Indonesia and Pakistan share civil society strategies on preventing adolescent anaemia

A story by: Asma Afrin Haque,
Monitoring & Quality Assurance Specialist, SUN Movement Pooled Fund

Adolescence is a critical time of life, where both physical and psycho-social changes occur, and where many learned behaviours take root in an individual’s life-long health.  Adolescents may seem like a narrow target population for nutrition advocacy, but teenagers represent one-sixth of the world’s population and account for 6% of those affected by the world’s global disease burden.  Even though more than 3,000 adolescents die every day from preventable diseases, adolescent nutrition is not a high priority for many countries. In the Southeast Asia region, the SUN Civil Society Alliances of Indonesia and Pakistan are working through the SUN Civil Society Asia Coordination Group to tackle the issue of adolescent undernutrition head-on, by focusing on the particular condition of iron-deficiency anaemia ^[1].

Anaemia is the state in which the body’s red blood cell count is lower than normal, often caused by iron-deficiency in one’s diet. It is a particular concern for Indonesia and Pakistan. National anaemia rates among adolescent girls in Indonesia reach 25%.  In Pakistan, more than 50% of adolescent girls are anaemic.  Both countries are committed to reducing the rate of anaemia through prevention programs such as adolescent nutrition education and supplementation.

“More than 50% of Pakistan adolescent girls are anemic. Pakistan has established a multi-sectoral platform to develop health and nutrition guidelines and strategies for adolescents and shall soon be working with the National Health Task Force, under the guidance of the Prime Minister, on a large-scale nutrition program to adopt the 1000+ Days approach for adolescents”

Dr. Khawaja Masuood Ahmed, National Coordinator-Nutrition National Fortification Alliance, Min. of National Health Services, Regulations & Coordination, Pakistan.

The COVID-19 pandemic has derailed health and nutrition welfare services in the Asia region, and shifted the focus away from adolescent health. The Civil Society Alliance of Indonesia and the Civil Society Alliance of Pakistan raised this concern in the SUN Civil Society Asia Coordination Group meetings and decided to take action.  With support from the #SUNPooledFund both CSAs initiated a plan to host the SUN ASIA CSA Webinar on Adolescent Nutrition, a SUN Asia Region teleconference series on adolescent nutrition in the context and lasting impacts of COVID-19.  Nutrition International had been running weekly iron folic acid (WIFA) supplementation in both Pakistan and Indonesia and used this opportunity to increase awareness and share knowledge and opportunities on adolescent nutrition interventions  by civil society groups in Asia.  This teleconference marked the first SUN Asia Region cooperation efforts on bilateral support to address adolescent anaemia.

Supported by Nutrition International regional office and the SUN Movement Pooled Fund, the Civil Society Alliances hosted an interactive and informative series over the course of two sessions.  Keynote speakers included Eriana Asri, Adolescent Nutrition Advisor,  of Nutrition International Indonesia, Dr. Khawaja Ahmed, National Coordinator for Nutrition and National Fortification Alliance from Pakistan’s Ministry of Health, and Anjali Bhardwaj the Regional Manager of Adolescent and Women’s Health & Nutrition for Nutrition International – Asia.

“This is also a wakeup call for policymakers and experts to devise handy solutions as we often experience a shutdown during epidemics, which keep occurring from time to time. ‘Health’ cannot be seen in isolation from ‘nutrition’, moreso in the current times and nutrition literacy is definitely the need of the hour”

Anjali Bhardwaj, Regional Manager, Adolescent and Women’s Health and Nutrition, Nutrition International, Asia

Key highlights from the discussions:

• Adolescent health and nutrition has been compromised due to school closures and disrupted health services since the COVID-19 outbreak. Multiple nutrition initiatives like school feeding programs and the Weekly Iron and Folic Acid Supplementation (WIFAS) were hampered by school closures. Civil society must fund alternatives or new formats in which to reach young people.

• Indonesia and Pakistan discussed case studies of successful adolescent nutrition strategies and best practices. The Civil Society Alliance in Indonesia presented the way in which the Ministry of Health has revitalized the WIFAS program, which provides iron supplements to 81% of adolescents in schools.

• Pakistan suffers a triple burden of malnutrition – underweight, micronutrient malnutrition, as well as overweight/obesity. Thanks to the presentation, participants learned some of the difficulties that adolescents face in making healthy food choices.  They face challenges such as inaccessibility or unaffordability of health foods as well as the inability to resist the available junk food and social pressures to consume them. In response, the Government of Pakistan has adopted diverse measures to prioritize adolescent nutrition alongside other health policies priorities.

• Pakistan’s response required the coordination of many actors, including the Government of Pakistan, the departments of Health and Education, Nutrition International, and  UNICEF. By working together, they paired WIFAS interventions with public education and replicable case studies.

• Bangladesh shared that they have also initiated a WIFA programme while the Philippines, Cambodia, and Myanmar expressed interest in advocating to their national governments to replicate and invest in such WIFAS programmes as well.

“Through constant advocacy by development agencies, WIFAS was revived. Adolescent girls were reached at their residences by village health workers and teachers to deliver iron tablets. While some schools distributed tablets in advance before the lockdown, in many areas community-based platforms were utilized for the distribution of tablets. To monitor compliance, the Ministry of Health is also developing a reporting application”

Eriana Asri, Adolescent Nutrition Advisor, Nutrition International Indonesia

Over 600 participants from all states, sectors, and SUN champions in the Asia region shared their expectation and commitment towards raising awareness on adolescent nutrition programming.  They acknowledged the important role that civil society organizations have to play, particularly in their region.  The series created an opportunity for cross-learning on tested adolescent nutrition strategies and opportunities to build back better.    Thanks to learning exchanges such as this one, the Civil Society Alliances of Indonesia and Pakistan have since completed their network plans on adolescent nutrition and hope to assist more alliances in their planning efforts.

Want to know more?

• Look out for news on the series “Creating Co-Benefits from Climate Smart Agriculture as a Case for Scaling Out via Development Programs” initiated by Civil Society Alliances of the Philippines and Cambodia.
• Continue reading about the SUN Civil Society Asia Coordination Group’s ongoing advocacy campaign (18 August 2020).
• Continue reading about adolescents using smartphones to fight the prevalence of anaemia in Indonesia (11 December 2019).
• Tune into the latest on the SUN Civil Society Alliance of Pakistan on Facebook and Twitter.

^[1] Chaparro et al., 2014