contents...chapter 2: adolescent nutrition in pakistan 20 2.1 epidemiological and demographic status...

Pakistan Adolescent Nutrition Strategy and Operational Plan | 2020 - 2025 3

CONTENTS

Preface 5Acknowledgements 7Acronyms 8Chapter 1: Introduction 111.1 Adolescent nutrition and malnutrition 111.2 Adolescent nutrition in the regional context 151.3 Addressing adolescent malnutrition 16

Chapter 2: Adolescent nutrition in Pakistan 202.1 Epidemiological and demographic status 202.2 Determinants of malnutrition among adolescents in Pakistan 262.3 Policy and programmatic response 27

2.4 Development of Pakistan Adolescent Nutrition Strategy 31

Chapter 3: Pakistan Adolescent Nutrition Strategy 353.1 Goal, objectives and outcomes 353.2 Strategic areas and sub-strategies 37

Strategic area 1: Enabling environment 37Strategic area 2: Programmatic response 41Strategic area 3: Evidence 45

3.3 Federal strategic plan 48

3.4 Provincial strategic plans 51

Chapter 4. Implementation arrangements 574.1 Implementing partners and their roles 57

4.2 Delivery platforms 62

Chapter 5. Monitoring, evaluation and reporting 645.1 Programme indicators 655.2 Management indicators 65

Pakistan Adolescent Nutrition Strategy and Operational Plan | 2020 - 20254

5.3 Progress monitoring 655.4 Reporting mechanisms 65

Strategy matrices 68Federal operational plan 69Balochistan operational plan 83Khyber Pakhtunkhwa operational plan 96Punjab operational plan 109

Sindh operational plan 123

ANNEXES 137Annex 1. Adolescent nutrition and supplementation guidelines 138Annex 2. Management indicators 141

FIGURES

FIGURES

Figure 1: Adolescent nutrition in the life cycle approach 14Figure 2: Framework of interventions and determinants of adolescent nutrition 17Figure 3: Underweight, short stature, overweight and obesity in adolescent boys and girls 23Figure 4: Delivery platforms for adolescent interventions 62

Table 1: Direct and indirect nutrition interventions 15Table 2: Review of adolescent health and nutrition strategies 18Table 3: Nutrition status of adolescent girls and boys in Pakistan, NNS 2018 21Table 4: Dietary patterns, perceptions and preferences of adolescents (NNS 2018 focus group discussions) 24Table 5: Key determinants of adolescent malnutrition in Pakistan 27Table 6: Planned outcomes and programme indicators for adolescent nutrition 36Table 7: Responsibilities of provincial government departments and authorities 59Table 8: Delivery platforms, services and sectors for adolescent nutrition 63


PREFACE

Adolescents are tomorrow’s adult population, and their health and well-being are crucial. Adolescence period is characterized by accelerated physical and psychosocial growth with increased requirements of macro and micronutrients. The adolescent period presents a window of opportunity to build behaviors and practices that will support good nutrition, health, and family wellbeing well into adulthood. Under-nutrition and micronutrient deficiencies manifest as thinness, underweight, stunting, and nutrition deficiency disorders. Whereas, overweight, obesity and excess micronutrient can increase the risk of diet-related non communicable diseases including heart disease, diabetes, stroke and some cancers which lead to great burden on the economy and households, in the long run.

Under-nutrition in girls 10-19 years has inter-generational effects. It contributes to low birth weight and child stunting which, in turn, leads to poor survival, growth & development, and poorer livelihoods. Investing in adolescent nutrition means investing in human capital and thus in economic growth. Thus, adolescence is the best time to prevent the onset of nutrition-related chronic diseases in adult life, while addressing adolescence-specific nutrition issues and possibly also correcting some nutritional problems originating in the past.

The findings from the last national nutrition survey (2017-18) of Pakistan revealed that the adolescent boys carry more burden of malnutrition (underweight, stunting, overweight and obesity) as compared to the girls. The survey found unhealthy eating habits and sedentary life style being common among boys and girls in the country. Given


the economic and public health implications of the adolescent’s current malnutrition status, it was imperative to design a multi-sectoral adolescent strategy to address the immediate, underlying and basic causes of malnutrition among girls and boys of early (10-15 years) and late (16-19 years) age groups. A country wide series of consultations were held and this strategy was formulated with the goal: all adolescent girls and boys in Pakistan reach their full potential, enjoying healthy lives and well-being, free from all forms of malnutrition. The following objectives of the strategy will lead to its goal: 1) Adolescent girls and boys have supportive surrounding and have adopted positive nutrition behaviours; 2) Evidence based, multi-sectoral, quality nutrition programs and services are provided at scale to the adolescent boys and girls

The support of UN and development partners, provincial governments, academia and other stakeholders in development of this strategy is highly appreciated. Special thanks to colleagues in the Ministry of NHSR&C for their support and cooperation in finalization and endorsement of the strategy. It is hoped that with the active leadership of the provinces in the implementation of the province specific operational plans will help in preventing malnutrition and enhancing health and nutrition status of the adolescents of Pakistan.

Dr Abdul Baseer Khan AchakzaiDirector, National Nutrition Programme,Ministry of National Health Services, Regulation & Coordination, Islamabad


ACKNOWLEDGEMENTS

The strategy is developed by the Nutrition Wing of the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C), with the support of UNICEF Pakistan country office, under leadership of Dr. Baseer Khan Achakzai (Director Nutrition, MoNHSR&C) in coordination with Dr. Eric Alain Ategbo (Chief Nutrition, UNICEF Islamabad).

Nutrition Wing of MoNHSR&C and UNICEF are particularly grateful to Dr. Suleman Qazi (consultant MoNHSR&C/UNICEF) for the development of this document and for his extensive contribution in the consultations and reviews. Special thanks to Dr. Khawaja Masuood Ahmed (MoNHSR&C); and Dr. Saba Shuja (UNICEF) who supervised the preparation and provided the technical inputs and backstopping for finalization of the guidelines

We are thankful to UNICEF, WHO and GAIN for their technical and financial support in completion of the strategy. We acknowledge the technical support and inputs provided by National Technical Advisory and Advocacy Group for Adolescent Nutrition and its provincial chapters during the development and finalization of the strategy and provincial implementation plans. The following organizations/individuals also contributed in the development of the strategy with their inputs: MoNHSR&C (Dr. Atiya Aabroo, Dr. Khawaja Masuood Ahmed), MoPD&R, MoCC, WHO (Dr. Lamia Mahmoud, Dr. Noureen Nishtar), UNICEF (Dr. Wisal Khan, Dr. Saba Shuja, Dr. Naureen Arshad), GAIN (Dr. Asma Badar), HELP (Dr. DS Akram), MNCHRN (Dr. Hana Mahmood), ACF, Shifa Foundation, Health Services Academy, AFPGMI, and PHRC.

It is important to mention MNCH and LHW Programs, and the Nutrition, Sections of Provincial Departments of Health and P&D, and other line departments from the provinces, without whose participation the development of strategy and the operational plans would not have been possible.


ACRONYM

AA-HA Accelerated Action for the Health of Adolescents (WHO)AAP Accelerated Action Plan (Sindh)ADB Annual development budgetAJK Azad Jammu and KashmirBISP Benazir Income Support ProgrammeBMI Body mass index C4D Communication for developmentCSO Civil society organizationDHIS District health information systemDoA Department of agriculture DoE Department of educationDoH Department of health DoL Department of lawGAIN Global Alliance for Improved Nutrition GB Gilgit BaltistanHAZ Height-for-age Z scoreHIES Household Integrated Economic Survey HIV and AIDS Human immunodeficiency virus/acquired immunodeficiency syndromeICT Islamabad Capital Territory IEC Information education communication IFA Iron folic acidIRMNCH Integrated reproductive, maternal, newborn and child healthIYCF Infant and young child feeding


KAP Knowledge, attitudes, practicesKP Khyber PakhtunkhwaKP-NMD Khyber Pakhtunkhwa Newly Merged Districts LHV Lady Health VisitorLHW Lady Health WorkerMNCH Maternal, newborn and child health MoNHSRC Ministry of National Health Services Regulation and CoordinationMoPDR Ministry of Planning, Development and Reform MSNC Multisectoral Nutrition CentreNDMA National Disaster Management Authority NGO non-government organizationNIPS National Institute of Population Studies NMIS Nutrition management information systemNNS National Nutrition SurveyPANS Pakistan Adolescent Nutrition StrategyPC1 Planning Commission 1 form (for project initiation)PDD Planning and development departmentPDHS Pakistan Demographic and Health SurveyPHED Public health engineering departmentPRSP Poverty Reduction Strategy Paper PSPU Policy and Strategic Planning UnitPWD Population welfare departmentSBCC Social and behavioural changeSDG Sustainable Development GoalSUN Scaling Up NutritionSWD social welfare departmentUNFPA United Nations Population FundUNICEF United Nations Children’s FundWASH Water, sanitation and hygieneWDD Women’s development departmentWHO World Health Organization


CONTEXT


INTRODUCTION

1.1 ADOLESCENT NUTRITION AND MALNUTRITIONAccording to the World Health Organization (WHO), adolescence is the period of a person’s life between 10 and 19 years of age. This is a time characterized by accelerated physical and psychosocial growth, when the human body has increased nutritional requirements for both macronutrients (carbohydrates, protein, fats) and micronutrients (vitamins and minerals). Boys and girls need these nutrients to grow and girls have additional nutritional requirements as they begin menstruating and if they begin childbearing.1

Types of Adolescent MalnutritionStunting reflects chronic undernutrition:2

- Stunting is associated with poor socioeconomic conditions and inadequate nutrition during childhood and adolescence

- Adolescent height-for-age Z-score (HAZ) is positively associated with school attendance, non-cognitive markers of self-efficacy, self-esteem, and educational aspirations, and

- Negatively associated with cognitive performance and school performance

- Maternal stunting is associated with negative birth outcomes (obstetric complications, child mortality, stunting, and underweight)

1 WHO (2018). Guideline: Implementing effective actions for improving adolescent nutrition. Geneva. Available at: https://www.who.int/nutrition/publications/guidelines/effective-actions-improving-adolescent/en/2 Underweight or thinness: BMI-for-age Z-score below -2 SD; severe thinness: BMI-for-age Z-score below -3 SD; overweight: BMI-for-age Z-score above 1; obesity: Z-score greater than 2 of the WHO growth reference standard. Adolescents aged 10–14 years with a mid-upper arm circumference below 160 mm and showing signs of severe visible wasting or bilateral pitting oedema are diagnosed as having severe acute malnutrition.

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Thinness is indicative of acute deficiency in macronutrients:

- Adolescent thinness is negatively associated with school performance

- Low maternal body mass index in early pregnancy increases risk of offspring who are small for gestational age, as well as stillbirth, infant mortality and cerebral palsy

Adolescent obesity is associated with:

- Increased risk of diet-related non-communicable diseases (hypertension, insulin resistance, metabolic syndrome, atherosclerosis, and non-alcoholic fatty liver disease)

- Childhood and adolescent obesity are strongly associated with adult obesity, which is linked to higher risk of cardiovascular disease, diabetes and cancer

Causes of Adolescent MalnutritionAdolescent malnutrition may occur due to poor access to adequate, safe and healthy food; low income, poverty and neglect; prevailing cultural norms; and individual food preferences.

This strategy is guided by the WHO guideline on effective actions for improving adolescent nutrition 3 and takes a food systems approach to identify the immediate, underlying and contextual factors that shape adolescent malnutrition.

Adolescents’ dietary preferences, diet and physical activity habits are influenced by their surroundings. With rapid social and economic development and heavy marketing, many adolescents are shifting to processed, low-cost, energy-dense, nutrient-poor and unhealthy foods and drinks. This, along with sedentary lifestyles, leads to growing rates of obesity.

Consequences of Adolescent MalnutritionPoor dietary intake results in either low or excessive amounts and proportions of protein, fat, energy and micronutrients. These in turn cause micronutrient deficiencies, high fasting plasma glucose, high blood pressure, and pre-conception nutrient deficiencies in pregnant teens. Adolescent malnutrition poses a double burden for a population:

3 Underweight or thinness: BMI-for-age Z-score below -2 SD; severe thinness: BMI-for-age Z-score below -3 SD; overweight: BMI-for-age Z-score above 1; obesity: Z-score greater than 2 of the WHO growth reference standard. Adolescents aged 10–14 years with a mid-upper arm circumference below 160 mm and showing signs of severe visible wasting or bilateral pitting oedema are diagnosed as having severe acute malnutrition.


- Undernutrition and micronutrient deficiency, which may present as wasting or thinness, underweight and stunting (short stature for age). Micronutrient malnutrition can manifest as deficiency disorders

- Overweight, obesity and excess micronutrient intake

Chronic undernutrition in adolescents is associated with poor maternal health and nutrition, frequent illness, inadequate infant and young child feeding (IYCF) and care, inadequate feeding and care in the later years (five years onwards) and poverty. Stunting among adolescents often coexists with micronutrient malnutrition, especially iodine, iron and vitamin A deficiency. Adolescents who are overweight and obese are at greater risk of diet-related non-communicable diseases such as heart disease, diabetes, stroke and some cancers. Iron deficiency anaemia is among the main underlying causes of disability-adjusted life years lost among adolescents (among lower respiratory infections and diarrhoea in 10–14 year olds; and maternal conditions, depressive and anxiety disorders and self-harm in 15–19 year olds).

Adolescent malnutrition has immense implications for individuals, families, communities, and nations. Malnourished adolescent boys and girls do not enjoy their full potential, acquire education, bear healthy infants or participate fully in economic activities. This contributes to significant losses in human capital and productivity. 4 Investing in adolescent nutrition means investing in human capital and thus in economic growth.

Malnutrition burdens the healthcare system and the economy. Malnourished people are less likely to be able to fully participate in economic activities to their fullest potential. Investing in adolescent nutrition is, thus, investing in human capital and in economic growth.

Among girls, poor nutrition status prior to conception can contribute to specific concerns related to childbearing and to the wellbeing and development of their children:

- Maternal obesity/pre-pregnancy overweight increases risk of hypertensive disorders, preeclampsia, gestational diabetes mellitus, C-sections, large for gestational age, haemorrhage, stillbirth, and risk of neonatal and infant death.

- Pre-pregnancy underweight and micronutrient deficiencies increase the risk of preterm birth and small for gestational age.

4 Madjdian et al (2018). “Sociocultural and economic determinants and consequences of adolescent undernutrition and micronutrient deficiencies in LLMICs: a systematic narrative review.” Annals of the New York Academy of Sciences, 1416: 117


- Short maternal stature may lead to obstructed labour and maternal and foetal or neonatal death.

- Maternal stunting and low body mass index (BMI) increase risk of foetal growth restriction.

- There may be specific micronutrient deficiencies related to babies who are small for gestational age born to young malnourished girls.

The Second Window of Opportunity The First 1,000 Days of life (from conception to two years of age) is a critical period in child development, when a nutritional foundation is laid for a lifetime. After the First 1,000 Days, adolescence offers the second window of opportunity to break the vicious cycle of intergenerational malnutrition, chronic disease and poverty (see Figure 1).

Figure 1: Adolescent nutrition in the life cycle approach


The Lancet series on maternal and child undernutrition (2013) identified direct and indirect interventions that improve adolescent nutrition within the context of maternal and child undernutrition:5

Table 1: Direct and indirect nutrition interventions

Direct interventions Indirect interventions - Micronutrient supplementation (most

commonly intermittent iron folic acid or IFA supplementation)

- Nutrition and health counselling

- School feeding

- Provision of nutrient-rich food

- Nutrition education within schools

- Education for obesity prevention

- Deworming

- Fortification: access to iodized salt

- Nutrition support for adolescents living with HIV and AIDS

- Adolescent-friendly reproductive health services

- Promotion of hygiene practices to households with adolescents

- Promotion of girls’ education

- Nutrition education in schools

- Promotion of economic empowerment and income generation

- Cash transfers for households with adolescents

Abstracted from Bhutta Z, Das JK et al, 2013

1.2 ADOLESCENT NUTRITION IN THE REGIONAL CONTEXTAdolescent nutrition is a relatively new area with no regular global reporting as yet. Indeed, a recent World Nutrition Report 6 called attention to the “outstanding need” for data on nutrition status of adolescents. Adolescent girls aged 15–19 years are considered women of reproductive age but generally data for the latter group (15–49 years) is not disaggregated by age. Adolescents aged 10–14 years old are virtually neglected. This impedes coherent planning and policymaking.

Analysis of BMI data from 200 countries finds growing prevalence of overweight and obesity in most regions during 1975–2016. 7 Nevertheless underweight remains more common in this age group than obesity. Analysis of demographic health survey data from 53 countries and national surveys in five countries shows that South Asia has the

5 Bhutta Z, Das JK et al (2013) “Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?” Series on Maternal and Child Nutrition 2 Lancet 382: 452–77 DOI: 10.1016/S0140-6736(13)60996-46 Global Nutrition Report (2017). Nourishing the SDGs. Development Initiatives. Bristol, UK.7 NCD Risk Factor Collaboration (2017). “World-wide trends in body mass index, underweight, overweight and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9M children, adolescents and adults”. Lancet 390: 2627.


highest prevalence of thinness, nearly twice that in East Asia or East and Central African countries.8 Furthermore, prevalence is increasing at about 1 per cent per year in rural areas. The double burden of malnutrition is increasingly prevalent in the region, with high rates of thinness in rural areas and overweight and obesity in towns and cities.

The prevalence of child marriage and early childbearing in the region means that there is a large cohort of adolescent girls with heightened nutritional requirements due to pregnancy. South Asia also has the highest burden of child and maternal anaemia in the world. About half of girls aged 15–19 years in South and South-east Asia are anaemic, which is associated with poor cognitive and educational performance.9

1.3 Addressing adolescent malnutritionWHO Global Accelerated Action for the Health of Adolescents (AA-HA!), 2017WHO proposed a logframe for national adolescent health programming, the Global Accelerated Action for the Health of Adolescents (AA-HA!) in 2017. 10 This framework of interventions and determinants of adolescent nutrition takes a unified approach to planning and evaluation of adolescent programmes, and identified four conditions for successful adolescent programming:

- Government leadership

- Adolescent participation

- Adequate financing

- National accountability

WHO Guideline: Implementing Effective Actions for Improving Adolescent Nutrition, 2018The WHO Guideline: Implementing Effective Actions for Improving Adolescent Nutrition (2018) identifies eight evidence-based nutrition interventions based on an analysis of the underlying causes of malnutrition and their corresponding solutions, and places them in a framework of interventions and determinants (see Figure 2). 11

- Promoting healthy diets

8 Jaacks, Slining, Popkin (2015). “Recent trends in the prevalence of under and overweight among adolescent girls in LMICs”. PediatrObes 10:428.9 UNICEF et al (2018). Child stunting, hidden hunger and human capital in South Asia. Kathmandu.10 WHO (2017). Global accelerated action for the health of adolescents (AA-HA!): guidance to support country imple-mentation. Geneva. Available at: https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accel-erated-action/en/11 WHO (2018). Guideline: Implementing effective actions for improving adolescent nutrition. Geneva. Available at: https://www.who.int/nutrition/publications/guidelines/effective-actions-improving-adolescent/en/


- Providing additional micronutrients through fortification of staple foods and targeted supplementation

- Managing acute malnutrition

- Preventing adolescent pregnancy and poor reproductive outcomes

- Promoting pre-conception and antenatal nutrition

- Providing access to safe environment and hygiene

- Promoting physical activity

- Disease prevention and management

In the Pakistan context two additional interventions are:

- Promoting health and nutrition awareness education in school-going adolescents

- Promoting behaviour change communication for out-of-school adolescents

Figure 2: Framework of interventions and determinants of adolescent nutrition

Source: WHO Guideline: Implementing effective actions for improving adolescent nutrition, 2018


Meta-analysis of adolescent nutrition strategiesA meta-analysis of adolescent health and nutrition interventions, which includes a review of pre-conception interventions, is summarized in Table 2. 12

Table 2: Review of adolescent health and nutrition strategies

Strategy EvidenceInterventions to promote healthy nutrition and prevent obesity (all from developed countries) that included (a) education, health promotion and/or psychological, family, behavioural therapy, counselling; (b) management interventions focusing on diet, physical activity or lifestyle support; or (c) both, with underlying intention to prevent obesity or further weight gain.

- Pooled data from all included interventions showed a non-significant decrease in BMI in the intervention group

- No data from developing countries

- Physical activity or dietary control alone were not impactful

- Interventions delivered in school were more effective than those delivered in non-educational settings

Micronutrient and balanced energy and protein supplementation. Provided in community or school-based settings, in both developing and developed countries, mostly to girls.

- Multi-micronutrient supplementation can reduce anaemia by 31%

- School-based multi-micronutrient supplementation significantly reduced anaemia, low ferritin levels and improved haemoglobin, ferritin, iron and zinc in adolescents

- Community-based delivery of multi-micronutrient was not effective in improving haemoglobin levels

- Interventions were effective in both developed and developing country settings

- No data on balanced energy and protein supplementation targeting adolescent age group

Pre-conception nutrition for adolescent girls - Micronutrient supplementation among adolescent girls can significantly reduce anaemia prevalence by 32%

- Folic acid supplementation can significantly reduce urinary tract defects but had no significant effects on cleft lip and palate, though quality of evidence was low

- Intervention was effective in both developing and developed country settings

12 Bhutta, Z.A. (undated), Adolescent Health & Nutrition Interventions: A Snapshot!. Available at: http://www.dcp-3.org/sites/default/files/events-files/Zulfi%20Bhutta_Adolescent%20Health.pdf


Strategy EvidenceInterventions to prevent pre-pregnancy obesity and gestational diabetes among adolescent girls

- Pre-pregnancy lifestyle modifications can marginally impact BMI of adolescent girls

- No data from developing countries

Nutrition for pregnant adolescents: provision of multi-micronutrients, routine IFA and nutritional education sessions

- Nutrition interventions targeting pregnant adolescents can reduce low birth weight by 30% and prematurity by 27% with improved mean birth weight

Interventions to prevent eating disorders - No conclusive evidence on impact of prevention programmes for eating disorders, although none of the comparisons indicated evidence of harm

Source: ZA Bhutta, Adolescent Health & Nutrition Interventions: A Snapshot!

Food systems approach to improving adolescents’ dietsFood systems comprise the various steps of growing, harvesting, processing, packaging, transporting, marketing, consuming, and disposing of food. Food systems are essential to deliver healthy, affordable and sustainable diets, but often they do not prioritize adolescents. This contributes to, on one hand, the unchecked marketing of processed and less nutritious foods and their easy availability and affordability, and on the other, lack of affordability and access to nutritious diets.

For this reason, it is essential for actors across food systems, including producers and suppliers, to consider the nutritional needs of adolescents when determining what foods to grow, produce, distribute, and sell. 13 Key aspects of the approach are:

- Sustainable production and offer of healthy and affordable diets through agricultural sector

- Provision of economically viable supply chains for healthy foods

- Creating conducive food environments to ensure availability of healthy, affordable, acceptable and appealing diets

- Creating demand among adolescents for healthy diets, ability to consume nutritious foods, and consequently to develop preferences for such diets in the long term

13 UNICEF Office of Research Innocenti (2018). Food systems for children and adolescents. Florence. Available at: https://www.unicef.org/nutrition/food-systems.html


ADOLESCENT NUTRITION IN PAKISTAN

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Pakistan is entering the stage of its demographic transition where the dependent population (children and older adults) is far smaller than the productive population (people aged 15–49 years). Around a quarter of Pakistanis are adolescents (aged 10–19 years). Of these, around half again are young adolescents (10–14 years).14

In a review of evidence for the Global Alliance for Improved Nutrition (GAIN), Beal and colleagues 15 point out that adolescent nutrition status in Pakistan is closely linked to economic and social trajectories including education, family formation and participation in the labour force. They argue that investment in the nutrition and human capital of adolescents “shapes the life course” and yields a triple dividend: for adolescents currently, as future adults and for the next generation.16

Today, Pakistani adolescents number around 40 million. This large cohort, with its undeniable impact on social and economic development, merits specific attention and strategic interventions to ensure optimal nutrition.

2.1 EPIDEMIOLOGICAL AND DEMOGRAPHIC STATUSPrior to the National Nutrition Survey (NNS) 2018, nutrition data on adolescents in Pakistan was limited in scope and quality. NNS 2018 provided an unprecedented body of data on adolescent nutrition (see Table 3) and may set a trend for other routine surveys including the Pakistan Demographic and Health Survey (PDHS); the most recent

14 Population Council (2016). Youth in Pakistan: Priorities, realities and policy responses. Islamabad. Available at: https://www.popcouncil.org/uploads/pdfs/2016PGY_YouthInPakistan.pdf15 GAIN (2018). Review of evidence on the nutritional status of adolescent girls and boys in Pakistan. Geneva. Available at: https://www.gainhealth.org/sites/default/files/publications/documents/world-bank-safansi-govt-of-pakistan-gain-re-view-of-evidence-on-nutrition-status-of-the-adolescents-girls-and-boys-in-pakistan.pdf16 Stephenson, Heslehurst, Hall et al (2018). “Before the beginning: nutrition and lifestyle in the pre-conception period and its importance for future health”. Lancet 391: 1830. DOI: 10.1016/S0140-6736(18)30311-8


PDHS (2017–2018) had a strong focus on women of reproductive age (15–49 years) but no separate data on adolescent girls and boys (10–19 years).

Comparison of NNS 2018 data reveals that adolescent boys carry a greater burden of malnutrition than girls (see Figure 3).

Table 3: Nutrition status of adolescent girls and boys in Pakistan, NNS 2018

Nutrition status Adolescent girls Adolescent boysUnderweight - Underweight: 11.8%

- Severely underweight: 3.6%

- Underweight: 21.1%

- Severely underweight: 8.1%

Rural vs urban - Rural: 11.8%

- Urban: 11.7%

- Rural: 21.3%

- Urban: 20.8%

Poor vs rich - Poorest quintile: 15.9%

- Richest quintile: 10.5%

- Poorest quintile: 28.2%


Education - No education: 10.8%

- Higher education: 7.9%

- No education: 24.7%


Provincial comparison - Balochistan: 12.2%

- KP: 6.2%

- Punjab: 10.5%

- Sindh: 16.6%

- Balochistan: 12.2%

- KP: 13.0%

- Punjab: 18.0%

- Sindh: 30.6%

Regional comparison - AJK: 12.1%

- GB: 6.0%

- ICT: 8.9%

- KP-NMD: 6.8%

- AJK: 19.6%

- GB: 7.8%

- ICT: 20.8%

- KP-NMD: 7.8%

Short stature - Short stature: 28.4%

- Very short stature: 11.2% (below -3 HAZ scores)

- Short stature: 31.7%

- Very short stature: 15.1% (below -3 HAZ scores)

Rural vs urban - Rural: 30.4%

- Urban: 25.0%

- Rural: 34.7%

- Urban: 27.3%

Poor vs rich - Poorest quintile: 37.8%




Education - No education: 32.9%


Provincial comparison - Balochistan: 41.7%

- KP: 28.4%

- Punjab: 26.3%

- Sindh: 29.4%


- KP: 46.1%

- Punjab: 26.4%

- Sindh: 32.8%


Nutrition status Adolescent girls Adolescent boysRegional comparison - AJK: 25.5%

- GB: 25.2%

- ICT: 13.2%

- KP-NMD: 46.2%

- AJK: 29.9%

- GB: 26.0%

- ICT: 16.0%

- KP-NMD: 50.7%

Overweight and obesity - Overweight: 16.8%

- Obesity: 5.5%

- Overweight: 17.8%

- Obesity: 7.7%

Rural vs urban (overweight)

- Rural: 16.1%

- Urban: 18.1%

- Rural: 16.4%

- Urban: 19.9%

Rural vs urban (obesity) - Rural: 5.2%

- Urban: 5.9%

- Rural: 7.5%

- Urban: 7.9%

Poor vs rich (overweight) - Poorest quintile: 13.4%




Education (overweight) - No education: 13.9%


- No education: 17.8%


Provincial comparison (overweight)


- KP: 23.8%

- Punjab: 17.6%

- Sindh: 11.0%


- KP: 26.7%

- Punjab: 18.0%

- Sindh: 12.1%.

Provincial comparison (obesity)

- Balochistan 9.1%

- KP 8.5%

- Punjab 5.5%

- Sindh 3.1%


- KP: 11.9%

- Punjab: 7.5%

- Sindh: 4.7%

Regional comparison (overweight)

- AJK 14.4%

- GB 11.9%

- ICT 18.5%

- KP-NMD 35.6%

- AJK: 13.9%

- GB: 13.8%

- ICT: 14.4%

- KP-NMD: 40.5%

Regional comparison (obesity)

- AJK: 4.3%

- GB: 2.3%

- ICT: 7.3%

- KP-NMD: 17.5%

- AJK: 4.3%

- GB: 3.9%

- ICT: 6.5%

- KP-NMD: 27.9%

Source: NNS 2018Note: AJK = Azad Jammu and Kashmir; ICT = Islamabad Capital Territory; GB = Gilgit-Baltistan; KP= Khyber Pakhtunkhwa; KP-NMD = KP Newly Merged Districts. NNS 2018 was conducted prior to the formal merger of the Federally Administered Tribal Areas with KP province as KP-NMD. For this reason, KP-NMD data is collected and analysed here separately from KP.


Figure 3: Underweight, short stature, overweight and obesity in adolescent boys and girls

Source: NNS 2018

Anaemia among adolescent girls NNS 2018 found that more than half (56.6 per cent) of adolescent girls were anaemic; 0.9 per cent had severe anaemia. Rural girls were more likely (58.1 per cent) to be anaemic than their urban peers (54.2 per cent). The prevalence of anaemia was high among girls who were uneducated or had only primary education (55.3 and 57.5 per cent respectively), compared to those with higher education (48.0 per cent). However, prevalence was high even among educated adolescent girls. Adolescent girls from the poorest quintile were more likely to develop anaemia (62 per cent) than those from the richest (50 per cent), but rates were high across the socioeconomic spectrum, suggesting that risk factors are likely ubiquitous.

Prevalence was highest in Balochistan (73.7 per cent) followed by Sindh (61.2 per cent), Punjab (55.4 per cent) and KP (46.8 per cent). Among the region, prevalence was highest in AJK (67.0 per cent) followed by KP-NMD (56.7 per cent), GB (55.6 per cent) and ICT (44.2 per cent).


Dietary patterns and preferencesThe qualitative component of NNS 2018 held focus group discussions with adolescent girls and boys across Pakistan about their dietary preferences, patterns and behaviours (see Table 4).

Table 4: Dietary patterns, perceptions and preferences of adolescents (NNS 2018 focus group discussions)

Topic Adolescent girls Adolescent boysWhy eat a nutritious diet

- Provides energy, helps in development, strengthens bones and nourishes skin.

- Micronutrient deficiencies contribute to short stature and growth problems, nail discoloration and hair loss.

- Provides strength, energy and health.

Nutritious versus non-nutritious food

- Nutritious versus non-nutritious food Nutritious food contains protein, minerals, carbohydrates, fats and vitamins.

- Healthy foods contain 1–2% fats.

