Populations living in remote and hard-to-reach areas continue to face challenges in accessing health facilities.
- Even mobile services are limited, and community-based referral systems have completely stopped functioning, due to many contributing reasons
Maha Dev Makwano
Tharparkar has constantly faced multiple humanitarian and environmental crises, crises; including multiple droughts, floods, irregular rainfall, small scale fire incidents, earthquakes, and severe malnutrition among the children and the women. The population of the district continues to deal with deep rooted poverty, extreme unemployment, and tragic incidents such as suicides specifically among the adults and women. Despite efforts by various stakeholders to respond to natural and manmade shocks, the district remains critically underdeveloped with the same critical issues and conditions. Tharparkar ranks the lowermost in Pakistan’s Human Development Index and has been witnessing famine-like conditions for decades. At the same time contributed a greatly in the national economy since decades.
This is proven that only sustainable solutions can solve the problems of the desert, not one-time emergency responses. Since 2013–14, the due to malnutrition the deaths of children under have been frequently reported and widely discussed across the country, among stakeholders. However, while national consideration has been drawn to the malnutrition issues, meaningful and lasting change remains limited.
According to the National Nutrition Survey 2018, the situation in the district of Tharparkar is alarming. Acute malnutrition (Wasting among children) was reported at 33.3%, and stunting, chronic malnutrition (stunting) prevalence stood at more than 60.0%. Underweight children made up 60.1% of the under-five population, and parallel stunting and wasting affected nearly 19.8% of children. These figures clearly show that nearly 1 in every 5 children in Tharparkar is battling multiple forms of malnutrition. This is not only alarming but embarrassing for all of the responsible departments and individuals.
The statistics we rely on today are almost six to seven years old, as the relevant government departments have not conducted a new National Nutrition Survey since 2018. This long gap highlights a serious lack of attention to one of the most urgent public health issues in Pakistan. In the meantime, health and nutrition services remain stagnant, with existing facilities either merged with other parallel programs or fully compromised in quality and function.
Relevant public agencies and stakeholders must promptly conduct a thorough needs assessment and updated surveys for Tharparkar district.
Populations living in remote and hard-to-reach areas continue to face challenges in accessing health facilities. Even mobile services are limited, and community-based referral systems have completely stopped functioning, due to many contributing reasons. This means that sick and malnourished individuals are not being identified and referred to the health facilities with the nutrition services in time, further worsening the crisis. The Sindh Lady Health Worker Program, which is supposed to be the backbone of primary healthcare in rural areas, is reported to cover nearly 65% of Tharparkar. Still, the actual on-ground coverage is significantly lower than what is officially documented and in records and reports. The remaining 35–45% of the population is not covered at all, and no stakeholders are currently addressing this gap in community outreach and referrals. As a result, many vulnerable women and children are left without any form of preventive or curative health services.
The crisis is further worsened by a lack of access to clean drinking water, poor sanitation, and the unavailability of medical staff and essential medicines at health facilities. Over the past decade, droughts and irregular rainfall have only intensified these challenges.
Data from NNS 2018 also highlights maternal malnutrition as a major contributor to the problem. The prevalence of underweight in women of reproductive age is 22.8% in Sindh, with Tharparkar being a major contributor. Nearly 21.2% of households in the district suffer from food insecurity. Furthermore, low birth weights due to maternal malnutrition lead to a higher risk of neonatal and infant mortality.
Despite multiple interventions, the core focus has remained on the Outpatient Therapeutic Program, which treats acute malnourished children. While this program is critical for children in severe conditions, it does not comprehensively cover the risk of malnutrition children and the children with moderate acute malnutrition. No parallel prevention-based programs have been introduced on a large scale. However, for multiple times the government has been establishing and rolling up the chapters, and task units under planning and development and the health department, Sindh Government, but all the programs unfortunately not been sustained.
An effective approach must include preventive strategies, such as, addressing the nutrition needs of children aged 6–9 months and 6–24 months, addressing the prevailing micronutrient deficiencies in children and pregnant and lactating women, strengthening community-based management of acute malnutrition at primary healthcare levels with fully coverage, and promoting awareness to change behaviors and attitudes about nutrition and health.
A key underlying cause lack of family planning services is often overlooked. Larger family sizes without adequate resources directly contribute to poverty and malnutrition. Unless such contributing factors are addressed at the policy-making level, the burden of malnutrition will either remain the same or worsen.
There is also a need to develop district-specific strategies. We often make the mistake of designing uniform programs for urban and rural areas, coastal belts, and deserts alike, despite their immensely different needs. This one-size-fits-all approach fails to create effective change. We must study local contexts and develop customized, sustainable strategies that respond directly to the needs of regions like Tharparkar.
As one expert once told me during a discussion on government safety net programs, “All interventions seem well-intentioned, but when I look closely, I see that the actual planning rarely focuses on saving the lives of those individuals who are just an inch away from death.”
Relevant public agencies and stakeholders must promptly conduct a thorough needs assessment and updated surveys for Tharparkar district. The results and suggestions must subsequently be communicated to those making policy-level decisions. Activating and effectively operationalizing the existing committees, local chapters, and technical working groups in the district is also crucial for their coordination and consultation with one another.
Up to this point, stakeholders have seemed reluctant to disclose details regarding their interventions. They now need to collaborate, exchange data, and reshape their initiatives according to the suggestions and results given by the technical working groups and committees. Enhanced cooperation and openness are vital for tackling the persistent crisis in Tharparkar.
Read: Tharparkar District Facing Multifaceted Crises
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Maha Dev Makwano is a writer and development and humanitarian practitioner. He contributes to public dialogue on health and nutrition through newspaper commentary, and writes for English and Sindhi newspapers and magazines. He can be reached at mahadevmakwano@gmail.com
