage System

38% 53% 51% 51% 62% 71% 75% 68% 74% 30% 18% 23% 30% 18% 14% 15% 14% 9% 18% 13% 12% 11% 10% 11% 18% 11% 10% 14% 9% 9% 6% 5% 6% 8% 13% 5% Overall Jamshoro Sanghar Tharparkar Umerkot Urban Rural Non-arid Desert/Arid Area Area District Urban/Rural Arid/Non-Arid

Underground Drains Covered Drains Open Drains No System

Fig 81: Access to Drainage System

36% 44% 57% 54% 63% 67% 60% 76% 69% 69% 68% 27% 27% 22% 23% 19% 17% 16% 17% 12% 14% 11% 17% 21% 9% 12% 14% 9% 10% 10% 20% 7% 6% 13%

11% 9% 7% 6% 11% 12% 12% 5% 10% 5%

Rich

Men

Poor

Middle

Women

VeryRich

VeryPoor

Agriculture

Sustainable

Unsustainable Non-Agriculture Gender of head of Status of primary Primary sources of Income Quintiles household sources of livelihood livelihood Underground Drains Covered Drains Open Drains No System

12. Assistance

The surveyed households received different types of assistance from multiple sources during the past six months, preceding the survey. The sources of assistance included government, local/international NGOs, UN agencies and relatives/friends/community members. Overall, most of the households (65%) received payments from Benazir Income Support Programme (BISP) followed by nutrition support for mothers and children (24%), free food (22%), cash/food for work/training (17%), zakat/khairat (alms) (5%) and agricultural support (inputs/training/livestock/irrigation support (4%). Free food, BISP payments and zakat/khairat (alms) were mostly received by surveyed households in Jamshoro, cash/food for work/training in Sanghar, nutrition support for mothers and children and agricultural support in Tharparkar.

Fig 82: Assistance Received During Past Six Months 80% Overall Jamshoro Sanghar Tharparkar Umerkot 70% 60% 50% 40% 30% 20% 10%

Other

FreeFood

Zakat/Khairat

work/training

Cash/foodfor

Drinkingwater

BISP payments

Government

compensation(cash)

Nutrition support Nutrition for

mothersand children

andNonconditional)

Agriculturalsupport

Tents/shelter material

Cash(Non-Govt. grants andirrigationsupport) (inputs/training/livestock Further, a higher proportion of rural households received cash/food for work/training, nutrition support, agricultural support and cash grants (non-government and non-conditional), whereas reverse holds true for surveyed households located in urban areas.

Fig 83: Assistance Received During Past Six Months Rural Urban

73%

63%

29%

26%

20%

19%

3% 3%

1% 1%

Other

FreeFood

material

Govt. and

Tents/shelter

Zakat/Khairat

Cash/foodfor

work/training

BISP paymentsBISP

Drinkingwater

Nonconditional)

Government

Cashgrants (Non-

ock irrigation… and

Agriculturalsupport

compensation(cash)

Nutrition support Nutrition for mothersand children (inputs/training/livest A higher proportion of surveyed households in desert/arid areas received cash/food for work/training, nutrition support, cash grants (non-government and non-conditional) and lower proportion of households received free food, BISP payments and agricultural support compared to their counter parts in non-arid areas.

Fig 84: Assistance Received During Past Six Months

68% Non-arid Area 62%

Desert/Arid Area

27% 27%

24%

21%

16%

Other

FreeFood

Zakat/Khairat

Cash/foodfor

work/training

BISP payments BISP

Drinkingwater

Government

ck irrigation… and

compensation(cash)

Nutrition support Nutrition for

Agriculturalsupport

motherschildren and

and Nonconditional)and

Tents/sheltermaterial

(inputs/training/livesto Cashgrants (Non-Govt.

The gender analysis in receipt of assistance found that proportionally more women headed households received free food, drinking water, cash/food for work/training, agricultural support and zakat/khairat than men headed households.

