Pakistan

As part of efforts to help government stakeholders understand and make strides against malnutrition, the Exemplars team conducted research to tease out drivers of subnational variation.

Contextually, from 2001 to 2018, Pakistan’s per capita gross domestic product (GDP) increased by 45 percent, from US$828 to US$1,198. However, over the same period, stunting remained relatively stagnant at the national level, falling just over a percentage point from 41.5 to 40.2 percent.

This broad pattern of relatively impressive economic growth alongside lagging human development indicators has been seen throughout Pakistan’s almost 75-year history. Because of this, and the country’s vast potential—as well as a series of recent reforms designed to tap into that potential—research aimed to look closely at the period between 2001–2018 to understand what can be done to turn the tide on nutrition and other human development priorities.

Exemplars’ research was designed to help answer two primary questions:

• What conclusions, if any, can be drawn about 2001–2011, where stunting rates persisted and 2011–2018, where stunting rates fell?

• Do differences between provinces and districts reveal lessons about best practices and key policies that could have contributed to change?

Completion of this research provided a large body of evidence to analyze and build better understandings of what has occurred in Pakistan. Post the triangulation of quantitative, qualitative, and policy analyses (and in concordance with in-country experts), the following set of explanations emerged.

Takeaways at the National and Provincial level

As the research makes clear, maternal and child undernutrition are multifactorial and complex, and addressing them requires action across multiple systems, including health, education, sanitation, food, and social protection. While data on key determinants are highlighted throughout the case report, the framework below helps organize the key takeaways and highlight top priorities for the future: