Background and Rationale of TORs

The Government of Pakistan has committed to SDGs and transforming the nation into a hunger-free country by
2030. This commitment builds upon the national objectives of increasing food security, access, affordability and
self-sufficiency for all sub-populations in rural and urban areas (Vision 2030, Reaching the 5Es).

Pakistan, is classified as a low-middle-income country (LMIC) with the sixth-largest population globally, high
fertility rates compounded with the triple dilemma of malnutrition, stunting and obesity. With 64% of Pakistan’s
population below age 30 years, the rates of stunting (40%), food insecurity (37%), moderate anemia (48%), and
obesity 9.5% (data from National Nutrition Survey (NNS) 2018) raises significant concerns for the long term
implications of lost human capital for the country. Global evidence unequivocally shows the detrimental (at times
irreversible) effects of malnutrition and stunting in low educational attainment, lost IQ points, learning disabilities,
disease susceptibility, mortality, and lost earning potential over a lifetime.

The situation is further complicated by distinct nutritional outcomes i.e. stunting/underweight along with
overweight/obesity in certain population sub-groups due to maldistribution of food resources (food insecurity),
unhealthy dietary practices, poor awareness of nutritious diets, adverse gender practices, financial deprivations,
low physical activity and space availability. The NNS 2018 shows that socio-economically marginalized
adolescents bear the burden of malnutrition and obesity during periods of rapid growth with higher levels of
micro-nutrient deficiencies and are often neglected in coverage of essential services. For example, boys and
girls both require essential macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins and
minerals) for healthy growth spurts during puberty. Girls have additional nutritional requirements, especially as
they begin menstruating. In many households and local environments availability and access to nutritious food
becomes a challenge.

In response to these development challenges, the Government of Pakistan along with UNICEF Pakistan has
targeted adolescents as an often missed group in launching the Pakistan Adolescent Nutrition Strategy (PANS)
in October 2020. PANS serves as a critical example of how political will can be translated into effective policy
and operational planning. This strategy provides a framework for health and social system actors to understand
their roles in preventing and treating adolescent malnutrition, addressing a critical health and nutrition issue
among this age group. UNICEF Pakistan is seeking an organization (current assignment) to explore barriers and
potential actions that would improve adolescent malnutrition. Key Objectives are:

I. Explore adolescent nutritional status and coverage of interventions in line with the existing policies and
programmatic documents on unhealthy foods, practices and guidelines
II. Identify key stakeholders and hold national/provincial consultations engaging marginalized groups,
organizations, transgender, women activists, young people, schools and other influencing drivers of
malnutrition and obesity in different communities across Pakistan.
III. Dialogue and in-depth interviews with policy makers on food regulations, guidelines and interventions at the
national and provincial levels. Dialogue with key caregivers, parents on challenges of access, affordability,
barriers that hold back marginalized and gendered young people and girls in particular from healthy nutrition
and information.

This collected information will be compiled into a series a Final report with sub-reports using the Innocenti
Framework’s drivers and determinant differentiation.
 Adolescent Malnutrition Using the Innocenti Framework (Figure 1)

The Innocenti Framework helps understand the different causes of malnutrition in children and adolescents using
a “food system approach”. The strength of the Framework is that its disaggregated the drivers into 5

main areas (Demographic, Socio-Cultural, Political-Economic, Technology and Biophysical Environment) with 4
main determinants namely Food Supply Chain, External Food Environment, Personal Food Environment and
Behaviors of Caregivers etc. This allows potential public-private and research interventions and solutions to be
targeted at all levels of key stakeholders and players. Using this Framework the Research and Development
Solutions (RADS) research team will explore in depth the multi-dimensional barriers that are leading to
compromised nutritional outcomes in adolescents.