Program for Improved

Nutrition in Sindh (PINS ER 2)

Project Charter
1.0

MASTERS IN PROJECT MANAGEMENT

(MPM-B)

Submitted To: Maa’m Farhat Fatima

Submitted By: Tooba Mirza – 1884136

Syed Areeb Bin Saleem Zaidi – 1884128
Dr. Shahmeen Nazar – 1884122
 Revision History
Date Version Description Author

Doc. No.:
 Table of Contents
1. Executive Summary 4

2. Project Purpose / Justification 4

3. Project Description 5
3.1 Project Objectives and Success Criteria 5
3.2 Requirements 6
3.3 Constraints 6
3.4 Assumptions 6
3.5 Preliminary Scope Statement 7

4. Risks 7

5. Project Deliverables & Summary Milestone Schedule 8

6. Summary Budget 9

7. Project Manager 9

8. Authorization 9
1. Executive Summary

Under PINS ER 2, Action Against Hunger plans to sustainably improve the nutritional status
of children under five (U5) and of Pregnant and Lactating Women (PLW) in Sindh in line
with the second target indicator of the SDG Goal No 2, enhancing coverage of nutrition
specific intervention in the targeted districts of Sindh province along with co-applicants
Concern (Shifa Foundation, PNFWH, TRDP) RSPN (SRSO, TRDP) and PPHI. This will be
achieved through the joint implementation work of EU PINS (Program for Improved
Nutrition in Sindh) partners and other EU programs in Sindh.

The specific objective of the Action is to capacitate the GoS (Government of Sindh) so that it
may efficiently implement its nutrition multi-sectoral policy while providing direct assistance
to significantly and rapidly reduce malnutrition in rural Sindh. To strengthen local /
government department capacities through nutrition specific interventions integrated with
primary health care at community/health facility level. Similarly, support will be provided to
existing GOS interventions such as the AAP (Accelerated Action Plan) project for stunting
reduction through creating synergies with the government strategies.

2. Project Purpose / Justification

This program is influenced by Aim 2 of the PINS call – respond to and prevent humanitarian
crises, address vulnerability and reinforce longer term resilience to food, water and nutritional
crises. In Pakistan, malnutrition is widespread among all ages, and for decades the progress
has been slow to address related social determinants. Malnutrition is not only confined to
children but is also rampant among women of reproductive age suffering from Anemia,
which is usually related to iron deficiency, as well as wasting among poorer communities
partly caused by food insecurity. Maternal malnutrition not only leads to increased risk of
mortality among women but also contributes to foetal growth restriction (small size of the
baby during pregnancy). This in turn, multiplies the risk of growth faltering and stunting in
childhood.

The most pervasive and dominant factor underlying maternal and child under nutrition is
widespread poverty and food insecurity. Despite being a largely agrarian economy, many
rural and urban families live in a state of food insecurity in Pakistan. The 2011 National
Nutrition Survey confirmed that not only the nutrition situation was dramatic in Pakistan, it
was also chronic with malnutrition rates which had not evolved over the past decades. The
country has the third highest number of children under five affected by stunting in the world
(45% country-wide, rising to 50% in Sindh Province and to a 63% average in rural Sindh).
Under five mortality rate is 89 out of every 1000 live births implying that one out of every 11
children born will die before their fifth birthday. Other national nutrition statistics are equally
worrying: Low Birth Weight of 25.0%; 0-5 Months Exclusive Breastfeeding of 37.7%.

According to National Nutrition Survey 2011, the prevalence of wasting in Sindh, stood at
19% which is higher than the WHO emergency threshold wasting rate average of 15%;
Anemia in women aged between 15-49 years is 51.1%; furthermore, there is growing stunting
inequality when it comes to indicators in areas impacting nutrition. Further to this, across the
country only 56% of the population has access to safe drinking water and 18% has access to
 proper sewerage system (only 6% in rural areas). Therefore, despite some progress, stunting
among children remains a major problem in Pakistan. According to the National Nutrition
Survey 2011, as many as 44% of the children are stunted, which is a substantial proportion of
the population resulting in significant burden on the economy, intellectual abilities and status
of health.

