Accelerating nutrition financing at the provincial level in Pakistan

Despite global gains in addressing malnutrition in the 21st century, some malnutrition challenges in Pakistan remain entrenched. Although the wasting burden has decreased from 14.9% in 2011 to 7.1% in 2018, the percentage of child stunting has been consistently around 40% since 2000. The financial impact on the country is significant – some estimates indicate that malnutrition costs Pakistan’s economy up to $7.6 billion USD every year, primarily via lost workforce due to malnutrition-related death and cognitive deficits.

The Pakistan Scaling Up Nutrition (SUN) Movement secretariat, located in the Ministry of Planning, Development and Special Initiatives (MOPDSI), is responsible for government stewardship of nutrition programming. In recent years, the Government of Pakistan has expressed a strong commitment to addressing malnutrition in the country with the implementation of the Benazir Income Support Programme Nashonuma, which provides support such as malnutrition prevention products to high risk mothers and children, and the Pakistan Nutrition Initiative (PANI) a multisectoral policy passed in 2024 with the goal of providing more coordinated support to nutrition programs in high-burden districts.

To better understand the challenges and opportunities for nutrition financing in Pakistan, SUN Pakistan convened a two-day workshop on “Pathways to Sustainable Nutrition Financing.” To support SUN Pakistan, R4D’s Market Shaping Practice and the Finance Capacity Development Platform (FCDP) for SUN countries teamed up with the Centre for Economic Research Pakistan (CERP) to support this workshop. R4D provided technical assistance on assessing the landscape for nutrition financing, identifying key bottlenecks, prioritizing next steps to strengthen systems for nutrition financing and exploring options for increased resource mobilization.

More than 60 participants, including government representatives from all four provinces and both administrative territories, federal representatives from the MOPDSI, as well as the Ministry of Finance and representatives from key implementing partners in the country such as UNICEF and the World Food Programme, gathered for this landmark workshop on nutrition financing held in Islamabad. In geographic breakout groups, R4D, CERP and SUN facilitators led participants through discussions to understand the challenges provinces face when it comes to financing nutrition and solutions they believe to be impactful in their specific province.

Over the course of the workshop, it became clear that in Pakistan, provinces are the key to accelerating nutrition financing in the country in alignment with federal initiatives.

Provinces identified several key challenges that must be addressed to improve nutrition financing:

• Lack of buy-in from key decision makers, such as parliamentarians, has stymied further investment on the provincial level. Across provinces, stakeholders noted that key policymakers often prioritized — or even reallocated — funds originally earmarked for nutrition for other, more visible development projects, like infrastructure or health services included in Universal Health Coverage (UHC). Nutrition was only reliably prioritized by policymakers in short-term humanitarian crises.
• Fragmented multisectoral coordination and weak governance means there is not an enabling environment for sustained and improved nutrition financing. Nutrition programming is implemented across many sectors at the provincial level, but there is often minimal, if any, coordination between them. This lack of coordination hinders collaborative planning and budgeting and can even lead to duplicative efforts.
• There is insufficient resource mobilization for nutrition from both domestic and external sources. The causes for insufficient resource mobilization vary from province to province. Some reasons include under-prioritization by policymakers, lack of coordinated donor engagement and funding disbursement delays.
• Budgeting and coordination challenges underly program implementation challenges, which are exacerbated by a lack of monitoring and evaluation for nutrition financing. Some provinces noted that fund releases were often delayed due to political challenges, or that key administrative personnel were frequently transferred. These difficulties were exacerbated by overall weak monitoring and evaluation (M&E) systems, thereby preventing effective implementation tracking.

Provinces also co-developed solutions to address these identified challenges:

• Support politician and policymaker sensitization by nutrition experts to improve buy-in. Although the need for nutrition investment has been well articulated in global and federal conversations, more targeted efforts to highlight the positive impact of nutrition investments on the provincial level can increase political will.
• Standardize and operationalize coordination and governance of nutrition programming. Establishing regular cross-sectoral coordination meetings and supporting multisectoral budget planning can help ensure consistent coordination and governance, and address fragmentation challenges.
• Explore innovative financing opportunities and coordinate efforts to secure external financing. While financial constraints are very difficult to surmount, innovative financing, such as exploring efforts to leverage financing from the Pakistani diaspora and private industry, and better coordination and planning for external financing, can help increase the financial envelope for nutrition.
• Institute nutrition budget tracking to strengthen M&E and identify more specific causes of implementation challenges. SUN PK has led efforts to track budgeting for nutrition across sectors but similarly tracking expenditures remains undone. By expanding their efforts to track expenditures, policymakers can better understand gaps in nutrition financing and implementation, and work to address them in a more granular and impactful manner.

Thanks to strong government stewardship by SUN Pakistan and a consortium of technical expertise across R4D teams and partners, clear actions are emerging on how to improve nutrition financing on the country- and province-level in Pakistan. SUN Pakistan’s province focal persons are now taking forward solutions with targeted support where needed.

To learn more about how the FCDP is providing technical assistance to improve country-led nutrition financing, see here.