Fig 85: Assistance Received During Past Six Months Women Men

65%

64%

29%

25%

22%

21%

20%

15%

5% 5%

Other

FreeFood

material

Govt. and

Tents/shelter

Zakat/Khairat

Cash/foodfor

work/training

BISP paymentsBISP

Drinkingwater

Nonconditional)

Government

Cashgrants (Non-

tockand irrigation…

Agriculturalsupport

compensation(cash)

(inputs/training/lives Nutrition support Nutrition for motherschildren and

13. Conclusions and Recommendations

13.1 Conclusions

Agriculture

Agriculture is one of the main sources of livelihoods in the surveyed districts and households have adopted different patterns and arrangements for cultivation including cultivation of own land and share cropping/tenancy etc. Most of the households did not own land whereas land ownership and cultivation were reported less by women headed households. Due to low production, own produced cereals were not sufficient for household consumption, particularly in households in desert/arid areas and those headed by women, and a significant number of households had no stocks at the time of survey.

Most households owned small ruminants, particularly goats in desert/arid areas. A considerable number of livestock losses have been reported, particularly in Sanghar and Tharparkar districts. Sale of the livestock was also common due to disease and reduced availability of fodder and water. Inadequate crop production and livestock losses are likely to have adverse impacts on livelihood and food security of the surveyed households. Low crop production leads to less availability of food and less income for farmers from sale of crop production. Loss of livestock also contributes towards less income, low purchasing power to buy food, and less consumption of animal products.

Household Assets and Livelihoods

Generally, ownership of domestic and productive assets was very low. Primary sources of livelihood include sale of crops/vegetables and labor including unskilled agriculture and non-agriculture labour. Households in non-arid areas were engaged in relatively more sustainable livelihood strategies than in the desert/arid areas. Women were also involved in income generation activities and their main sources of livelihood were handicrafts, agriculture labor and BISP support.

Food Consumption

More than half of the households had poor food consumption while none of the survey districts had a high dietary diversity score. The diet of the people in desert/arid areas was poorer in terms of quality and quantity than the non-arid areas and low dietary diversity was highest in Tharparkar. Dietary diversity among women and children was also very low, particularly in Tharparkar and Umerkot respectively. Further, households were resorting to a number of food based coping strategies e.g. almost all households in the surveyed areas were employing ‘medium coping strategies’. Beside food based coping strategies, households also use livelihood based coping strategies to cope with food needs in lean periods.

Most of the households were dependent on markets for acquisition of food on cash and credit basis except milk and dairy products. The average distance to the market from communities particularly in desert/arid areas was very long. The cost of the transportation and unavailability of transport were main problems in accessing the markets.

Food Insecurity

Prevalence of food insecurity determined by FIES module-an indicator of SDG 2, was quite high in the surveyed districts as two-thirds of households had moderate and severe food insecurity, particularly around three-quarters in Sanghar and Tharparkar. Further, prevalence of moderate and severe food insecurity was higher in rural, desert/arid, women headed, and households that had unsustainable and agriculture based sources of livelihoods. Very high prevalence of food insecurity could be associated with high malnutrition among women and children in the surveyed districts.

Shocks and Coping Strategies

A high proportion of surveyed households also experienced shocks, particularly dry spells and livestock disease outbreaks, during the six months preceding the survey, particularly in desert/arid areas and by households with unsustainable sources of livelihood. Contracting debt, particularly for purchasing food, covering health expenses and debt repayments, was also quite common in the surveyed districts and households in Tharparkar had the largest amount of outstanding debt. Migration for better livelihood opportunities and for fodder/water for their livestock was a common practice in the surveyed districts, particularly in desert/arid, rural and men headed households.

Health and Nutrition

Access to healthcare is an important issue and distance to health providers was the most common problem reported, particularly in rural and desert/arid areas. Overall, prevalence of malnutrition (GAM- MUAC based) among children age 6-59 months was above the emergency threshold; significantly higher among children in desert/arid areas, women headed, very poor and households that had unsustainable and non-agriculture based sources of livelihood. Further, overall, 15.1% of PLWs were malnourished (MUAC below 21.0 CM); significantly higher in women headed and unsustainable livelihood sources households, considerably higher in agriculture based households, whereas slightly higher in rural and desert/arid areas households compared to reference groups. The overall situation of higher food insecurity, poor food consumption, low dietary diversity, high malnutrition among pregnant and lactating women (PLW), and poor access to health, improved water sources and sanitation are expected to contribute towards high malnutrition among children in the surveyed districts.

