Provincial Inception Meeting Report- Punjab
DISCLAIMER
This document is an output from a project funded by the UK Department for International Development (DFID) and Australian Agency for International Development (AusAID) for the benefit of developing countries. The views expressed and information contained in it are not necessarily those of or endorsed by DFID, AusAID or the Maternal and Newborn Health Programme Research and Advocacy Fund(RAF), which can accept no responsibility or liability for such views, completeness or accuracy of the information or for any reliance placed on them.
ACKNOWLEDGEMENT
‘Studying the knowledge, beliefs and practices of unmarried and married adolescent girls with respect to nutrition and on the sources of nutrition information the adolescents have access to and use’ is a project funded by the Maternal and Newborn Health Programme Research and Advocacy Fund (RAF) and is implemented by Fatima Memorial Hospital, in collaboration with its implementing partner Nur Center for Research and Policy (NCRP).
PROVINCIAL INCEPTION MEETING- PUNJAB
CONTENTS
Disclaimer ........................................................................................................................ 2 Acknowledgement............................................................................................................ 3 Contents........................................................................................................................... 4 Introduction ..................................................................................................................... 5 Objective of meetings in provinces ............................................................................................ 6 Specific Objectives of thE seminar held in Punjab ...................................................................... 6 Scope ....................................................................................................................................... 6
Participant Profile ............................................................................................................ 6 Meeting Methodology ...................................................................................................... 7 Proceedings .............................................................................................................................. 7 Situation Analysis: Nutrition related issues in Punjab ................................................................................ 7 Nutritional Status of Adolescent Girls & its implications for MNH Outcomes – An Overview of the RAFfunded Research Study ............................................................................................................................... 7 Progress on Nutrition Policy Guidance Notes, Strategy & Operational Plans ............................................ 8 Salient features of Multi Sectoral Nutrition Policy ..................................................................................... 8 Integrated Reproductive Maternal Newborn & Child Health (RMNCH) & Nutrition Program– Response of Health Department for addressing Nutritional Issues in Punjab ............................................................ 8
Discussion ................................................................................................................................ 9
Closing comments ............................................................................................................ 9 RecommendationS of Participants .................................................................................. 10 Annex 1- Introduction to FMH .................................................................................................................... A Annex 2- Background of Meeting ............................................................................................................... B Annex 3- Agenda ......................................................................................................................................... C Annex 4- Participants’ Registration and Attendance (1 of 7) .....................................................................D Annex 4- Participants’ Registration and Attendance (2 of 7) ..................................................................... E Annex 4- Participants’ Registration and Attendance (4 of 7) .................................................................... G Annex 4- Participants’ Registration and Attendance (5 of 7) .....................................................................H Annex 4- Participants’ Registration and Attendance (6 of 7) ...................................................................... I Annex 4- Participants’ Registration and Attendance (7 of 7) ...................................................................... J Annex 5- Feedback Form ............................................................................................................................ K Annex 6- Pictures from the Provincial Inception Meeting, Punjab ............................................................. L
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INTRODUCTION Nur Center for Research and Policy (NCRP) and the Punjab government organized a joint seminar for the dual purpose of initiating dialogue with relevant stakeholders for the development of strategy as a follow up to the recently formulated Punjab Nutrition Policy, and to place in this context the multicenter national adolescent nutrition study led by NCRP. Recognizing the implications of high levels of malnutrition and efforts to achieve Millennium Development Goals (MDGs), the Government of Punjab (GoP) and its partners decided to undertake a multisectoral nutrition review involving representatives of key development sectors which, collectively, have considerable potential for reducing malnutrition significantly in the province. These reviews are designed to assess provincial malnutrition levels, identify sectoral programs which have been associated