The Government has taken initiative in the form of a Project Commission-1 in various
districts of Sindh to implement nutrition specific programming. Furthermore, the Legislation
at the Provincial Assembly passed in 2013 titled as “The Sindh protection and promotion of
breast-feeding and child nutrition Act”, was a major step towards creating more and more
advocacy. However, translating all policies in true spirit at micro level will require
considerable efforts.

Rightly identified by the European Union (EU), the current intervention under EU PINS will
serve as a vital step towards enabling the Government to take full responsibility to address
the issue of malnutrition and its under lying causes. Action Against Hunger intends to
facilitate and coordinate the action on second result of Nutrition Specific interventions (PINS
ER 2) through co-applicants. Therefore, this intervention aims at reinforcing the capacity of
the GoS to fully implement its nutrition policy framework, through technical assistance as
well as via nutrition focused activities that it would implement directly or outsource, while in
parallel, undertaking a number of nutrition specific and sensitive activities at the community
level through grants. The current EU PINS project is based largely on its precursor project
titled as EU WINS3, which adopted a multi sectoral approach to address malnutrition in 4
districts that showed worst statistics in terms of malnutrition. Some major learning from EU
WINS showed that the Government should be enabled to undertake all activities related to
prevention and treatment of malnutrition at provincial level. In this regard, PINS have an
exclusive result for policy advocacy and further enhancing the capacity of the government
through evidence generation on effective modeling

3. Project Description
3.1 Project Objectives and Success Criteria
Under this intervention, Action Against Hunger plans to contribute towards ending under
nutrition and hunger (SDG 2) by improving the health and nutrition status of children
and mothers by rapidly expanding and enhancing coverage of nutrition specific
intervention in the targeted districts of Sindh province. This will be achieved through the
joint implementation work of EU PINS (Program for Improved Nutrition in Sindh)
partners

● To capacitate the GoS (Government of Sindh) so that it may efficiently implement its
nutrition multi-sectoral policy while providing direct assistance to significantly and
rapidly reduce malnutrition in rural Sindh.
● Provision of nutrition care and treatment for children with severe acute malnutrition
(SAM)
● Prevention of under nutrition in early childhood through promotion of appropriate infant
and young child feeding (IYCF) practices
 ● Prevention of micronutrient deficiencies in women and children through provision of
multiple micronutrient supplementation (MMS)
● Strengthening local capacity to integrate community-based management of acute
malnutrition (CMAM) into primary healthcare systems.

3.2 Requirements

This project must meet the following list of requirements to achieve success.
● To sustainably improve the nutritional status of children under five (U5) and of
Pregnant and Lactating Women (PLW) in Sindh in line with the second target
indicator of the SDG Goal No2.
● Treatment of malnutrition in the targeted districts in health facilities supported by an
outreach program to screen children, a referral system for their follow up and a
behavior change communication program for improved child care, sanitation and
feeding practices.
Additional requirements may be added as necessary, with project sponsor approval, as the
project moves forward.

3.3 Constraints
The following constraints pertain to the project:
● Security situation in the country/ province worsens and access to project sites is denied.
● Political buy in shifts from nutrition
● Economic situation in Country externally create high prices (inflation or exchange rate
changes)
● Budget limitation
● The scope and targets of the program has to be achieved in a timeline of 3 years
● Transportation and Logistics issues in Province / Districts (lack of roads, route blockages
etc.)
3.4 Assumptions
The following are a list of assumptions. Upon agreement and signature of this document, all
parties acknowledge that these assumptions are true and correct:

● Stable political/security context enables access to communities;

● Relevant Government policies and protocols remain largely consistent throughout the
period after 2018 elections
● Disasters, shocks and climate change do not result in considerable changes to the
environment and the nutrition situation of the population resulting in significantly higher
caseloads
● The exchange rates remain within expected bounds of fluctuation.
● The current partners engaged in health delivery remain active and operational under the
wider health programs of GoS (Government of Sindh)
● Nutrition Supplies RUTF stock out and supplies international procurement shall be
acquired in an efficient manner.
 ● Communities and government continue to have good acceptance of Action Against
Hunger and partner’s actions and are willing to participate.
● Government health staff remains available and there is no human resource gap
experienced throughout the project.
● Social and religious acceptance on therapeutic food utilization at community.