- Junk foods are commercialized foods with limited nutritious value but attractive taste.

- Junk foods cause pimples, obesity, indigestion, hair loss and hormonal disturbances.

- Nutritious food improves physical fitness, mental health and provides energy for physical work.

- Fast and junk foods bought from outside the home are harmful, providing flavour but no health benefits.

- Cold drinks upset the gastrointestinal tract and harm fitness.

- Poor diet can lead to chronic diseases: joint problems, heart problems, diabetes, obesity.


Topic Adolescent girls Adolescent boysFood preferences - Fear of weight gain and

acne from nutritious food.

- Concern that poor quality of meat available in the market causes hormonal imbalance.

- Preference for fast foods due to taste, texture, toppings and the variety available.

- Oily and spicy foods are unhealthy.

- Chicken and eggs can cause allergies.

- Prefer to eat cheap and easily accessible street foods but these ultimately cause gastrointestinal problems.

- Preference for junk food is because of its taste, easy access and habitual eating

outside the home.

- There is peer pressure to eat outside the home.

- Dislike taste of homemade food and its lack of variety.

Access to nutritious diet - Junk food is easily available in markets, through home delivery and in school and college canteens.

- Fast foods are easily available at the doorstep, in schools, and in every street.

- People earning less money in rural areas and urban slums cannot afford fruits and healthy foods.

- Labourers who live away from their families have to eat at restaurants and experience gastric upset.

Influence on diet - Parents try to stop consumption of junk food but cravings are hard to control.

- Coverage on social media about hazards of fast food changes behaviours.

- Doctor’s recommendation to avoid oily and unhealthy foods from the market is followed during illness.

- Individual health and fitness consciousness.

- Pressure from family members (parents, elder sisters).

- Unhygienic preparation of street foods, as seen on social media.

Source: NNS 2018

2.2 Determinants of malnutrition among adolescents in PakistanThe immediate causes of malnutrition in Pakistani adolescents include low-quality diets, infection and malnutrition during childhood. Contextual determinants include poverty,


maldistribution of food, lack of nutritional knowledge, low literacy, and poor health services. Observational studies on specific population subgroups or convenience samples of Pakistani adolescents report associations between nutritional status of adolescent girls with maternal education, family income and sociodemographic characteristics.

A countrywide study found that although poor adolescent girls, their households and community members were generally aware that adolescents have greater nutritional needs, poverty and lack of understanding prevented them from providing healthy diets to girls. Meat, eggs, dairy products and lentils were eaten thrice monthly or less by many households and the mean daily intake of adolescent girls was only 1,500 calories. 17

Household food insecurity is an important factor underlying poor diets, especially in rural areas where more than half of households are food insecure for most of the year. Adolescent diets have little diversity, consisting mainly of wheat. Although dairy is consumed regularly, there is a trend towards unhealthy “junk” foods including sweetened drinks and energy-dense purchased snacks. In urban areas meals are increasingly purchased. Adolescent girls have little control over food expenditure within the family, and both adolescents and mothers have limited nutrition knowledge. Low school attendance, especially in rural areas, and low literacy, especially among girls, is a concern. Table 5: Key determinants of adolescent malnutrition in Pakistan

Strategy EvidenceDiet quality Generally diet quality is low, contributing to undernutrition, overweight, obesity,

and noncommunicable diseases

Education Education indicators are low, particularly for adolescent girls from rural and poor households

Adolescent pregnancy

Adolescent pregnancy is declining but still concerning in rural, low-income and poorly educated households

Physical activity Low physical activity, poor self-rated athletic ability and increased screen time contribute to overweight and obesity

Access to health services

Access to health services varies; for example, lack of access to antenatal care ranges from 2% in urban Punjab to 48% in rural Balochistan (PDHS 2017–2018)

Contextual determinants

Poverty, maldistribution of food and lack of nutritional knowledge. Adolescent girls are socially and biologically more vulnerable than boys

Source: GAIN (2018) Technical Report: Review of evidence on the nutritional status of adolescent girls and boys in Pakistan; PDHS 2017–2018.

17 Fatima Memorial Hospital Nur Centre for Research and Policy (2014). A snapshot of poor adolescent girls’ nutrition and related issues in Pakistan. Lahore. Available at: http://nurfoundation.org/ncrp/?page_id=1790


2.3 Policy and programmatic responseExisting policies and programmesPakistan’s National Health Vision 2016–2025 and National Vision for Reproductive, Maternal, Newborn, Child and Adolescent Health 2016–2025 address adolescent health and nutrition with particular focus on girls and women of reproductive age. Pakistan is a signatory to the Sustainable Development Goals (SDGs) and the global Scaling Up Nutrition (SUN) Movement. These international commitments have, since devolution of powers in 2010, also become provincial mandates.

The National Multisectoral Nutrition Strategy (2018–2025) addresses regulation and coordination, while provincial multisectoral nutrition strategies focus on nutrition programming and implementation. All include aspects aimed at addressing malnutrition in adolescents, especially girls, through coordinated action in the education, water sanitation and hygiene (WASH) and social protection sectors. However, few provincial programmes specifically address the nutrition status of adolescent girls and none targets boys.

Additionally, few programmes aim to address micronutrient malnutrition among Pakistani adolescents. Nutrition-specific interventions, such as food fortification or iron folic acid (IFA) supplementation for pregnant women, reach adolescents only as part of a larger target population. Programmes specifically targeting adolescents exist mainly in areas of education and sexual and reproductive health and have only limited nutrition-specific components, and no evidence is collected of their impact on nutrition specifically. The geographical coverage of nutrition-specific and nutrition-sensitive interventions directly targeting adolescent girls is limited to a few districts per province18.

All provinces have some reference to adolescent nutrition in ongoing programmes:

- Balochistan: Nutrition Programme for Mothers and Children

- Punjab: Chief Minister’s Three-year Stunting Reduction programme

- Sindh: Accelerated Action Plan (AAP)

18 GAIN (2017). Embodying the future: How to improve the nutrition status of adolescent girls in Pakistan. Geneva. Available at: https://www.gainhealth.org/resources/reports-and-publications/embodying-future-how-improve-nutri-tion-status-adolescent-girls


Nevertheless, the programmatic response in Pakistan is limited in terms of geographical coverage (covering few districts), inclusiveness (no focus on adolescent boys) and scope (no focus on obesity).

Gaps and bottlenecks in programmes and policies for adolescent nutrition

- There is inadequate policy and programmatic focus on adolescents, especially for early adolescents (aged 10–14 years) of either gender, and older adolescent boys (15¬–19 years). Girls in late adolescence are addressed primarily in terms of reproductive health.

- Adolescents are missing from sectoral plans and programmes. Even the most recently developed provincial plan, the KP Health Sector Policy Plan (2019), does not cover their nutrition needs.

- Legislations to address early marriage are at various stages of development and approval in different provinces.

- Compulsory education for adolescents, particularly as a means to encourage positive nutritional behaviours, is not addressed.

- Programmatic interventions do not address adolescent nutrition in a fully gender-responsive and age-sensitive manner.

- While the health sector offers nutrition-specific services these mostly focus on maternal health.

- Access to health is compromised because services are unwelcoming, and little to no nutrition counselling is offered to adolescents at health facilities. Menstrual hygiene management support is almost non-existent.

- Nutrition-sensitive sectors (education, WASH, agriculture and social protection) generally do not offer service for adolescent nutrition.

- There is substantial room for improvement in multisectoral nutrition planning, coordination and implementation at every level.

- Until the release of NNS 2018 findings in mid-2019, little data on adolescent nutrition was available, especially at local level, which hindered effective programme design.

- No policy or programme focuses on adolescents with special needs, transgenders and those in humanitarian situations. With no established nutrition service delivery platform for adolescents, reaching this highly diverse group equitably and addressing their needs is a challenge.

- There is no evidence-based behaviour change communication strategy aimed at adolescents, Institutional arrangements addressing boys and girls; weak


implementation capacity; resource constraints; and low government and donor prioritization are all challenges to sustainable behaviour change.

- Planning and budgetary allocations and releases are cumbersome and time-consuming. Lengthy strategy endorsement and PC119 approval processes are often followed by cuts to costed activities and delayed budgetary releases which affect the overall strategic goal and impact of initiatives.

National debate on adolescent nutritionTo fill the information gap on adolescent nutrition, in 2015 Aga Khan University conducted a landscape analysis of multisectoral nutrition interventions in Pakistan. 20 A Save the Children study also appeared in 2015 and reviewed existing approaches for future policy and programming for adolescent nutrition in SUN countries.

In 2017, the Ministry of National Health Services, Regulation and Coordination (MoNHSRC) partnered with GAIN to develop a Framework for Action for adolescent nutrition in Pakistan 21 to guide policy and programme development and cross-sectoral strategies. The framework identifies high-level priority actions for government commitment to ensure sustained achievement based on global, regional and local best practices. It identifies the following critical areas for resources and action:

- Advocacy and awareness raising

- Policy priorities

- Nutrition-specific interventions in the health sector

- Nutrition-sensitive interventions in the non-health sector

- Scaling up for impact

- Monitoring, learning and accountability

Discussions on national programmatic response began in 2017 when Pakistan adopted the WHO’s AA-HA! Framework on adolescent health and nutrition. A consultative process is underway to adopt WHO guidelines on adolescent nutrition

19 Planning Commission 1 (PC1) forms are government planning documents required for the initiation of projects in the social sector development, production and infrastructure sectors.20 Bhutta ZA, Nyaku A, et al. (2015). “Landscape analysis of multi-sectoral initiatives for under-nutrition in Pakistan.” MQSUN, 1-60. Available at: http://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/21221 Badar, A, Rasool F, et al (2019) A policy paper on adolescent nutrition in Pakistan: Framework for action, policies and programmes. Global Alliance for Improved Nutrition (GAIN) policy paper. Available at: https://www.gainhealth.org/re-sources/reports-and-publications/framework-action-programs-and-policies-policy-paper-adolescent-nutrition-pakistan


and supplementation which were launched in 2018. Draft Guidelines on Adolescent Nutrition and Supplementation in Pakistan were prepared and are under review.22

In July 2019 the National Health Task Force issued a Nutrition Concept Note largely focused on stunting prevention, but also including the following points which address the needs of adolescent girls:

- Ensure maximum coverage of the Lady Health Worker (LHW) Programme of community health workers in target areas and engage at least 160,000 LHWs to deliver effective and integrated community-based nutrition services by mid-2021.

- Promote nutrition services at health facilities and in areas not covered by LHWs by training one female health and nutrition counsellor in each dispensary, basic health unit and rural health centre by mid-2021.

- Provide iron, micronutrient and food supplementation and nutrition counselling to adolescent girls and women of reproductive age through LHWs, health and nutrition counsellors, primary healthcare facilities and general physicians, prioritizing food-insecure districts and alignment with the health insurance programme.

2.4 Development of Pakistan Adolescent Nutrition Strategy The need for an adolescent nutrition strategy was first highlighted during the consultative process for the adoption of the AA-HA! Framework in Pakistan in 2017. On 29 March 2019, a federal consultative workshop was held in Islamabad, with provincial participation, to introduce ideas on the development of a Pakistan Adolescent Nutrition Strategy (PANS). This was followed by provincial workshops to develop action plans based on the strategy structure:

- Sindh: 10 April 2019

- KP: 17 April 2019

- Balochistan: 2 May 2019

- Punjab: 15 July 2019

The provincial workshops included participants from different sectors who were provided presentations on the background, causes and consequences of adolescent malnutrition, and on country-specific issues and broader strategic actions proposed in international and national guiding documents. In each workshop, participants were divided into four groups to discuss the strategy components:

22 WHO and MoNHSRC (draft) Pakistan adolescent nutrition and supplementation guidelines.


- Advocacy and awareness raising

- Nutrition-specific interventions in the health sector

- Nutrition-sensitive interventions in non-health sector

- Monitoring, learning and accountability

Each thematic group was provided the background of the strategic area, issues and challenges documented in key guiding documents:

- GAIN and MoNHSRC Framework for Action (2017)

- WHO and MoNHSRC Guidelines on Adolescent Nutrition and Supplementation (draft)

- Save the Children Adolescent Nutrition: Policy and Programming in SUN+ Countries (2015)

Each group discussed and agreed on the appropriate focus of activities in improving the adolescent nutrition in their province. The groups presented their work and the proposed interventions were discussed in detail to develop operational plans for each province.

A final validation workshop was held on 2–3 October 2019 in Islamabad. At the workshop provincial representatives revisited the strategic areas and operational interventions given in the draft PANS. The workshop provided an opportunity to observe and share approaches and progress. After the workshop a period of time was allocated for further sectoral submissions which were then incorporated into PANS.


Pakistan Adolescent Nutrition Strategy


PAKISTAN ADOLESCENT NUTRITION STRATEGY

03

3.1 GOAL, OBJECTIVES AND OUTCOMESThe goal of the Pakistan Adolescent Nutrition Strategy (PANS) is:

“All adolescent girls and boys in Pakistan reach their full potential and enjoy lives of health and well-being, free from all forms of malnutrition”

To achieve this goal, PANS has set the following objectives:

- Adolescent girls and boys have supportive surrounding and have adopted positive nutrition behaviours

- Evidence-based multisectoral, quality nutrition programmes and services are provided at scale to adolescent boys and girls

These objectives will be reached using three strategies and their underlying sub-strategies (see section 3.2).

- Creation of a sustained enabling environment to address adolescent nutrition

- Programmatic response to adolescent nutrition across sectors

- Continued evidence generation for guidance, learning and accountability

Achieving these objectives will ensure progress against key quantitative and qualitative indicators related to adolescent nutrition, listed in Table 6, below. These also serve as programme indicators and will be used for monitoring progress (see Chapter 5).


Table 6: Planned outcomes and programme indicators for adolescent nutrition

Indicator Baseline* 2020 2021 2022 2023 2024Thinness (girls) 11.8% 11.4% 11% 10% 9% 8%

Thinness (boys) 21% 20.6% 20.2% 19.2% 18.2% 17.2%

Overweight (girls) 11.4% 11% 10.6% 10% 9.6% 9%

Overweight (boys) 10.2% 9.8% 9.4% 9% 8.6% 8.2%

Adolescent anaemia (girls) 57.7% 56% 54% 52% 50% 48%

Iron folic acid (pregnant adolescent girls)

4% 5% 8% 12% 16% 20%

Consumption of all food groups that comprise a healthy diet (girls and boys)

TBD † Baseline

+15% †

Junk food consumption discouraged through regulation: high taxes, discouragement of trans-fatty acids

No legislation

Legislation implemented

* Baseline data from NNS 2018 unless otherwise indicated† Knowledge, attitudes and practices survey to be conducted to determine baseline (pre-KAP) and repeated in 2024 (post-KAP)

The implementation of this strategy is also expected to contribute to nutrition-sensitive indicators and in turn to achieving Pakistan’s SDGs, however no accountability is implied. These additional indicators are:

- Health and wellbeing

� Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group (SDG 3.7.2)

- Education and learning

� Primary education completion rate

� Out-of-school adolescents

- Protection

- Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 (SDG 5.3.1)

- WASH

� Proportion of population using safely managed drinking water services (SDG 6.1.1)

� Proportion of population using safely managed sanitation services, including a hand-washing facility with soap and water (SDG 6.1.2)


3.2 Strategic areas and sub-strategies

Strategic Area 1: Creation of a sustained enabling environment to address

adolescent nutrition

Sub-strategy 1.1: Conduct evidence-based policy advocacy for equity-based inclusion of

adolescent nutrition as a specific area of focus, and for resource mobilization in existing

and future strategies, plans and programmes (legislations, implementation, rules and

regulations)

Sub-strategy 1.2: Design and implement evidence-based social and behaviour change

communication strategies to address adolescent nutrition at all levels (population,

household and community)

Sub-strategy 1.3: Set policy priorities and resource allocations for adolescent nutrition

Strategic Area 2: Programmatic response to adolescent nutrition across sectors

Sub-strategy 2.1: Design and implement nutrition-specific interventions for adolescents in

the health sector

Sub-strategy 2.2: Design and implement nutrition-sensitive interventions for adolescents

in non-health sectors (education, agriculture, WASH and social protection)

Sub-strategy 2.3: Design and implement nutrition strategies for marginalized adolescents

and those with specialized needs

Strategic Area 3: Continued evidence generation for guidance, learning and

accountability

Sub-strategy 3.1: Monitoring, evaluation, surveillance and accountability

Sub-strategy 3.2: Effective knowledge management and reflecting on what works

Strategic area 1: Enabling environmentCreation of a sustained enabling environment to address adolescent nutrition

Sub-strategy 1.1: Policy advocacyConduct evidence-based policy advocacy for equity-based inclusion of adolescent nutrition as a specific area of focus and for resource mobilization in existing and future strategies, plans and programmes (legislations, implementation, rules and regulations)

What is needed There is an urgent need to place adolescent nutrition higher on the government agenda through legislation and changes in policy, strategies and planning.


Multisectoral nutrition strategies must address adolescents as a specific group in their own right and support provision of youth-friendly services across sectors. Coordination across sectors is needed to integrate nutrition for adolescents into strategies and programmes for health, education, livelihood development, social protection, economy, life skills and gender. Sectoral strategies and plans should also reinforce improved nutrition for adolescents.

This multisectoral effort necessitate a high degree of political commitment, government leadership and engagement. To achieve this, policy- and decision-makers in government must be engaged on issues around adolescent nutrition and understand the value of investing in adolescents.

Legislative changes are required in three specific areas:

- Introducing or amending child marriage legislation to raise the minimum age of marriage to 18 years

- Introducing or amending legislation and rules of business to implement Article 25A of the Constitution on compulsory education to ensure that no adolescent remains uneducated

- Food rules that prohibit provision of substandard and junk foods in and around schools

Regular, structured physical activity must be provided to adolescents23 through guidance, school or community sport activities, or urban planning and school construction regulations to ensure spaces are available for physical activity, and facilitating safe and accessible routine activities such as walking and cycling for both girls and boys.

Reference documentsThe Save the Children review of policy and programming in SUN+ countries 24 recommends that interventions should be gender- and age-sensitive, dividing adolescents into at least two age groups (10–14 and 15–19 year olds), and to include specific support for adolescents with particular issues such as HIV, chronic illness such as diabetes and substance abuse. It advises that emerging concerns around overweight should be

23 World Health Organization (2010). Global recommendations on physical activity for health. Geneva. Available at: https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/ See in particular “Supportive policies in promoting physical activity” (page 37–38).24 Save the Children (2015). Adolescent nutrition: Policy and programming in SUN+ countries. London. Available at: https://resourcecentre.savethechildren.net/node/8970/pdf/adolescent_nutrition.pdf


recognized and addressed alongside undernutrition. It also recommends that services providers must be provided the knowledge and skills, particularly communication and counselling skills, to work with adolescents.

The MoNHSRC/WHO Adolescent Nutrition and Supplementation Guidelines for Pakistan25 recommend clear standards to support healthier foods, regulate marketing of unhealthy foods and beverages, and food fortification, as well as to provide access to safe water and urban planning to encourage physical activity. At community and individual level, the guidelines recommend policies to promote healthy habits, address anaemia, manage malnutrition, ensure nutritional support during pregnancy, and encourage physical activity. They argue that cultural sensitivities around sexual and reproductive health may be overcome by applying a nutrition lens to programming.

The MoNHSRC/GAIN Framework of Action for adolescent nutrition in Pakistan26 proposes evidence-based advocacy and dialogue with legislators and policymakers on enhancing the First 1,000 Days approach to include adolescent nutrition (First 1,000 Days Plus), and to revise the Child Marriage Restraint Act and enforce it at national and provincial levels.

Sub-strategy 1.2: Social and behaviour change communication strategiesDesign and implement evidence-based social and behaviour change communication strategies to address adolescent nutrition at all levels (population, household and community)

What is neededCommunities, families and adolescents must be made aware of adolescents’ nutritional needs, nutrition concerns and appropriate diets.

Community values and norms, and stigmatization of health issues, exert a strong influence on young people and may deter them from seeking care. To shift social norms, deep-rooted social change must be achieved at population, household and community levels, and must target both adolescent girls and boys, as well as parents

25 WHO and MoNHSRC (draft) Pakistan adolescent nutrition and supplementation guidelines.26 Badar, A, Rasool F, et al (2019) A policy paper on adolescent nutrition in Pakistan: Framework for action, policies and programmes. Global Alliance for Improved Nutrition (GAIN) policy paper. Available at: https://www.gainhealth.org/re-sources/reports-and-publications/framework-action-programs-and-policies-policy-paper-adolescent-nutrition-pakistan


and the community at large. Fathers have particular influence as role models and an important role in purchasing food items in most households, and should be specifically targeted.

Nutrition interventions for adolescents should be integrated, multisectoral, and utilize community platforms (including schools, mosques, churches, madrassahs, etc.), mass media and new platforms (including social media, influencers and mobile communication).

The advertisement of unhealthy food to adolescents must be limited, alongside promoting the intake of fruits and vegetables, and discouraging consumption of energy-dense micronutrient-poor foods and sweetened drinks. Limiting exposure of adolescents to the heavy marketing of these products and providing them with the information and critical skills to make healthy food choices will also improve nutrition status.

Reference documentsThe MoNHSRC/WHO Adolescent Nutrition and Supplementation Guidelines for Pakistan 27 recommend nutrition education and counselling including through life skills, health and nutrition education and premarital counselling, and increasing awareness of diverse diets, personal and menstrual hygiene, WASH, chronic malnutrition, parenting and available services. Specific recommended measures are: building capacity of community workers to counsel adolescents, awareness activities in schools and communities; providing private, easily-accessible and friendly package of services to adolescents; peer-to-peer education on reproductive health, family planning and nutrition; counselling on supplementation for adolescent girls; and adolescent-friendly reproductive health services for both girls and boys (including via schools).

The MoNHSRC/GAIN Framework of Action for adolescent nutrition in Pakistan28 proposes development of a communication strategy with tailored messages on the long-terms benefits of good nutrition for adolescents and its value for families and communities. It recommends various channels including trained community health workers, mobile technology and social media, and existing community structures to catalyse participation by families and communities.



Sub-strategy 1.3: Policy prioritization and resource allocations Set policy priorities and resource allocations for adolescent nutrition

What is neededThe food systems approach29 entails attention to the social, economic and political drivers of adolescent malnutrition to exert policy influence on key institutions and their complex interactions to ensure safe and adequate food is available for adolescents.

The social determinants of health should be addressed through reviews of national and provincial sectoral policies to identify gaps and allocate budget for interventions targeting adolescent girls and boys, taking into account the urban/rural divide, differences in income and education, and other equity concerns.

Reference documents Under the MoNHSRC/GAIN Framework of Action for adolescent nutrition in Pakistan30, national-level prioritization occurs in three steps: landscape analysis, budgetary needs assessment and priority setting and budgetary allocations. In Pakistan’s broader development debate, policy advocacy is required to put adolescents at the centre of development. The framework recommends that policies be developed that improve access of low-income families to nutritious foods and prevent over-consumption of low-value foods. It also suggests creating synergies between policies on girls’ nutrition and education, protection concerns (such as child marriage) and cultural norms around gender. Finally, it recommends the development of a national policy to guide programme design and multisectoral strategies to address all forms of adolescent malnutrition.

Strategic area 2: Programmatic response Programmatic response to adolescent nutrition across sectors

Sub-strategy 2.1: Nutrition-specific interventionsDesign and implement nutrition-specific interventions for adolescents in the health sector

29 UNICEF Office of Research Innocenti (2018). Food systems for children and adolescents. Florence. Available at: https://www.unicef.org/nutrition/food-systems.html30 Badar, A, Rasool F, et al (2019) A policy paper on adolescent nutrition in Pakistan: Framework for action, policies and programmes. Global Alliance for Improved Nutrition (GAIN) policy paper. Available at: https://www.gainhealth.org/re-sources/reports-and-publications/framework-action-programs-and-policies-policy-paper-adolescent-nutrition-pakistan


What is neededSeizing the opportunity offered during adolescence to address lifelong malnutrition requires adolescent-friendly health and nutrition services which are accessible, equitable, acceptable, appropriate, comprehensive, effective and efficient.

Addressing the high rates of anaemia in Pakistan is critical during adolescence. As such IFA supplementation (including weekly IFA) is a top-level priority. Other important nutrition-specific services include community- and school-based nutrition screening and referrals of adolescents for acute malnutrition, food fortification and supplementation, preventing adolescent pregnancy and poor reproductive outcomes, promoting pre-conception and antenatal nutrition, and training in nutrition counselling for health and nutrition service providers.

Reference documentsThe Adolescent Nutrition and Supplementation Guidelines for Pakistan31 note that there is an evidence gap on nutrition for younger adolescents which should be filled. They recommend nutrition counselling, awareness-raising and screening to assess anthropometry and anaemia status, and deworming appropriate to pregnancy status. Where anaemia and other micronutrient deficiencies are high, supplementation should be provided, particularly IFA. Underweight girls should also be provided multi-micronutrient tablets (see Annex 1 for more details on nutrition-specific recommendations in the guidelines).

The MoNHSRC/GAIN Framework of Action for adolescent nutrition in Pakistan32 proposes the development of a core package of nutrition-specific interventions covering healthy eating, nutrient supplementation, behaviour change for health and avoiding risk and hygiene and sanitation. This should be supplemented with a training package to build the capacity of healthcare providers to enhance the quality and reach of the services they provide, and costed PANS-aligned plans to address issues around geographical coverage and lack of access.



Sub-strategy 2.2: Nutrition-sensitive interventionsDesign and implement nutrition-sensitive interventions for adolescents in non-health sectors (education, agriculture, WASH and social protection)

What is neededNutrition-sensitive interventions address some of the underlying causes of malnutrition, change behaviours, contribute to community, household or school assets, align with nutrition action plans and strategies and apply a gender and protection lens to nutrition33.

Education: Schools (formal, non-formal and informal) and madrassahs offer opportunities to educate students on nutrition through its incorporation into curricula. Schools can also promote physical activity and maintain healthy food environments. Educational institutions can be delivery platforms for nutrition-specific interventions such as providing nutrition messages, deworming and IFA or weekly IFA supplementation.

WASH: In schools, health facilities and other public institutions, the sector can protect access to nearby safe, separate and private sanitation facilities which are essential for menstrual hygiene management and to ensure the dignity, comfort and health of adolescent girls. The sector can also ensure clean and safe drinking water and its safe storage, sanitation facilities, waste disposal, and ensure safe food services in schools and other places where adolescents gather.

Social welfare and women’s development: Legislation to prevent child marriage must be implemented across Pakistan with appropriate protective mechanisms in place. This may be supported by the health and education systems through counselling and educating at-risk individuals and their families and communities.

Agriculture and food: Food policies and regulations can control supply-side factors in food systems and promote access to micronutrient foods though support for kitchen and school gardens. Cash vouchers and conditional grants can improve adolescent nutrition and retention in schools. Food fortification and demand creation for fortified food through schools is an opportunity for intersectoral collaboration.

33 Adapted from https://www.ennonline.net/fex/55/nutsensitiveprogrammingwfp


Local governments and urban development: The sector can encourage structured sports and physical activity in schools, communities and the workplace, develop parks and sport facilities, and encourage routine physical activity such as walking and cycling for both girls and boys.

Social protection: Social protection schemes such as Ehsaas and the Benazir Income Support Programme (BISP) can identify and reach the most marginalized adolescents with cash transfers, food vouchers and other forms of support.

Reference documentsThe MoNHSRC/GAIN Framework of Action for adolescent nutrition in Pakistan34 recommends the development of a core package of nutrition-sensitive interventions targeting adolescents and integrated into key non-health sectors: education, WASH, food safety, agriculture and livelihoods, social protection, gender empowerment and skills building, etc. An essential component of this is to develop training packages to build the capacity of departments and their staff to implement the package, and to work with planning departments to develop costed plans to incorporate the package into provincial programming.

Sub-strategy 2.3: Marginalized adolescents and adolescents with specialized needsDesign and implement nutrition strategies for marginalized adolescents and those with specialized needs

What is neededAdolescents with specialized needs – those belonging to marginalized groups, transgenders, seasonal migrants and nomads, HIV-positive adolescents, adolescents with disabilities, adolescents belonging to racial, ethnic or religious minorities, the very poor and those living in humanitarian situations – face even greater nutritional challenges than their peers. Particular groups of adolescents continue to face systemic barriers to entering and staying in school, accessing economic opportunities and benefiting from critical social services such as healthcare and protection. These adolescents are more likely to experience abuse and exploitation. It is essential to identify and reach these adolescents with services, support and information and thus ensure that nutritional support is equitable.

34 Badar, A, Rasool F, et al (2019) A policy paper on adolescent nutrition in Pakistan: Framework for action, policies and programmes. Global Alliance for Improved Nutrition (GAIN) policy paper. Available at: https://www.gainhealth.org/re-sources/reports-and-publications/framework-action-programs-and-policies-policy-paper-adolescent-nutrition-pakistan


Reference documentsThe guidance from the United Nations Children’s Fund (UNICEF) on programming for adolescents 35 recommends that marginalized adolescents and those with special needs should be engaged at every step of the programme cycle from prioritization and results setting to monitoring and evaluation. Data should be disaggregated to illuminate critical contextual inequalities, and these should be used by policymakers and implementers to map and reach marginalized adolescents. In strategic planning, reaching adolescents experiencing multiple forms of discrimination and exclusion should be prioritized, and clear accountabilities should be defined within sectors. During implementation, programming should support efforts to address stigma and discrimination, provide equitable service delivery with accountability measures to track if marginalized adolescents are being reached, and actively engage the most marginalized adolescents through community groups and other partners.

Strategic area 3: Evidence Continued evidence generation for guidance, learning and accountability

Sub-strategy 3.1: Monitoring and evaluationMonitoring, evaluation, surveillance and accountability

What is neededMonitoring, evaluation and accountability processes identify the changes needed to design and redesign programmes for greatest effectiveness, efficiency and equity. Documentation and review of the dynamics that contribute to a programme’s success or failure provide lessons for future design, planning and implementation. Monitoring and evaluation systems are crucial for accountability and effective governance and require a committee structure that reaches across sectors and extends from national to community level.

NNS 2018 was the first survey in Pakistan to collection data on adolescent nutrition, and its findings demonstrated the critical need for regular data collection. For this reason, existing household surveys (including NNS but also PDHS and the Household Integrated Economic Survey, HIES) must be enhanced to collect data on adolescent

35 UNICEF (2018). Programme guidance for the second decade: Programming with and for adolescents. New York. Available at: https://www.unicef.org/media/57336/file


nutrition and enable regular monitoring of high-level nutrition indicators for younger and older adolescents including those belonging to marginalized groups.

Since adolescent behaviours and conditions may persist into adulthood, preventive measures and health policies that impact adolescents have implications through adulthood and the health of their children. For this reason incorporating adolescent data into national nutrition surveillance systems is necessary to monitor trends and impacts. Existing information management systems, such the district health information systems (DHIS) in each province must also be enhanced to collect and report disaggregated data on adolescent nutrition.