with malnutrition reductions, and to begin identifying possible roles for these sectors in a collective effort to reduce malnutrition in the province. Also made explicit in the review are likely benefits to each sector from improved nutrition in the province. The seminar brought together members of the Department of Health, academia, researchers and development professional who have been playing an active role in the field of Nutrition (participants’ list attached as Annex I). The seminar proceedings started with a situation analysis of nutrition indicators and nutrition related issues in Pakistan particularly the Punjab province. Representatives from international organizations and key government institutions shared their perspectives with participants. This was followed by a rich and participatory discussion. Participants endorsed the areas of focus of the Punjab guidance document which outlines the vision for investment in nutrition as well as need for intersectoral partnerships in this regard. The discussion also added additional actions and recommendations. The closing remarks were made by Prof. Dr. Humayun Maqsood, Principal, Fatima Memorial College of Medicine & Dentistry. He expressed his organization’s commitment to partner with stakeholders, development partners and government institutions to address the issue of malnutrition in relation to various sociodemographic factors. NCRP is a technical arm of the Fatima Memorial Hospital (FMH) and is currently implementing a nutrition research project, supported by the Research & Advocacy Fund (RAF). The evidence-generated is expected to make a compelling case for prioritizing and strengthening nutritional aspects of health and other programs. The project hereby has policy implications and is being undertaken at an opportune time when the provinces are working on developing their nutritional strategies. It aims to document the knowledge, beliefs and practices of unmarried and married adolescent girls with respect to nutrition; and record different sources of nutrition information. It also sought to determine the role and practices of stakeholders including school teachers in promoting adequate nutrition among students. Stakeholders also included health policy-makers and managers so that their views and knowledge contributes to better future interventions. The study findings are expected to contextualize an array of possible factors influencing nutritional status of marginalized girls as well as adolescent mothers, with the purpose of informing MNCH policies and strategies to accelerate progress towards achievement of Millennium Development Goals (MDGs) 4 & 5. The provincial inception meeting is a part of project titled ‘Studying the knowledge, beliefs and practices of unmarried and married adolescent girls with respect to nutrition and on the sources of nutrition information the adolescents have access to and use’ , funded by the Maternal and Newborn Health Programme Research and Advocacy Fund (RAF) and is implemented by Fatima Memorial Hospital.
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The technical assistance for the project is being provided by the Principal Investigator, the four provincial coordinators, technical expert gender, M&E, research, statistics and epidemiology. The project further has support of an entire panel of nutritional experts on board of Fatima Memorial Hospital and Nur Center for Research and Policy. This provincial inception meeting is a joint collaborative project of FMH and its implementing as well as provincial partner in Punjab i.e. Nur Center for Research and Policy.
OBJECTIVE OF MEETINGS IN PROVINCES i. ii. iii.
To develop an understanding of the project To understand the need of the study keeping MDG 4 and 5 in perspective To understand the need to study adolescent girls due to lack of evidence in this age group, particularly after the National Nutrition Survey 2011 To bring about a consensus on the purpose of the study and possible outcomes
iv.
SPECIFIC OBJECTIVES OF THE SEMINAR HELD IN PUNJAB The Seminar was organized to provide a forum to review issues and challenges facing Punjab in improving the nutritional status of its people and to take further the dialogue on the development of the proposed multisectoral nutrition strategy. i.
To facilitate direct interaction between policy-makers; development partners and members of the Technical Working Group on formulation of multisectoral nutrition strategy To share an overview of the RAF-funded research with participants and advocate for the utilisation of the evidence generated in the Punjab government nutrition strategy and other relevant health and nutrition related actions. To make recommendations to strengthen the Punjab Health strategies for addressing nutrition issues and combating malnutrition.
ii.
iii.
SCOPE The Meeting focused on five areas:
Theme 1:MDGs 4 and 5 Theme 2: Adolescents in Pakistan Theme 3: Role of early marriages Theme 4: Role of nutrition Theme 5: Outcome of research study
PARTICIPANT PROFILE
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Participants included Senior Health Professionals from MNCH and PGHS, UNICEF Nutrition, Micronutrient Initiative, RAF Office, other Provincial Program representatives, policymakers, activists, healthcare workers, educators, community leaders, UN Agencies representatives, senior level staff of local, national, regional and international NGOs and CSOs working for nutrition. For more information, please refer to Annexure.
MEETING METHODOLOGY
Power Point Presentation on the project, the research problem and background of the grantee i.e. Fatima Memorial Hospital. Presentations lasted between 15-30 minutes and provided opportunity for questions and discussion. Discussion during which participants discussed the role of various stakeholders in the nutrition of adolescent girls, particularly that of LHWs, LHVs, TBAs and CMWs. The discussion also revolved around the steps that can be taken by institutions like KMU and FMH, in covering nutrition in the curricula at undergrad, grad and post-grad levels.
