Improving Dietary Diversity and Quality to Address Child Stunting: A Woman and Small Farmer Centered Community-based Pilot in Punjab

pipeline

An integrated cross sectoral “convergence” approach has been developed by the World Bank to address high child stunting levels in Pakistan, which affect about 40% children under the age of five. This approach geographically co-locates interventions in safely managed water and sanitation, primary health care, nutrition, early childhood development and social protection to achieve the multi-sectoral outcome of child stunting reduction. In rural Punjab, this convergence approach is being rolled out in selected tehsils from among sixteen that are part of the Punjab Rural Sustainable Water Supply and Sanitation Project (PRSWSSP). PRSWSSP is providing safely managed water and sanitation services to tehsils in the most deprived districts of rural Punjab. Critical primary health care services will be expanded in the same tehsils, along with social transfers for pregnant and lactating mothers by restructuring other World Bank financed projects, namely, Punjab Human Capital Program, the Punjab National Health Support Program, and the National Family Planning Program.The biggest gap in this sectoral convergence is the lack of focus of public investments on dietary diversity and nutritional value of household food consumption, especially among infants, young children, pregnant women, and lactating mothers. This gap could significantly limit the potential of the convergence approach to accelerate a reduction in child stunting. The JSDF project will help close this gap by improving the quality and diversity of household diets. The core objectives of the project are to promote the year-round production and consumption of nutrient rich vegetables and fruits, increase the availability of affordable animal protein, reduce the wastage of fresh produce, and ensure that food is handled and prepared in a manner that is safe and maintains its nutrient value. The primary focus will households with pregnant or lactating women (PLW), newly married women who will soon become pregnant and households with children under the age of two. Given Pakistan’s fertility rate, this includes some 70 percent of all rural households. These objectives will be achieved through the following activities in each program village: (1) the promotion of homestead vegetable gardens (including small-scale vegetable farms) and the integration of fruit and other beneficial trees in backyard gardens and in farms. This will include the development and delivery of advisory materials through group meetings using village-based community organizations, demonstration gardens in each village where hands on training would be provided and household level handholding and troubleshooting, as needed; (2) training and support to set up one or more seed and plant nurseries in each village. Village-level entrepreneurs will be trained and provided material support for setting up a seed and plant nursery. This would be run as a community business to ensure the sustained supply of high-quality and affordable seeds and plant and tree saplings in the village; (3) the provision of solar dehydrators to ensure that all excess produce is processed for safe storage; (4) the provision of solar chicken hatcheries to ensure the availability of affordable eggs. The solar hatcheries and solar dehydrators will also be run by community organizations as a community business on a cost recovery basis to ensure sustainability. A fully trained horticulturist and veterinarian will train two community members in each tehsil to serve as assistant horticulturist and assistant veterinarian. In addition, two community volunteers will be trained in each village to support the assistant horticulturist and veterinarian. These community volunteers will support households on a day to day basis in the cultivation of fruits and vegetables and in managing their poultry production. The volunteers will act as knowledge centers, promoting best practices in small scale organic and sustainable farming and the harvesting and post-harvest management of fruits and vegetables. They will also distribute input packages to eligible households. The horticulturist and veterinarian will cover all program villages and remain available for trouble shooting that exceeds the expertise of the tehsil level assistant horticulturist and veterinarian and the village level trained community volunteers. To build sustained demand for nutrient-rich foods, the staff of the implementing agency (social organizers) will also deliver behavior change communication (BCC) messages on the importance of dietary diversity and quality in the complementary feeding of infants as well as for the health of women during preconception, pregnancy, and lactation. A key component of this will be the organization of monthly meetings which will include cooking demonstrations and advice on food safety. Finally, the project will include a robust randomized impact evaluation. This will help build the evidence for a successful scale up of the program. It will have two objectives: (i) to build evidence on the key final outcomes; (ii) support the implementation of the project so it can make needed course corrections or modifications.