Reference documentsThe Save the Children review of policy and programming in SUN+ countries 36 recommends that national systems and structures be developed to monitor and evaluate outcomes for adolescents from programmes and services for nutrition, and points out that an assumption of coverage is not sufficient for this purpose. It advocates for the development of tools to assess the extent to which adolescents, especially the most vulnerable, are able to access services.

The MoNHSRC/WHO Adolescent Nutrition and Supplementation Guidelines for Pakistan 37recommend that monitoring and evaluation be built into the implementation process, with periodic evaluations to assess coverage and quality. It recommends that monitoring and evaluation should engage with adolescents, including meaningful engagement prior to data collection and ensuring they participate in developing recommendations. At all times, monitoring and evaluation processes must take into account adolescents’ protection needs.

The MoNHSRC/GAIN Framework of Action38 proposes that the adolescent age group be integrated into routine nutrition surveillance, appropriately sampled in population surveys and disaggregated in programme evaluations. It recommends that determinants of poor nutrition be documented using standardized indicators. To collect and utilize learning effectively, it recommends training for mid-level and senior government

36 Save the Children (2015). Adolescent nutrition: Policy and programming in SUN+ countries. London. Available at: https://resourcecentre.savethechildren.net/node/8970/pdf/adolescent_nutrition.pdf37 WHO and MoNHSRC (draft) Pakistan adolescent nutrition and supplementation guidelines.38 Badar, A, Rasool F, et al (2019) A policy paper on adolescent nutrition in Pakistan: Framework for action, policies and programmes. Global Alliance for Improved Nutrition (GAIN) policy paper. Available at: https://www.gainhealth.org/re-sources/reports-and-publications/framework-action-programs-and-policies-policy-paper-adolescent-nutrition-pakistan


officials programme implementation research and ensure that adolescents participate in interpretation of evaluation findings and the design and implementation of policies, programmes and guidelines.

Sub-strategy 3.2: Knowledge managementEffective knowledge management and reflecting on what works

What is neededEffective knowledge management is needed to share lessons learned, innovation and good practices in planning, implementation, monitoring and evaluation. It includes the development of cross-cutting studies, case studies and policy briefs, guidelines and documentation of lessons learned. This will require building knowledge management capacity and knowledge exchange through workshops, peer exchanges and knowledge products, with effective dissemination platforms.

There is a need to set the research agenda in adolescent nutrition in Pakistan. Critical reflections, successful innovations, and syntheses of external and internal sources of knowledge must be collected as briefs suitable for use by policymakers.

While Pakistan has significant experience in measuring intervention coverage, deeper investments are required to strengthen implementation research to improve programme delivery, uptake, cost effectiveness and scale.

Reference documentsThe MoNHSRC/GAIN Framework of Action39 recommended that adolescent data be collected in existing large-scale surveys. National standards should be devised for standardized indicators and data collection tools to measure and monitor health and nutrition.

Key areas of research include neglected micronutrient deficiencies (e.g. folate, zinc, calcium, and vitamin D) in adolescents, the determinants of undernutrition and dietary patterns. Longitudinal studies are required on the effects of multiple micronutrient supplementation and food supplementation during adolescence on maternal nutrition

39 Badar, A, Rasool F, et al (2019) A policy paper on adolescent nutrition in Pakistan: Framework for action, policies and programmes. Global Alliance for Improved Nutrition (GAIN) policy paper. Available at: https://www.gainhealth.org/re-sources/reports-and-publications/framework-action-programs-and-policies-policy-paper-adolescent-nutrition-pakistan


outcomes. Finally, the framework recommends studies on the underlying causes of and potential policy responses to the emerging concern of adolescent overweight and obesity.

3.3 Federal strategic planThe federal chapter of PANS has a dual role: overarching coordination, harmonization and standardization across Pakistan, and implementation of programmatic interventions in the non-provincial regions: ICT, GB and AJK.

Strategic area 1: Enabling environment Sub-strategy 1.1: Policy advocacyThe PANS federal chapter will engage with legislators and policymakers through evidence-informed advocacy events on specific themes such as healthy school lunches and the inclusion of messages on healthy food in school curricula.

The federal chapter will advocate for the revision, enactment and enforcement of the Child Marriage Restraint Act.

Meanwhile, measures must be put in place to ensure that early pregnancy is prevented and, if teenage pregnancy occurs, it is carefully managed.

The federal chapter emphasizes free and compulsory education and the inclusion of IYCF in medical curricula for doctors, nurses, Lady Health Visitors (LHV) and paramedics.

A critical aspect of multisectoral programming is leadership, from the highest management levels to communities, to integrate, coordinate, supervise and monitor activities. The federal chapter proposes that focal persons from multisectoral platforms provide training of trainers in concerned sectors. These trainers will provide trickledown training within their sectors.

The federal chapter will broaden the First 1,000 Days approach to the First 1,000 Plus Days, recognizing that better adolescent nutrition also improves maternal and child health outcomes.

Sub-strategy 1.2: Social and behaviour change communication strategiesThe PANS federal chapter recommends the development of an evidence-informed social and behaviour change communication (SBCC) strategy to address adolescent


nutrition at all levels (population, household and community). The SBCC strategy should be based on formative research, developed in consultation with key stakeholders, and include the use of a range of channels including mobile technology and social media to influence behaviours related to adolescent nutrition.

Sub-strategy 1.3: Policy prioritization and resource allocationsThe PANS federal chapter has not recommended specific strategic inputs to integrate adolescent nutrition into regular, public sector, non-development annual budget statements and accountability at national, provincial and local levels in other sectors.

Strategic area 2: Programmatic response Programmatic response in the federal strategic plan primarily relates to response in AJK, ICT and GB.

Sub-strategy 2.1: Nutrition-specific interventions The PANS federal chapter proposes nutrition-specific interventions for adolescents to be implemented through the health sector. This includes provision of additional micronutrients through:

- Fortification of staple foods such as wheat (iron, folic acid, zinc, vitamin B-12), oil (vitamins A and D) and salt (iodine)

- Targeted supplementation such as weekly provision of iron folic acid supplements to adolescents (weekly IFA supplementation) and deworming

The federal chapter will strengthen efforts to prevent early pregnancy by measuring trends in early marriage and enforcement of laws through surveys such as the PDHS. It will strengthen services by enhancing the functional integration of nutrition with maternal, newborn and child health (MNCH) and population welfare departments to serve the reproductive health, family planning and nutritional needs of married adolescents. This will require building the capacity of community-based workers to provide nutrition counselling.

The federal chapter will engage public and private sector health practitioners and provide them with information on adolescent nutrition.


Sub-strategy 2.2: Nutrition-sensitive interventions The PANS federal chapter will use formal and informal education systems and madrassahs to provide hygiene education, drinking water, gender-segregated toilet facilities and menstrual hygiene management to adolescent students.

The federal chapter will promote healthy diets by seeking prohibition of unhealthy food within schools and in their immediate vicinities, and by offering nutritious meals at school canteens. Messages on healthy diets will be included in school curricula and teachers will be trained on nutrition and nutrition awareness.

High drop-out rates of adolescent girls due to the unavailability of female teachers and distance from schools must be addressed on a priority basis. The federal chapter proposes offering conditional cash transfers and food vouchers to adolescents from poor households to increase enrolment.

Nutrition-sensitive interventions in the agriculture sector include support for establishing kitchen gardens and rural poultry farming. Agriculture extension workers should be trained in nutrition awareness-raising and micronutrient distribution in under-served agriculture areas.

Sub-strategy 2.3: Marginalized adolescents and adolescents with specialized needsThe PANS federal chapter identifies categories of marginalized adolescents in need of special support. These include HIV-positive, transgender, adolescents with disabilities, street children, out-of-school adolescents, scavengers, minorities, delinquent and imprisoned adolescents, and those in disaster or humanitarian situations. The federal chapter will initiate discussions with public sector and non-governmental stakeholders on nutrition concerns in these groups and how to address them effectively.

The federal Ehsaas programme40 will be engaged to address nutrition concerns among marginalized communities in general.

Strategic area 3: Evidence Sub-strategy 3.1: Monitoring and evaluation The PANS federal chapter recommends revisiting provincial DHISs to ensure these capture age and sex-disaggregated data on nutrition status, and the preventive and curative actions taken to address nutrition concerns.

40 See: http://www.pakistan.gov.pk/ehsaas-program.html


The federal chapter recommends periodic screening of students to record their nutrition status. It will continuously monitor and evaluate large-scale sustainable services such as those related to the promotion of healthy and nutritious diets and micronutrient supplementation through the nutrition management information system (NMIS).

Sub-strategy 3.2: Knowledge management The PANS federal chapter will incorporate context-specific age-, sex-, income-, education- and geographically-disaggregated data on adolescent dietary patterns, eating habits and unique nutritional issues and their major determinants in all relevant surveys (NNS, PDHS, HIES, etc.). It will identify innovations and suitable delivery platforms for adolescents to achieve scale-up, health systems integration and sustainability.

3.4 Provincial strategic plansEach province has developed a strategy matrix and operational plan to implement PANS within its specific context.

Strategic area 1: Enabling environment Sub-strategy 1.1: Policy advocacyAll PANS provincial chapters consider legislation on the prohibition of child marriage a priority intervention. Substantial progress has already been made, though processes are at different stages in each province.

All provincial chapters will institute and implement legislation on compulsory education (i.e. implementation of Article 25A of the Constitution on free and compulsory education), and on food regulation to prohibit junk food and fizzy drinks in educational institutions. Punjab has taken practical measures to implement this ban.

The Balochistan and KP chapters propose urban planning and development legislation and reform to address the need for physical activity for adolescents (such as through parks and school sport).

The Punjab chapter will include adolescent nutrition (through an assessment-based module and addenda) within primary, higher and medical education.

Punjab will also revitalize coordination mechanisms for the multisectoral nutrition approach at district, tehsil and union council levels, while Balochistan and KP will


integrate targeted adolescent nutrition interventions in existing strategies (provincial multisectoral nutrition strategies), sectoral plans and programmes.

Sub-strategy 1.2: Social and behaviour change communication strategiesAll provincial chapters will develop a comprehensive, multisectoral, low-cost, innovative SBCC strategy and action plan to promote adolescent nutrition, healthy diet and positive behaviours and will engage a range of stakeholders and sectors to deliver messages to target audiences. The chapters will focus particularly on reaching parents, especially fathers.

Sub-strategy 1.3: Policy prioritization and resource allocationsThe PANS Balochistan and Punjab chapters will review and refine existing policies, budgets and strategies, including the Poverty Reduction Strategy Paper (PRSP), annual development budgets (ADB) and budgetary allocations for pilot interventions, IFA supplementation, curriculum revision and promotion activities.

The KP chapter will ensure that sectoral roles in adolescent nutrition are identified in the Provincial Sustainable Development Strategy (drafted in 2019).

Sindh will also review and refine existing policies related to the food environment to improve quality of diet and access to nutritious foods, and discourage consumption of low-value foods by adolescents.

The Punjab chapter will seek to establish or strengthen nutrition departments at key provincial universities to create a foundation for research and capacity building related to adolescent nutrition.

Strategic area 2: Programmatic response Sub-strategy 2.1: Nutrition-specific interventions All PANS provincial chapters have identified a core package of nutrition-specific interventions for adolescents:

- Preventing micronutrient deficiency through food fortification, targeted supplementation and deworming

- Targeted IFA supplementation

- Preventing adolescent pregnancy and poor reproductive outcomes


- Promoting pre-conception and antenatal nutrition

- Raising awareness of balanced diets and dietary diversity

- Enhancing quality and reach of services by providing pre-service and in-service training to public and private healthcare providers

- Screening adolescents at schools, health facilities and in communities

- Referring to the Adolescent Health and Development Strategy on disease prevention and management for adolescents

Sub-strategy 2.2: Nutrition-sensitive interventions Education sector: PANS provincial chapters will support the inclusion of nutrition in school curricula and nutrition counselling in teacher training. Schools are recommended as channels for micronutrient supplementation and deworming, and to promote healthy diets through cooking demonstrations and awareness sessions.

Agriculture sector: The provincial chapters recommend raising nutrition awareness and improving availability of nutritious food by promoting kitchen/school gardening and poultry rearing. This support may include providing seeds, ensuring water availability, and supporting fish farming, poultry and livestock rearing. The food department will also support enactment of a law on food fortification.

WASH sector: The provincial chapters will incorporate WASH messages into communication strategies. The sector will ensure WASH facilities are available in schools and other public institutions, with safe, separate and private sanitation facilities to protect the dignity, comfort and health of adolescent girls, including for menstrual hygiene management.

Social protection sector: The provincial chapters will support the design and pilot of social protection interventions to enhance access to quality food for marginalized adolescents, and conditional cash transfers and food vouchers based on secondary school enrolment and attendance.

Sub-strategy 2.3: Marginalized adolescents and adolescents with specialized needsWhile three provincial chapters are yet to define concrete measures targeting marginalized adolescents, it is expected that links will be explored between the provincial social welfare departments (SWD) and the Ehsaas programme.


Strategic area 3: Evidence Sub-strategy 3.1: Monitoring and evaluation The PANS provincial chapters will support modification of the provincial DHIS to capture age- and sex-disaggregated data on the nutrition status of adolescents and programmatic progress on addressing nutritional concerns for this age group. They also recommend periodically screening students to record their nutritional statuses and to monitor and evaluate large-scale services such as distribution of micronutrient supplementation through NMIS.

There is a need for a formal platform to exchange knowledge on research and to monitor its translation into policies and practice. United Nations and development partners have a role to play in reducing the research and practice gap by strategically engaging the research community and MoNHSRC. This engagement will also ensure curricula are regularly updated based on emerging evidence.

Sub-strategy 3.2: Knowledge management The PANS provincial chapters will establish and operationalize digital dashboards to streamline the use of data for decision-making.

The provincial chapters will work to include context-specific, age-, sex-, income-, education- and geographically-disaggregated data on adolescents’ dietary patterns, nutritional concerns and major determinants in the relevant surveys. They will also identify innovations and suitable delivery platforms to reach adolescents for scale-up, health system integration and sustainability.


Delivering PANS


IMPLEMENTATION ARRANGEMENTS

04

4.1 Implementing partners and their rolesThe responsibility for implementing PANS lies with authorities at the three levels of government: federal, provincial and district, with support and collaboration by partners, civil society, non-government organizations (NGO), professional bodies and faith-based organizations.

The health sector has custodianship of PANS at federal and provincial levels. MoNHSRC leads in the implementation of PANS at federal level, and provincial health departments lead at provincial levels.

To ensure smooth implementation, strong coordination will be built with other sectors through existing government-led structures including steering committees and taskforces with the cooperation of the Ministry of Planning, Development and Reform (MoPDR) at federal level and provincial planning and development departments at provincial level.

Federal implementation MoNHSRC has a key role in nutrition-specific programming, regulations and inter- and intra-sectoral coordination. The Technical Advisory and Advocacy Working Group for Improved Adolescent Nutrition within MoNHSRC will provide the technical backstop to nutrition-sensitive and nutrition-specific strategies. This platform aims to “provide a forum for planning, coordination, advocacy and exchange of information/experience to guide policies, provide strategic directions for programmes on Adolescent Nutrition as well as to monitor the progress at national and provincial level and make appropriate


recommendations.” The working group also provided all technical and operational support required to develop PANS.

MoPDR and the federal SUN Secretariat will assist in coordinating and building links between the nutrition-sensitive and nutrition-specific interventions as and when required. They will also facilitate resource mobilization, effective implementation and monitoring of nutrition-sensitive interventions and activities.

The National Food Fortification Alliance will coordinate with MoNHSRC to design, implement monitor and evaluate food fortification interventions. The Ehsaas programme and BISP will be engaged by the Nutrition Cell to cover the social protection aspects of nutrition for marginalized adolescents.

All concerned ministries will ensure adequate resources for full implementation of PANS in their specific roles. The non-provincial regions will be guided by the federal plan.

Provincial implementationThe provinces are developing provincial extensions of the Technical Advisory and Advocacy Working Group for Improved Adolescent Nutrition. These platforms will provide overall guidance and oversight, and nutrition programmes in the provincial departments of health (DoH) and relevant departments will be responsible for implementation in line with commitments in their respective provincial action plans. Sindh and Punjab have already moved towards the finalization and notification of provincial working groups.

As with their federal counterparts, provincial planning and development departments (PDD) and the SUN provincial chapters will assist in coordination, resource mobilization, implementation and monitoring and evaluation of nutrition-sensitive interventions.


Table 7: Responsibilities of provincial government departments and authorities

Provincial body ResponsibilitiesDepartment of health (DoH) - Through the primary health care revitalization initiatives currently

underway, ensure that adolescent nutrition programming is adequately staffed.

- Ensure that adolescent nutrition is reflected in guidelines and minimum standards and that these are periodically reviewed and updated.

- Keep under review formative research on innovations in delivery of adolescent nutrition services in primary care settings.

- Ensure sectoral implementation of nutrition-specific health interventions in PANS.

- Strengthen linkages with nutrition-sensitive provincial and sub-provincial stakeholders for SBCC and distribution of food and micronutrient supplementation.

- Include gender-sensitive, age group-specific adolescent nutrition indicators in routine monitoring, health information systems and specialized surveys.

Food Fortification Alliance - Coordinate with DoH on delivery of food fortification interventions targeting adolescent boys and girls.

Planning and development department (PDD) and SUN offices

- Assist in coordination, building linkages between nutrition-sensitive and -specific interventions.

- Facilitate resource mobilization, effective implementation and monitoring of nutrition-sensitive interventions and activities.

Department of education (DoE)

- Revitalize and update nutrition and life skills curricula to address the needs of adolescent boys and girls, including those who are out of school.

- Renew emphasis on schools as channels to engage communities in improving adolescent nutrition knowledge and practices, and to reach out-of-school adolescents.

- Re-emphasize the critical importance of school enrolment and retention in preventing child marriage and early pregnancy, extend full support to the implementation of child marriage restraint legislation.

Public health engineering department (PHED)

- Achieve and sustain universal open-defecation-free environments.

- Intensify behaviour change communication around the use of latrines and handwashing at critical times (after latrine use, before food preparation or consumption, etc).

- Enhance coverage of improved water sources and safe drinking water.


Department of agriculture (DoA)

- With agriculture and food production the backbone of diet and nutrition, policies should emphasize that eating better helps to ensure sustainable systems.

- Keep under review the extent to which dominant food systems contribute to adverse nutrition outcomes for adolescents.

- In the long run, ensure that food systems and markets are sensitive to the needs of adolescents.

- Engage adolescents in finding less resource-intensive ways to produce safe, nutritious, healthy diets and develop their capacities to build a sustainable food supply.

Department of social protection

- Liaise with the federal Ehsaas programme and formulate inclusive context-specific nutrition-sensitive interventions.

- As opportunities arise, reshape national cash transfer programmes aimed at low-income women to deliver benefits specifically to adolescent girls.

- Sensitize social and community workers on social protection programme benefits for low-income adolescents and their potential nutrition impacts.

- Track social protection contributions to nutrition-sensitive spending, particularly on adolescents.

Departments of population welfare (PWD) and women’s development (WDD)

- Join in advocacy efforts to discourage early marriage.

- Provide reproductive health and family planning services to married adolescents on delaying early pregnancy.

District and community implementationServices will be provided by public sector district offices and service providers with the support of NGOs and development partners. Local governments are best placed to provide coordination and integration of empowerment, health and nutritional promotion activities aimed at adolescents, however there is a need to develop the capacity of local government staff in integrating response.

The role of local governments is to:

- Oversee district-level coordination amongst line departments

- Collaborate with communities and provincial DoH to identify core adolescent priority interventions

- Collaborate with communities to strengthen community support for adolescent nutrition, learn lessons and track resources and results

- Identify new stakeholders in implementing PANS and encourage their participation and contribution


At community level, their role is to:

- Bring adolescent concerns, priorities and needs identified by communities to managers of health and other facilities including schools

- Ensure implementation of PANS is consistent at health facilities and within communities

- Explain concepts around malnutrition and its prevention to communities

- Spearhead community mobilization and the establishment of functioning community groups

Other partnersNGOs and civil society organizations (CSO)

- Demonstrate leadership by publicly endorsing and implementing PANS

- Support government in shifting to a focus on malnutrition prevention

- Communicate with the public on structural and other barriers to improved adolescent nutrition behaviours

- Work with federal and provincial ministries to explain to families and communities that adolescent malnutrition is preventable

- Mobilize youth and communities around adolescent nutrition

- Pilot and research approaches to address adolescent malnutrition

- Support monitoring and accountability of programmes

- Work with government in public-private partnerships for service delivery

- Bring experience and learning from other countries

Development partners

- Fund and support innovation in adolescent nutrition programme delivery at all levels, and help identify approaches that are ready for scale up and can deliver results

- Assist in developing an agenda for formative research which examines key barriers to scale up, means of measurement and effective advocacy

- Bring experiences from other countries to bear on implementation strategies in Pakistan

- Provide technical support to government


4.2 Delivery platforms As the social circles of adolescents expand beyond their immediate families and they enter into more complex interactions with their peers, academic institutions, community, media and broader social and cultural influences, all these channels can serve as delivery platforms for adolescent nutrition (see Figure 4). The services that may be delivered through these expanded platforms are listed in Table 8.

Figure 4: Delivery platforms for adolescent interventions

Source: UNICEF programme guidance for the second decade: Programming with and for adolescents, 2018


Table 8: Delivery platforms, services and sectors for adolescent nutrition

Delivery platform Sector Services Health services Health

Nutrition

WASH

- Nutrition counselling

- Screening; micronutrient and protein supplementation

- Deworming

- Puberty and sexual and reproductive health information

Schools (formal and non-formal learning platforms)

Health

Nutrition

WASH

Education

- Micronutrient supplementation and deworming

- Nutrition, hygiene and menstrual health education

- Life skills education

- Physical activity and sports

- Access to dignity kits

- Healthy school meals

Families and communities Health

Nutrition

WASH

Social inclusion

Communication for development (C4D)

- Micronutrient supplementation and deworming

- Nutrition education

- Life skills education

- Social protection programmes (e.g., cash transfers, scholarships, health insurance)

- Physical activity and sports

- Community-led total sanitation

- Adolescent peer support

- Provision of iodized salt

Digital and non-digital communication platforms

Health

HIV

Nutrition

WASH

C4D

Communication

- Media and interpersonal communication interventions to build community awareness and address negative social norms

- Peer support groups

- Advocacy with private sector including food and beverage companies

Adapted from: UNICEF programme guidance for the second decade: Programming with and for adolescents, 2018


MONITORING, EVALUATION AND REPORTING

05

Strategic interventions and actions in support of adolescent nutrition must be monitored to ensure they are progressing, and evaluated to ensure they are effective.

Data from monitoring will help justify continuation or modification of course of actions taken to implement this strategy. For this reason, sectors with defined interventions and activities must ensure continual monitoring and feedback on programmatic interventions.

Periodic evaluations will help objectively assess progress towards and achievement of the strategy’s goal and objectives. Monitoring will include both quality (process) and outcome (progress) indicators. Process monitoring must include effective participation by adolescents in the programme design, and progress measurement will include changes in behaviours of adolescents over time.

To implement PANS it is recommended that a monitoring and evaluation plan be developed to provide a standardized framework on how data will be collected, processed, analysed, interpreted, shared and used.

Consideration should be given to involving adolescent organizations, such as Girl Guides and Boy Scouts, to provide data for monitoring. However, the strength, capacity and penetration of organizations that include adolescent participation, or have are exclusively for adolescents, varies across provinces and their involvement cannot be expected to be uniform.

5.1 Programme indicatorsProgramme delivery indicators correspond to the outcome-level indicators listed in Table 6 in Chapter 3. Additional nutrition-sensitive indicators, to which PANS may contribute but holds no accountability, are also listed in Chapter 3.


5.2 Management indicatorsTo ensure accountability for results at federal and provincial levels, country and provincial management indicators are defined based on UNICEF guidance for adolescent programming.1 These management indicators should be reviewed annually.

- Domain 1: Evidence on adolescents is generated

- Domain 2: Results are defined, monitored and documented

- Domain 3: National leadership is reflected in policies, plans and budgets

- Domain 4: External and internal coordination mechanisms to review and monitor implementation of plans

- Domain 5: Internal resources secured to support adolescent programming

Specific indicators falling under each domain are provided in Annex 2.

5.3 Progress monitoringProgress will be monitored against the indicators outlined in federal and provincial operational plan matrixes.

5.4 Reporting mechanismsThe reporting mechanism for PANS may adapt existing systems or devise a new system.

The health sector currently uses two information systems: DHIS and NMIS. Gaps persist in adolescent reporting and it is therefore recommended that these information systems include PANS output/outcome indicators and process indicators on their regular reporting forms.

Advocacy is also required to ensure that population surveys (NNS, PDHS and HIES) include gender and age-disaggregated adolescent nutrition indicators.

Since PANS is based on a multisectoral approach and provincial multisectoral nutrition strategies are already in place, the latter’s reporting channels should be adopted to avoid duplication or the creation of a standalone information and reporting system.

1 UNICEF (2018). Programme guidance for the second decade: Programming with and for adolescents. New York. Available at: https://www.unicef.org/media/57336/file


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us

lead

ers,

cha

mpi

ons,

not

able

per

sons

XX

XX

X#

of th

emat

ic/s

ecto

ral w

orks

hops

/ev

ents

org

aniz

ed

# of

them

atic

/sec

tora

l sta

keho

lder

s se

nsiti

zed

MoP

DR,

SU

N

Secr

etar

iat,

MoN

HSR

C, M

oE,

Min

istr

y of

Clim

ate

Chan

ge (f

or W

ASH

), M

inis

try

of S

ocia

l W

elfa

re, M

inis

try

of W

omen

’s D

evel

opm

ent,

GAI

N,

UN

ICEF

PDD

Cond

uct

them

atic

w

orks

hops

w

ith

med

ia

and

relig

ious

op

inio

n m

aker

s to

sen

sitiz

e th

em o

n se

lect

ed i

ssue

s,

incl

udin

g he

alth

y fo

od p

rom

otio

n.

XX

XX

X#

of m

edia

per

sons

sen

sitiz

ed#

of re

ligio

us le

ader

s se

nsiti

zed

Sect

oral

st

akeh

olde

rs, U

NIC

EFSe

ctor

-spe

cifi c

st

akeh

olde

rs

Inte

rven

tion

1.1.

3:Co

nven

e na

tiona

l and

regi

onal

dia

logu

es

on h

ow t

he 1

000

Day

s Pl

us a

ppro

ach

supp

lem

ente

d w

ith a

dole

scen

t nut

ritio

n in

terv

entio

n im

prov

es M

CH o

utco

mes

XX

X#

of s

emin

ars

orga

nize

d #

of in

divi

dual

s se

nsiti

zed

MoN

HSR

CM

oNH

SRC

Inte

rven

tion

1.1.

4:

Build

cou

ntry

-wid

e se

ctor

al c

apac

ity t

o im

plem

ent

PAN

S st

rate

gies

dow

n to

lo

cal g

over

nmen

t lev

el


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Prov

ide

sect

or-s

peci

fi c tr

aini

ng

of tr

aine

rs b

y fo

cal p

erso

ns fr

om

mul

tisec

tora

l pla

tform

s to

dev

elop

m

aste

r tra

iner

s, fo

llow

ed b

y se

ctor

-sp

ecifi

c tr

ickl

edow

n tr

aini

ng

XCa

paci

ty-b

uild

ing

of lo

cal g

over

nmen

t offi

cia

ls a

nd e

mpl

oyee

s to

inte

grat

e,

coor

dina

te, s

uper

vise

and

mon

itor a

ll ac

tiviti

es a

t com

mun

ity le

vel

MoP

DR,

SU

N, a

ll co

ncer

ned

sect

ors

P&D

Inte

rven

tion

1.1.

5:Ra

ise

awar

enes

s ar

ound

chi

ld m

arria

ge

and

avoi

danc

e of

ear

ly p

regn

ancy

XX

XIn

tegr

ated

Re

prod

uctiv

e,

Mat

erna

l, N

ewbo

rn

and

Child

Hea

lth

Prog

ram

me

(IRM

NCH

)

IRM

NCH

Pro

gram

me

FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

2

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.2.

1D

evel

op c

ompr

ehen

sive

, mul

tisec

tora

l, lo

w-c

ost,

inno

vativ

e nu

triti

on S

BCC

stra

tegy

for p

rom

otio

n of

ado

lesc

ent

nutr

ition

, hea

lthy

diet

and

pos

itive

be

havi

ours


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

2

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Und

erta

ke fo

rmat

ive

rese

arch

and

fe

asib

ility

stud

yX

Esse

ntia

l sec

tora

l inf

orm

atio

n is

ca

ptur

ed

MoP

DR,

SU

N

Secr

etar

iat,

MoN

HSR

C,

MoE

, Min

istr

y of

Cl

imat

e Ch

ange

(W

ASH

), M

inis

try

of A

gric

ultu

re a

nd

Live

stoc

k, M

inis

try

of S

ocia

l Wel

fare

, M

inis

try

of W

omen

’s D

evel

opm

ent

MoN

HSR

C

Dev

elop

SBC

C st

rate

gy b

ased

on

form

ativ

e re

sear

ch a

nd in

con

sulta

tion

with

key

sta

keho

lder

s

X

Roll

out S

BCC

stra

tegy

X

Inte

rven

tion

1.2.

2:D

evel

op a

nd im

plem

ent i

nnov

ativ

e lo

w-c

ost a

ppro

ache

s in

clud

ing

the

use

of m

obile

tech

nolo

gy a

nd s

ocia

l med

ia

to in

fl uen

ce b

ehav

iour

s re

late

d to

ad

oles

cent

nut

ritio

n.

XX

XX

X#

of th

emat

ic/s

ecto

ral k

now

ledg

e pr

oduc

ts s

how

case

d

Inte

rven

tion

1.2.

3:D

evel

op a

nd im

plem

ent i

nter

vent

ions

ut

ilizin

g ex

istin

g co

mm

unity

-bas

ed

stru

ctur

es a

nd s

choo

ls a

s pl

atfo

rms

for c

atal

ysin

g br

oade

r par

ticip

atio

n by

fa

milie

s an

d co

mm

uniti

es in

nut

ritio

n w

ellb

eing

of a

dole

scen

t boy

s an

d gi

rls,

incl

udin

g th

ose

who

are

out

of s

choo

l.

XX

XX


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

1Pr

ovid

e ad

ditio

nal m

icro

nutr

ient

s th

roug

h fo

rtifi

catio

n of

sta

ple

food

s an

d ta

rget

ed s

uppl

emen

tatio

n:

Whe

at: i

ron,

folic

aci

d, z

inc,

vita

min

B12

Oil:

vita

min

s A

and

DSa

lt: io

dine

IF

XX

XX

X%

of fl

our

mills

pro

duci

ng fo

rtifi

ed

fl our

(atta

)%

of o

il m

ills p

rodu

cing

fort

ifi ed

oil

and

ghee

%

of h

ouse

hold

s us

ing

iodi

zed

salt

% o

f ado

lesc

ent g

irls

(targ

eted

) re

ceiv

ing

IFA

supp

lem

enta

tion

Food

For

tifi c

atio

n Pr

ogra

mm

e, re

gion

al

food

aut

horit

ies

for

AJK,

GB

DoH

, foo

d de

part

men

ts

Prov

ide

wee

kly

IFA

supp

lem

ents

to

adol

esce

nts

XX

XX

X%

of a

dole

scen

t girl

s sc

reen

ed fo

r an

aem

ia

% o

f ana

emic

girl

s re

ceiv

ing

IFA

DoH

(LH

Ws,

hea

lth

faci

litie

s)D

oE

DoH

Inte

rven

tion

2.1.

