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Professional profile
feeding and a national board for USI that brings
representatives from different government
sectors, UN agencies and some other organisations
to coordinate efforts.
In terms of how technical support is realised,
a Nutrition Advisory Committee made up of
experts in nutrition, provides technical advice
to the MoPH through the Public Nutrition
Department. “Overall, we ensure that we coordinate
all partners’ efforts to address the
national priorities in terms of nutrition and we
believe that we are on the right track. Visibility
of current nutrition programmes are not at a
satisfactory level. Still the dominant mentality
about nutrition programmes is only treatment
of acute malnutrition. The other programmes
are in their infancy stages and we need to work
a lot to create awareness regarding the other
programmes, especially with regards to IYCF
and micronutrients”.
Q: What are the main priorities for nutrition
in the coming years?
The main priorities for the coming years are:
• Nutrition promotion through awareness
raising, counselling, participatory demonstrations
and community support activities
implemented.
• Infant and Young Child Feeding, especially
early initiation of breastfeeding, exclusive
breastfeeding until six months, restricted use
of commercial infant formula and respect of
the International Code of Marketing of Breast
Milk Substitutes, continued breastfeeding
until 2 years and beyond, and introduction of
solid/semi-solid foods at six months.
• Micronutrients including nutrition education,
adequate fortification of staple foods
and micronutrient supplementation.
• Adequate care during severe acute malnutrition
treatment through in-patient care in
hospitals for complicated cases, and outpatient
care from hospitals or Comprehensive
Health Centres for non-complicated cases.
• Food safety and quality control to ensure all
foods made available to Afghan consumers,
whether produced by the households,
purchased on local markets, or imported,
should be safe for consumption and respect
national food safety and food quality
standards.
• Effective nutritional surveillance and monitoring.
Information on the nutrition situation
and on the results and impacts of nutrition
interventions should be regularly collected
and analysed as part of relevant surveillance
and monitoring and evaluation systems.
• Capacity development for public nutrition.
Public nutrition training should be part of
pre-service and in-service training for all
health workers, and relevant staff working
in the fields of agriculture, education,
women’s and youth affairs, economics and
social affairs.
Q: What are some of the main opportunities
and the challenges for advancing nutrition?
Among the main opportunities is commitment
of the leadership in the MoPH. There is a
committed and competent team in the public
nutrition department and we have commitment
of donor agencies to support nutrition related
activities. The Basic Package of Health Services
(BPHS) is a system to deliver main services to
all villages of the country.
The main challenges for advancing nutrition
in the country are a shortage of technical cadres
of nutrition staff, lack of institutions to generate
nutritionists and experts in dietetics, dependency
on donor financing and the security
situation. Also, Afghanistan as a traditional
society with several culturally rooted taboos on
food consumption, low awareness on proper
nutrition practices and barriers toward women
status in the society create other challenges. In
addition, many people live in very remote and
often inhospitable mountainous areas making
access at certain times of the year very difficult,
if not impossible.
Q: With respect to the position of women,
what impact is this having on their and their
children’s nutritional status?
It is obvious that social status of women has a
direct effect on their health and nutrition status
and on their children. Our priority target
groups in nutrition programmes are children
and women. Raising awareness through different
channels, ensuring that all programmes are
gender-friendly (taking all special needs and
cultural issues into account), messages and
activities are socially and culturally sensitive
and trying to involve men in all activities that
require women’s participation, such as IYCF, is
vital. Men are the decision makers in the
Afghan society.
Providing services such as blanket food distribution,
targeted supplementary feeding
programmes and treatment programmes for
women are the main steps we are taking to
address this challenge. We are also trying to
increase the age at which a girl marries to 16
years – today it is not uncommon for girls to be
married at the age of 12 years. There is also a
very high level of violence against women, especially
in rural areas where many are also
illiterate. Thus, there is a vicious cycle of early
adolescent pregnancies which increases their risk
of mortality and infant and child malnutrition.
Q: Afghanistan is very complex and challenging
environment, can you describe how this
impacts on your work in nutrition and your
efforts to address women’s issues?
One of the challenges in this complex environment
is how to reach the women and adolescent
girls to provide them with appropriate education
and support in nutrition issues, especially
in the remote areas. However, we have piloted
projects in different parts of the country in the
past years to involve women in nutrition related
activities by organising them into community
support groups for breastfeeding and family
action groups for child survival. Using the
lessons learned from these pilot projects, we can
scale up activities at the national level and use
this opportunity also to improve the social
status of women among their communities. We
are going to conduct a study on nutrition
programmes targeting adolescent girls in partnership
with the World Bank. This project is in
its very early design stages and we hope to learn
some important lessons from it to scale up our
interventions targeting adolescent girls.
We have made real progress in reducing both
the under-five mortality and infant mortality
rates over the past ten years and we need to
continue this progress though addressing nutrition
related problems.
Q: How well supported is Afghanistan by
external donors and agencies for nutrition
advancement and will Afghanistan become
part of the Scaling Up Nutrition (SUN)
movement?
Currently, nutrition programmes in
Afghanistan are well supported by external
donors. UNICEF, WHO, WFP and FAO are the
active UN partners and supporters of nutrition
activities. We have already started preparation
of a ‘multi-sectoral plan of action for nutrition’
involving five key sectors (Health, Agriculture,
Education, Rural Development and
Commerce). The plan is in its draft stage and we
hope that it will be launched officially by the
end of the current fiscal year. To oversee the
implementation of this plan, a committee at the
Cabinet level will be established hopefully with
the leadership of the Vice-President. A
Secretariat will manage and coordinate the
activities which will be supported by the World
Bank. These are the steps to Scaling up
Nutrition as a national development agenda.
Q: Is there anything else you would want
readers of Field Exchange to know about
nutrition in Afghanistan?
Malnutrition in Afghanistan is a consequence,
as well as a cause, of widespread poverty. The
people of Afghanistan have suffered from
decades of war, instability and violence, which
have led to greater poverty. This poverty is in
turn worsened by the consequences of inadequate
nutrition and affects future generations as
well. Thus, combating malnutrition in
Afghanistan is not only a humanitarian and
survival issue but a development issue and a
key strategy to eliminate poverty. We need to
work hard with a long term vision to free the
future generations of Afghans from the vicious
cycle of poverty-malnutrition as we did in
reducing maternal and child mortality rates
during the past 10 years. We are confident that
with a focused and coordinated effort, we can
do more in the field of public nutrition. There is
already support and commitment from the
international community in this regard, which
we are grateful for, and we hope that this international
cooperation and partnership will
continue so that we can contribute to the development
goals.
Q: Is there a memorable moment in your
professional career that you would like to
recount?
When I arrived to work in the Ministry in 2005,
I came from a regional hospital and was faced
with a huge amount of decision-making responsibilities.
I slept very little in the early days but
when I became Deputy Minister, I was part of
the team to work on reducing infant, child and
maternal mortality which was like a ‘quiet
tsunami’ needing urgent attention. A great
personal moment was being part of the team to
announce to the media the reductions in infant
and maternal mortality achieved after ten years
of dedicated efforts – a reduction in maternal
mortality rate from 1,600 per 100,000 to 327 per
100,000, in the under 5 mortality rate from
257/100,000 in 2002 to 97/100,000 in 2010 and
in infant mortality rate fron165 to 77 per 1,000
live births.
For more information, visit the MoPH website:
www.moph.gov.af
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