Although nutrition support programmes are undergoing in the surveyed districts, particularly in the desert/arid areas, still more integrated and coordinated efforts are required to reduce the high malnutrition among young children and women (PLWs).

Water and Sanitation

Around two-thirds of households were accessing water from improved sources: this was highest in Sanghar (76%) and lowest in Tharparkar (50%). Hand pumps were the main source, followed by piped water/public taps and unprotected wells. Distance to the water sources was a major impediment, particularly for children and women who generally fetch water from long distances, which is likely to affect their health, education and care including breastfeeding of young children. Further, overall, around half of the households and two-thirds in Tharparkar district had no toilet/latrine at home, which may cause adverse implications for health and security of children and women.

Assistance

Most of the surveyed households (65%) received support from BISP followed by nutritional support, food assistance, cash/food for work/training and agriculture/livestock support from multiple sources (Government, UN, I/L NGOs, relatives/friends/community members) during the six months preceding the survey.

13.2 Recommendations Agriculture

• Agriculture/livestock related support during the lean period • Support agricultural extension and veterinary services • Support on improving crop production, crop diversification, drought resistant crops, climate smart agriculture • Ensuring availability of quality seeds • Support in establishment of agro-forestry nurseries and promotion of agro/ farm forestry • Construction /rehabilitation of existing irrigation infrastructure, improvement of conventional irrigation system, water conservation, introduction of micro-irrigation system and water harvesting • Capacity building of farmers through Farmers Field Schools (FFS), Farm Business School (FBS) and Women Open Schools • Construction/rehabilitation of farm to market roads through cash for work • Cash based interventions for provision of fodder during the lean period • Extending livestock related assistance (fodder/feed, medicines/vaccinations) to needy and vulnerable livestock/poultry rearers • Re-stocking of livestock and poultry • Trainings on livestock and poultry rearing, Livestock Farmer Field Schools (LFFS), LEGS training • Establishment of livestock/fodder markets accessible to communities in the desert/arid areas

Food Security and Nutrition

• Cash plus interventions particularly focusing on women and other vulnerable households in collaboration with BISP • Conditional cash based interventions focusing on food security nutrition and livelihood • Integration of cash transfer programmes and social protection to address food security and nutrition • Training on kitchen gardening, diet diversity, food processing and food safety • Support for fish ponds in the irrigated areas • Estimation of cost of diet in the surveyed districts • Enhanced provision and integration of nutrition support programmes • Ensure provision of vitamin A supplementation • Provision of micronutrients through food supplementation and food fortification • Regular monitoring of food security, nutrition and livelihoods through seasonal surveys such as LFSA

Off-farm Livelihood

• Trainings on skills enhancement • Direct and indirect market support interventions

Water and Sanitation

Annex A: List of Enumerators

S.No District Name Organization 1 Ishfaque Ahmed (District Leader) Bureau of Statistics, Sindh 2 Shoukat Ali Bureau of Statistics, Sindh 3 Deedar Ali HANDS 4 Jamshoro Imran Bughio ACF International 5 Janib Ali ACF International 6 Sana Rajput Apex International 7 Sanam Naz Apex International 8 Naveeda Shaikh ACF International 9 Kaleem Ullah (District Leader) Bureau of Statistics, Sindh 10 Muhammad Ali Bureau of Statistics, Sindh 11 Allah Bachayo Plan International 12 Sanghar Faheem Raza BEST-Pak 13 Irshad Ali Village Development Organizatino 14 Irum Baloch Apex International 15 Shumaila Arain NDF 16 Seharish Village Development Organizatino 17 Siki Ladho (District Leader) Bureau of Statistics, Sindh 18 Mumtaz Ali Bureau of Statistics, Sindh 19 Rukhsana Umrani Sukaar Welfare Organization 20 Tharparkar Sajan Dass International Rescue Committee 21 Sajjad Ali TRDP 22 Shahid Ahmed ACTED 23 Togo Mal Sami Foundation 24 Saima parveen Apex International 25 Khizar Khan (District Leader) Bureau of Statistics, Sindh 26 Anil Kumar TRDP 27 Irfan Bhalai BEST-Pak 28 Umerkot Irum Muzammil Apex International 29 Mehnaz BEST-Pak 30 Sadiya Pervez ACTED 31 Rajesh Kumar SRDO 32 Imtiaz Ahmed SRDO

