The Challenges and Constraints of Child Health and Nutrition in Pakistan in the Context of Poverty: A Qualitative Content Analysis with the Focus of Balochistan

Abstract

Child survival and nutrition are still one of the chronic public-health and human-development issues in Pakistan. In spite of the improvement in mortality over the last 30 years, the country still has a high burden of preventable deaths, malnutrition (both chronic and acute), maternal ill health, food insecurity, poverty and inequitable access to essential health services. Furthermore, the challenges are especially high in Balochistan due to its geographical difficulties, lack of skilled health workers, lack of institutional capacity, lack of physical infrastructure, and the fact that the population is widespread. This study explores the systemic factors that impact child health and nutrition in Pakistan, especially in Balochistan, as well as the interplay of poverty, population dynamics, maternal health and the performance of the health system. The qualitative content-analysis method was used. The documentary corpus comprised the National Integrated Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition Implementation Strategy and Action Plan 2016–2020, the corresponding province Balochistan strategy, the Demographic and nutrition surveys, Multiple Indicator Cluster Survey data, government reports and United Nations reports, as well as peer-reviewed academic literature. Systems thinking, the World Health Organization (WHO) framework of a health system and United Nations Children's Fund (UNICEF) conceptual framework on maternal and child nutrition guided the analysis. The results show that child health and nutrition outcomes are the product of interdependent constraints, rather than discrete deficiencies. There are several major themes: the links between poverty, high fertility, food insecurity, maternal deprivation and poor child development are mutually reinforcing; there is chronic under nutrition; child survival is not equal; there is low and delayed financing; there are shortages and maldistribution of skilled human resources; governance and information systems are fragmented; and sociocultural and geographical barriers to service use. These interactions are illustrated by the nutrition indicators of children under five in Balochistan: 46.6% stunting in the 2018 National Nutrition Survey, 18.9% wasting in the same survey and 31.0% children being underweight in the 2019-2020 Balochistan Multiple Indicator Cluster Survey (MICS). The paper argues that efforts to reduce child mortality and malnutrition must go beyond isolated programmes to work towards an integrated approach involving primary care, nutrition sensitive social policy and strengthening institutional capacity in the provinces.