2:

Prev

ent a

dole

scen

t pre

gnan

cy

XX

XX

X#

of d

istr

icts

whe

re e

arly

mar

riage

la

w is

enf

orce

d %

of p

opul

atio

n aw

are

of e

arly

m

arria

ge le

gisl

atio

nTr

end

in e

arly

mar

riage

s (P

DH

S)

DoL

; Nat

iona

l Ins

titut

e of

Pop

ulat

ion

Stud

ies

(NIP

S); P

WD

;di

stric

t adm

inis

trat

ion

Esta

blis

h in

ter-

depa

rtm

enta

l lin

kage

s fo

r fam

ily p

lann

ing,

ach

ievi

ng th

e fu

nctio

nal i

nteg

ratio

n of

the

MN

CH

prog

ram

me,

pop

ulat

ion

wel

fare

de

part

men

ts a

nd n

utrit

ion

XX

Func

tiona

l ref

erra

l sys

tem

to s

erve

th

e re

prod

uctiv

e, fa

mily

pla

nnin

g,

nutr

ition

al n

eeds

of a

dole

scen

ts

DoH

, PW

DD

oH, P

WD

Stre

ngth

en re

prod

uctiv

e he

alth

se

rvic

es to

pre

vent

and

man

age

teen

age

preg

nanc

y

XX

XRe

prod

uctiv

e, fa

mily

pla

nnin

g,

nutr

ition

al n

eeds

of m

arrie

d ad

oles

cent

s at

MN

CH P

rogr

amm

e,

PWD

Inte

rven

tion

2.1.

3:Pr

omot

e pr

e-co

ncep

tion

and

ante

nata

l nut

ritio

n (a

s is

alre

ady

bein

g im

plem

ente

d by

LH

Ws)

XX

% o

f ado

lesc

ent g

irls

awar

e of

be

nefi t

s of

IFA

in p

re-c

once

ptio

n pe

riod

% o

f ado

lesc

ent g

irls

awar

e of

be

nefi t

s of

ant

enat

al n

utrit

ion

DoH

, LH

Ws,

DoE

, m

edia


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

4:Im

plem

ent a

dole

scen

t-frie

ndly

dis

ease

pr

even

tion

and

man

agem

ent w

hich

is

sub

-age

gro

up s

peci

fi c, t

hrou

gh th

e Ad

oles

cent

Hea

lth a

nd D

evel

opm

ent

Stra

tegy

X%

of a

dole

scen

t rec

eive

dis

ease

m

anag

emen

t car

eD

oH

Inte

rven

tion

2.1.

5:Bu

ild c

apac

ity o

f com

mun

ity-b

ased

w

orke

rs (L

HW

s, c

omm

unity

mid

wiv

es,

mal

e an

d fe

mal

e FW

As, F

WW

, FW

C,

FTO

, soc

ial m

obiliz

ers)

in c

ouns

ellin

g ar

ound

pos

itive

nut

ritio

n be

havi

ours

of

adol

esce

nts

X#

of c

apac

ity-b

uild

ing

trai

ning

s co

nduc

ted

DoH

DoH

Revi

ew tr

aini

ng c

urric

ula

of c

omm

unity

-ba

sed

wor

kers

X

Dev

elop

trai

ning

mat

eria

ls o

n ad

oles

cent

nut

ritio

nX

Trai

ning

mat

eria

ls fo

r LH

Ws

and

com

mun

ity m

idw

ives

X

Trai

ning

mat

eria

ls fo

r pop

ulat

ion

wel

fare

sta

ff X

Trai

ning

of m

aste

r tra

iner

s on

the

new

/re

vise

d tr

aini

ng m

anua

lX

Cond

uct t

rickl

edow

n tr

aini

ngs

X


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

1: E

duca

tion

sect

orIn

terv

entio

n 2.

2.1.

1:

Prov

ide

acce

ss to

saf

e en

viro

nmen

t an

d hy

gien

e in

edu

catio

n fa

cilit

ies

XX

XX

XPr

ovis

ion

of b

asic

WAS

H a

nd h

ygie

ne

serv

ices

pac

kage

D

oE, P

HED

, WAS

H

Part

ners

DoE

Prov

ide

acce

ss to

saf

e dr

inki

ng w

ater

an

d ad

equa

te s

anita

tion

faci

litie

s in

sc

hool

s an

d m

adra

ssah

s

XX

XX

XAv

aila

bilit

y of

drin

king

wat

erD

oH, P

WD

DoH

, PW

D

Impl

emen

t hea

lth a

nd h

ygie

ne

(men

stru

al a

nd p

hysi

cal)

inte

rven

tions

XX

XX

XAv

aila

bilit

y of

sep

arat

e la

trin

es fo

r girl

s an

d bo

ys

DoE

, lo

cal

gove

rnm

ent,

rele

vant

pa

rtne

rs

DoE

Inte

rven

tion

2.2.

1.2:

Pr

omot

e ph

ysic

al a

ctiv

ityX

XX

XX

Man

dato

ry o

pen

area

for s

port

s ac

tiviti

esD

oE, l

ocal

go

vern

men

t, re

leva

nt

part

ners

DoE

Inte

rven

tion

2.2.

1.3:

Pr

omot

e he

alth

y fo

od a

nd d

iet a

t sc

hool

XX

XX

XM

ay b

e in

itiat

ed a

s se

lf-re

gula

tory

ac

tion

or a

s de

part

men

tal d

irect

ive

inst

ead

of w

aitin

g fo

r leg

isla

tion

DoE

, loc

al

gove

rnm

ent,

rele

vant

pa

rtne

rs

DoE

Initi

ate

heal

thy

scho

ol m

eals

initi

ativ

eX

XX

XX

Prov

isio

n of

nut

ritio

nally

enr

iche

d ba

lanc

ed m

eals

Prov

inci

al fo

od

auth

oriti

es, s

choo

l m

anag

emen

t

Scho

ol a

dmin

istr

atio

ns to

impo

se b

an

on fi

zzy

drin

ks in

the

vici

nity

of s

choo

ls

XX

XX

XBa

n on

sal

e of

sof

t drin

ks, j

unk

food

s,

chal

ia, s

upar

i, ch

oora

n et

c at

sch

ool

cant

eens

and

in v

icin

ity o

f sch

ools

Inte

rven

tion

2.2.

1.4:

Ca

sh in

cent

ives

for p

ositi

ve b

ehav

iour

s

Initi

ate

cond

ition

al c

ash

tran

sfer

/ fo

od v

ouch

er s

chem

es to

incr

ease

se

cond

ary

scho

ol e

nrol

men

t and

at

tend

ance

am

ong

poor

hou

seho

lds

XX

XX

XIn

itiat

ion

of c

ondi

tiona

l cas

h tr

ansf

er o

r fo

od v

ouch

er s

chem

eD

oE, p

rogr

amm

atic

pa

rtne

rs


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.2.

1.5:

Co

nduc

t hea

lthy

food

s pr

omot

ion

cam

paig

n

XX

XX

XN

utrit

ion

prom

otio

n ac

tiviti

es

cond

ucte

d

Inte

rven

tion

2.2.

1.6:

Incl

ude

mes

sage

s on

hea

lthy

food

in

sch

ool c

urric

ula,

incl

udin

g at

m

adra

ssah

s, fo

rmal

, non

form

al a

nd

info

rmal

sch

ools

Revi

ew c

urric

ula

and

cour

ses

and

deve

lop

reco

mm

enda

tions

on

adol

esce

nt n

utrit

ion

XN

utrit

ion

curr

icul

um d

evel

oped

DoE

DoE

, Waf

aq u

l M

adar

is

Incl

ude

reco

mm

enda

tions

on

adol

esce

nt n

utrit

ion

in c

urric

ula

for

scho

ols

and

mad

rass

ahs

XX

Med

ium

-spe

cifi c

revi

sed

curr

icul

a w

ith

age-

spec

ifi c

mes

sage

s an

d ap

proa

ches

to

hea

lth a

nd n

utrit

ion

DoE

, Waf

aq u

l M

adar

is

Inte

rven

tion

2.2.

1.7:

Impl

emen

t foo

d an

d nu

triti

on

educ

atio

n an

d be

havi

oura

l cha

nge

com

mun

icat

ion

activ

ities

for

adol

esce

nts

in s

choo

ls, i

nclu

ding

m

adra

ssah

s, fo

rmal

, non

-form

al a

nd

info

rmal

sch

ools

, and

in c

omm

uniti

es

XX

XX

XCo

mm

unity

reso

urce

per

sons

co

mm

unity

hea

lth w

orke

rs, i

nfor

mal

sc

hool

s en

gage

d to

pro

mot

e nu

triti

on

awar

enes

s

Loca

l gov

ernm

ent,

vert

ical

pro

gram

mes

, N

GO

par

tner

s

Build

cap

acity

of s

choo

lteac

hers

in

clud

ing

at m

adra

ssah

s, fo

rmal

, no

nfor

mal

and

info

rmal

sch

ools

, and

ag

ricul

ture

ext

ensi

on w

orke

rs o

n fo

od

and

nutr

ition

and

on

diet

ary

guid

elin

es

XX

# of

teac

hers

/mud

arris

seen

trai

ned

on

nutr

ition

aw

aren

ess

# of

par

ents

trai

ned

on n

utrit

ion

awar

enes

s #

of lo

cal g

over

nmen

t em

ploy

ees

trai

ned

on n

utrit

ion

awar

enes

s#

of a

gric

ultu

re e

xten

sion

wor

kers

tr

aine

d on

nut

ritio

n aw

aren

ess

DoE

, Waf

aq u

l M

adar

is, f

ood

depa

rtm

ent,

DoA


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

2: A

gric

ultu

re s

ecto

r In

terv

entio

n 2.

2.2.

1:

Prov

ide

skills

dev

elop

men

t for

food

pr

oces

sing

and

val

ue a

dditi

on to

de

crea

se p

osth

arve

st lo

sses

to fa

rmer

s

X#

of a

dole

scen

t tra

inee

s tr

aine

d D

oAD

oA

Inte

rven

tion

2.2.

2.2:

Prom

ote

kitc

hen

gard

enin

g of

ve

geta

bles

rich

in m

icro

nutr

ient

s an

d ru

ral p

oultr

y re

arin

g

X

Prov

ide

trai

ning

, con

ditio

nal c

ash

tran

sfer

s an

d in

-kin

d su

ppor

t for

se

tting

up

kitc

hen

gard

ens

X#

of a

dole

scen

t ben

efi c

iarie

s D

oAD

oA

Inte

rven

tion

2.2.

2.3:

Im

plem

ent p

rogr

amm

atic

inte

rven

tions

to

pre

vent

food

, wat

er a

nd v

ecto

r-bo

rn

dise

ases

# of

ben

efi c

iarie

s D

oAD

oA

Trai

n ag

ricul

ture

ext

ensi

on w

orke

rs o

n fo

od p

rese

rvat

ion

and

prev

entio

n of

fo

od, w

ater

and

vec

tor-

born

dis

ease

s.

X#

of a

gric

ultu

re e

xten

sion

wor

kers

tr

aine

d

Cond

uct s

essi

ons

with

ado

lesc

ents

on

food

pre

serv

atio

n an

d pr

even

tion

of

food

, wat

er a

nd v

ecto

r-bo

rn d

isea

ses.

X#

of a

dole

scen

ts tr

aine

d

2.2.

3: W

ASH

sec

tor

Inte

rven

tion

2.2.

3.1:

En

sure

acc

ess

to s

afe

drin

king

wat

er a

nd

adeq

uate

san

itatio

n fa

ciliti

es in

sch

ools

XX

XX

# of

saf

e w

ater

sch

emes

com

plet

ed

# of

san

itatio

n sc

hem

es c

ompl

eted

(g

ende

r dis

aggr

egat

ed)

Wat

er a

nd S

anita

tion

Auth

ority

, PH

ED, D

oEW

ASA

2.2.

4: S

ocia

l pro

tect

ion

sect

or

Inte

rven

tion

2.2.

4.1:

D

esig

n an

d pi

lot s

ocia

l pro

tect

ion

inte

rven

tions

to e

nhan

ce a

cces

s of

m

argi

naliz

ed a

dole

scen

ts to

qua

lity

food

XX

XX


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

2: A

gric

ultu

re s

ecto

r In

terv

entio

n 2.

2.2.

1:

Prov

ide

skills

dev

elop

men

t for

food

pr

oces

sing

and

val

ue a

dditi

on to

de

crea

se p

osth

arve

st lo

sses

to fa

rmer

s

X#

of a

dole

scen

t tra

inee

s tr

aine

d D

oAD

oA

Inte

rven

tion

2.2.

2.2:

Prom

ote

kitc

hen

gard

enin

g of

ve

geta

bles

rich

in m

icro

nutr

ient

s an

d ru

ral p

oultr

y re

arin

g

X

Prov

ide

trai

ning

, con

ditio

nal c

ash

tran

sfer

s an

d in

-kin

d su

ppor

t for

se

tting

up

kitc

hen

gard

ens

X#

of a

dole

scen

t ben

efi c

iarie

s D

oAD

oA

Inte

rven

tion

2.2.

2.3:

Im

plem

ent p

rogr

amm

atic

inte

rven

tions

to

pre

vent

food

, wat

er a

nd v

ecto

r-bo

rn

dise

ases

# of

ben

efi c

iarie

s D

oAD

oA

Trai

n ag

ricul

ture

ext

ensi

on w

orke

rs o

n fo

od p

rese

rvat

ion

and

prev

entio

n of

fo

od, w

ater

and

vec

tor-

born

dis

ease

s.

X#

of a

gric

ultu

re e

xten

sion

wor

kers

tr

aine

d

Cond

uct s

essi

ons

with

ado

lesc

ents

on

food

pre

serv

atio

n an

d pr

even

tion

of

food

, wat

er a

nd v

ecto

r-bo

rn d

isea

ses.

X#

of a

dole

scen

ts tr

aine

d

2.2.

3: W

ASH

sec

tor

Inte

rven

tion

2.2.

3.1:

En

sure

acc

ess

to s

afe

drin

king

wat

er a

nd

adeq

uate

san

itatio

n fa

ciliti

es in

sch

ools

XX

XX

# of

saf

e w

ater

sch

emes

com

plet

ed

# of

san

itatio

n sc

hem

es c

ompl

eted

(g

ende

r dis

aggr

egat

ed)

Wat

er a

nd S

anita

tion

Auth

ority

, PH

ED, D

oEW

ASA

2.2.

4: S

ocia

l pro

tect

ion

sect

or

Inte

rven

tion

2.2.

4.1:

D

esig

n an

d pi

lot s

ocia

l pro

tect

ion

inte

rven

tions

to e

nhan

ce a

cces

s of

m

argi

naliz

ed a

dole

scen

ts to

qua

lity

food

XX

XX

FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.3

: Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for

mar

gina

lized

ado

lesc

ents

and

thos

e w

ith s

peci

aliz

ed n

eeds

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.3.

1:

Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for e

ligib

le tr

ansg

ende

r ad

oles

cent

s an

d H

IV-p

ositi

ve

adol

esce

nts

Cond

uct m

eetin

gs w

ith k

ey p

opul

atio

n re

pres

enta

tive

to d

iscu

ss n

utrit

ion

issu

es a

nd m

eans

of a

ddre

ssin

g th

em

for a

dole

scen

ts in

key

pop

ulat

ions

XPr

ogra

mm

atic

inte

rven

tions

defi

ned

As

soci

atio

n of

Peo

ple

Livin

g w

ith H

IV,

Nat

iona

l AID

S Co

ntro

l Pr

ogra

mm

e, M

oNH

SRC

(Nut

ritio

n W

ing)

MoN

HSR

C (N

utrit

ion

Win

g)

Inte

rven

tion

2.3.

2:

Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for a

dole

scen

ts li

ving

with

di

sabi

litie

s

XX

XX

XM

anda

tory

ope

n ar

ea fo

r spo

rts

activ

ities

DoE

, loc

al g

over

nmen

t, re

leva

nt p

artn

ers

DoE

Cond

uct m

eetin

gs w

ith th

e re

pres

enta

tives

to d

iscu

ss n

utrit

ion

issu

es a

nd m

eans

of a

ddre

ssin

g th

em

for a

dole

scen

ts w

ith d

isab

ilitie

s

XN

atio

nal I

nstit

ute

of

Reha

bilit

ativ

e M

edic

ine

MoN

HSR

C

Inte

rven

tion

2.3.

3:

Des

ign

and

impl

emen

t ado

lesc

ent

nutr

ition

str

ateg

ies

for e

ligib

le o

ut-o

f-sc

hool

ado

lesc

ents

Cond

uct m

eetin

gs w

ith re

pres

enta

tives

of

org

aniz

atio

ns w

orki

ng w

ith s

tree

t ch

ildre

n, o

ut-o

f-sch

ool a

dole

scen

ts,

scav

enge

rs, r

ehab

ilitat

ion

of d

elin

quen

t an

d im

pris

oned

ado

lesc

ents

and

ot

hers

, to

disc

uss

nutr

ition

issu

es a

nd

way

s to

add

ress

them

XM

echa

nism

s de

fi ned

for a

ddre

ssin

g nu

triti

on n

eeds

of o

ut-o

f-sch

ool

adol

esce

nts

Edhi

Fou

ndat

ion,

Se

lani

Wel

fare

Tru

st


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.3

: Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for

mar

gina

lized

ado

lesc

ents

and

thos

e w

ith s

peci

aliz

ed n

eeds

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.3.

4:

Des

ign

and

impl

emen

t ado

lesc

ent

nutr

ition

str

ateg

ies

unde

r dis

aste

r/hu

man

itaria

n re

spon

se

Cond

uct m

eetin

gs w

ith s

take

hold

ers

wor

king

in h

uman

itaria

n si

tuat

ions

to

disc

uss

nutr

ition

issu

es a

nd w

ays

to

addr

ess

them

XM

utua

lly a

gree

d pl

an a

vaila

ble

for

hum

anita

rian

situ

atio

ns, w

ith p

artn

er

role

s an

d in

terv

entio

n de

fi ned

Nat

iona

l Dis

aste

r M

anag

emen

t Aut

horit

y (N

DM

A); P

rote

ctio

n G

roup

, Nut

ritio

n in

Em

erge

ncie

s G

roup

. M

oNH

SRC,

UN

ICEF

MoN

HSR

C

FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

1:

Asse

ss a

nd a

djus

t rou

tine

info

rmat

ion

syst

ems

to c

aptu

re a

dole

scen

t nu

triti

on a

spec

ts

XX

XX

X

Revi

sit D

HIS

and

NM

IS to

ass

ess

the

exte

nt to

whi

ch th

ese

capt

ure

age

and

sex-

disa

ggre

gate

d da

ta o

n nu

triti

on

stat

us, a

nd th

e pr

even

tive

and

cura

tive

actio

ns ta

ken

to a

ddre

ss n

utrit

iona

l he

alth

pro

blem

s

X#

of k

ey a

dole

scen

t ind

icat

ors

inco

rpor

ated

in ro

utin

e D

HIS

# of

ado

lesc

ent n

utrit

ion

indi

cato

rs

inco

rpor

ated

in N

MIS

DH

IS, n

utrit

ion

sect

orD

OH

, MoN

HSR

C

Inco

rpor

ate

the

reco

mm

ende

d ch

ange

s in

to th

e dr

aft f

orm

ats

of re

cord

ing

and

repo

rtin

g to

ols

and

pilo

t the

m

X


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Base

d on

the

pilo

t exe

rcis

e,

reco

mm

end

nece

ssar

y ch

ange

s in

th

e to

ols,

repo

rtin

g an

d fe

edba

ck

mec

hani

sm

X

Cond

uct d

ata

colle

ctio

n an

d re

port

ing

usin

g th

e re

vise

d to

ols

XX

XX

Rout

ine

data

col

lect

ion

and

repo

rtin

g in

clud

es a

dole

scen

t nut

ritio

n as

pect

s

Inte

rven

tion

3.1.

2:Pe

riodi

cally

scr

een

stud

ents

at

mad

rass

ahs,

form

al, n

onfo

rmal

and

in

form

al s

choo

ls to

ass

ess

nutr

ition

st

atus

.

XX

XX

X#

of s

tude

nts

scre

ened

for n

utrit

ion

stat

us

DoH

, DoE

DoH

, DoE

Inte

rven

tion

3.1.

3:

Cond

uct c

ontin

uous

mon

itorin

g an

d ev

alua

tion

of la

rge-

scal

e su

stai

nabl

e se

rvic

es th

at a

re a

ppro

pria

te fo

r all

adol

esce

nts,

e.g

., pr

omot

ion

of h

ealth

y an

d nu

triti

ous

diet

s, d

istr

ibut

ion

of

mic

ronu

trie

nt s

uppl

emen

tatio

n

XX

XX

X%

of a

dole

scen

t boy

s an

d gi

rls

prov

ided

sup

plem

enta

tion

in

scho

ols/

col

lege

s%

of a

dole

scen

t boy

s an

d gi

rls

prov

ided

sup

plem

enta

tion

in

com

mun

ity

DoH

(LH

W

Prog

ram

me)

co

mm

unity

-bas

ed

orga

niza

tions

, ru

ral d

evel

opm

ent

orga

niza

tions

, Chi

ld

Prot

ectio

n U

nits

vo

catio

nal t

rain

ing

inst

itute

s

DoH

, Min

istr

y of

So

cial

Wel

fare

, DoE

Inte

rven

tion

3.1.

4:In

rele

vant

sur

veys

incl

ude

cont

ext-

spec

ifi c

data

on

adol

esce

nts

disa

ggre

gate

d by

age

, sex

, inc

ome,

ed

ucat

ion

and

geog

raph

y on

die

tary

pa

ttern

s an

d ea

ting

habi

ts (N

NS)

and

on

uni

que

nutr

ition

al is

sues

and

maj

or

dete

rmin

ants

XX

XX

XD

ata

is g

athe

red

on b

oys

and

girls

age

d 10

–14,

boy

s an

d gi

rls

aged

15–

19, n

utrit

iona

l sta

tus,

(a

nthr

opom

etry

), di

etar

y di

vers

ity a

nd

repo

rted

in N

NS,

PD

HS,

HIE

S et

c.

NIP

SG

over

nmen

t of

Paki

stan


FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

5:As

sess

beh

avio

ural

pro

fi les

, die

tary

pa

ttern

s, c

ost o

f the

die

t and

maj

or

infl u

ence

rs o

f ado

lesc

ents

in th

e co

ntex

t of t

heir

soci

al a

nd p

sych

osoc

ial

deve

lopm

ent i

n or

der t

o in

form

pr

ogra

mm

es a

nd p

olic

ymak

ing

XX

XX

X#

of re

sear

ch p

aper

s an

d po

licy

pape

rs o

n di

et a

nd b

ehav

iour

de

velo

ped

DoH

, nut

ritio

nre

sear

cher

s,

acad

emia

,de

velo

pmen

t pa

rtne

rs

Inte

rven

tion

3.1.

6:Co

nduc

t fol

low

-up

rese

arch

on

impl

emen

tatio

n to

iden

tify

inno

vatio

ns

and

deliv

ery

plat

form

s th

at re

ach

and

aff e

ct a

dole

scen

ts in

ord

er to

ach

ieve

sc

ale-

up, h

ealth

sys

tem

s in

tegr

atio

n an

d su

stai

nabi

lity

XX

# of

inno

vatio

ns id

entifi

ed

and

inco

rpor

ated

to a

ddre

ss a

dole

scen

t ne

eds

PDD

Conc

erne

d lin

e de

part

men

ts

FED

ERAL

OPE

RATI

ON

AL P

LAN

: ICT

, GB,

AJK

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

3.2

: Eff

ectiv

e kn

owle

dge

man

agem

ent a

nd r

efl e

ctin

g on

wha

t wor

ks

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.2.

1:

Esta

blis

h di

gita

l das

hboa

rds

for p

rovi

ncia

l-lev

el k

now

ledg

e m

anag

emen

t

XD

igita

l das

hboa

rds

prov

idin

g up

-to

-dat

e in

form

atio

n on

pro

vinc

ial

nutr

ition

situ

atio

n of

ado

lesc

ents

PDD

, SU

N U

nits

Revi

sit D

HIS

and

NM

IS to

ass

ess

the

exte

nt to

whi

ch th

ese

capt

ure

age

and

sex-

disa

ggre

gate

d da

ta o

n nu

triti

on

stat

us, a

nd th

e pr

even

tive

and

cura

tive

actio

ns ta

ken

to a

ddre

ss n

utrit

iona

l he

alth

pro

blem

s

X#

of k

ey a

dole

scen

t ind

icat

ors

inco

rpor

ated

in ro

utin

e D

HIS

# of

ado

lesc

ent n

utrit

ion

indi

cato

rs

inco

rpor

ated

in N

MIS

DH

IS, n

utrit

ion

sect

orD

OH

, MoN

HSR

C


Balo

chist

an o

pera

tiona

l pla

nPR

OVI

NCI

AL O

PERA

TIO

NAL

PLA

N: B

ALO

CHIS

TAN

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.1.

1:Le

gisl

atio

n on

pro

hibi

tion

of c

hild

m

arria

ge

Ensu

re b

ill dr

afte

d by

the

soci

al w

elfa

re

depa

rtm

ent i

s ta

bled

thro

ugh

the

Prov

inci

al A

ssem

bly

Secr

etar

iat

XD

raft

child

mar

riage

pre

vent

ion

bill

tabl

ed

SWD

, WD

D, D

oL, M

inis

try

of L

aw a

nd Ju

stic

e,

Min

istr

y of

Hum

an R

ight

s an

d M

inor

ity A

ff airs

, U

nite

d N

atio

ns P

opul

atio

n Fu

nd (U

NFP

A)

SWD

Achi

eve

appr

oval

of l

aw p

reve

ntin

g ch

ild m

arria

geX

Dev

elop

rule

s an

d re

gula

tions

on

proh

ibiti

on o

f chi

ld m

arria

ge

X

Achi

eve

appr

oval

of r

ules

and

re

gula

tions

on

proh

ibiti

on o

f chi

ld

mar

riage

X

Dis

sem

inat

e la

w, r

ules

and

regu

latio

ns

on p

rohi

bitio

n of

chi

ld m

arria

geX

XX

% d

eclin

e in

the

inci

denc

e of

un

dera

ge m

arria

ge (P

DH

S)SW

D

Inte

rven

tion

1.1.

2:En

sure

legi

slat

ion

on c

ompu

lsor

y ed

ucat

ion

impl

emen

ting

Artic

le 2

5A

Achi

eve

amen

dmen

t of t

he B

aloc

hist

an

Com

puls

ory

Educ

atio

n Ac

t, 20

14, t

o al

ign

with

SD

G-4

targ

ets

and

its q

ualit

y at

trib

utes

XLa

w d

rafte

d, v

ette

d by

DoL

, leg

isla

tion

pass

ed, r

ules

of b

usin

ess

enac

ted

DoE

, law

dep

artm

ent

DoE


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.1.

3:

Ensu

re fo

od re

gula

tion

legi

slat

ion

to b

an ju

nk fo

od a

nd fi

zzy

drin

ks

in s

choo

ls a

nd o

ther

edu

catio

nal

inst

itutio

ns

Get

the

bill

draf

ted

by B

aloc

hist

an F

ood

Auth

ority

and

tabl

ed th

roug

h Pr

ovin

cial

As

sem

bly

Secr

etar

iat

XD

raft

bill

tabl

ed

Balo

chis

tan

Food

Au

thor

ity, D

oE, U

NIC

EF

Balo

chis

tan

Food

Au

thor

ity

Dev

elop

rule

s an

d re

gula

tions

X

Ensu

re a

ppro

val o

f rul

es a

nd

regu

latio

ns

X

Dis

sem

inat

e la

w, r

ules

and

regu

latio

ns

XX

XSc

hool

mea

ls re

gula

tions

pro

hibi

t sa

le o

f unh

ealth

y fo

ods

(unh

ealth

y sn

acks

, ene

rgy

drin

ks, s

oft d

rinks

) in

and

arou

nd e

duca

tiona

l set

tings

Balo

chis

tan

Food

Au

thor

ity

Inte

rven

tion

1.1.

4:

Legi

slat

ion

and

refo

rm o

n ur

ban

plan

ning

and

dev

elop

men

t add

ress

ing

the

need

of p

hysi

cal a

ctiv

ity fo

r ad

oles

cent

, gov

erni

ng p

arks

, sch

ool

spor

ts, e

tc

Dev

elop

men

t aut

horit

ies

(PH

ED, B

aloc

hist

an

Dev

elop

men

t Aut

horit

y,

Que

tta D

evel

opm

ent

Auth

ority

), D

oE,

depa

rtm

ent o

f co

mm

unic

atio

n an

d w

orks

, loc

al g

over

nmen

t, sp

orts

, env

ironm

ent)

Urb

an

deve

lopm

ent

sect

ion

with

in P

DD

Get

bill

draf

ted

by D

oE a

nd ta

bled

th

roug

h Pr

ovin

cial

Ass

embl

y Se

cret

aria

tX

Dra

ft bi

ll ta

bled

PD

D, l

ocal

gov

ernm

ent

DoE

, UN

ICEF

, WH

O

PDD

Dev

elop

rule

s an

d re

gula

tions

X

Ensu

re a

ppro

val o

f rul

es a

nd

regu

latio

ns

X


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Dis

sem

inat

e la

w, r

ules

and

regu

latio

ns

XX

Impl

emen

t law

, rul

es a

nd re

gula

tions

X

XSt

ruct

ured

spo

rts

and

phys

ical

ac

tiviti

es h

appe

n re

gula

rly a

t sch

ools

, th

e co

mm

unity

and

the

wor

kpla

ce

Ensu

re c

ompl

ianc

e w

ith la

w, r

ules

and

re

gula

tions

XX

# of

pub

lic a

nd p

rivat

e, fo

rmal

, non

-fo

rmal

sch

ools

whe

re p

hysi

cal a

ctiv

ity

for a

dole

scen

t is

regu

larly

pra

ctic

ed

(dis

aggr

egat

ed)

PDD

Inte

rven

tion

1.1.

5:

Inte

grat

e ta

rget

ed a

dole

scen

t nut

ritio

n in

terv

entio

ns in

exi

stin

g st

rate

gies

/se

ctor

al p

lans

and

pro

gram

mes

DoH

, DoE

, SW

D, P

WD

, PH

ED, D

oA, f

ood

depa

rtm

ent

PDD

Revi

sit p

rovi

ncia

l mul

tisec

tora

l nut

ritio

n st

rate

gy to

link

and

upd

ate

the

adol

esce

nt c

ompo

nent

XAd

oles

cent

nut

ritio

n is

em

bedd

ed in

m

ultis

ecto

ral n

utrit

ion

stra

tegi

esPD

D

Incl

ude

an a

dole

scen

t com

pone

nt in

se

ctor

al p

lans

XX

XX

XAd

oles

cent

is in

clud

ed a

s a

cros

scut

ting

or s

peci

fi c in

terv

entio

n in

sec

tora

l pla

ns

PDD

, DoH

, DoE

, liv

elih

oods

dev

elop

men

t, so

cial

pro

tect

ion,

WAS

H

PDD


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.2.