PROCEEDINGS The welcome note to the august audience was given by the Principal Investigator Dr Shabnum Sarfraz. The seminar proceedings comprised of five presentations and a group discussion
SITUATION ANALYSIS: NUTRITION RELATED ISSUES IN PUNJAB (Dr. Tahir Manzoor, Health & Nutrition Specialist, UNICEF) The session presented a statistical overview of malnutrition as a global as well as a regional problem involving developing countries. UNICEF data estimates that there are more than 150 million malnourished children under the age of 5 years. In addition, up to 35% of the 9.2 million annual deaths globally are attributable to malnutrition. While recognizing under-nutrition as a major health problem in which contributes to country’s high maternal/child mortality and morbidity, it ranks Pakistan 57th on the Global Hunger Index. The prevalence of anemia is alarmingly high among children under 5 years of age. This was identified as leading to vulnerability to disease and higher child mortality rates particularly when there exists no organized system of nutrition counseling and early screening. According to UN report 2008, 51% of population in Pakistan is food insecure. The presentation touched upon the need to identify gaps in legislations in order to ensure adequate nutrition for high-risk population. It also called for exploring an integrated or multisectoral approach involving different departments and organizations. It further emphasized on improving research quality by gathering reliable data that contributes to institutionalize policies directed at eradication of malnutrition.
NUTRITIONAL STATUS OF ADOLESCENT GIRLS & ITS IMPLICATIONS FOR MNH OUTCOMES – AN OVERVIEW OF THE RAF-FUNDED RESEARCH STUDY
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(Dr. ShabnUm Sarfraz, Chief Operating Officer, NCRP-FMS) It included review of the ongoing project at NCRP, regarding knowledge, beliefs and practices of unmarried and married adolescent girls with respect to nutrition at NCRP. The study involves evaluation of nutritional status of adolescent girls in Pakistan. It also aims at sociocultural factors which serve as barriers to comprehensively address the issue of malnutrition. The issue of unsafe abortions and pregnancy at earlier age were discussed in context of gender inequalities. It also identified school-going children particularly girls as most vulnerable to nutritional deficiencies which has contributed to constant rise in maternal and child mortality. The Principal Investigator summarized the research objectives, project scope and expected output after completion of data collection phase. She called for participants’ support for collaborative advocacy in order to ensure the utilization of the evidence generated by the study.
PROGRESS ON NUTRITION POLICY GUIDANCE NOTES, STRATEGY & OPERATIONAL PLANS (Tauseef Khatana, Deputy Program Director (M&E), Punjab Health Sector Reforms Program) The presentation summarized the progress made since September 2011 and the follow up meeting held in February 2012. It recalled the devolution through 18th amendment which necessitates that provinces develop multisectoral nutrition policy, strategy and operational plans. The Micronutrient Initiative is the lead development partner for this initiative and formation of Provincial Steering Committee under the Chairmanship of Chairman P&D in June 2012 was a continuation of the same strategy. The committee is tasked to provide strategic guidance. On the other hand, Technical Working Group constituted six sectoral sub-groups which submitted their recommendations on October 31, 2012. To date, nutrition policy notes approved as well as TORs of sectoral groups have been approved to clear the way forward.
SALIENT FEATURES OF MULTI SECTORAL NUTRITION POLICY (Munawar Hussain, Program Manager, Punjab Micronutrient Initiative) The presentation discussed the functioning of Steering Committee on Nutrition Strategy which is tasked with formulation of a comprehensive conceptual framework for provincial nutrition strategy. The committee has emphasized on role of other departments and sectors which need to complement corresponding activities of health department. It was expected that this nutrition strategy will significantly improve health indicators related to women and children’s nutritional status, thus contributing to overall socioeconomic uplift and increasing school enrollment rates. It also mentioned the merit of devising a suitable agricultural strategy which takes into account local population’s nutritional requirements and sustainability. He stressed upon Agriculture Department to provide subsidies on micronutrient rich plant varieties.