Annex B: List of Surveyed Union Councils/Urban Towns

District Tehsil /Taluka Urban/Rural Union Council/Urban Town Kotri Urban Bolahri Muncipality Kotri Urban Jamshoro Muncipality Kotri Urban Kotri Muncipality Kotri Rural Allah Bachayo Shoro Kotri Rural Dhaboon Manjhand Rural Khanote Manjhand Rural Shalmani Jamshoro Sehwan Urban Sehwan Muncipality Sehwan Urban Sehwan Muncipality Sehwan Rural Jhangara Sehwan Rural Talti Thana Bula Khan Urban Thana Bula Khan Town Thana Bula Khan Rural Mole Thana Bula Khan Rural Sarri Jam Nawaz Ali Rural Hoot Wassan Khipro Rural Bilawal Hingorjo Khipro Rural Kamil Hingoro Khipro Rural Khori Sanghar Urban Sanghar City, Ward 4 Sanghar Urban Sanghar City, Ward No 2 Sanghar Sanghar Rural Jakhrao Sanghar Rural Mian Shahdadpur Urban Mehran Town Shahdadpur Rural Barhoon Wazeer Rind Sinjhoro Rural Azeemabad Tando Adam Urban U.C 2 Ward 3 Tando Adam Urban Tando Adam City Tando Adam Rural Mir Hussain Mari Chachro Rural Kantio Chachro Rural Sarangaryo Dahli Rural Parno Diplo Rural Bolhari Diplo Rural Sobhiar Islamkot Rural Sonel Beh Tharparkar Mithi Urban Mithi City Mithi Urban Mithi City Mithi Rural Mithiro Bhatti Mithi Rural Mohrano Nangarparkar Rural Dabho Nangarparkar Rural Peelu

District Tehsil /Taluka Urban/Rural Union Council/Urban Town Kunri Urban Kunri Town Kunri Rural Bustan Kunri Rural Talhi Pithoro Rural Shadi Polli Samaro Urban Samaro Town Samaro Rural Araro Bhurghari Umerkot Samaro Rural Satriyoon Umerkot Urban Umerkot City Umerkot Urban Umerkot City Umerkot Rural Chhore Umerkot Rural Dhoronaro Umerkot Rural Faqeer Abdullah Umerkot Rural Kaplore Note: In each selected UC, two villages were surveyed.

The Livelihood and Food Security Assessment (LFSA) has been conducted to assess the situation of livelihood and food security in the four drought prone districts in Sindh, namely, Jamshoro, Sanghar, Tharparkar and Umerkot.

Food Security Cluster-Pakistan, under the leadership of FAO and WFP, conducted this assessment in coordination with Provincial Disaster Management Authority (PDMA-Sindh), Bureau of Statistics-Sindh and FSC member organizations. The financial support was provided by ECHO.

A household questionnaire was used to collect data from 1,573 households located in 36 rural union councils (72 villages) and 17 urban blocks of 20 sub-districts (tehsils/talukas) of 4 districts. These households were surveyed in both urban and rural, and desert/arid and non-arid areas of the four districts.

The LFSA report provides detailed account of sufficiency of own-produced cereals, livestock ownership, sales and losses, livelihood sources, food consumption, dietary diversity, reduced and livelihood coping strategies, food security, nutrition, housing structure, access to water and sanitation assistance received by the surveyed households.

The findings of LFSA will assist the stakeholders, the Government of Pakistan, the Government of Sindh, national and international humanitarian actors, for improved decision making and designing effective interventions/programs for the communities in drought prone districts in Sindh.

FAO Representation, NARC Premises, Park Road, Chak Shahzad,

Phone: 92-51-9255491-3, Web: http://fao.org/pakistan/

Food and Agriculture Organization of the United Nations, Islamabad