Seven years after nutrition survey, Pakistan still lacks dedicated funding line

ISLAMABAD: A Dawn analysis has argued that Pakistan’s 2018 National Nutrition Survey produced the country’s most extensive nutrition dataset to date, but the findings were not matched by a dedicated budgetary response in the years that followed.

The article says the fifth National Nutrition Survey since 1965 was carried out by the Ministry of National Health Services in collaboration with Aga Khan University and Unicef. It covered more than 115,600 households and, for the first time, provided district-level data as well as information on adolescents and water quality. The report notes that the survey has since been used widely in policymaking and cited in international forums, while also being incorporated into global nutrition dashboards and at least four major national strategy documents.

What the 2018 survey found

According to the survey figures cited in the article, four in 10 children under the age of five were stunted, meaning around 12 million children were living with chronic malnutrition. Wasting stood at 17.7 per cent, which the article describes as the highest level recorded in Pakistan’s history and above the World Health Organisation’s 15pc emergency threshold. It also states that more than half of children aged six to 59 months were anaemic.

Among women of reproductive age, 42.6pc were anaemic, while 46.9pc of pregnant women were iron-deficient, the article says. It adds that 81.2pc of pregnant women were deficient in vitamin D. At the same time, the survey pointed to rising overnutrition, with overweight prevalence nearly doubling in seven years and 13.9pc of women of reproductive age classified as obese.

The article further says the 2018 survey was the first to show the simultaneous burden of stunting and wasting in children, affecting 5.9pc of under-fives, mostly in the south of the country. It also found boys fared worse than girls, urban children were more affected by wasting and stunting than often assumed, and 58pc of household water supplies were contaminated with coliform bacteria.

Budget allocations and nutrition funding

The article compares these findings with federal spending patterns. It says Pakistan’s federal budget for fiscal year 2025-26 was Rs17.573 trillion, of which nearly Rs8.2tr went to debt servicing. Defence was allocated Rs2.55tr, up 20pc, while the Benazir Income Support Programme received Rs716 billion after a 20-21pc increase, covering 10 million families.

Within this framework, the article says the health budget for 2025-26 was set at Rs46.1bn, down 16pc from Rs54.87bn a year earlier. It adds that no new health schemes were included in the Public Sector Development Programme for that fiscal year. According to the article, nutrition does not appear as a separate line item in the federal budget and is instead folded into health, social protection and agriculture, making it difficult to track spending and accountability.

The piece states that the estimated budget needed for nutrition between 2023 and 2030 is Rs1.79tr, with Rs227.9bn required for the current fiscal year alone. Against that requirement, it says, actual allocations amount to only a fraction and are declining.

Conditions since 2018

The article says conditions have deteriorated since the survey was published. It cites the 2022 floods as having disrupted nutrition services in 84 affected districts at a time when millions of women and children were especially vulnerable. It also refers to World Bank projections that Pakistan’s poverty rate will remain between 40pc and 42.4pc, with another 1.9 million people expected to fall below the poverty line.

According to the article, more than two-thirds of the population cannot afford a nutritionally adequate daily diet. It says climate-related shocks including floods, heatwaves and agricultural disruption are worsening the nutrition crisis by reducing food availability, raising prices and damaging supply chains for micronutrient-rich foods in rural and peri-urban areas.

The article also cites Nutrition International’s Cost of Inaction Tool, which estimates that Pakistan loses at least $17 billion annually, or about Rs4.7tr to Rs4.8tr, because of undernutrition through lower productivity, higher healthcare costs, weaker cognitive development and premature mortality. It further refers to the World Bank’s 2024 Nutrition Investment Framework, which estimates that every dollar spent on proven nutrition interventions yields about $23 in economic returns.

According to those estimates cited in the article, meeting the 2030 global target for reducing stunting alone would prevent 855,000 cases each year, avert 48,000 deaths, and preserve 8.8 million IQ points and 1.4 million school years, with annual economic savings of $6.6bn.