1:

Dev

elop

com

preh

ensi

ve, m

ultis

ecto

ral,

low

-cos

t, in

nova

tive

nutr

ition

SBC

C st

rate

gy fo

r pro

mot

ion

of a

dole

scen

t nu

triti

on, h

ealth

y di

et a

nd p

ositi

ve

beha

viou

rs

X

Esta

blis

h Pr

ovin

cial

Adv

isor

y an

d Ad

voca

cy P

latfo

rm fo

r Im

prov

ed

Adol

esce

nt N

utrit

ion

for c

oord

inat

ion

and

cros

s-se

ctor

and

cro

ss-p

rovi

ncia

l le

arni

ng

XPr

ovin

cial

Adv

isor

y an

d Ad

voca

cy

Plat

form

est

ablis

hed

and

oper

atio

nal

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, W

ASH

, DoA

, SW

D, W

DD

PD

D

Dev

elop

agr

eed

term

s of

refe

renc

e fo

r fi rm

s or

con

sulta

nts

task

ed w

ith

deve

lopi

ng S

BCC

stra

tegy

X

Sect

oral

inpu

ts fr

om d

iff er

ent

stak

ehol

ders

inco

rpor

ated

into

term

s of

refe

renc

e

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, W

ASH

, DoA

, SW

D, W

DD

PD

D

Dev

elop

men

t of c

oste

d SB

CC s

trat

egy

by th

e fi r

m o

r con

sulta

nt

X

SBCC

str

ateg

y ad

dres

ses

need

s of

bo

th b

oys

and

girls

at s

choo

l/col

lege

an

d ou

t of s

choo

l, de

fi ne

the

deliv

ery

poin

ts a

nd re

spon

sibl

e pe

rson

s

PDD

Dev

elop

kno

wle

dge

prod

ucts

(in

form

atio

n, e

duca

tion.

co

mm

unic

atio

n or

IEC,

beh

avio

ur

chan

ge c

omm

unic

atio

n, a

dvoc

acy

mat

eria

ls)

XPD

D

Inte

rven

tion

1.2.

2:

Impl

emen

t pro

vinc

ial S

BCC

actio

n pl

an,

with

sec

tora

l res

pons

ibilit

ies

assi

gned

XAl

l sec

tors

impl

emen

t SBC

C co

mpo

nent

s in

thei

r res

pect

ive

sect

oral

wor

k pl

ans,

Co

ncer

ned

sect

ors


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.3

: Set

pol

icy

prio

ritie

s an

d re

sour

ce a

lloca

tions

for

adol

esce

nt n

utri

tion

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.3.

1:

Revi

ew a

nd re

fi ne

exis

ting

polic

ies,

bu

dget

s an

d st

rate

gies

(e.g

. PRS

P)

Dev

elop

agr

eed

term

s of

refe

renc

e fo

r th

e fi r

m o

r con

sulta

nt to

be

task

ed w

ith

anal

ysin

g ex

istin

g po

licie

s

XSe

ctor

al in

puts

from

diff

eren

t st

akeh

olde

rs in

corp

orat

ed in

to te

rms

of re

fere

nce

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, W

ASH

, DoA

, SW

D, W

DD

, BIS

P

PDD

Dis

sem

inat

e th

e an

alys

is a

nd d

ecis

ions

on

way

forw

ard

X

Follo

w u

p on

the

reco

mm

enda

tions

of

the

anal

ysis

X

XX

X%

of a

gree

d re

com

men

datio

ns b

eing

im

plem

ente

d PD

D, S

UN

Sec

reta

riat,

DoH

, DoE

, WAS

H, D

oA,

SWD

, WD

D, B

ISP

PDD

Inte

rven

tion

1.3.

2:

Revi

ew a

nnua

l dev

elop

men

t pla

n an

d bu

dget

ary

allo

catio

ns fo

r pilo

t in

terv

entio

ns (I

FA s

uppl

emen

tatio

n,

curr

icul

um re

visi

on, p

rom

otio

n ac

tiviti

es e

tc.)

XBu

dget

defi

cit

addr

esse

d to

ac

hiev

e ta

rget

s of

initi

ativ

es u

nder

co

nsid

erat

ion

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, W

ASH

, Ag

ricul

ture

and

Li

vest

ock,

SW

D, W

DD

PDD

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

1:D

evel

op a

cor

e pa

ckag

e of

nut

ritio

n-sp

ecifi

c in

terv

entio

ns a

nd p

rom

ote

its

prov

isio

n to

all

adol

esce

nts

Prov

ide

addi

tiona

l micr

onut

rient

s th

roug

h fo

rtifi c

atio

n of

sta

ple

food

s, ta

rget

ed

supp

lem

enta

tion

and

dew

orm

ing

XX

# of

ado

lesc

ents

who

rece

ived

m

icro

nutr

ient

sup

plem

ents

# of

ado

lesc

ents

dew

orm

ed

Prov

inci

al N

utrit

ion

Dire

ctor

ate

, DoE

, U

NIC

EF, W

HO

DoH

, Foo

d Au

thor

ity


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Prov

ide

targ

eted

IFA

supp

lem

enta

tion

XX

# of

ado

lesc

ents

who

rece

ived

IFA

DoH

(Nut

ritio

n Pr

ogra

mm

e, M

NCH

, LH

W P

rogr

amm

es)

DoH

, Foo

d Au

thor

ity

Inte

rven

tion

2.1.

2:

Prev

ent a

dole

scen

t pre

gnan

cy a

nd

poor

repr

oduc

tive

outc

omes

XX

XX

X#

of h

ealth

aw

aren

ess

sess

ions

co

nduc

ted

Enac

tmen

t of l

egis

latio

n ag

ains

t chi

ld

and

forc

ed m

arria

ge

DoH

(Nut

ritio

n Pr

ogra

mm

e, M

NCH

, LH

W P

rogr

amm

e)

WD

D, S

WD

, law

de

part

men

t

Law

dep

artm

ent

(impl

emen

tatio

n of

Ac

t)

Inte

rven

tion

2.1.

3:

Prom

ote

pre-

conc

eptio

n an

d an

tena

tal

nutr

ition

XX

XX

X#

of a

nten

atal

che

ck u

ps

# of

girl

s an

d w

omen

rece

ivin

g aw

aren

ess

on a

nten

atal

nut

ritio

n

DoH

(Nut

ritio

n Pr

ogra

mm

e, M

NCH

, LH

W P

rogr

amm

e)

DoH

(hea

lth

secr

etar

y, di

rect

or-

gene

ral f

or h

ealth

se

rvic

es)

Inte

rven

tion

2.1.

4:

Impl

emen

t ado

lesc

ent-f

riend

ly d

isea

se

prev

entio

n an

d m

anag

emen

t whi

ch

is s

ub-a

ge g

roup

spe

cifi c

, thr

ough

the

Adol

esce

nt H

ealth

and

Dev

elop

men

t St

rate

gy

XX

X#

of a

dole

scen

ts (g

irls

and

boys

) tr

eate

d D

oHD

oH

Inte

rven

tion

2.1.

5:Ra

ise

awar

enes

s an

d pr

omot

e ba

lanc

ed d

iet a

nd d

ieta

ry d

iver

sity

XX

XX

X#

of a

war

enes

s se

ssio

ns c

ondu

cted

#

of c

ooki

ng d

emon

stra

tions

DoH

(Nut

ritio

n Pr

ogra

mm

e, L

HW

Pr

ogra

mm

e), D

oE

Prov

inci

al H

ealth

D

irect

orat

e

Inte

rven

tion

2.1.

6:Bu

ild c

apac

ity o

f pub

lic a

nd p

rivat

e se

ctor

hea

lthca

re p

rovi

ders

to e

nhan

ce

the

qual

ity a

nd re

ach

of n

utrit

ion

serv

ices

for a

dole

scen

t girl

s an

d bo

ys

Build

cap

acity

of c

omm

unity

-bas

ed

wor

kers

(LH

Ws,

com

mun

ity m

idw

ives

, m

ale

and

fem

ale

FWA,

FW

W, F

WC,

FTO

, so

cial

mob

ilizer

s) a

nd re

ligio

us o

pini

on-

mak

ers

in c

ouns

ellin

g ar

ound

pos

itive

nu

triti

on b

ehav

iour

s of

ado

lesc

ents

XX

# of

trai

ning

s co

nduc

ted

# of

com

mun

ity-b

ased

hea

lth c

are

prov

ider

s tr

aine

d

DoH

/ Pop

ulat

ion

Wel

fare

(MN

CH,

LHW

Pro

gram

me,

N

utrit

ion

Prog

ram

me)

Prov

inci

al

Dire

ctor

ate


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Build

cap

acity

of h

ealth

faci

lity

serv

ice

prov

ider

s (m

edic

al o

ffi ce

rs, l

ady

med

ical

offi

cers

, mid

wiv

es, M

T/FM

T et

c.) i

n co

unse

lling

arou

nd p

ositi

ve

nutr

ition

beh

avio

urs

of a

dole

scen

t )

X#

of tr

aini

ngs

cond

ucte

d #

of h

ealth

car

e pr

ovid

ers

trai

ned

DoH

/ Pop

ulat

ion

Wel

fare

(MN

CH,

LHW

Pro

gram

me,

N

utrit

ion

Prog

ram

me)

Prov

inci

al

Dire

ctor

ate

Inco

rpor

ate

adol

esce

nt n

utrit

ion

into

pr

e-se

rvic

e an

d in

-ser

vice

cur

ricul

a fo

r fa

cilit

y-ba

sed

heal

thca

re p

rovi

ders

XX

Curr

icul

a re

vise

d D

oH, P

DD

(hea

lth

and

nutr

ition

sec

tion

unde

r SU

N)

Addi

tiona

l ch

ief s

ecre

tary

(d

evel

opm

ent)

offi c

e

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

1: E

duca

tion

sect

orIn

terv

entio

n 2.

2.1.

1:

Inte

grat

e co

re p

acka

ge o

f nut

ritio

n in

terv

entio

ns in

edu

catio

n se

ctor

DoE

(Boa

rd o

f Cu

rric

ulum

), D

oH,

Balo

chis

tan

Food

Au

thor

ity, N

utrit

ion

Prog

ram

me

UN

ICEF

Addi

tiona

l ch

ief s

ecre

tary

(d

evel

opm

ent)

offi c

e, D

oE, f

ood

depa

rtm

ent

Revi

se c

urric

ula

XX

Curr

icul

a re

vise

d, n

utrit

ion

mes

sage

s in

corp

orat

ed

Cond

uct t

each

er tr

aini

ngs

X#

of te

ache

rs tr

aine

d

Impl

emen

t sch

ool-b

ased

mic

ronu

trie

nt

supp

lem

enta

tion

and

dew

orm

ing

XX

XX

X#

of a

dole

scen

ts re

ceiv

ing

mic

ronu

trie

nt s

uppl

emen

tatio

n #

of a

dole

scen

ts d

ewor

med


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Prom

ote

heal

thy

food

and

di

ets

at s

choo

l thr

ough

coo

king

de

mon

stra

tions

and

aw

aren

ess

sess

ions

XX

XX

X#

of c

ooki

ng d

emon

stra

tions

2.2.

2: A

gric

ultu

re s

ecto

r

Inte

rven

tion

2.2.

2.1:

Pr

omot

e ki

tche

n/sc

hool

gar

deni

ng

(mic

ronu

trie

nt-r

ich

vege

tabl

es) a

nd

rura

l pou

ltry

rear

ing

Prov

ide

seed

s an

d en

sure

ava

ilabi

lity

of w

ater

to p

rom

ote

kitc

hen/

scho

ol

gard

enin

g

XX

XX

X#

of p

rom

otio

n se

ssio

ns c

ondu

cted

#

of s

choo

ls p

rovi

ded

with

see

dsFo

od, i

rrig

atio

n de

part

men

ts, D

oA,

DoE

, DoH

, ver

tical

pr

ogra

mm

es, F

ood

and

Agric

ultu

re

Org

aniz

atio

n

Addi

tiona

l ch

ief s

ecre

tary

(d

evel

opm

ent)

offi c

e –

sect

ions

, PD

D

Inte

rven

tion

2.2.

2.2:

Pr

ovid

e in

-kin

d su

ppor

t for

fi sh

farm

ing,

po

ultr

y an

d liv

esto

ck a

nd a

war

enes

s

XX

XX

X#

of a

dole

scen

t ben

efi c

iarie

s Co

ncer

ned

depa

rtm

ents

Inte

rven

tion

2.2.

2.3:

En

actm

ent o

f foo

d fo

rtifi

catio

n ac

t/law

by

food

dep

artm

ent

XX

Food

dep

artm

ent

Food

dep

artm

ent

2.2.

3: W

ASH

sec

tor

Inte

rven

tion

2.2.

3.1:

Pr

omot

e W

ASH

-rel

ated

bes

t pra

ctic

es

by in

corp

orat

ing

mes

sage

s in

to

com

mun

icat

ion

stra

tegi

es


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Prov

ide

safe

wat

er, h

ygie

ne a

nd

sani

tatio

n fa

cilit

ies

in s

choo

ls a

nd o

ther

pu

blic

inst

itutio

ns

X#

of s

choo

ls w

ith p

rope

r WAS

H

faci

litie

s #

of s

essi

ons

on h

ygie

ne c

ondu

cted

PHED

, DoH

, D

oE, i

ndus

trie

s de

part

men

t, SW

D,

WD

DU

NIC

EF

Ensu

re a

cces

s to

nea

rby

safe

, sep

arat

e an

d pr

ivat

e sa

nita

tion

faci

litie

s,

esse

ntia

l for

men

stru

al h

ygie

ne

man

agem

ent,

dign

ity, c

omfo

rt a

nd

heal

th o

f ado

lesc

ent g

irls

X

2.2.

4: S

ocia

l pro

tect

ion

sect

or

Inte

rven

tion

2.2.

4.1:

Des

ign

and

pilo

t soc

ial p

rote

ctio

n in

terv

entio

ns to

enh

ance

acc

ess

of

mar

gina

lized

ado

lesc

ents

to q

ualit

y fo

od

XX

XX

# of

fam

ilies

enro

lled

in c

ondi

tiona

l ca

sh tr

ansf

er p

rogr

amm

es

# of

ado

lesc

ents

enr

olle

d in

se

cond

ary

educ

atio

n

SWD

, DoE

, BIS

P

Inst

itute

con

ditio

nal c

ash

tran

sfer

and

fo

od v

ouch

er s

chem

es to

incr

ease

se

cond

ary

scho

ol e

nrol

men

t and

at

tend

ance

Link

cas

h tr

ansf

ers

thro

ugh

BISP

to

enha

nce

seco

ndar

y sc

hool

enr

olm

ent

and

atte

ndan

ce


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.3

: Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for

mar

gina

lized

ado

lesc

ents

and

thos

e w

ith s

peci

aliz

ed n

eeds

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.3.

1:

Dev

elop

pro

gram

mat

ic re

spon

se fo

r ad

oles

cent

s in

spe

cial

circ

umst

ance

s (e

.g. t

rans

gend

er a

dole

scen

ts, H

IV-

posi

tive

adol

esce

nt a

nd a

dole

scen

ts

with

dis

abilit

ies)

XX

DoH

(Pro

vinc

ial A

IDS

Cont

rol P

rogr

amm

e),

SWD

Prov

inci

al H

ealth

D

irect

orat

e/

Dire

ctor

ate

of

Soci

al W

elfa

re

Inte

rven

tion

2.3.

2:D

evel

op p

rogr

amm

atic

resp

onse

for

adol

esce

nts

belo

ngin

g to

mig

rant

or

inte

rnal

ly d

ispl

aced

pop

ulat

ions

XX

Inte

rven

tion

2.3.

4:

Dev

elop

pro

gram

mat

ic re

spon

se

for a

dole

scen

ts in

dis

aste

rs a

nd

hum

anita

rian

resp

onse

XX

Prov

inci

al D

isas

ter

Man

agem

ent

Auth

ority

, UN

ICEF

Nut

ritio

n Ce

ll

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

1:

Asse

ss a

nd a

djus

t rou

tine

info

rmat

ion

syst

ems

to c

aptu

re a

dole

scen

t nu

triti

on

XX

XX

X

Revi

sit D

HIS

to a

sses

s th

e ex

tent

to

whi

ch it

cap

ture

s ag

e- a

nd s

ex-

disa

ggre

gate

d da

ta o

n nu

triti

on s

tatu

s an

d pr

even

tive

and

cura

tive

actio

ns

take

n to

add

ress

nut

ritio

nal c

once

rns

X#

of k

ey a

dole

scen

t ind

icat

ors

inco

rpor

ated

in ro

utin

e D

HIS

# of

ado

lesc

ent n

utrit

ion

indi

cato

rs

inco

rpor

ated

in N

MIS

DH

IS, n

utrit

ion

sect

orD

OH

, MoN

HSR

C


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inco

rpor

ate

the

reco

mm

ende

d ch

ange

s in

to th

e dr

aft f

orm

ats

of

reco

rdin

g an

d re

port

ing

tool

s an

d pi

lot

the

initi

ativ

e

X

Base

d on

the

pilo

t exe

rcis

e,

reco

mm

end

chan

ges

in to

ols,

repo

rtin

g an

d fe

edba

ck m

echa

nism

X

Cond

uct d

ata

colle

ctio

n an

d re

port

ing

on re

vise

d to

ols

XX

XX

Rout

ine

data

col

lect

ion

and

repo

rtin

g in

clud

es a

dole

scen

t nut

ritio

n as

pect

s

Inte

rven

tion

3.1.

2:

Cond

uct p

erio

dic

scre

enin

g of

stu

dent

s of

mad

rass

ahs,

form

al, n

on-fo

rmal

and

in

form

al s

choo

ls to

ass

ess

nutr

ition

st

atus

XX

XX

# of

stu

dent

s sc

reen

ed fo

r nut

ritio

n st

atus

DoH

, DoE

DoH

, DoE

Inte

rven

tion

3.1.

3:

Cond

uct c

ontin

uous

mon

itorin

g an

d ev

alua

tion

of la

rge-

scal

e su

stai

nabl

e se

rvic

es th

at a

re a

ppro

pria

te fo

r all

adol

esce

nts

incl

udin

g, e

.g.,

serv

ices

re

late

d to

the

prom

otio

n of

hea

lthy

and

nutr

itiou

s di

ets,

mic

ronu

trie

nt

supp

lem

enta

tion

XX

XX

% o

f ado

lesc

ent b

oys

and

girls

pr

ovid

ed s

uppl

emen

tatio

n in

sc

hool

s/ c

olle

ges

% o

f ado

lesc

ent b

oys

and

girls

pr

ovid

ed s

uppl

emen

tatio

n in

co

mm

unity

DoH

(LH

W

Prog

ram

me)

,co

mm

unity

-bas

ed

orga

niza

tions

, ru

ral d

evel

opm

ent

orga

niza

tions

, Chi

ld

Prot

ectio

n U

nits

voca

tiona

l tra

inin

g in

stitu

te

DoH

, SW

D, D

oE

Inte

rven

tion

3.1.

4:

In re

leva

nt s

urve

ys in

clud

e co

ntex

t-sp

ecifi

c da

ta o

n ad

oles

cent

s di

sagg

rega

ted

by a

ge, s

ex, i

ncom

e,

educ

atio

n an

d ge

ogra

phy

on d

ieta

ry

patte

rns

and

eatin

g ha

bits

(NN

S) a

nd

on u

niqu

e nu

triti

onal

issu

es a

nd m

ajor

de

term

inan

ts

XX

XX

Dat

a ga

ther

ed o

n bo

ys a

nd g

irls

aged

10

–14,

boy

s an

d gi

rls a

ged

15–1

9,

nutr

ition

al s

tatu

s, (a

nthr

opom

etry

), di

etar

y di

vers

ity a

nd re

port

ed in

NN

S,

PDH

S, H

IES

etc.

NIP

SG

over

nmen

t of

Paki

stan


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

5:

Asse

ss b

ehav

iour

al p

rofi l

es, d

ieta

ry

patte

rns,

cos

t of t

he d

iet a

nd m

ajor

in

fl uen

cers

of a

dole

scen

ts in

the

cont

ext o

f the

ir so

cial

and

psy

chos

ocia

l de

velo

pmen

t in

orde

r to

info

rm

prog

ram

mes

and

pol

icym

akin

g

XX

XX

X#

of re

sear

ch a

nd p

olic

y pa

pers

pr

epar

ed o

n di

et a

nd b

ehav

iour

D

oH, n

utrit

ion

rese

arch

ers,

ac

adem

ia,

deve

lopm

ent

part

ners

Inte

rven

tion

3.1.

6:

Cond

uct f

ollo

w-u

p re

sear

ch o

n im

plem

enta

tion

to id

entif

y in

nova

tions

an

d de

liver

y pl

atfo

rms

that

reac

h an

d aff

ect

ado

lesc

ents

in o

rder

to a

chie

ve

scal

e-up

, hea

lth s

yste

ms

inte

grat

ion

and

sust

aina

bilit

y

XX

XX

# of

inno

vatio

ns id

entifi

ed

and

inco

rpor

ated

PD

DCo

ncer

ned

line

depa

rtm

ents

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: BAL

OCH

ISTA

N

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.2

: Eff

ectiv

e kn

owle

dge

man

agem

ent a

nd r

efl e

ctin

g on

wha

t wor

ks

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.2.

1:

Esta

blis

h di

gita

l das

hboa

rds

for p

rovi

ncia

l-lev

el k

now

ledg

e m

anag

emen

t

XD

igita

l das

hboa

rd o

pera

tiona

l x


Khyb

er P

akht

unkh

wa

oper

atio

nal p

lan

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.1.

1:Le

gisl

atio

n on

pro

hibi

tion

of c

hild

m

arria

ge

Tabl

e th

e dr

aft a

men

ded

bill

thro

ugh

the

Prov

inci

al A

ssem

bly

Secr

etar

iat

XAm

ende

d la

w d

rafte

d an

d ve

tted

by D

oL. p

rese

nted

in

KP

Cabi

net a

nd ta

bled

in

prov

inci

al a

ssem

bly

SWD

, WD

D, M

inis

try

of

Law

and

Just

ice,

Min

istr

y of

H

uman

Rig

hts

and

Min

ority

Aff

airs

, UN

FPA

SWD

, law

dep

artm

ent

Cond

uct d

ialo

gues

to s

ensi

tize

polic

ymak

ers

X#

of p

olic

ymak

ers

and

legi

slat

ors

sens

itize

dSW

D, W

DD

,la

w d

epar

tmen

t, D

oH,

parli

amen

taria

ns

(legi

slat

ors)

, DoE

SWD

, law

dep

artm

ent

Dev

elop

rule

s of

bus

ines

s X

Rule

s of

Bus

ines

s de

velo

ped,

vet

ted

by

DoL

and

est

ablis

hmen

t de

part

men

t

SWD

, est

ablis

hmen

t de

part

men

t

Impl

emen

t the

law

XX

% d

eclin

e in

inci

denc

e of

un

dera

ge m

arria

ge (P

DH

S)Lo

cal g

over

nmen

t (re

cord

of

nik

ah re

gist

ratio

n)

Inte

rven

tion

1.1.

2:

Ensu

re le

gisl

atio

n on

com

puls

ory

educ

atio

n im

plem

entin

g Ar

ticle

25A

Dev

elop

byl

aws

of K

P Ac

t 201

7: F

ree

and

Com

puls

ory

Educ

atio

n (5

–16

year

s)

XBy

law

s of

Pro

vinc

ial A

ct,

2017

, dev

elop

ed

DoE

(dep

artm

ent o

f el

emen

tary

and

sec

onda

ry

educ

atio

n), P

rivat

e Sc

hool

As

soci

atio

n

DoE

(dep

artm

ent o

f el

emen

tary

and

sec

onda

ry

educ

atio

n)


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Enfo

rce

byla

ws

XX

XPr

ivat

e Sc

hool

Reg

ulat

ory

Auth

ority

est

ablis

hed

to

impl

emen

t byl

aws

DoE

Inst

itute

mon

itorin

g by

the

inde

pend

ent m

onito

ring

unit

of th

e ed

ucat

ion

depa

rtm

ent

XX

X#

of m

onito

ring

visi

t rep

orts

% o

f sch

ool e

nrol

men

t in

crea

se (b

oth

sexe

s)%

dro

p ou

t dec

reas

e

DoE

(dep

artm

ent o

f el

emen

tary

and

sec

onda

ry

educ

atio

n) In

depe

nden

t M

onito

ring

Uni

t

DoE

Ensu

re p

rivat

e sc

hool

s ar

e m

onito

red

by th

e co

ncer

ned

auth

ority

XX

XX

# of

mon

itorin

g vi

sit r

epor

tsD

oE

Inte

rven

tion

1.1.

3:

Legi

slat

ion

on fo

od re

gula

tion

to b

an

junk

food

and

fi zz

y dr

inks

in s

choo

ls

and

othe

r ins

titut

ions

Mon

itor c

ompl

ianc

e w

ith th

e la

w,

food

sta

ndar

ds a

s pe

r not

ifi ca

tion/

in

stru

ctio

ns is

sued

to p

ublic

and

pr

ivat

e sc

hool

s

XX

XX

X#

of m

onito

ring

repo

rts

shar

ed b

y Fo

od S

afet

y an

d H

alal

Aut

horit

y

Food

Saf

ety

and

Hal

al

Auth

ority

, DoH

, DoE

Food

Saf

ety

and

Hal

al

Auth

ority

Inte

rven

tion

1.1.

4:

Legi

slat

ion

and

refo

rm o

n ur

ban

plan

ning

and

dev

elop

men

t add

ress

ing

the

need

of p

hysi

cal a

ctiv

ity fo

r ad

oles

cent

, gov

erni

ng p

arks

, sch

ool

spor

ts, e

tc

Ensu

re th

at n

ew s

choo

l des

igns

pr

ovid

e sp

ace

for s

port

s an

d ph

ysic

al

activ

ity, m

odify

ing

the

stan

dard

des

ign

deve

lope

d by

the

com

mun

icat

ion

and

wor

ks d

epar

tmen

t and

app

rove

d by

th

e ed

ucat

ion

depa

rtm

ent

XX

XX

Scho

ol d

esig

n ch

ange

d by

co

mm

unic

atio

n an

d w

orks

de

part

men

t

DoE

, loc

al g

over

nmen

t/

loca

l aut

horit

y, ru

ral

deve

lopm

ent d

epar

tmen

t, sp

orts

dep

artm

ent,

Urb

an

Polic

y an

d Pl

anni

ng U

nit,

Pesh

awar

Loca

l gov

ernm

ent/

loca

l au

thor

ity


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Mon

itor p

hysi

cal a

ctiv

ity in

sch

ools

XX

XX

X%

of m

onito

red

scho

ols

whe

re p

hysi

cal a

ctiv

ity is

re

gula

rly e

nsur

ed

DoE

Inde

pend

ent

Mon

itorin

g U

nit

Sens

itize

and

adv

ocat

e w

ith lo

cal

gove

rnm

ents

, loc

al a

utho

ritie

s an

d de

part

men

t of r

ural

dev

elop

men

t to

allo

cate

spa

ce fo

r par

ks a

nd p

hysi

cal

activ

ity

XX

# of

sen

sitiz

atio

n an

d ad

voca

cy s

essi

ons

held

DoE

Inte

rven

tion

1.1.

5:

Inte

grat

e ta

rget

ed a

dole

scen

t nut

ritio

n in

terv

entio

ns in

exi

stin

g st

rate

gies

/se

ctor

al p

lans

and

pro

gram

mes

Revi

se th

e pr

ovin

cial

mul

tisec

tora

l nu

triti

on s

trat

egy

for K

P an

d KP

-NM

D

to in

clud

e ad

oles

cent

nut

ritio

n

XRe

vise

d m

ultis

ecto

ral

nutr

ition

str

ateg

y in

clus

ive

of a

dole

scen

t nut

ritio

n de

velo

ped

and

endo

rsed

PDD

, DoH

, DoE

, DoA

, SW

D,

DoI

, Foo

d Sa

fety

Aut

horit

y,

food

dep

artm

ent,

PWD

, lo

cal g

over

nmen

t, PH

ED

PDD

Revi

se s

ecto

ral p

lans

und

er th

e re

vise

d KP

mul

tisec

tora

l nut

ritio

n st

rate

gy

XN

ew o

r rev

ised

PC1

re

fl ect

ing

adol

esce

nt

nutr

ition

app

rove

d

PDD

, DoH

, DoE

, DoA

, SW

D, D

oI, P

WD

, PH

ED,

food

dep

artm

ent,

loca

l go

vern

men

t, Fo

od S

afet

y Au

thor

ity

PDD

Form

ulat

e, a

ppro

ve a

nd im

plem

ent

mul

tisec

tora

l ado

lesc

ent n

utrit

ion

inte

rven

tions

XX

XSe

ctor

al P

C1s

incl

udin

g ad

oles

cent

nut

ritio

n fo

rmul

ated

, app

rove

d an

d im

plem

ente

d

DoH

, DoE

, DoA

, SW

D, D

oI,

Food

Saf

ety

Auth

ority

, foo

d de

part

men

t, PW

D, l

ocal

go

vern

men

t, PH

ED

PDD


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.2.

1:

Dev

elop

com

preh

ensi

ve, m

ultis

ecto

ral,

low

-cos

t, in

nova

tive

nutr

ition

SBC

C st

rate

gy fo

r pro

mot

ion

of a

dole

scen

t nu

triti

on, h

ealth

y di

et a

nd p

ositi

ve

beha

viou

rs

X

Esta

blis

h Pr

ovin

cial

Adv

isor

y an

d Ad

voca

cy P

latfo

rm fo

r Im

prov

ed

Adol

esce

nt N

utrit

ion

for c

oord

inat

ion

and

cros

s se

ctor

and

cro

ss p

rovi

ncia

l le

arni

ng

XPr

ovin

cial

Adv

isor

y an

d Ad

voca

cy P

latfo

rm

esta

blis

hed

and

oper

atio

nal

PDD

, SU

N S

ecre

taria

t, ,

DoH

, DoE

, PH

ED (W

ASH

), D

oA, S

WD

, WD

D

PDD

Dev

elop

term

s of

refe

renc

e fo

r fi rm

s an

d co

nsul

tant

s to

be

task

ed w

ith

deve

lopi

ng th

e SB

CC s

trat

egy

XSe

ctor

al in

puts

are

pr

esen

t fro

m d

iff er

ent

stak

ehol

ders

in th

e To

Rs.