3.5 Preliminary Scope Statement

The objectives of this grant are in line with the Annual Strategic Plan of Action Against
Hunger. The Global goals are described below.
Global Goal 2: No Hunger
End Hunger, achieve food security and improved nutrition and promote
sustainable agriculture.
Global Goal 3: Good Health
Ensure healthy lives and promote well-being
for all at all ages.
Global Goal 4: Gender Equality
Achieve gender equality and empower all
women and girls.
Global Goal 6:
Ensure availability and sustainable management of water and sanitation for all.

To sustainably improve the nutritional status of children under five (U5) and of Pregnant and
Lactating Women (PLW) in Sindh in line with the second target indicator of the SDG Goal
No2.

4. Risks

The following risks for the PINS project have been identified. The project manager will
determine and employ the necessary risk mitigation/avoidance strategies as appropriate to
minimize the likelihood of these risks:
● Security situation in the Country / Province worsens and access to project sites is denied.
● Economic conditions in country or externally create high prices (inflation or exchange
rate changes)
● Unable to access women because of customs and culture.
● LHWs are not available to implement the community outreach activities component due
to cessation of salaries, as a consequence of non-availability of adequate funds within
the provincial government. Lack of interest to work with integration in nutrition outreach
intervention
● Occurrence of a natural disaster in the project site leads to diversion of human and
financial resources
● Supplies availability (delays from vendor, NOC from drugs regulation authority , delays in
customs clearance process including taxation )
 ● Taxation systems change affecting the price of goods and our requirement to pay tax

5. Project Deliverables & Summary Milestone Schedule

Milestones
Activity
First Year Second Third Year Total
Year

SAM (Severe Acute Malnourished) 83,393 66,715 28,184 178292

OTP: # of SAM (6-59 months children )

SC: # of SAM Children with Medical 8,339 6,671 2,818 17829

Complications (6-59 months children )

MM (Multi Micronutrients) 188,911 151,129 60,386 400426

Supplementation: # of children 6-23
months of age not enrolled in OTP

MM (Multi Micronutrients) 769,345 615,476 236,695 1621516

Supplementation / IFA (Iron Folic
Acid): # of PLW receiving MM Tablets
/ IFA Tablet

6. Project Deliverables

Results Indicators Baseline Targets

To sustainably improve the %age of infants 0 to 6 29 % (Multi 35% (2%

nutritional status of children months who are Indicator cluster increase per year)
under five (U5) and of exclusively breastfed Survey 2014) ****
Pregnant and Lactating
Women (PLW) in Sindh %age of pregnant women 62.1% (National 50%
who are anemic (Hb < 12 Nutrition Survey
g/dL) 2011) ***

Prevalence of stunting of 48% Sindh (2014 44% (1 %

children aged below five MICS) *** reduction per
years in Sindh year)

Treatment of malnutrition in % of children 6 to 23 9.3 % (MICS 2014) 15%

the targeted districts in health months receiving a ****
facilities supported by an minimum acceptable diet
outreach programme to in addition to milk.
 screen children and PLWs % of Pregnant & lactating 20.7 % (NNS 80% (segregated
Women receiving IFA 2011)*** in covered &
supplementation. non-covered area
of LHW).

% of programme-targeted PC1 Nutrition 100%

UCs covered through OTP Support Program Geographic
service delivery. implementation coverage and
strategy for OTP. 50% Targeted
*** papulation of
SAM cases as per
Sphere of OTP
coverage in rural
Sindh.

7. Summary Budget
The following is a high-level summary budget based on the planned cost components and
estimated costs required for successful completion of the project.

❖ EU Contribution - EUR 7,289,127/-

❖ Co-Financing by PPHI - EUR 225,437/-
Total Project Amount - EUR 7,514,564/-

8. Project Manager

Tooba Mirza is a named Project Manager nominated from EU ACF for the duration of the
PINS project. She has an experience of 12+ years in managing varying projects in Public
Health sector. Ms. Mirza’s responsibility is to manage all project tasks, scheduling, and
communication regarding the project. Her team will coordinate with PINS internal review
committee and other co-applicants in a Functional Organizational Structure. She is
authorized to approve all budget expenditures up to, and including, the allocated budget
amounts. Any additional funding must be requested through the Project Sponsor body, ACF.
She will provide weekly updates to the Project Sponsor.

9. Authorization

Approved by the Project Sponsor: Date:

European Union (EU)
Action Against Hunger