WHEN a child is reported stunted, it is tempting to ask which ministry is responsible. Is it the ministry of health, nutrition, social protection, or others? In reality, all of them are responsible institutionally — and none when it comes to implementation on the ground.
Forty per cent of Pakistan’s children under five years are stunted while 17.7pc suffer from wasting, as of 2018. The scale of this crisis cannot be understated. Driven by more than just diet, the onset of stunting in a child is driven cumulatively by maternal nutrition, household poverty, food security, sanitation, healthcare, and education.
Over the past several years and despite frequent administrative changes, Pakistan has actively recognised this reality, progressively building a multi-sectoral policy architecture to tackle stunting at both federal and provincial levels. However, progress has remained limited. The challenge the country faces today is not a shortage of programming: it is a recurrent gap between high-level multisectoral policy and local-level multisectoral delivery.
While health and nutrition were devolved to provinces following the 18th Amendment, parallel ministries and a persistent federal-provincial overlap have stymied how national-level targets trickle down to the local level. With the 2018 National Nutrition Survey revealing steep geographical disparities in stunting that would otherwise remain concealed behind national-level averages, responsible institutions are forced to ask an important question: after targets are set, how do we reach the last mile of multisectoral coordination and delivery?
Pakistan’s stunting problem needs more than a nutrition response.
Pakistan’s social protection system offers one promising avenue through the Benazir Nashonuma Programme (BNP).
The programme’s latest independent evaluation in May 2026 painted a promising picture: child beneficiaries displayed an 18pc lower risk of stunting at 12 months, a 12pc reduction in child anaemia, and a 17pc increase in full immunisation coverage. At the same time, the evaluation offered a warning — and an opportunity — that runs the risk of being ignored: despite improved pregnancy weight gain, fewer than 25pc of participating women achieved adequate dietary diversity.
That is because despite the BNP’s nutrition-specific interventions, multisectoral factors continue to affect maternal malnutrition and, ultimately, child stunting. A cash transfer cannot secure nutritious foods if they are not available in local markets. A health facility cannot compensate for sanitation. And, a nutrition programme cannot improve the socioeconomic conditions shaping what families eat on a daily basis.
We already have evidence that the programme’s delivery systems work. The opportunity now lies in using what the programme already has — its reach into vulnerable households, service delivery network, and growing data infrastructure — to connect those households to other government sectoral programmes at the local level.
BNP operates across 158 districts on one of the country’s most extensive social protection datasets to date. The National Socio-economic Registry already provides a mechanism for identifying and reaching vulnerable households, while BNP tracks additional maternal and child health data.
These datasets can be used to diagnostically identify districts where BNP households show particularly high concentrations of specific risk factors. Are households lacking safe water? Are mothers receiving antenatal and postnatal care? Are children immunised? Are girls attending schools? Can families afford robust diets?
The answers would determine which government departments would need to act next in addressing stunting locally. Figuring out the accountability and ownership piece is the next step — Indonesia offers a useful model. Under its Stranas Stunting convergence strategy, districts analyse local stunting and service gaps, use those findings to align existing departmental plans and budgets, and then monitor whether priority households receive the services they need.
Cross-sectoral convergence for stunting is often misunderstood as a plurality of programmes.
In reality, the principle is simpler: convergence occurs when government programmes target the same problem, in the same place, for the same child. The early successes of BNP offer an opportunity for Pakistan to not simply scale social protection and cash transfer programmes by expanding the number of beneficiaries reached, but to connect its investments in child and maternal health, WASH, food systems, education, and population to existing platforms that already reach vulnerable households.
The writer is an analyst working for an international organisation that provides counsel for effective social impact.
Published in Dawn, September 1st, 2026