PDD

, SU

N

Secr

etar

iat,

, D

oH,

DoE

, PH

ED (

WAS

H),

DoA

, SW

D, W

DD

PDD

Firm

or c

onsu

ltant

to d

evel

op c

oste

d SB

CC s

trat

egy

XSB

CC s

trat

egy

addr

esse

s ne

eds

of b

oth

boys

and

gi

rls a

t sch

ool/c

olle

ge

and

out o

f sch

ool,

defi n

e th

e de

liver

y po

ints

and

re

spon

sibl

e pe

rson

s

PDD

Dev

elop

kno

wle

dge

prod

ucts

(IEC

/BCC

/ad

voca

cy m

ater

ial)

XPD

D

Inte

rven

tion

1.2.

2:

Impl

emen

t pro

vinc

ial S

BCC

actio

n pl

an,

with

sec

tora

l res

pons

ibilit

ies

assi

gned

XAl

l sec

tors

impl

emen

t SB

CC c

ompo

nent

s in

thei

r re

spec

tive

sect

oral

wor

k pl

ans

Vario

us s

ecto

rs


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.3

: Set

pol

icy

prio

ritie

s an

d re

sour

ce a

lloca

tions

for

adol

esce

nt n

utri

tion

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.3.

1:

Revi

ew a

nd re

fi ne

exis

ting

polic

ies,

bu

dget

s an

d st

rate

gies

(e.g

. PRS

P)

Iden

tify

sect

oral

role

s fo

r ado

lesc

ent

nutr

ition

in K

P Su

stai

nabl

e D

evel

opm

ent

Stra

tegy

(dra

fted

in 2

019)

XAl

l rel

evan

t lin

e de

part

men

ts/ s

ecto

rsPD

D, c

once

rned

de

part

men

ts

Ensu

re a

ppro

val o

f KP

Sust

aina

ble

Dev

elop

men

t Str

ateg

y (in

clud

ing

actio

n pl

an w

ith c

ostin

g)

XKP

Sus

tain

able

D

evel

opm

ent S

trat

egy,

in

clud

es s

ecto

ral r

oles

on

adol

esce

nt n

utrit

ion

Impl

emen

t KP

Sust

aina

ble

Dev

elop

men

t Str

ateg

yX

XX

XAn

nual

revi

ew re

port

s pr

oduc

ed re

port

ing

on

sect

oral

con

trib

utio

ns to

ad

oles

cent

nut

ritio

n

PDD

, SU

N

Inte

rven

tion

1.3.

2:

Revie

w o

f AD

P an

d bu

dget

ary

allo

catio

n fo

r pilo

t int

erve

ntio

ns (I

FA

supp

lem

enta

tion,

dew

orm

ing,

cur

ricul

um

revis

ion,

pro

mot

ion

activ

ities

etc

.)

XPC

1 ap

prov

ed

PDD

, fi n

ance

dep

artm

ent,

DoH

, DoE

PDD

, con

cern

ed li

ne

depa

rtm

ents

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

1:D

evel

op a

cor

e pa

ckag

e of

nut

ritio

n-sp

ecifi

c in

terv

entio

ns a

nd p

rom

ote

its

prov

isio

n to

all

adol

esce

nts


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Prov

ide

addi

tiona

l mic

ronu

trie

nts

thro

ugh

fort

ifi ca

tion

of s

tapl

e fo

ods,

ta

rget

ed s

uppl

emen

tatio

n an

d de

wor

min

g

XX

# of

ado

lesc

ents

who

rece

ived

m

icro

nutr

ient

sup

plem

ents

# of

ado

lesc

ents

dew

orm

ed

Prov

inci

al N

utrit

ion

Dire

ctor

ate

, DoE

, U

NIC

EF, W

HO

DoH

, Foo

d Au

thor

ity

Prov

ide

targ

eted

IFA

supp

lem

enta

tion

XX

# of

ado

lesc

ents

who

rece

ived

IF

A D

oH (N

utrit

ion

Prog

ram

me,

MN

CH,

LHW

Pro

gram

mes

)

DoH

, Foo

d Au

thor

ity

Inte

rven

tion

2.1.

2:

Cont

inue

and

enh

ance

pre

vent

ion

of a

dole

scen

t pre

gnan

cy a

nd p

oor

repr

oduc

tive

outc

omes

(alre

ady

bein

g do

ne s

ince

201

9)

XX

XX

X#

of d

istr

icts

with

ear

ly m

arria

ge

law

enf

orce

d

% o

f pop

ulat

ion

awar

e ab

out

early

mar

riage

legi

slat

ion

Tren

d in

ear

ly m

arria

ges

(PD

HS)

SWD

, DO

H, P

WD

, ,

UN

FPA

SWD

Inte

rven

tion

2.1.

3:

Prom

ote

pre-

conc

eptio

n an

d an

tena

tal

nutr

ition

XX

XX

X#

of a

nten

atal

che

ck u

ps

# of

girl

s an

d w

omen

rece

ivin

g aw

aren

ess

on a

nten

atal

nu

triti

on

DoH

(Nut

ritio

n Pr

ogra

mm

e, M

NCH

, LH

W P

rogr

amm

e)

DoH

(hea

lth s

ecre

tary

, di

rect

or-g

ener

al fo

r he

alth

ser

vice

s)

Inte

rven

tion

2.1.

4:

Impl

emen

t ado

lesc

ent-f

riend

ly d

isea

se

prev

entio

n an

d m

anag

emen

t whi

ch

is s

ub-a

ge g

roup

spe

cifi c

, thr

ough

the

Adol

esce

nt H

ealth

and

Dev

elop

men

t St

rate

gy

XX

X#

of a

dole

scen

ts (g

irls

and

boys

) tr

eate

d D

oHD

oH

Inte

rven

tion

2.1.

5:Ra

ise

awar

enes

s an

d pr

omot

e ba

lanc

ed d

iet a

nd d

ieta

ry d

iver

sity

XX

XX

X#

of a

war

enes

s se

ssio

ns

cond

ucte

d #

of c

ooki

ng d

emon

stra

tions

DoH

(Nut

ritio

n Pr

ogra

mm

e, L

HW

Pr

ogra

mm

e), D

oE

Prov

inci

al H

ealth

D

irect

orat

e

Inte

rven

tion

2.1.

6:Bu

ild c

apac

ity o

f pub

lic a

nd p

rivat

e se

ctor

hea

lthca

re p

rovi

ders

to e

nhan

ce

the

qual

ity a

nd re

ach

of n

utrit

ion

serv

ices

for a

dole

scen

t girl

s an

d bo

ys


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Build

cap

acity

of c

omm

unity

-bas

ed

wor

kers

(LH

Ws,

com

mun

ity m

idw

ives

, m

ale

and

fem

ale

FWA,

FW

W, F

WC,

FTO

, so

cial

mob

ilizer

s) a

nd re

ligio

us o

pini

on-

mak

ers

in c

ouns

ellin

g ar

ound

pos

itive

nu

triti

on b

ehav

iour

s of

ado

lesc

ents

XX

# of

trai

ning

s co

nduc

ted

# of

com

mun

ity-b

ased

hea

lth

care

pro

vide

rs tr

aine

d

DoH

/ Pop

ulat

ion

Wel

fare

(MN

CH, L

HW

Pr

ogra

mm

e, N

utrit

ion

Prog

ram

me)

Prov

inci

al D

irect

orat

e

Build

cap

acity

of h

ealth

faci

lity

serv

ice

prov

ider

s (m

edic

al o

ffi ce

rs, l

ady

med

ical

offi

cers

, mid

wiv

es, M

T/FM

T et

c.) i

n co

unse

lling

arou

nd p

ositi

ve

nutr

ition

beh

avio

urs

of a

dole

scen

ts)

X#

of tr

aini

ngs

cond

ucte

d #

of h

ealth

car

e pr

ovid

ers

trai

ned

DoH

(MN

CH, L

HW

Pr

ogra

mm

e, N

utrit

ion

Prog

ram

me)

Prov

inci

al D

irect

orat

e

Inco

rpor

ate

adol

esce

nt n

utrit

ion

into

pr

e-se

rvic

e an

d in

-ser

vice

cur

ricul

a fo

r fa

cilit

y-ba

sed

heal

thca

re p

rovi

ders

XX

Curr

icul

a re

vise

d D

oH, P

DD

(hea

lth a

nd

nutr

ition

sec

tion

unde

r SU

N)

Addi

tiona

l ch

ief s

ecre

tary

(d

evel

opm

ent)

offi c

e

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

1: E

duca

tion

sect

orIn

terv

entio

n 2.

2.1.

1:

Inte

grat

e co

re p

acka

ge o

f nut

ritio

n in

terv

entio

ns in

edu

catio

n se

ctor

DoE

(Boa

rd o

f Cu

rric

ulum

), D

oH,

Balo

chis

tan

Food

Au

thor

ity, N

utrit

ion

Prog

ram

me

UN

ICEF

Addi

tiona

l ch

ief s

ecre

tary

(d

evel

opm

ent)

offi c

e, D

oE, f

ood

depa

rtm

ent

Revi

se c

urric

ula

XX

Curr

icul

a re

vise

d, n

utrit

ion

mes

sage

s in

corp

orat

ed


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Cond

uct t

each

er tr

aini

ngs

X#

of te

ache

rs tr

aine

d

Impl

emen

t sch

ool-b

ased

mic

ronu

trie

nt

supp

lem

enta

tion

and

dew

orm

ing

XX

XX

X#

of a

dole

scen

ts re

ceiv

ing

mic

ronu

trie

nt s

uppl

emen

tatio

n #

of a

dole

scen

ts d

ewor

med

Prom

ote

heal

thy

food

and

di

ets

at s

choo

l thr

ough

coo

king

de

mon

stra

tions

and

aw

aren

ess

sess

ions

XX

XX

X#

of c

ooki

ng d

emon

stra

tions

2.2.

2: A

gric

ultu

re s

ecto

r

Inte

rven

tion

2.2.

2.1:

Pr

omot

e ki

tche

n/sc

hool

gar

deni

ng

(mic

ronu

trie

nt-r

ich

vege

tabl

es) a

nd

rura

l pou

ltry

rear

ing

Prov

ide

seed

s an

d en

sure

ava

ilabi

lity

of w

ater

to p

rom

ote

kitc

hen/

scho

ol

gard

enin

g

XX

XX

X#

of p

rom

otio

n se

ssio

ns c

ondu

cted

#

of s

choo

ls p

rovi

ded

with

see

dsFo

od, i

rrig

atio

n de

part

men

ts, D

oA,

DoE

, DoH

, ver

tical

pr

ogra

mm

es, F

ood

and

Agric

ultu

re

Org

aniz

atio

n

Addi

tiona

l ch

ief s

ecre

tary

(d

evel

opm

ent)

offi c

e –

sect

ions

, PD

D

Inte

rven

tion

2.2.

2.2:

Pr

ovid

e in

-kin

d su

ppor

t for

fi sh

farm

ing,

po

ultr

y an

d liv

esto

ck a

nd a

war

enes

s

XX

XX

X#

of a

dole

scen

t ben

efi c

iarie

s Co

ncer

ned

depa

rtm

ents

Inte

rven

tion

2.2.

2.3:

En

actm

ent o

f foo

d fo

rtifi

catio

n ac

t/law

by

food

dep

artm

ent

XX

Food

dep

artm

ent

Food

dep

artm

ent

2.2.

3: W

ASH

sec

tor

Inte

rven

tion

2.2.

3.1:

Pr

omot

e W

ASH

-rel

ated

bes

t pra

ctic

es

by in

corp

orat

ing

mes

sage

s in

to

com

mun

icat

ion

stra

tegi

es


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

adol

esce

nts

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Prov

ide

safe

wat

er, h

ygie

ne a

nd

sani

tatio

n fa

cilit

ies

in s

choo

ls a

nd o

ther

pu

blic

inst

itutio

ns

X#

of s

choo

ls w

ith p

rope

r WAS

H

faci

litie

s #

of s

essi

ons

on h

ygie

ne c

ondu

cted

PHED

, DoH

, DoE

, in

dust

ries

depa

rtm

ent,

SWD

, WD

DU

NIC

EF

Ensu

re a

cces

s to

nea

rby

safe

, sep

arat

e an

d pr

ivat

e sa

nita

tion

faci

litie

s,

esse

ntia

l for

men

stru

al h

ygie

ne

man

agem

ent,

dign

ity, c

omfo

rt a

nd

heal

th o

f ado

lesc

ent g

irls

X

2.2.

4: S

ocia

l pro

tect

ion

sect

or

Inte

rven

tion

2.2.

4.1:

Des

ign

and

pilo

t soc

ial p

rote

ctio

n in

terv

entio

ns to

enh

ance

acc

ess

of

mar

gina

lized

ado

lesc

ents

to q

ualit

y fo

od

XX

XX

# of

fam

ilies

enro

lled

in c

ondi

tiona

l ca

sh tr

ansf

er p

rogr

amm

es

# of

ado

lesc

ents

enr

olle

d in

se

cond

ary

educ

atio

n

SWD

, DoE

, BIS

P

Inst

itute

con

ditio

nal c

ash

tran

sfer

and

fo

od v

ouch

er s

chem

es to

incr

ease

se

cond

ary

scho

ol e

nrol

men

t and

at

tend

ance

Link

cas

h tr

ansf

ers

thro

ugh

BISP

to

enha

nce

seco

ndar

y sc

hool

enr

olm

ent

and

atte

ndan

ce


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.3

: Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for

mar

gina

lized

ado

lesc

ents

and

thos

e w

ith s

peci

aliz

ed n

eeds

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.3.

1:

Dev

elop

pro

gram

mat

ic re

spon

se fo

r ad

oles

cent

s in

spe

cial

circ

umst

ance

s (e

.g. t

rans

gend

er a

dole

scen

ts, H

IV-

posi

tive

adol

esce

nt a

nd a

dole

scen

ts

with

dis

abilit

ies)

XX

Plan

ning

cyc

le d

ocum

ents

are

ad

oles

cent

s in

spe

cial

circ

umst

ance

sD

oH (P

rovi

ncia

l AID

S Co

ntro

l Pro

gram

me)

, SW

D

Prov

inci

al H

ealth

D

irect

orat

e/

Dire

ctor

ate

of

Soci

al W

elfa

re

Inte

rven

tion

2.3.

2:D

evel

op p

rogr

amm

atic

resp

onse

for

adol

esce

nts

belo

ngin

g to

mig

rant

or

inte

rnal

ly d

ispl

aced

pop

ulat

ions

XX

Haz

ards

and

str

ateg

y fo

r pre

vent

ion,

pl

anni

ng a

nd c

oord

inat

ion

iden

tifi e

dD

oE, D

oH (H

IV

Prog

ram

me)

, PW

DPr

ovin

cial

go

vern

men

t

Inte

rven

tion

2.3.

4:

Dev

elop

pro

gram

mat

ic re

spon

se

for a

dole

scen

ts in

dis

aste

rs a

nd

hum

anita

rian

resp

onse

XX

Prov

inci

al D

isas

ter

Man

agem

ent

Auth

ority

, UN

ICEF

Nut

ritio

n Ce

ll

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

1:

Asse

ss a

nd a

djus

t rou

tine

info

rmat

ion

syst

ems

to c

aptu

re a

dole

scen

t nu

triti

on

Revi

sit D

HIS

to a

sses

s th

e ex

tent

to

whi

ch it

cap

ture

s ag

e- a

nd s

ex-

disa

ggre

gate

d da

ta o

n nu

triti

on s

tatu

s an

d pr

even

tive

and

cura

tive

actio

ns

take

n to

add

ress

nut

ritio

nal c

once

rns

X#

of k

ey a

dole

scen

t ind

icat

ors

inco

rpor

ated

in ro

utin

e D

HIS

# of

ado

lesc

ent n

utrit

ion

indi

cato

rs

inco

rpor

ated

in N

MIS

DH

IS, n

utrit

ion

sect

orD

OH

, MoN

HSR

C


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inco

rpor

ate

the

reco

mm

ende

d ch

ange

s in

to th

e dr

aft f

orm

ats

of

reco

rdin

g an

d re

port

ing

tool

s an

d pi

lot

the

initi

ativ

e

X

Base

d on

the

pilo

t exe

rcis

e,

reco

mm

end

chan

ges

in to

ols,

repo

rtin

g an

d fe

edba

ck m

echa

nism

X

Cond

uct d

ata

colle

ctio

n an

d re

port

ing

on re

vise

d to

ols

XX

XX

Rout

ine

data

col

lect

ion

and

repo

rtin

g in

clud

es a

dole

scen

t nut

ritio

n as

pect

s

Inte

rven

tion

3.1.

2:

Cond

uct p

erio

dic

scre

enin

g of

stu

dent

s of

mad

rass

ahs,

form

al, n

on-fo

rmal

and

in

form

al s

choo

ls to

ass

ess

nutr

ition

st

atus

XX

XX

# of

stu

dent

s sc

reen

ed fo

r nut

ritio

n st

atus

DoH

, DoE

DoH

, DoE

Inte

rven

tion

3.1.

3:

Cond

uct c

ontin

uous

mon

itorin

g an

d ev

alua

tion

of la

rge-

scal

e su

stai

nabl

e se

rvic

es th

at a

re a

ppro

pria

te fo

r all

adol

esce

nts

incl

udin

g, e

.g.,

serv

ices

re

late

d to

the

prom

otio

n of

hea

lthy

and

nutr

itiou

s di

ets,

mic

ronu

trie

nt

supp

lem

enta

tion

XX

XX

% o

f ado

lesc

ent b

oys

and

girls

pr

ovid

ed s

uppl

emen

tatio

n in

sc

hool

s/ c

olle

ges

% o

f ado

lesc

ent b

oys

and

girls

pr

ovid

ed s

uppl

emen

tatio

n in

co

mm

unity

DoH

(LH

W

Prog

ram

me)

,co

mm

unity

-bas

ed

orga

niza

tions

, ru

ral d

evel

opm

ent

orga

niza

tions

, Chi

ld

Prot

ectio

n U

nits

voca

tiona

l tra

inin

g in

stitu

te

DoH

, SW

D, D

oE

Inte

rven

tion

3.1.

4:

In re

leva

nt s

urve

ys in

clud

e co

ntex

t-sp

ecifi

c da

ta o

n ad

oles

cent

s di

sagg

rega

ted

by a

ge, s

ex, i

ncom

e,

educ

atio

n an

d ge

ogra

phy

on d

ieta

ry

patte

rns

and

eatin

g ha

bits

(NN

S) a

nd

on u

niqu

e nu

triti

onal

issu

es a

nd m

ajor

de

term

inan

ts

XX

XX

Dat

a ga

ther

ed o

n bo

ys a

nd g

irls

aged

10

–14,

boy

s an

d gi

rls a

ged

15–1

9,

nutr

ition

al s

tatu

s, (a

nthr

opom

etry

), di

etar

y di

vers

ity a

nd re

port

ed in

NN

S,

PDH

S, H

IES

etc.

NIP

SG

over

nmen

t of

Paki

stan


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

5:

Asse

ss b

ehav

iour

al p

rofi l

es, d

ieta

ry

patte

rns,

cos

t of t

he d

iet a

nd m

ajor

in

fl uen

cers

of a

dole

scen

ts in

the

cont

ext o

f the

ir so

cial

and

psy

chos

ocia

l de

velo

pmen

t in

orde

r to

info

rm

prog

ram

mes

and

pol

icym

akin

g

XX

XX

X#

of re

sear

ch a

nd p

olic

y pa

pers

pr

epar

ed o

n di

et a

nd b

ehav

iour

D

oH, n

utrit

ion

rese

arch

ers,

aca

dem

ia,

deve

lopm

ent p

artn

ers

Inte

rven

tion

3.1.

6:

Cond

uct f

ollo

w-u

p re

sear

ch o

n im

plem

enta

tion

to id

entif

y in

nova

tions

an

d de

liver

y pl

atfo

rms

that

reac

h an

d aff

ect

ado

lesc

ents

in o

rder

to a

chie

ve

scal

e-up

, hea

lth s

yste

ms

inte

grat

ion

and

sust

aina

bilit

y

XX

XX

# of

inno

vatio

ns id

entifi

ed

and

inco

rpor

ated

PD

DCo

ncer

ned

line

depa

rtm

ents

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: KH

YBER

PAK

HTU

NKH

WA

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.2

: Eff

ectiv

e kn

owle

dge

man

agem

ent a

nd r

efl e

ctin

g on

wha

t wor

ks

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.2.

1:

Esta

blis

h di

gita

l das

hboa

rds

for p

rovi

ncia

l-lev

el k

now

ledg

e m

anag

emen

t

XD

igita

l das

hboa

rd o

pera

tiona

l


Punj

ab o

pera

tiona

l pla

nPR

OVI

NCI

AL O

PERA

TIO

NAL

PLA

N: P

UN

JAB

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.1.

1:Ac

tivat

e a

polic

y fo

rum

for a

dole

scen

ts

Form

ulat

e, n

otify

and

act

ivat

e a

Sub-

Com

mitt

ee o

n Ad

oles

cent

Hea

lth &

N

utrit

ion

(sub

-gro

up o

f the

Ste

erin

g Co

mm

ittee

on

Nut

ritio

n), i

nclu

ding

ad

oles

cent

nut

ritio

n in

its

term

s of

re

fere

nce

XSu

b-co

mm

ittee

on

adol

esce

nt h

ealth

and

nu

triti

on (s

ub-g

roup

of

nut

ritio

n st

eerin

g co

mm

ittee

) act

ivat

ed

Chie

f Min

iste

r, Pu

njab

, nu

triti

on-s

ensi

tive

depa

rtm

ents

, UN

ICEF

PDD

Cond

uct p

olic

y di

alog

ue o

n ad

oles

cent

he

alth

and

nut

ritio

n X

X#

of d

ialo

gues

Pa

rliam

enta

rians

, in

tern

atio

nal N

GO

s,

CSO

s, P

DD

, dep

artm

ent

repr

esen

tativ

es,

com

mun

ity w

orke

rs, y

outh

re

pres

enta

tives

, aca

dem

ia,

med

ical

inst

itute

s, m

edia

, U

NIC

EF

PDD

Cond

uct a

dvoc

acy

and

tech

nica

l w

orki

ng g

roup

ses

sion

sX

XX

XX

Dep

artm

ent

repr

esen

tativ

es,

inte

rnat

iona

l NG

Os,

ad

oles

cent

s, m

edia

PDD

Inte

rven

tion

1.1.

2:

Legi

slat

ion

on p

rohi

bitio

n of

chi

ld

mar

riage

Pres

ent t

he d

raft

of re

visi

ons

to th

e re

vise

d Ch

ild M

arria

ges

Rest

rain

t Act

, 19

29, t

o th

e ch

ief m

inis

ter f

or a

ppro

val

XPW

D, D

oH, D

oE, W

DD

, Pu

njab

Com

mis

sion

on

the

Stat

us o

f Wom

en, P

olic

y an

d St

rate

gic

Plan

ning

Uni

t (P

SPU

), U

NFP

A

PWD


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Dev

elop

rule

s an

d re

gula

tions

on

proh

ibiti

on o

f chi

ld m

arria

ge

X

Achi

eve

appr

oval

of r

ules

and

re

gula

tions

on

the

proh

ibiti

on o

f chi

ld

mar

riage

X

Dis

sem

inat

e th

e la

w, r

ules

and

re

gula

tions

on

the

proh

ibiti

on o

f chi

ld

mar

riage

XX

X%

dec

line

in in

cide

nce

of

unde

rage

mar

riage

(PD

HS)

PWD

Inte

rven

tion

1.1.

3:

Impl

emen

t the

law

on

com

puls

ory

educ

atio

n (im

plem

entin

g Ar

ticle

25A

)

X%

of o

ut-o

f-sch

ool

adol

esce

nts

enga

ged

in

educ

atio

n

DoE

, CSO

s, U

NFP

A CM

’s Pr

ovin

cial

Tas

k Fo

rce

Inte

rven

tion

1.1.

4:

Legi

slat

ion

on fo

od re

gula

tion

to b

an

junk

food

and

fi zz

y dr

inks

in s

choo

ls

and

othe

r ins

titut

ions

XX

XX

X%

of s

choo

ls c

ompl

iant

with

le

gisl

atio

nPu

njab

Foo

d Au

thor

ity,

educ

atio

n in

stitu

tions

, foo

d re

gula

tors

Punj

ab F

ood

Auth

ority

Inte

rven

tion

1.1.

5:

Impl

emen

tatio

n of

legi

slat

ion

and

refo

rms

on u

rban

pla

nnin

g an

d de

velo

pmen

t, ad

dres

sing

ado

lesc

ents

’ ne

ed to

eng

age

in p

hysi

cal a

ctiv

ity

thro

ugh

part

, sch

ool s

port

s, e

tc

XX

XX

X%

of d

istr

icts

whe

re e

xist

ing

legi

slat

ion

is im

plem

ente

d by

loca

l gov

ernm

ent

Loca

l and

dis

tric

t go

vern

men

ts (m

ayor

/ un

ion

coun

cils

), yo

uth

aff a

irs d

epar

tmen

t; de

puty

co

mm

issi

oner

s, P

DD

, CSO

s

Loca

l and

dis

tric

t go

vern

men

ts, P

DD

Impl

emen

t the

law

, rul

es a

nd

regu

latio

nsX

XX

XSt

ruct

ured

spo

rts

and

phys

ical

act

iviti

es h

appe

n re

gula

rly a

t sch

ools

, th

e co

mm

unity

and

the

wor

kpla

ce

DoE

, City

Dev

elop

men

t Au

thor

ity/m

unic

ipal

ity

auth

oriti

es

PDD


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Ensu

re im

plem

enta

tion

and

com

plia

nce

XX

XX

# of

pub

lic a

nd p

rivat

e,

form

al, n

on-fo

rmal

sch

ools

w

here

phy

sica

l act

ivity

for

adol

esce

nt is

regu

larly

pr

actic

ed (d

isag

greg

ated

)

Inte

rven

tion

1.1.

6:

Inte

grat

e ta

rget

ed a

dole

scen

t nut

ritio

n in

terv

entio

ns in

exi

stin

g st

rate

gies

/se

ctor

al p

lans

and

pro

gram

mes

XAd

oles

cent

nut

ritio

n in

clud

ed in

dra

ft Pu

njab

H

ealth

Sec

tor S

trat

egy

DoH

, DoE

, foo

d de

part

men

t re

quire

d to

inte

grat

e ex

istin

g in

terv

entio

ns

PDD

(Mul

tisec

tora

l Nut

ritio

n Ce

ntre

, MSN

C)Pu

njab

Foo

d Au

thor

ity,

PSPU

, IRM

NCH

, UN

FPA,

D

oH, C

SOs

PDD

, PSP

U

Revi

sit t

he p

rovi

ncia

l mul

tisec

tora

l nu

triti

on s

trat

egy

to li

nk a

nd u

pdat

e th

e ad

oles

cent

com

pone

nt

XAd

oles

cent

nut

ritio

n is

em

bedd

ed in

mul

tisec

tora

l nu

triti

on s

trat

egie

s

PDD

Incl

ude

an a

dole

scen

t nut

ritio

n co

mpo

nent

in s

ecto

ral p

lans

XX

XX

XAd

oles

cent

s ar

e in

clud

ed

as c

ross

-cut

ting

or s

peci

fi c

inte

rven

tions

in s

ecto

ral

plan

s

PDD

, DoH

, DoE

, liv

elih

oods

de

velo

pmen

t, so

cial

pr

otec

tion,

WAS

H

PDD

Incl

ude

an a

sses

smen

t-bas

ed

adol

esce

nt n

utrit

ion

mod

ule

and

adde

ndum

s in

to p

rimar

y, hi

gher

and

m

edic

al e

duca

tion

XAl

l rel

evan

t cur

ricul

a in

clud

e ad

oles

cent

nut

ritio

n PD

D (M

SNC)

, DoE

(hig

her

educ

atio

n de

part

men

t),

Paki

stan

Med

ical

and

D

enta

l Cou

ncil,

spec

ializ

ed

heal

thca

re a

nd m

edic

al

educ

atio

n de

part

men

t

PDD

Revi

taliz

e di

stric

t, te

hsil

and

unio

n co

unci

l coo

rdin

atio

n m

echa

nism

sX

XX

XD

MAC

, TM

AC, U

MAC

op

erat

iona

lized

PD

D (M

SNC)

, IRM

NCH

, di

stric

t aut

horit

ies

PDD


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.2.

1:

Dev

elop

com

preh

ensi

ve, m

ultis

ecto

ral,

low

-cos

t, in

nova

tive

nutr

ition

SBC

C st

rate

gy fo

r pro

mot

ion

of a

dole

scen

t nu

triti

on, h

ealth

y di

et a

nd p

ositi

ve

beha

viou

rs

Sect

or-s

peci

fi c in

dica

tors

ava

ilabl

e in

th

e fr

amew

ork

PDD

(MSN

C), D

oH, (

PSPU

, IR

MN

CH),

DoE

(SED

, H

ED, H

EC),

deve

lopm

ent

part

ners

DoH

, PD

D (M

SNC)

Esta

blis

h an

adv

ocac

y an

d co

mm

unic

atio

n w

orki

ng g

roup

to g

uide

de

part

men

ts

XAd

voca

cy a

nd c

omm

unic

atio

n w

orki

ng g

roup

is e

stab

lishe

d an

d fu

nctio

nal

MSN

C PD

D

Dev

elop

term

s of

refe

renc

e fo

r fi rm

s an

d co

nsul

tant

s to

be

task

ed w

ith

deve

lopi

ng th

e SB

CC s

trat

egy

XSe

ctor

al in

puts

from

diff

eren

t st

akeh

olde

rs in

corp

orat

ed in

the

term

s of

refe

renc

e

PDD

, SU

N S

ecre

taria

t, M

oNH

SRC,

DoH

, DoE

, PH

ED (W

ASH

), D

oA, S

WD

, W

DD

PDD

Prov

ide

tech

nica

l ass

ista

nce

on th

e de

velo

pmen

t of t

he c

oste

d SB

CC

stra

tegy

XSB

CC s

trat

egy

addr

esse

s ne

eds

of b

oys

and

girls

(in

and

out o

f sc

hool

), de

fi ne

deliv

ery

poin

ts a

nd

resp

onsi

bilit

ies

Dev

elop

men

t par

tner

s

Dev

elop

kno

wle

dge

prod

ucts

(IEC

/BCC

/ad

voca

cy m

ater

ial)

XKn

owle

dge

and

info

rmat

ion

abou

t ado

lesc

ent n

utrit

ion

need

s di

ssem

inat

ed a

cros

s th

e pr

ovin

ce

thro

ugh

eff e

ctiv

e ca

mpa

igns

Punj

ab F

ood

Auth

ority

, U

NIC

EF, U

NFP

A,W

HO

, IR

MN

CH, P

DD

(MSN

C),

Nut

ritio

n In

tern

atio

nal,

PSPU

PDD

(MSN

C)

Inte

rven

tion

1.2.