INTEGRATED REPRODUCTIVE MATERNAL NEWBORN & CHILD HEALTH (RMNCH) & NUTRITION PROGRAM– RESPONSE OF HEALTH DEPARTMENT FOR ADDRESSING NUTRITIONAL ISSUES IN PUNJAB
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(Dr Akhtar Rashid, Secretery, Technical Working Group, Lady Health Workers’ Programme ) It explored malnutrition as a behavioral issue or attributed to unbalanced diet. He said, “Malnutrition is a complex issue undetermined whether it is issue related to low BMI or marginalized segment”. The presentation also mentioned exploring the issue from a multisectoral perspective which relies on synchronized implementation. To support this, women focused approach (1000+) model was devised which targets females before they are pregnant. Conceptually, the model is based on preventive as well as curative arms under Integrated Provincial Nutrition Board. The presenter also shared departmental initiatives on mobile-health and pros and cons of the strategy thus far. He reported interested of corporate sector in strengthening and upscaling community initiatives including Lady Health Workers’ Program. The topic also touched upon improving birth rates supervised by skilled birth attendants despite overall limitations of health department. After the presentations, the forum was declared open for discussion.
DISCUSSION • • • • • • • • • • • •
Participants noted lack of robust monitoring and evaluation mechanism as well as research capacity which are considered pre-requisite for achieving milestones. Also discussed need to remove legislative ambiguities in order to ensure nutrition sufficiency besides prosecution and punishment for food adulterations. Lauded the role of private sector institutions like NCRP in promoting the research and collaboration to eradicate malnutrition in Punjab. Discussion over need to identify interventions which could be completed within existing resources and those requiring additional resources. Development partners were also urged to provide assistance wherever possible. Need to improve school enrollments for promotion of nutrition literacy and awareness of preventable nutritional deficiencies. Participants urged the provincial departments bridge coordination gaps which have prevented maximizing potential of Punjab Micronutrient Initiative. They also deliberated on need to appoint professional and qualified staff to improve functioning of department of health. The topic of establishing partnership across different sectors to boost resources and explore alternate funding opportunities also came up for discussion. Devise protocol for compliance with supplementation regimen including folic acid. Merits of introducing warrants a performance-based system which is goal-oriented and keeps staff motivation levels to maximum. Participants advocated for greater inclusion of local communities as well as information technology for effective implementation.
CLOSING COMMENTS
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BY THE CHAIRPERSON EXECUTIVE COMMITTEE AND PRINCIPAL FMH COLLEGE OF MEDICINE AND DENTISTRY
This was an important and productive forum. A note of thanks was given to all the participants. This group of participants can together act as a think tank, towards generating more information and evidence for policy makers.
RECOMMENDATIONS OF PARTICIPANTS
The following recommendations emerged from the deliberations of the seminar: I. II. III.
IV. V. VI. VII.
Explore multisectoral approach and its potential to address the issue of malnutrition in Punjab through community participation and collaborations. Advocacy for inclusion of information technology and its applications in order to reach remote locations and devise innovative strategies which strengthen working of Lady Health Workers. Clearly define intrasectoral roles-more specifically of academic institutions to improve governance and managerial capacity of provincial departments which is necessary for effective implementation of policies and strategies. Operational research capacity development and institutionalization of operational research to effectively monitor and evaluate progress and fine tune strategies. Improve and enhance intra and intersectoral coordination mechanisms and structures to ensure better coordination, cooperation and collaboration in implementation of strategies. Develop a focused human resource development policy and comprehensive collaborative strategies to address the health human resources (HRH) shortages, quality and skill mix issues. Initiate evidence-based advocacy and promotional campaigns through partnering with media.
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ANNEX 1- INTRODUCTION TO FMH
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ANNEX 2- BACKGROUND OF MEETING
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ANNEX 3- AGENDA
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ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (1 OF 7)
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ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (2 OF 7)
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PROVINCIAL INCEPTION MEETING- PUNJAB ANNEXURE
ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (3 OF 7)
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ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (4 OF 7)
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PROVINCIAL INCEPTION MEETING- PUNJAB ANNEXURE
ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (5 OF 7)
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PROVINCIAL INCEPTION MEETING- PUNJAB ANNEXURE
ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (6 OF 7)
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ANNEX 4- PARTICIPANTS’ REGISTRATION AND ATTENDANCE (7 OF 7)
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ANNEX 5- FEEDBACK FORM
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ANNEX 6- PICTURES FROM THE PROVINCIAL INCEPTION MEETING, PUNJAB
Chairperson Executive Committee, Mrs. Shahima Rehman addressing the audience
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Dr Akhtar Rashid, Lady Health Workers’ Programme
Seminar Proceedings
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Group Photograph- End of Seminar
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A REPORT FROM THE RAF PROJECT OFFICE AT FATIMA MEMORIAL HOSPITAL IMPLEMENTING PARTNER : NUR CENTER FOR RESEARCH AND POLICY 2013