LAHORE: Parveen Bibi is one of the many individuals who are living below the poverty line. The 45-year-old woman, who carries out household chores at different houses in her locality to make ends meet, lives with her three children.

Her children study at government schools.  For Parveen, who is hardly able to pay the fees of her school-going children, the Punjab government’s School Khana Programme (SKP) is no less than a blessing.

“I always wanted to give good and healthy food to my three sons but due to my financial condition, I could not afford healthy meals or a nutritious diet for them.

“Now our children will enjoy good and healthy meals at schools too that would help them while growing up. This will also make them efficient citizens of the country,” she said.

Pakistan has been facing a malnutrition crisis with little change of indicators over the past several decades. Despite massive food production, the latest National Nutrition Survey (NNS-2018) revealed that 36.9 per cent of the population in Pakistan is food insecure.

Most of the nutrition indicators have not improved over the past few decades in Pakistan. Rather, many indicators have worsened with the passage of time. Vitamin A deficiency reportedly affects 54pc of children while moderate and severe anaemia affects 61.9pc of children.

Furthermore, zinc, vitamin D, calcium and protein deficiencies are also widely prevalent in the public.

These nutrient deficiencies have serious manifestations and result in very high chronic malnutrition indices with 44pc stunting and 15pc wasting in children under five years of age.

School Khana

Speaking to Bol News, a senior official at the School Education Department (SED) said that the Punjab government collaborated with Allah Wallay Trust, a local charity organisation focused on providing free meals to students of primary schools, and Honda Pakistan to provide free meals to children studying at government schools.

“This collaboration focused on fighting issues including malnutrition and stunted growth among young children across the province. Our department started the School Khana Programme in early 2020. Unfortunately, the pace of the programme was impacted by the Covid-19 pandemic,” he said.

He maintained that till now, 20 primary schools in Lahore are being provided with free midday meals every day. “In the initial phase, our target is to provide quality food to 23,000 students in 100 primary schools on a daily basis.”

This initiative is proving to be very beneficial particularly for the students from less privileged backgrounds who are facing the challenge of food insecurity, elaborated the senior SED official. “In Pakistan, four out of 10 children under five years of age are stunted with low height-for-age while 17.7pc suffer from wasting with low weight-for-height. The double burden of malnutrition is becoming increasingly apparent, with almost one in three children underweight which is 28.9pc alongside a high prevalence of overweight at 9.5pc in the same age group.”

The prevalence of overweight children under five has almost doubled over seven years, increasing from 5pc in 2011 to 9.5pc in 2018, he explained.

The senior official told Bol News that it was the need of the hour to start this programme on war footings because eight out of 10 children in Pakistan do not eat the right type and quantity of food.

Diversified menu

“On Monday we provide them potato chicken with plain bread. On Tuesday, they are served with rice lentils, on Wednesday they eat black chickpeas with plain bread, on Thursday the students eat chickpea rice, on Friday, they enjoy eating fritter curry and plain bread and on Saturday they are served with vegetable rice,” the senior official concluded.

Speaking to Bol News, Shifa Ali, a clinical dietician at Ittefaq Hospital Trust in Lahore commented that this meal programme is indeed a great initiative of the Punjab government as it will cater to the needs of school-going children. “Children need a nutritious meal during their school hours as their bodies continuously need calories, protein, calcium, iron and other nutrients needed for the rapid growth phase they are going through.”

She maintained that this not only improves their mental capabilities and class concentration but also their physical health.

For Shifa, the SKP gives a varied menu with nutritious options throughout the week. This meal provides a good amount of carbohydrates, fats and high-quality protein to the growing children.

“Combination of lentils, beans and grain gives complete proteins as per the rule of protein complementation. This meal caters to at least one-fourth to half of their daily protein requirements which is in fact a great help to the otherwise underprivileged children who have less access to routine intake of good quality protein.”

The clinical dietician also said that getting these calories during school hours ensures dietary protein which is crucial for muscle building and brain growth.

“This one meal also caters to at least one-fourth of the daily requirements of minerals and vitamins of school-going children.”

Usman Tufail, one of the students studying at a government primary school, shared that he feels more energetic and felt that his concentration level increased after getting these nutritious meals at school. “I used to eat chicken or meat once a year but now we are getting it every week. I am very excited and have also stopped skipping classes because at least I get the food here. Back at home, my parents could hardly afford to feed me.”

Increased school attendance

Speaking to Bol News, Punjab Education Minister Murad Raas, who is the main force behind the start of SKP, shared that since the inception of the meal programme, the impact on students has also been measured which has shown tremendous improvement in their learning abilities and physical growth.

“Let me share with you that as per the data collected from eight schools in Lahore, the revised BMI of students saw a 77pc healthy upturn. Even the students that are still underweight, as per the standards, have now shown improvement from their initial measurements. With betterment in basic health of their students, these schools have seen an average increase of 33pc in their attendance as well.”

Dairy needs

To fight stunting and malnutrition, the Punjab government also started the School Milk Programme (SMP) in 90 schools adopted under PEF Public Schools Support programme in Attock and Sheikhupura districts.

FrieslandCampina Engro Pakistan Limited (FCEPL) (formerly Engro Foods) and University of Veterinary & Animal Sciences (UVAS) joined hands to provide implementation support for scientific evidence generation regarding impact on nutritional status. This included anthropometric assessment, dietary assessment, nutritional deficiency signs and symptoms, body composition analysis and school performance.

In the first phase, the programme will run for six months and the learnings in terms of nutrition improvement, school performance, student retention, supply chain management and programme management will be shared with government and stakeholders for rollout at larger scale. Speaking to Bol News, Dr Muhammad Aamir Iqbal, manager scientific and regulatory affairs at FCEPL stated that the SMP will help reduce malnutrition and improve health of schoolchildren. “It will also improve the school enrolment, attendance, and subsequent academic results associated with attendance.

“Children need to develop milk taste at an early age to continue drinking it throughout life. It promotes a healthy habit of milk drinking.”

Shifa said that the SMP provides a 180 millilitres (ml) pack of milk to the minors. This milk caters to their calcium and vitamin D intake. “The amount of vitamin D present in this milk (2.25 ug) is just adequate enough to prevent children from a common paediatric bone disease called rickets.”

Vitamin D is also crucial for the absorption of calcium, she added. “Vitamin A being provided to the children through SMP fulfils approximately 40pc of their daily vitamin A needs. SMP and SKP can be a major step in bringing these deficiency figures down.”

Room for improvement?

Shifa maintains that on a long-term basis, some more foods can be added to the meals to optimise nutrition.

“On some days a boiled egg can be added. Each child should get either a serving of yogurt or milk daily. Adding fresh vegetables as salad with rice and a fruit will also enhance the nutritional value of the meal,” she recommended.

She added that similarly on some days, 200ml-250 ml of plain milk instead of vitamin D enriched flavoured milk can be given to further increase the protein intake and to make kids accustomed to plain milk flavour, making it a ‘joyful’ experience with peers.

“These are some suggestions to augment the palatability and nutrition of the meal. This is indeed a commendable effort of the government and should not only be sustained but also further spread to all schools across Pakistan.”

Speaking to Bol News, Lahore-based journalist Ahsan Raza, who is also the father of four children, shared that these are good steps by the education department to take care of schoolchildren’s nutrition.

From the very beginning, Prime Minister Imran Khan has been calling for policies to address the stunting issue. Even in his first address, he showed pictures of stunted kids.

“The project must be expanded to other districts, especially south Punjab. And other provinces must follow Punjab.”