2:

Impl

emen

t pro

vinc

ial S

BCC

actio

n pl

an,

with

sec

tora

l res

pons

ibilit

ies

assi

gned

XAl

l sec

tors

impl

emen

t SBC

C co

mpo

nent

s in

wor

kpla

nsIn

tegr

ated

app

roac

h to

ado

lesc

ent

nutr

ition

thro

ugh

heal

th a

nd

educ

atio

n de

part

men

ts a

cros

s Pu

njab

Punj

ab F

ood

Auth

ority

, U

NIC

EF, U

NFP

A,W

HO

, IR

MN

CH, P

DD

(MSN

C),

Nut

ritio

n In

tern

atio

nal,

PSPU

DoH

Sens

itize

med

ia, C

SOs,

com

mun

ity

grou

ps, h

ealth

ser

vice

pro

vide

rsX

XX

XAl

l key

sta

keho

lder

s re

pres

ente

d in

pr

ovin

cial

wor

ksho

pAl

l nut

ritio

n-se

nsiti

ve

and

nutr

ition

-spe

cifi c

de

part

men

ts

Advo

cacy

and

co

mm

unic

atio

n w

orki

ng g

roup


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Cond

uct e

lect

roni

c ca

mpa

ign

on

adol

esce

nt h

ealth

and

nut

ritio

n,

prep

arin

g an

inno

vativ

e se

ries

on

adol

esce

nt n

utrit

ion

XX

XX

# of

cha

nnel

s en

gage

d#

of T

V an

d ra

dio

spot

s pe

r mon

thPD

D (M

SNC)

, IRM

NCH

, PH

ED, H

UD

, DoE

, par

tner

sAd

voca

cy a

nd

com

mun

icat

ion

wor

king

gro

up

Cond

uct p

rint m

edia

cam

paig

n X

XX

X#

of m

edia

hou

ses

enga

ged

# of

adv

ertis

emen

ts in

new

spap

ers

MSN

C, IR

MN

CH, P

HED

, Ed

ucat

ion

Dep

artm

ent

and

Part

ners

Advo

cacy

and

co

mm

unic

atio

n w

orki

ng g

roup

Cond

uct s

ocia

l med

ia c

ampa

ign

XX

XX

# of

mob

ile m

essa

ges

# of

soc

ial m

edia

like

sPD

D (M

SNC)

, IRM

NCH

, PH

ED, D

oE, p

artn

ers

Advo

cacy

and

co

mm

unic

atio

n w

orki

ng g

roup

Cond

uct c

omm

unity

cam

paig

n w

ith

stre

et th

eatr

e, s

choo

l com

petit

ions

and

ce

lebr

atio

n of

hea

lth a

nd n

utrit

ion

XX

XX

# of

act

iviti

es

PDD

(MSN

C), I

RMN

CH,

PHED

, DoE

, par

tner

sAd

voca

cy a

nd

com

mun

icat

ion

wor

king

gro

up

Enga

ge y

outh

am

bass

ador

s id

entifi

ed

thro

ugh

Nut

ritio

n Cl

ubs

in s

choo

ls a

nd

mad

rass

ahs

XX

XX

# of

you

th a

mba

ssad

ors

enga

ged

Com

mun

ity

repr

esen

tativ

es, C

SOs

Advo

cacy

and

co

mm

unic

atio

n w

orki

ng g

roup

Trai

n co

mm

unity

hea

lth w

orke

rs o

n SB

CC fo

r ado

lesc

ent h

ealth

X

X#

of C

HW

s tr

aine

d#

of c

omm

unity

ses

sion

sD

oH, D

oE, i

nfor

mat

ion

min

istr

yAd

voca

cy a

nd

com

mun

icat

ion

wor

king

gro

up

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.3

: Set

pol

icy

prio

ritie

s an

d re

sour

ce a

lloca

tions

for

adol

esce

nt n

utri

tion

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.3.

1:

Revi

ew a

nd re

fi ne

exis

ting

polic

ies,

bu

dget

s an

d st

rate

gies

(e.g

. PRS

P)


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.3

: Set

pol

icy

prio

ritie

s an

d re

sour

ce a

lloca

tions

for

adol

esce

nt n

utri

tion

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Dev

elop

agr

eed

term

s of

refe

renc

e fo

r th

e fi r

m o

r con

sulta

nt to

be

task

ed w

ith

anal

ysin

g ex

istin

g po

licie

s

XSe

ctor

al in

puts

from

diff

eren

t st

akeh

olde

rs in

corp

orat

ed in

to te

rms

of re

fere

nce

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, P

HED

(WAS

H),

DoA

, SW

D, W

DD

, BIS

P

PDD

Dis

sem

inat

e th

e an

alys

is re

port

and

de

cisi

ons

on w

ay fo

rwar

d X

Follo

w u

p on

the

reco

mm

enda

tions

of

the

anal

ysis

repo

rtX

XX

X%

of a

gree

d re

com

men

datio

ns

impl

emen

ted

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, P

HED

(WAS

H),

DoA

, SW

D, W

DD

, BIS

P

PDD

Inte

rven

tion

1.3.

2:

Revi

ew a

nnua

l dev

elop

men

t pla

n an

d bu

dget

ary

allo

catio

ns fo

r pilo

t in

terv

entio

ns (I

FA s

uppl

emen

tatio

n,

curr

icul

um re

visi

on, p

rom

otio

n ac

tiviti

es e

tc.)

XAd

dres

sing

bud

get d

efi c

its in

ac

hiev

ing

initi

ativ

e ta

rget

s is

und

er

cons

ider

atio

n

PDD

, SU

N S

ecre

taria

t, D

oH, D

oE, P

HED

(WAS

H),

DoA

, SW

D, W

DD

,

PDD

Inte

rven

tion

1.3.

3:

Esta

blis

h an

d st

reng

then

aca

dem

ic a

nd

rese

arch

inst

itutio

ns

Esta

blis

h a

depa

rtm

ent o

f pre

vent

ive

paed

iatr

ics

with

trai

ned

retir

ed

cons

ulta

nts

at C

hild

ren

Hos

pita

l, La

hore

XD

epar

tmen

t est

ablis

hed

DoH

, PD

DCh

ildre

n H

ospi

tal

man

agem

ent

Esta

blis

h a

depa

rtm

ent o

f hum

an

nutr

ition

at t

he U

nive

rsity

of V

eter

inar

y Sc

ienc

es

XD

epar

tmen

t est

ablis

hed

DoA

, PD

DU

nive

rsity

of

Vete

rinar

y Sc

ienc

es

man

agem

ent

Stre

ngth

en th

e nu

triti

on d

epar

tmen

t, ho

me

econ

omic

s, p

ublic

hea

lth

depa

rtm

ent a

nd s

ocio

logy

de

part

men

ts a

t the

Uni

vers

ity o

f th

e Pu

njab

on

adol

esce

nt n

utrit

ion

rese

arch

and

cap

acity

bui

ldin

g

XD

epar

tmen

ts

cont

ribut

e re

sear

ch

and

capa

city

bui

ldin

g on

ado

lesc

ent

nutr

ition

PDD

Uni

vers

ity o

f th

e Pu

njab

m

anag

emen

t


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

1:D

evel

op a

cor

e pa

ckag

e of

nut

ritio

n-sp

ecifi

c in

terv

entio

ns a

nd p

rom

ote

its

prov

isio

n to

all

adol

esce

nts

Nut

ritio

n-sp

ecifi

c in

terv

entio

n pa

ckag

e dr

afte

d an

d pr

ovis

ions

pr

omot

ed to

all

adol

esce

nts

DoH

, PD

DD

oH

Prov

ide

addi

tiona

l mic

ronu

trie

nts

thro

ugh

fort

ifi ca

tion

of s

tapl

e fo

ods,

ta

rget

ed s

uppl

emen

tatio

n:W

heat

: iro

n, fo

lic a

cid,

zin

c, v

itam

in

B-12

Oil:

vita

min

s A

and

DSa

lt: io

dine

IFA

supp

lem

enta

tion,

wee

kly

IFA

XX

XX

XFo

rtifi

ed fo

od a

vaila

ble

in th

e m

arke

t %

of a

dole

scen

t girl

s an

d bo

ys p

rovi

ded

with

targ

eted

su

pple

men

tatio

n %

of m

ills p

rodu

cing

fort

ifi ed

fl ou

r an

d oi

l

DoH

, foo

d de

part

men

tD

oH, f

ood

depa

rtm

ent

Inte

rven

tion

2.1.

2:

Prov

ide

targ

eted

IFA

supp

lem

enta

tion

XX

XX

X%

of g

irls

and

boys

rece

ivin

g IF

A D

oH, f

ood

depa

rtm

ent

DoH

, foo

d de

part

men

t

Inte

rven

tion

2.1.

3:

Prev

ent a

dole

scen

t pre

gnan

cy a

nd

poor

repr

oduc

tive

outc

omes

XX

XX

X#

of a

dole

scen

t pre

gnan

cies

So

cial

pro

tect

ion,

WD

D,

PWD

, DoH

So

cial

pro

tect

ion

Inte

rven

tion

2.1.

4:

Prom

ote

pre-

conc

eptio

n an

d an

tena

tal

nutr

ition

XX

XX

X%

of a

dole

scen

t girl

s aw

are

of

bene

fi ts

of IF

A in

pre

-con

cept

ion

perio

d%

of a

dole

scen

t girl

s aw

are

of

bene

fi ts

of a

nten

atal

nut

ritio

n

DoH

, PW

DD

oH, P

WD

Inte

rven

tion

2.1.

5:

Impl

emen

t ado

lesc

ent-f

riend

ly d

isea

se

prev

entio

n an

d m

anag

emen

t whi

ch

is s

ub-a

ge g

roup

spe

cifi c

, thr

ough

the

Adol

esce

nt H

ealth

and

Dev

elop

men

t St

rate

gy

XX

XX

X#

of c

ases

ass

esse

d an

d m

anag

ed

by s

choo

l hea

lth a

nd n

utrit

ion

supe

rvis

ors

DoH

, DoE

D

oH


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

6:

Prov

ide

follo

w-u

p tr

aini

ng to

LH

Ws,

LH

S an

d sc

hool

hea

lth a

nd n

utrit

ion

supe

rvis

ors

who

wer

e tr

aine

d in

D

ecem

ber 2

018

on th

e re

vise

d pi

nk

trai

ning

man

ual

XX

XX

X%

of L

HW

s tr

aine

d on

Pin

k M

anua

l%

of s

choo

l hea

lth a

nd n

utrit

ion

supe

rvis

ors

trai

ned

on P

ink

Man

ual

DoH

DoH

Build

cap

acity

of c

omm

unity

-bas

ed

wor

kers

(LH

Ws,

com

mun

ity m

idw

ives

, m

ale

and

fem

ale

FWAs

, FW

W, F

WC,

FT

O, s

ocia

l mob

ilizer

s) a

nd re

ligio

us

opin

ion-

mak

ers

in c

ouns

ellin

g ar

ound

po

sitiv

e nu

triti

on b

ehav

iour

s of

ad

oles

cent

s

XX

XX

X#

of c

omm

unity

-bas

ed h

ealth

w

orke

rs tr

aine

dD

oHD

oH

Inte

rven

tion

2.1.

7:In

corp

orat

e ad

oles

cent

nut

ritio

n in

to

pre-

serv

ice

and

in-s

ervi

ce c

urric

ula

for f

acilit

y-ba

sed

heal

thca

re p

rovi

ders

(w

here

in-s

ervi

ce is

cov

ered

by

heal

th

and

pre-

serv

ice

need

s to

be

adde

d)

XX

XX

XD

oHD

oH

Inte

rven

tion

2.1.

8:

Scre

en a

dole

scen

ts in

com

mun

ities

, sc

hool

s an

d he

alth

faci

litie

s by

LH

Ws,

LH

Vs, d

octo

rs, s

choo

l hea

lth a

nd

nutr

ition

sup

ervi

sor,

teac

hers

, hea

lth

faci

litie

s

XX

XX

X#

of a

dole

scen

ts s

cree

ned

(dis

aggr

egat

ed)

DoH

, DoE

DoH

(IRM

NCH

&N

Pr

ogra

mm

e) M

&E

cell


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

ado

lesc

ents

in n

on-h

ealth

sec

tors

(ed

ucat

ion,

agr

icul

ture

, WAS

H a

nd

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

1: E

duca

tion

sect

orIn

terv

entio

n 2.

2.1.

1:

Revi

sion

(Add

ition

) to

curr

icul

aX

Chap

ters

dev

elop

ed#

of b

ooks

pub

lishe

dD

oH, D

oE

Inte

rven

tion

2.2.

1.2:

Ca

paci

ty b

uild

ing

of te

ache

rsX

Cond

uct t

each

er tr

aini

ngs

XM

anua

l dev

elop

ed

Trai

ning

of m

aste

r tra

iner

s co

mpl

eted

Inte

rven

tion

2.2.

1.3:

In

stitu

te s

choo

l-bas

ed

supp

lem

enta

tion

and

dew

orm

ing

XX

XX

X#

of a

dole

scen

t girl

s pr

ovid

ed

mic

ronu

trie

nt s

uppl

emen

tatio

n#

of a

dole

scen

t girl

s de

wor

med

DoH

, DoE

, Pun

jab

Food

Au

thor

ityD

oH, D

oE, P

unja

b Fo

od A

utho

rity

Inte

rven

tion

2.2.

1.4:

Pr

omot

e he

alth

y fo

od a

nd d

iet a

t sc

hool

Impl

emen

t edu

catio

n in

stitu

tion

regu

latio

nsX

XX

XX

% o

f sch

ools

impl

emen

ting

regu

latio

ns

Take

mea

sure

s to

incr

ease

nut

ritio

n aw

aren

ess

at s

choo

ls in

clud

ing

nutr

ition

pla

ys

XX

XX

X#

of s

tude

nts

scre

ened

and

rece

ivin

g de

wor

min

g an

d su

pple

men

tatio

n Pu

njab

Foo

d Au

thor

ity

DoE

Cond

uct l

unch

box

idea

s co

mpe

titio

nsX

XX

XX

Stan

dard

s fo

r sch

ool m

eals

defi

ned

by

food

aut

horit

y an

d im

plem

ente

d by

sta

keho

lder

s

DoE

, Pun

jab

Food

Au

thor

ity

Cele

brat

e nu

triti

on w

eek

at s

choo

lsX

XX

XX

# of

sch

ools

cel

ebra

ting

nutr

ition

w

eek

DoE

2.2.

2: A

gric

ultu

re s

ecto

r In

terv

entio

n 2.

2.2.

1:

Prom

ote

kitc

hen/

scho

ol g

arde

ning

(m

icro

nutr

ient

-ric

h ve

geta

bles

) and

ru

ral p

oultr

y re

arin

g

XX

XX

# of

sen

sitiz

atio

n se

ssio

ns in

sch

ools

in

Pun

jab

dist

ricts

#

of v

eget

able

see

d ki

ts s

uppl

ied

# of

adv

ertis

emen

ts

DoA

, DoE

DoA

, DoE


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nu

triti

on-s

ensi

tive

inte

rven

tions

for

ado

lesc

ents

in n

on-h

ealth

sec

tors

(ed

ucat

ion,

agr

icul

ture

, WAS

H a

nd

soci

al p

rote

ctio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

3: W

ASH

sec

tor

Inte

rven

tion

2.2.

3.1:

Aw

aren

ess

gene

ratio

n fo

r per

sona

l hy

gien

e an

d pr

emis

es c

lean

lines

s

Inte

rven

tion

2.2.

3.2:

Pr

ovid

e sa

fe w

ater

, hyg

iene

and

sa

nita

tion

faci

litie

s in

sch

ools

and

oth

er

publ

ic in

stitu

tions

, ens

urin

g ac

cess

to

nea

rby

safe

, sep

arat

e an

d pr

ivat

e sa

nita

tion

faci

litie

s, w

hich

are

ess

entia

l fo

r men

stru

al h

ygie

ne m

anag

emen

t, di

gnity

, com

fort

and

hea

lth o

f ad

oles

cent

girl

s

XX

XX

X#

of d

emon

stra

tions

, aw

aren

ess

mes

sage

sM

onito

ring

of w

ell-e

quip

ped

was

hroo

ms

WAS

H s

ecto

r, D

oE

WAS

H s

ecto

r

Cond

uct c

lean

lines

s co

mpe

titio

nsX

XX

XX

# of

sch

ools

hol

ding

cle

anlin

ess

com

petit

ion

DoE

2.2.

4: S

ocia

l pro

tect

ion

sect

or

Inte

rven

tion

2.2.

4.1:

Des

ign

and

pilo

t soc

ial p

rote

ctio

n in

terv

entio

ns to

enh

ance

acc

ess

of

mar

gina

lized

ado

lesc

ents

to q

ualit

y fo

od

XX

XX

X

Inst

itute

con

ditio

nal c

ash

tran

sfer

and

fo

od v

ouch

er fo

r ado

lesc

ents

Dat

a m

aint

aine

d at

soc

ial p

rote

ctio

n se

ctor

and

sch

ools

# of

ado

lesc

ent b

enefi

cia

ries

Soci

al p

rote

ctio

n se

ctor

, D

oH, D

oESo

cial

pro

tect

ion

sect

or

Supp

ort k

itche

n ga

rden

ing,

live

stoc

k


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

1:

Asse

ss a

nd a

djus

t rou

tine

info

rmat

ion

syst

ems

to c

aptu

re a

dole

scen

t nu

triti

on

Revi

sit D

HIS

and

NM

IS to

ass

ess

exte

nt

to w

hich

thes

e ca

ptur

e ag

e an

d se

x-di

sagg

rega

ted

data

on

adol

esce

nt

nutr

ition

sta

tus

and

prev

entiv

e an

d cu

rativ

e ac

tions

take

n to

add

ress

nu

triti

onal

hea

lth p

robl

ems.

X#

of k

ey a

dole

scen

t ind

icat

ors

inco

rpor

ated

in ro

utin

e D

HIS

# of

ado

lesc

ent n

utrit

ion

indi

cato

rs

inco

rpor

ated

in N

MIS

DH

IS, n

utrit

ion

sect

orD

OH

, MoN

HSR

C

Inco

rpor

ate

the

reco

mm

ende

d ch

ange

s in

to th

e dr

aft f

orm

ats

of

reco

rdin

g an

d re

port

ing

tool

s an

d pi

lot

the

initi

ativ

e

X

Base

d on

the

pilo

t exe

rcis

e,

reco

mm

end

chan

ges

in to

ols,

repo

rtin

g an

d fe

edba

ck m

echa

nism

X

Advo

cate

for i

nclu

sion

of n

ew

indi

cato

rs

XIn

dica

tors

end

orse

d by

gov

ernm

ent

Prov

ide

trai

ning

s/or

ient

atio

n on

add

ing

indi

cato

rs to

man

agem

ent i

nfor

mat

ion

syst

ems

X

Dat

a co

llect

ion

and

repo

rtin

g on

re

vise

d to

ols

XX

XX

Rout

ine

data

col

lect

ion

and

repo

rtin

g in

clud

es a

dole

scen

t nut

ritio

n

Inte

rven

tion

3.1.

2:

Cond

uct p

erio

dic

scre

enin

g of

stu

dent

s of

mad

rass

ahs,

form

al, n

on-fo

rmal

and

in

form

al s

choo

ls to

ass

ess

nutr

ition

st

atus

XX

XX

X#

of s

tude

nts

scre

ened

for n

utrit

ion

stat

us

Prev

alen

ce o

f defi

cie

ncie

s, e

g H

B fo

r iro

n de

fi cie

ncy,

asse

ssed

DoH

, DoE

DoH

, DoE


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

3:

Cond

uct c

ontin

uous

mon

itorin

g an

d ev

alua

tion

of la

rge-

scal

e su

stai

nabl

e se

rvic

es th

at a

re a

ppro

pria

te fo

r all

adol

esce

nts

incl

udin

g, e

.g.,

serv

ices

re

late

d to

the

prom

otio

n of

hea

lthy

and

nutr

itiou

s di

ets,

mic

ronu

trie

nt

supp

lem

enta

tion

XX

XX

X%

of a

dole

scen

t boy

s an

d gi

rls

prov

ided

sup

plem

enta

tion

in

scho

ols/

col

lege

s%

of a

dole

scen

t boy

s an

d gi

rls

prov

ided

sup

plem

enta

tion

in

com

mun

ity

DoH

(LH

W P

rogr

amm

e),

com

mun

ity-b

ased

or

gani

zatio

ns,

rura

l dev

elop

men

t or

gani

zatio

ns, C

hild

Pr

otec

tion

Uni

tsvo

catio

nal t

rain

ing

inst

itute

DoH

, SW

D, D

oE

Inte

rven

tion

3.1.

4:

In re

leva

nt s

urve

ys in

clud

e co

ntex

t-sp

ecifi

c da

ta o

n ad

oles

cent

s di

sagg

rega

ted

by a

ge, s

ex, i

ncom

e,

educ

atio

n an

d ge

ogra

phy

on d

ieta

ry

patte

rns

and

eatin

g ha

bits

(NN

S) a

nd

on u

niqu

e nu

triti

onal

issu

es a

nd m

ajor

de

term

inan

ts

XX

XX

XD

ata

gath

ered

on

boys

and

girl

s ag

ed

10–1

4, b

oys

and

girls

age

d 15

–19,

nu

triti

onal

sta

tus,

(ant

hrop

omet

ry),

diet

ary

dive

rsity

and

repo

rted

in N

NS,

PD

HS,

HIE

S et

c.

NIP

SG

over

nmen

t of

Paki

stan

Inte

rven

tion

3.1.

5:

Asse

ss b

ehav

iour

al p

rofi l

es, d

ieta

ry

patte

rns,

cos

t of t

he d

iet a

nd m

ajor

in

fl uen

cers

of a

dole

scen

ts in

the

cont

ext o

f the

ir so

cial

and

psy

chos

ocia

l de

velo

pmen

t in

orde

r to

info

rm

prog

ram

mes

and

pol

icym

akin

g

XX

XX

X#

of re

sear

ch a

nd p

olic

y pa

pers

pr

epar

ed o

n di

et a

nd b

ehav

iour

D

oH, n

utrit

ion

rese

arch

ers,

aca

dem

ia,

deve

lopm

ent p

artn

ers

DoE

, foo

d de

part

men

t, fo

od In

dust

ry

Inte

rven

tion

3.1.

6:

Cond

uct f

ollo

w-u

p re

sear

ch o

n im

plem

enta

tion

to id

entif

y in

nova

tions

an

d de

liver

y pl

atfo

rms

that

reac

h an

d aff

ect

ado

lesc

ents

in o

rder

to a

chie

ve

scal

e-up

, hea

lth s

yste

ms

inte

grat

ion

and

sust

aina

bilit

y

# of

inno

vatio

ns id

entifi

ed

and

inco

rpor

ated

PD

DCo

ncer

ned

line

depa

rtm

ents


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: PU

NJA

B

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.2

: Eff

ectiv

e kn

owle

dge

man

agem

ent a

nd r

efl e

ctin

g on

wha

t wor

ks

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.2.

1:

Esta

blis

h di

gita

l das

hboa

rds

for p

rovi

ncia

l-lev

el k

now

ledg

e m

anag

emen

t

X

Esta

blis

h po

rtal

s at

pro

vinc

ial a

nd

dist

rict l

evel

sX

# of

dis

tric

t por

tals

func

tiona

l

Inte

rven

tion

3.2.

2:

Esta

blis

h Pr

ovin

cial

Adv

isor

y an

d Ad

voca

cy P

latfo

rm fo

r Im

prov

ed

Adol

esce

nt N

utrit

ion

for c

oord

inat

ion

and

cros

s-se

ctor

and

cro

ss-p

rovi

ncia

l le

arni

ng

Asse

ss n

utrit

ion

stat

us in

sch

ools

and

co

llege

s at

ent

ry a

nd e

xit,

info

rmin

g nu

triti

on in

dica

tors

XX

XX

% o

f pla

nned

tech

nica

l wor

king

gro

up

revi

ew m

eetin

gs o

rgan

ized

Tech

nica

l wor

king

gro

up

stak

ehol

ders

IR

MN

CH


Sind

h op

erat

iona

l pla

nPR

OVI

NCI

AL O

PERA

TIO

NAL

PLA

N: S

IND

H

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.1.

1:

Revi

sion

in la

w o

n pr

ohib

ition

of c

hild

m

arria

ge (n

atio

nal C

hild

Mar

riage

s Re

stra

int A

ct, 1

929)

Get

dra

ft am

ende

d bi

ll ta

bled

thro

ugh

the

Prov

inci

al A

ssem

bly

Secr

etar

iat

XAm

ende

d la

w d

rafte

d an

d ve

tted

by

DoL

SWD

, WD

D, M

inis

try

of

Relig

ious

Aff a

irs a

nd

Min

oriti

es

PDD

Cond

uct d

ialo

gues

to s

ensi

tize

polic

ymak

ers

XX

XX

X#

of p

olic

ymak

ers

and

legi

slat

ors

sens

itize

dAA

P se

ctor

s, W

DD

, DoL

, hu

man

righ

ts d

epar

tmen

t, pa

rliam

enta

rians

PDD

Revi

ew ru

les

of b

usin

ess

XRu

les

of B

usin

ess

deve

lope

d an

d ve

tted

by D

oL a

nd e

stab

lishm

ent

depa

rtm

ent

AAP

Secr

etar

iat,

sect

ors

Impl

emen

t the

law

XX

X%

dec

line

in th

e in

cide

nce

of

unde

rage

mar

riage

(PD

HS)

Inte

rven

tion

1.1.

2:

Impl

emen

t leg

isla

tion

on c

ompu

lsor

y ed

ucat

ion

(Art

icle

25A

; Sin

dh R

ight

of

Chi

ldre

n To

Fre

e an

d Co

mpu

lsor

y Ed

ucat

ion

Act,

2013

% o

f out

-of-s

choo

l ado

lesc

ents

AA

P se

ctor

sM

oE

Map

sta

keho

lder

s an

d co

nduc

t si

tuat

ion

anal

ysis

XX

Dev

elop

dra

ft ru

les

XX

Org

aniz

e th

emat

ic d

ialo

gues

X

Subm

it up

date

d dr

aft f

or a

ppro

val

thro

ugh

conc

erne

d m

inis

trie

s an

d de

part

men

ts

X


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Tabl

e dr

aft l

egis

latio

nX

Dev

elop

pol

icy

and

med

ia b

riefs

XX

XX

Sens

itize

bur

eauc

rats

, pa

rliam

enta

rians

, med

ia, r

elig

ious

le

ader

s, c

ham

pion

s an

d no

tabl

e pe

rson

s

XX

XX

X

Inte

rven

tion

1.1.

3:

Impl

emen

t the

AAP

SBC

C pl

an,

incl

udin

g ad

voca

cy fo

r ado

lesc

ent

nutr

ition

AAP

Secr

etar

iat a

nd

sect

ors

PDD

co

mm

unic

atio

n ce

lls

Dev

elop

IEC

mat

eria

l for

them

atic

w

orks

hops

for p

olic

ymak

ers,

med

ia

and

relig

ious

opi

nion

mak

ers

XX

Org

aniz

e th

emat

ic s

emin

ars/

wor

ksho

ps, a

dvoc

acy

sem

inar

for

polic

ymak

ers,

adv

ocac

y se

min

ar fo

r m

edia

hou

ses

and

pers

onne

l, ad

voca

cy

for r

elig

ious

opi

nion

mak

ers

XX

# of

pol

icym

aker

s, m

edia

per

sonn

el

and

opin

ion

mak

ers

sens

itize

d

Inte

rven

tion

1.1.

4:

Dev

elop

resp

onsi

ble

adve

rtis

emen

t in

itiat

ive

to c

ompe

l com

pani

es

prom

otin

g fi z

zy d

rinks

to in

form

ad

oles

cent

s ab

out t

he u

ndes

irabl

e eff

ect

s of

con

sum

ing

such

drin

ks

XX

XX

Fizz

y dr

inks

labe

lled

with

nut

ritio

n va

lues

and

risk

sSi

ndh

Food

Aut

horit

y, AA

P Se

cret

aria

t, m

edia

Sind

h Fo

od

Auth

ority

, PE

MRA

, PD

D

com

mun

icat

ion

cell

Inte

rven

tion

1.1.

5:

Legi

slat

ion

and

refo

rms

on u

rban

pl

anni

ng a

nd d

evel

opm

ent,

addr

essi

ng

the

need

for p

hysi

cal a

ctiv

ity o

f ad

oles

cent

s th

roug

h pa

rks,

sch

ool

spor

ts, e

tc.

Loca

l gov

ernm

ent,

Priv

ate

Scho

ol A

ssoc

iatio

n, D

oELo

cal g

over

nmen

t, lo

cal a

utho

rity


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.1

: Con

duct

evi

denc

e-ba

sed

polic

y ad

voca

cy fo

r equ

ity-b

ased

incl

usio

n of

ado

lesc

ent n

utri

tion

as a

spe

cifi c

are

a of

focu

s an

d fo

r res

ourc

e

mob

iliza

tion

in e

xist

ing

and

futu

re s

trat

egie

s, p

lans

and

pro

gram

mes

(leg

isla

tions

, im

plem

enta

tion,

rul

es a

nd r

egul

atio

ns)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Ensu

re th

at n

ew s

choo

l des

igns

pr

ovid

e sp

ace

for s

port

s an

d ph

ysic

al

activ

ity

XX

XX

XSc

hool

des

ign

chan

ged

by

com

mun

icat

ion

and

wor

ks

depa

rtm

ent

Mon

itor s

choo

lsX

XX

X%

of m

onito

red

scho

ols

whe

re

phys

ical

act

ivity

is re

gula

rly e

nsur

ed

DoE

Cond

uct s

ensi

tizat

ion

and

advo

cacy

w

ith lo

cal g

over

nmen

t, lo

cal a

utho

ritie

s an

d ru

ral d

evel

opm

ent t

o al

loca

te

spac

e fo

r par

ks a

nd p

hysi

cal a

ctiv

ity

XX

# of

sen

sitiz

atio

n an

d ad

voca

cy

sess

ions

hel

d

Inte

rven

tion

1.1.

6:

Inte

grat

e ta

rget

ed a

dole

scen

t nut

ritio

n in

exi

stin

g st

rate

gies

/sec

tora

l pla

ns a

nd

prog

ram

mes

Revi

se p

rovi

ncia

l mul

tisec

tora

l nut

ritio

n st

rate

gy to

incl

ude

adol

esce

nt n

utrit

ion

XRe

vise

d m

ultis

ecto

ral n

utrit

ion

stra

tegy

incl

udin

g ad

oles

cent

nu

triti

on d

evel

oped

and

end

orse

d

DoH

, PD

D, D

oE, fi

nan

ce

depa

rtm

ent,

othe

r lin

e de

part

men

ts

PDD

Revi

se s

ecto

ral p

lans

und

er th

e Si

ndh

mul

tisec

tora

l nut

ritio

n st

rate

gy

XN

ew/r

evis

ed P

C1 (r

efl e

ctin

g ad

oles

cent

nut

ritio

n) a

ppro

ved

AAP

Secr

etar

iat

Impl

emen

t ado

lesc

ent n

utrit

ion

inte

rven

tions

XX

XAA

P Se

cret

aria

tD

oH, o

ther

line

de

part

men

ts


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.2

: Des

ign

and

impl

emen

t evi

denc

e-ba

sed

soci

al a

nd b

ehav

iour

cha

nge

com

mun

icat

ion

stra

tegi

es to

add

ress

ado

lesc

ent n

utri

tion

at a

ll

leve

ls (p

opul

atio

n, h

ouse

hold

and

com

mun

ity)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.2.

1:

Impl

emen

t com

preh

ensi

ve,

mul

tisec

tora

l, N

utrit

ion

SBCC

str

ateg

y to

pro

mot

e op

timal

ado

lesc

ent

nutr

ition

, hea

lthy

diet

and

pos

itive

be

havi

ours

XX

XX

Mul

tisec

tora

l inp

uts

are

incl

uded

AA

P Se

cret

aria

t, se

ctor

sAA

P

Des

ign

and

impl

emen

t for

mat

ive

rese

arch

X

Und

erta

ke fe

asib

ility

stud

yX

Dev

elop

SBC

C st

rate

gy in

con

sulta

tion

with

key

sta

keho

lder

sX

Dev

elop

inno

vativ

e lo

w-c

ost

appr

oach

es in

clud

ing

the

use

of

mob

ile te

chno

logy

and

soc

ial m

edia

to

infl u

ence

ado

lesc

ent n

utrit

ion

beha

viou

rs

XX

X

Inte

rven

tion

1.2.

2:

Dev

elop

kno

wle

dge

prod

ucts

(IEC

/BCC

/ad

voca

cy m

ater

ial)

XX

PDD

, SU

N S

ecre

taria

t, M

oNH

SRC,

DoH

, DoE

, PH

ED (W

ASH

), D

oA, S

WD

, W

DD

PDD


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 1

: Cre

atio

n of

a s

usta

ined

ena

blin

g en

viro

nmen

t to

addr

ess

adol

esce

nt n

utri

tion

Sub-

stra

tegy

1.3

: Set

pol

icy

prio

ritie

s an

d re

sour

ce a

lloca

tions

for

adol

esce

nt n

utri

tion

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

1.3.

1:

Revi

ew a

nd re

fi ne

exis

ting

polic

ies

rela

ted

to fo

od, g

row

th a

nd

cons

umpt

ion

of a

gric

ultu

re, l

ives

tock

fi s

herie

s, A

AP, P

WD

and

env

ironm

ent

so a

s to

ens

ure

bette

r die

t qua

lity

and

impr

oved

acc

ess

to n

utrit

ious

food

s an

d di

scou

rage

con

sum

ptio

n of

low

-va

lue

food

s by

ado

lesc

ents

XX

XX

XG

aps

in e

xist

ing

polic

ies

iden

tifi e

d w

ith c

oncr

ete

reco

mm

enda

tions

AA

P se

ctor

sSt

eerin

g Co

mm

ittee

PD

D

Inte

rven

tion

1.3.

2:

Legi

slat

ions

on

fort

ifi ed

food

, foo

d sa

fety

and

sec

urity

XX

XX

New

/am

ende

d le

gisl

atio

ns a

vaila

ble

AAP,

PD

D, S

indh

Foo

d Au

thor

ityFo

od d

epar

tmen

t

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

1:Pr

ovid

e ad

ditio

nal m

icro

nutr

ient

s th

roug

h fo

rtifi

catio

n of

sta

ple

food

s,

targ

eted

sup

plem

enta

tion:

Whe

at: i

ron,

folic

aci

d, z

inc,

vita

min

B-

12O

il: v

itam

ins

A an

d D

Salt:

iodi

neIF

ABi

ofor

tifi c

atio

n of

see

ds

XX

XX

X%

of fl

our

mills

pro

duci

ng fo

rtifi

ed

fl our

(atta

)%

of o

il m

ills p

rodu

cing

fort

ifi ed

oil

and

ghee

%

of h

ouse

hold

s us

ing

iodi

zed

salt

% o

f ado

lesc

ent g

irls

(targ

eted

) re

ceiv

ing

IFA

supp

lem

enta

tion

AAP,

DoA

, Foo

d Fo

rtifi

catio

n Pr

ogra

mm

e,

Sind

h Fo

od A

utho

rity

Stee

ring

Com

mitt

ee P

&D

Prov

ide

wee

kly

IFA

supp

lem

ents

to

adol

esce

nts

XX

XX

X%

of a

dole

scen

t girl

s sc

reen

ed fo

r an

aem

ia

% o

f ana

emic

girl

s re

ceiv

ing

IFA

AAP,

DoH

(LH

W

Prog

ram

me,

hea

lth

faci

litie

s), D

oE

Stee

ring

Com

mitt

ee


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.1.

2:

Prev

ent a

dole

scen

t pre

gnan

cy

XX

XX

X#

of d

istr

icts

whe

re e

arly

mar

riage

la

w is

enf

orce

d %

of p

opul

atio

n aw

are

of e

arly

m

arria

ge le

gisl

atio

nTr

end

in e

arly

mar

riage

s (P

DH

S)

DoL

, PW

D, S

WD

, dis

tric

t ad

min

istr

atio

n D

eput

y Co

mm

issi

oner

s an

d di

stric

t law

en

forc

emen

t co

mm

ittee

und

er

sess

ions

judg

e

Inte

rven

tion

2.1.

3:

Prom

otin

g pr

e-co

ncep

tion

and

ante

nata

l nut

ritio

n (a

lread

y be

ing

impl

emen

ted

by L

HW

s)

XX

XX

X%

of a

dole

scen

t girl

s aw

are

of

bene

fi ts

of IF

A in

pre

-con

cept

ion

perio

d%

of a

dole

scen

t girl

s aw

are

of

bene

fi ts

of a

nten

atal

nut

ritio

n

AAP

Sect

or, D

oH (L

HW

Pr

ogra

mm

e), D

oE, m

edia

Stee

ring

Com

mitt

ee

Inte

rven

tion

2.1.

4:

Impl

emen

t ado

lesc

ent-f

riend

ly d

isea

se

prev

entio

n an

d m

anag

emen

t whi

ch

is s

ub-a

ge g

roup

spe

cifi c

thro

ugh

the

Adol

esce

nt H

ealth

and

Dev

elop

men

t St

rate

gy

XX

XX

% o

f ado

lesc

ent r

ecei

ving

dis

ease

m

anag

emen

t car

eAA

P, D

oH, P

eopl

e’s

Prim

ary

Hea

lthca

re

Initi

ativ

e, H

IS, M

ERF,

H

AND

S et

c

AAP

Inte

rven

tion

2.1.

5:

Build

cap

acity

of c

omm

unity

-bas

ed

wor

kers

(LH

Ws,

com

mun

ity m

idw

ives

, m

ale

and

fem

ale

FWAs

, FW

W, F

WC,

FT

O, s

ocia

l mob

ilizer

s) in

cou

nsel

ling

on

adol

esce

nt n

utrit

ion

XX

XX

# of

cap

acity

bui

ldin

g tr

aini

ngs

cond

ucte

dAA

P, D

oHAA

P

Revi

ew tr

aini

ng c

urric

ula

for

com

mun

ity-b

ased

wor

kers

XAA

PSt

eerin

g Co

mm

ittee

Revi

ew tr

aini

ng m

ater

ial o

n ad

oles

cent

nu

triti

onX

Revi

ew tr

aini

ng m

ater

ial f

or L

HW

s an

d co

mm

unity

mid

wiv

esX

Dev

elop

trai

ning

mat

eria

l in

Sind

hi

lang

uage

X


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.1

: Des

ign

and

impl

emen

t nut

ritio

n-sp

ecifi

c in

terv

entio

ns fo

r ad

oles

cent

s in

the

heal

th s

ecto

r

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Dev

elop

trai

ning

mat

eria

l for

po

pula

tion

wel

fare

sta

ff X

D

oH, P

WD

, AAP

, DoE

P&D

Trai

n m

aste

r tra

iner

s on

the

new

/re

vise

d tr

aini

ng m

anua

lX

Cond

uct t

rickl

edow

n tr

aini

ngs

XX

X

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nut

ritio

n-se

nsiti

ve in

terv

entio

ns fo

r ado

lesc

ents

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soc

ial

prot

ectio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

1: E

duca

tion

sect

orIn

terv

entio

n 2.

2.1.

1:

Prov

ide

acce

ss to

saf

e en

viro

nmen

t an

d hy

gien

e

XX

XX

XBa

sic

WAS

H a

nd h

ygie

ne s

ervi

ces

pack

age

prov

ided

AAP

WAS

H (S

aaf S

uthr

o Si

ndh)

, DoE

, PH

ED, W

ASH

pa

rtne

rs

AAP

Prov

ide

acce

ss to

saf

e dr

inki

ng w

ater

an

d ad

equa

te s

anita

tion

faci

litie

s in

sc

hool

s an

d m

adra

ssah

s

XX

XX

XAv

aila

bilit

y of

drin

king

wat

erAv

aila

bilit

y of

toile

tsD

oE, l

ocal

gov

ernm

ent,

PHED

, WAS

H p

artn

ers

AAP

Impl

emen

t hea

lth a

nd h

ygie

ne

(men

stru

al a

nd p

hysi

cal)

inte

rven

tions

XX

XX

XAv

aila

bilit

y of

sep

arat

e la

trin

es fo

r gi

rls a

nd b

oys

to e

nsur

e pr

ivac

y an

d hy

gien

e

DoE

, loc

al g

over

nmen

t, re

leva

nt p

artn

ers

AAP

Inte

rven

tion

2.2.

1.2:

Pr

omot

e ph

ysic

al a

ctiv

ityX

XX

XX

Man

dato

ry o

pen

area

for s

port

DoE

P&D

Inte

rven

tion

2.2.

1.3:

Pr

omot

e he

alth

y fo

od a

nd d

iets

at

scho

ol

XX

XX

XSi

ndh

Food

Aut

horit

y,

food

dep

artm

ent

Food

dep

artm

ent,

Stee

ring

Com

mitt

ee


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nut

ritio

n-se

nsiti

ve in

terv

entio

ns fo

r ado

lesc

ents

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soc

ial

prot

ectio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Laun

ch h

ealth

y sc

hool

mea

l ini

tiativ

eX

XX

XX

Prov

isio

n of

nut

ritio

nally

enr

iche

d ba

lanc

ed m

eals

Avai

labi

lity

of n

utrit

ious

mea

ls in

sc

hool

can

teen

Sind

h Fo

od A

utho

rity,

Pr

ogra

mm

e fo

r Im

prov

ed

Nut

ritio

n

PDD

Ban

fi zzy

drin

ks in

sch

ool v

icin

ity b

y sc

hool

adm

inis

trat

ion

XX

XX

XBa

n on

the

sale

of s

oft d

rinks

, jun

k fo

ods,

cha

lia, s

upar

i, ch

oora

n et

c in

sc

hool

can

teen

s an

d in

the

vici

nity

of

scho

ols

Sind

h Fo

od A

utho

rity,

D

oE, P

rivat

e Sc

hool

As

soci

atio

ns

Dep

uty

Com

mis

sion

er

Inte

rven

tion

2.2.

1.4:

D

evel

op c

ash

ince

ntiv

es fo

r pos

itive

be

havi

ours

Prov

ide

cond

ition

al c

ash

tran

sfer

s/

food

vou

cher

s to

incr

ease

sec

onda

ry

scho

ol e

nrol

men

t and

atte

ndan

ce in

po

or h

ouse

hold

s

XX

XX

XIn

itiat

ion

of c

ondi

tiona

l cas

h tr

ansf

ers/

food

vou

cher

sD

oE, p

rogr

amm

atic

pa

rtne

rs

Inte

rven

tion

2.2.

1.5:

Co

nduc

t hea

lthy

food

s pr

omot

ion

cam

paig

n

XX

XX

XN

utrit

ion

prom

otio

n ac

tiviti

es

DoE

, DoH

, AAP

D

oE, P

DD

Inte

rven

tion

2.2.

1.6:

In

clud

e m

essa

ges

on h

ealth

y fo

od

in c

urric

ula

for m

adra

ssah

s, fo

rmal

, no

nfor

mal

and

info

rmal

sch

ools

Revi

ew c

urric

ula

and

prov

ide

reco

mm

enda

tions

on

adol

esce

nt

nutr

ition

XN

utrit

ion

curr

icul

um d

evel

oped

DoE

, AAP

Stee

ring

Com

mitt

ee

Incl

ude

reco

mm

enda

tions

on

adol

esce

nt n

utrit

ion

in c

urric

ula

of

scho

ols

and

mad

rass

ahs

XX

Med

ium

-spe

cifi c

cur

ricul

a w

ith

age-

brac

ket s

peci

fi c m

essa

ges

and

appr

oach

es fo

r hea

lth a

nd n

utrit

ion

DoE

, AAP

Stee

ring

Com

mitt

ee


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nut

ritio

n-se

nsiti

ve in

terv

entio

ns fo

r ado

lesc

ents

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soc

ial

prot

ectio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.2.

1.7:

D

evel

op fo

od a

nd n

utrit

ion

educ

atio

n an

d SB

CC a

ctiv

ities

for a

dole

scen

ts a

t m

adra

ssah

s, fo

rmal

, non

-form

al a

nd

info

rmal

sch

ools

and

in c

omm

uniti

es

XX

XX

XCo

mm

unity

reso

urce

per

sons

co

mm

unity

hea

lth w

orke

rs, i

nfor

mal

sc

hool

s en

gage

d to

pro

mot

e nu

triti

on a

war

enes

s

AAP

sect

ors

AAP

Secr

etar

iat

Build

cap

acity

of t

each

ers

(incl

udin

g m

adra

ssah

s, fo

rmal

, non

-form

al a

nd

info

rmal

sch

ools

)and

agr

icul

tura

l ex

tens

ion

wor

kers

on

food

and

nu

triti

on a

nd o

n di

etar

y gu

idel

ines

XX

XX

X#

of te

ache

rs tr

aine

d on

nut

ritio

n aw

aren

ess

# of

par

ents

trai

ned

on n

utrit

ion

awar

enes

s #

of lo

cal g

over

nmen

t em

ploy

ees

trai

ned

on n

utrit

ion

awar

enes

s #

of a

gric

ultu

re e

xten

sion

wor

kers

tr

aine

d on

nut

ritio

n aw

aren

ess

AAP,

DoE

St

eerin

g Co

mm

ittee

2.2.

2: A

gric

ultu

re s

ecto

r In

terv

entio

n 2.

2.2.

1:

Enga

ge in

ski

lls d

evel

opm

ent f

or fo

od

proc

essi

ng, v

alue

add

ition

(to

decr

ease

po

stha

rves

t los

ses)

to fa

rmer

s

X#

of a

dole

scen

t tra

inee

s tr

aine

d AA

P, D

oA

DoA

Inte

rven

tion

2.2.

2.2:

Pr

omot

e ki

tche

n ga

rden

ing

of

mic

ronu

trie

nt-r

ich

vege

tabl

es a

nd ru

ral

poul

try

rear

ing

X

Prov

ide

cond

ition

al c

ash

tran

sfer

for

setti

ng u

p ki

tche

n ga

rden

sX

# of

ben

efi c

iarie

s AA

P (a

lread

y do

ing

this

th

roug

h D

oA)

AAP

Inte

rven

tion

2.2.

2.3:

Pr

ogra

mm

atic

inte

rven

tions

for

prev

entio

n of

food

, wat

er a

nd v

ecto

r-bo

rn d

isea

ses

XX

XX

# of

ben

efi c

iarie

s D

oH, l

ocal

gov

ernm

ent

DG

Hea

lth


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.2

: Des

ign

and

impl

emen

t nut

ritio

n-se

nsiti

ve in

terv

entio

ns fo

r ado

lesc

ents

in n

on-h

ealth

sec

tors

(edu

catio

n, a

gric

ultu

re, W

ASH

and

soc

ial

prot

ectio

n)

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

2.2.

3: W

ASH

sec

tor

Inte

rven

tion

2.2.

3.1:

Aw

aren

ess

gene

ratio

n on

per

sona

l hy

gien

e an

d cl

eanl

ines

s of

the

prem

ises

XX

XX

XAc

hiev

emen

t aga

inst

ope

n-de

feca

tion

free

targ

ets

Wor

ld B

ank

proj

ects

(S

indh

Enh

anci

ng

Resp

onse

for R

educ

tion

of S

tunt

ing

Proj

ect;

Saaf

Su

thro

Sin

dh)

AAP

(WAS

H)

Inte

rven

tion

2.2.

3.2:

Pr

ovid

e sa

fe w

ater

, (pe

rson

al) h

ygie

ne

and

sani

tatio

n fa

cilit

ies

in s

choo

ls a

nd

othe

r pub

lic in

stitu

tions

, ens

urin

g ac

cess

to th

e ne

arby

saf

e, s

epar

ate

and

priv

ate

sani

tatio

n fa

cilit

ies

esse

ntia

l fo

r men

stru

al h

ygie

ne m

anag

emen

t, di

gnity

, com

fort

and

hea

lth o

f ad

oles

cent

girl

s

XX

XX

XD

emon

stra

tions

, aw

aren

ess

mes

sage

s, m

onito

ring

of w

ell-

equi

pped

was

hroo

ms

DoE

, Wat

er a

nd S

anita

tion

Auth

ority

, mun

icip

aliti

esD

oE, W

ASA,

m

unic

ipal

ities

2.2.

4: S

ocia

l Pro

tect

ion

sect

or

Inte

rven

tion

2.2.

4.1:

D

esig

n an

d pi

lot s

ocia

l pro

tect

ion

inte

rven

tions

to e

nhan

ce a

cces

s of

m

argi

naliz

ed a

dole

scen

ts to

qua

lity

food

XX

XX

PRSP

PDD

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 2

: Pro

gram

mat

ic r

espo

nse

to a

dole

scen

t nut

ritio

n ac

ross

sec

tors

Sub-

stra

tegy

2.3

: Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for

mar

gina

lized

ado

lesc

ents

and

thos

e w

ith s

peci

aliz

ed n

eeds

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

2.3.

1:

Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for t

rans

gend

er a

dole

scen

ts

XX

XX

To b

e de

term

ined

onc

e in

terv

entio

ns

are

defi n

ed

SWD

SWD


Inte

rven

tion

2.3.

2:

Des

ign

and

impl

emen

t str

ateg

ies

for

adol

esce

nts

in m

igra

nt p

opul

atio

ns

XX

XX

To b

e de

term

ined

onc

e in

terv

entio

ns

are

defi n

ed

Emer

genc

y O

pera

tions

Ce

ntre

sD

eput

y co

mm

issi

oner

s

Inte

rven

tion

2.3.

3:

Des

ign

and

impl

emen

t nut

ritio

n st

rate

gies

for H

IV-p

ositi

ve a

dole

scen

ts

XX

XX

To b

e de

term

ined

onc

e in

terv

entio

ns

are

defi n

ed

PDD

, HIV

Pro

gram

me

Dire

ctor

-gen

eral

H

ealth

Inte

rven

tion

2.3.

4:

Des

ign

and

impl

emen

t ado

lesc

ent

nutr

ition

str

ateg

ies

in d

isas

ters

and

du

ring

hum

anita

rian

resp

onse

XX

XX

To b

e de

term

ined

onc

e in

terv

entio

ns

are

defi n

ed

AAP

Hea

lth, U

NIC

EF,

Wor

ld F

ood

Prog

ram

me,

Pr

ovin

cial

Dis

aste

r M

anag

emen

t Aut

horit

y,

dist

rict d

isas

ter

man

agem

ent a

utho

ritie

s

AAP

Secr

etar

iat

Inte

rven

tion

2.3.

5:

Des

ign

and

impl

emen

t ado

lesc

ent

nutr

ition

str

ateg

ies

targ

etin

g ad

oles

cent

s w

ith d

isab

ilitie

s

XX

XX

To b

e de

term

ined

onc

e in

terv

entio

ns

are

defi n

ed

SWD

SWD

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

1:

Asse

ss a

nd a

djus

t rou

tine

info

rmat

ion

syst

ems

to c

aptu

re a

dole

scen

t nu

triti

on a

spec

ts

Revi

sit D

HIS

to a

sses

s th

e ex

tent

to

whi

ch it

cap

ture

s ag

e an

d se

x-di

sagg

rega

ted

data

on

nutr

ition

sta

tus,

an

d pr

even

tive

and

cura

tive

actio

ns

take

n

XX

X#

of k

ey a

dole

scen

t ind

icat

ors

inco

rpor

ated

in ro

utin

e D

HIS

# of

ado

lesc

ent n

utrit

ion

indi

cato

rs

inco

rpor

ated

in N

MIS

DH

IS, A

AP (m

anag

emen

t in

form

atio

n sy

stem

)D

oH, M

oNH

SRC,

AA

P

Inco

rpor

ate

reco

mm

ende

d ch

ange

s in

th

e dr

aft r

ecor

ding

and

repo

rtin

g to

ols

and

pilo

t the

initi

ativ

e

X


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Base

d on

pilo

t exe

rcis

e, re

com

men

d ch

ange

s in

the

tool

s, re

port

ing

and

feed

back

mec

hani

sm

X

Initi

ate

data

col

lect

ion

and

repo

rtin

g on

re

vise

d to

ols

XX

XX

Rout

ine

data

col

lect

ion

and

repo

rtin

g in

clud

es a

dole

scen

t nut

ritio

n

Inte

rven

tion

3.1.

2:

Perio

dica

lly s

cree

n st

uden

ts a

t m

adra

ssah

s, fo

rmal

, non

-form

al a

nd

info

rmal

sch

ools

to a

sses

s nu

triti

on

stat

us

XX

XX

X#

of s

tude

nts

scre

ened

for n

utrit

ion

stat

us

AAP

(edu

catio

n), D

oH, D

oEAA

P (e

duca

tion)

Inte

rven

tion

3.1.

3:

Cond

uct c

ontin

uous

mon

itorin

g an

d ev

alua

tion

of la

rge-

scal

e su

stai

nabl

e se

rvic

es a

ppro

pria

te fo

r all

grou

ps o

f ad

oles

cent

s in

clud

ing

thos

e re

late

d to

the

prom

otio

n of

hea

lthy

and

nutr

itiou

s di

ets

and

mic

ronu

trie

nt

supp

lem

enta

tion

XX

XX

X%

of a

dole

scen

t boy

s an

d gi

rls

prov

ided

sup

plem

enta

tion

in

scho

ols/

col

lege

s%

of a

dole

scen

t boy

s an

d gi

rls

prov

ided

sup

plem

enta

tion

in

com

mun

ities

AAP

sect

ors,

DoH

(L

HW

Pro

gram

me)

, co

mm

unity

-bas

ed a

nd

rura

l dev

elop

men

t or

gani

zatio

ns, C

hild

Pr

otec

tion

Uni

ts

voca

tiona

l ins

titut

es

DoH

, SW

D, D

oE

Inte

rven

tion

3.1.

4:

In re

leva

nt s

urve

ys in

clud

e co

ntex

t-sp

ecifi

c da

ta o

n ad

oles

cent

s di

sagg

rega

ted

by a

ge, s

ex, i

ncom

e,

educ

atio

n an

d ge

ogra

phy

on d

ieta

ry

patte

rns

and

eatin

g ha

bits

(NN

S) a

nd

on u

niqu

e nu

triti

onal

issu

es a

nd m

ajor

de

term

inan

ts

XX

XX

XD

ata

gath

ered

on

boys

and

girl

s ag

ed

10–1

4, b

oys

and

girls

age

d 15

–19,

nu

triti

onal

sta

tus,

(ant

hrop

omet

ry),

diet

ary

dive

rsity

and

repo

rted

in N

NS,

PD

HS,

HIE

S et

c.

NIP

SG

over

nmen

t of

Paki

stan


PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.1

: Mon

itori

ng, e

valu

atio

n, s

urve

illan

ce a

nd a

ccou

ntab

ility

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.1.

5:

Asse

ss b

ehav

iour

al p

rofi l

es, d

ieta

ry

patte

rns,

cos

t of t

he d

iet a

nd m

ajor

in

fl uen

cers

of a

dole

scen

ts in

the

cont

ext o

f the

ir so

cial

and

psy

chos

ocia

l de

velo

pmen

t in

orde

r to

info

rm

prog

ram

mes

and

pol

icym

akin

g

XX

XX

X#

of re

sear

ch a

nd p

olic

y pa

pers

pr

epar

ed o

n di

et a

nd b

ehav

iour

D

oH, n

utrit

ion

rese

arch

ers,

aca

dem

ia,

deve

lopm

ent p

artn

ers

Gov

ernm

ent o

f Pa

kist

an

Inte

rven

tion

3.1.

6:

Cond

uct f

ollo

w-u

p re

sear

ch o

n im

plem

enta

tion

to id

entif

y in

nova

tions

an

d de

liver

y pl

atfo

rms

that

reac

h an

d aff

ect

ado

lesc

ents

in o

rder

to a

chie

ve

scal

e-up

, hea

lth s

yste

ms

inte

grat

ion

and

sust

aina

bilit

y

X#

of in

nova

tions

iden

tifi e

d an

d in

corp

orat

ed

PDD

Stee

ring

Com

mitt

ee

PRO

VIN

CIAL

OPE

RATI

ON

AL P

LAN

: SIN

DH

Stra

tegi

c ar

ea 3

: Con

tinue

d ev

iden

ce g

ener

atio

n fo

r gu

idan

ce, l

earn

ing

and

acco

unta

bilit

y

Sub-

stra

tegy

3.2

: Eff

ectiv

e kn

owle

dge

man

agem

ent a

nd r

efl e

ctin

g on

wha

t wor

ks

Inte

rven

tion/

Activ

ityTi

mel

ine

Indi

cato

rsSt

akeh

olde

rsAc

coun

tabi

lity

2020

2021

2022

2023

2024

Inte

rven

tion

3.2.

1:

Esta

blis

h a

digi

tal d

ashb

oard

for

know

ledg

e m

anag

emen

t at p

rovi

ncia

l le

vel

XX

AAP

Secr

etar

iat

Stee

ring

Com

mitt

ee


Annexes


Summary of recommendations on the design of nutrition-specific interventions in the WHO and MoNHSRC (draft) “Pakistan adolescent nutrition and supplementation guidelines”.

10–14 year age group 15–19 year age groupBoys Girls Non-pregnant girls Pregnant girls

- Fill the evidence gap on nutrition status in national and regional surveys.

- Fill the evidence gap on nutrition status in national and regional surveys.

- Organize nutrition awareness sessions on appropriate diet and optimum nutrient requirements, with culturally-sensitive IEC materials for at-school and out-of-school boys.

- Organize counselling and awareness sessions on dietary diversity, balanced diet and personal hygiene.

- Organize nutrition awareness and counselling sessions on appropriate diet and optimum nutrient requirements, dietary diversity, balanced diet, and personal hygiene, with culturally-sensitive IEC material for at-school and out-of-school girls.

- Conduct awareness sessions on early marriage and early pregnancy, dietary diversity, balanced diet and personal hygiene.

- Provide information on specialized topics: IYCF, menstrual hygiene management and nutrition during pregnancy and lactation.

- Provide counselling on healthy eating and keeping physically active during pregnancy to stay healthy and prevent excessive weight gain.

- Enhance utilization of antenatal and postnatal care services, promote adolescent nutrition, breastfeeding, complementary feeding and routine immunization services.

ADOLESCENT NUTRITION AND SUPPLEMENTATION GUIDELINES

Annex 1



- Hold quarterly screening camps for adolescent boys in schools and communities to assess anthropometry and anaemia status.

- Hold frequent screening camps for adolescent girls in schools, hospitals and communities to assess anthropometry and anaemia status.

- Hold frequent screening camps for adolescent girls in schools, hospitals and communities to assess anthropometry and anaemia status.

- Track anthropometric assessments for maternal nutrition during and after pregnancy through antenatal and postnatal clinics.

- Conduct biochemical tests for anaemia and other associated conditions at antenatal and postnatal care visits.

- Regulate school/college meals through the Food Safety Authorities; prohibit unhealthy snacks, energy drinks and sale of soft drinks on school/college premises.

- Regulate marketing of unhealthy foods and beverages such as foods high in saturated fats, trans-fatty acids, free sugars or salt.







- Provide preventive chemotherapy (deworming).



- Provide preventive chemotherapy (deworming) after the first trimester.



- Provide intermittent IFA supplementation for boys in areas where anaemia prevalence is high

- Provide intermittent (weekly) IFA supplementation

- Provide daily IFA as a public health intervention for menstruating adolescent girls in settings where anaemia is highly prevalent (40% or higher)

- Daily IFA supplementation

- Oral iron supplementation, +/- folic acid supplementation, to postpartum women for 6–12 weeks following delivery in settings where gestational anaemia is of public health concern.

- Vitamin A supplementation (for pregnant women (not recommended in first trimester) only in areas where deficiency is a severe public health concern.

- Daily calcium, vitamin D (where deficiency is documented) supplementation as recommended by WHO/Food and Agriculture Organization for pregnant women.

- Provide multi-micronutrient tablets to underweight adolescent girls.

- Provide multi-micronutrient tablets to underweight non-pregnant adolescents (one tablet per day for three months).

- Provide multi-micronutrient tablets during pregnancy and lactation to underweight women (one tablet per day).


MANAGEMENT INDICATORS

Annex 2

Indicators should be reviewed annually.

Yes In Progress Planned NoDomain 1 : Evidence on adolescents is generated

1.1 Most recent SitAn and/or other countrywide/provincewide assessment includes a review of adolescents/youth vulnerabilities, opportunities and challenges

1.2 Adolescent-focused research/analysis/survey/programme evaluation conducted during the past three years

Domain 2: Results are defined, monitored and documented2.1 Adolescent-related results (outcome and/or output) included in the results framework

2.2 Age-disaggregated adolescent-specific indicators are included in the results matrix

2.3 Adolescent-related indicators included in the results matrix are sex-disaggregated

2.4 Monitoring and/or evaluation framework is developed for adolescent interventions, or adolescent components are integrated into sectoral monitoring frameworks

2.5 Adolescents are engaged in planning, monitoring and evaluation

Domain 3: National leadership is reflected in policies, plans and budgets3.1 National/provincial adolescent policy exists (or adolescents are explicitly addressed in the child or youth policy)

3.2 National/provincial adolescent policy is implemented with appropriate budget


3.3 Adolescent priorities clearly reflected in national/provincial sectoral policies and are operational with appropriate budget

Domain 4: External and internal coordination mechanisms to review and monitor implementation of plans4.1 National/provincial taskforce/coordination mechanisms established and operational at central level to establish and monitor achievement of adolescent priorities

4.2 Taskforce/ coordination mechanisms established and operational at decentralized level to establish and monitor achievement of adolescent priorities

4.3 Taskforce/coordination mechanisms established and operational to coordinate adolescent programmes and monitor achievement of adolescent priorities in humanitarian and/or development contexts

4.4 Coordination mechanism established and operational to monitor adolescent results

Domain 5: Internal resources secured to support adolescent programming5.1 Proposals to mobilize funds for adolescent work (and/or fundraising for adolescent interventions) mainstreamed in sectoral funding proposal developed and disseminated

Adapted from: UNICEF Programme guidance for the second decade: Programming with and for adolescents (2018)

contents...chapter 2: adolescent nutrition in pakistan 20 2.1 epidemiological and demographic status...

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