Emergency Preparedness and Response Planning in Pakistan Megan Gayford and Aien Khan Afridi Nutrition Cluster Coordinators, Pakistan Global Nutrition Cluster Annual Meeting Geneva, 10 July 2013

OVERVIEW 6th most populace country in the world [193 million DISASTER HISTORY Frequent earthquakes, occasionally severe especially in north and west and flooding along Indus [July-Aug] The location of the nutrition centre/cmam sites are indicative of the flood affected areas in 2010,2011,2012 HUMANITARIAN RESPONSE The magnitude and frequency of disasters in Pakistan makes preparedness planning a critical need nation-wide – and this has been reflected in unprecedented Government led preparedness planning in 2013 – including the inclusion of nutrition in the government plans for the first time.

Country Context: Pakistan The nutritional status in Pakistan is not improving; acute malnutrition continues to rise. The acute malnutrition rates, NNS 2011, show that the acute malnutrition rate is above 10% in Punjab and FATA and above 15% in KP, Sindh and Bal. – critical levels. Frequent and high magnitude disasters further destabilize the existing fragile nutrition situation in Pakistan, particularly in food insecure areas. Surveys in flood and/or conflict affected areas show that the disasters, particularly recurrent disasters negatively impact nutrition and food security and lead to increased levels of acute malnutrition.

Operational Context Disaster preparedness and response is led by the National Disaster Management Authority and the Provincial Disaster Management Authorities Decentralized process Linkages between Government and the Humanitarian Country Team For the first time, nutrition is included in the Government preparedness plans Operational Context Disaster preparedness and response is led by the NDMA and the PDMAs – the national system was first developed following the 2005 earthquake. This process has evolved significantly in recent years, based on lessons learnt from recent disasters that have been unprecedented in size The PDMAs are central actors; the process is largely decentralized. In KP, capacity in emergency preparedness and response was built earlier than other provinces, due to the experiences of the complex emergency and the IDP crisis that started in 2008 and the 2005 earthquake In 2013, the NDMA and the PDMA requested inputs from the Humanitarian Country Team partners into the national preparedness planning process For the first time, nutrition is included in the Government preparedness plans There are strong agency and organizational preparedness processes that inform the cluster preparedness planning

Developing the Preparedness and Response Plan at the Sub-National Level Coordinated by OCHA in and in coordination with PDMA and FATA Disaster Management Authority Compilation and review of agency/organizational plans Preparedness Planning Workshop for cluster partners Based on specific scenarios and informed by experience Risk analysis Beneficiary caseloads agreed for various scenarios Emergency human resource response rosters and focal points Contingency/stand-by agreements agreed with potential partners by UN Agencies Review and consolidation with the National Nutrition Cluster planning process At the subnational/provincial level the process is coordinated by OCHA in coordination with PDMA and FATA Disaster Management Authority UNICEF/WFP has its individual preparedness plans which adds to the overall nutrition cluster plan led by PDMA/FDMA/DoH Based on various scenarios and previous experience of dealing with emergencies (earthquake, floods, conflict) significant lessons learnt have been documented. A risk analysis was conducted and emergency prone areas identified by the Government Contingency/stand-by agreements agreed with potential partners by UN Agencies to be activated at the onset of emergency Caseload agreed for various scenarios assumed and percentage of response by Government and each cluster Emergency human resource response rosters and focal points at provincial and district level with alternates identified and in place.

Developing the Preparedness and Response Plan at the National Level Planning Scenario of the Pakistan Plan All clusters develop plans – annexed to the National Plan National Nutrition Cluster process Human Resources and Contingency Stocks Linkages to the Provincial Plans Plan dissemination Timeframe Reviews and updates The Pakistan PRP is based on a range of planning figures rather than a single scenario Eight clusters draft PRPs that inform the overall plan, based on the same range of planning figures Nutrition Cluster - A PRP was developed, and the Nutrition Cluster partners in Islamabad met to discuss the content Each cluster partner reported on HR and availability of contingency stocks The plan was shared with the Provincial Cluster Coordinators, other national clusters and technical experts for inputs Overall a three month process, plus continued updates

Enabling Factors Significant capacity of the Nutrition Cluster partners Strong agency/organizational preparedness planning parallel processes Nutrition Cluster strategy Capacity building Participation Deadlines Strong linkages to the Government of Pakistan’s Preparedness Planning process Significant capacity of the Nutrition Cluster partners for both response and preparedness in Pakistan– a general understanding of the importance of preparedness Strong organizational preparedness planning provided a basis for cluster planning The Nutrition Cluster has an agreed strategy, upon which the response activities are based Capacity building opportunities have been recently facilitated by the Nutrition Cluster and OCHA Participation from both local and international NGOs Deadlines set by OCHA and strong linkages to the Government of Pakistan’s Preparedness Planning process at the National level

Challenges Change of Government Low engagement of the NDMA and the Pakistan Red Crescent Society Establishing linkages with the Provincial PRPs Different timeframes The planning figures vary between National and Provincial levels Stretch of resources and shift of attention from response to planning Lack of understanding of malnutrition and its consequences Low engagement of the NDMA at the Cluster level and the Pakistan Red Crescent Society New Government Establishing linkages with the Provincial PRPs was difficult due to different timelines and variable processes being coordinated by the PDMAs The planning figures vary between National and Provincial levels Complex emergency context and emergency response ongoing for more than 1.1 million IDPs in KP/FATA – stretch of resources and change of attention from response to planning Widespread lack of understanding of malnutrition and its consequences (often mixed with food security and therefore receive less attention)

Implications for the Cluster Government engagement Lessons learned from previous emergency responses Inclusive process Linkages Supporting capacity of Nutrition Cluster partners Opportunities for advocacy Government engagement in the nutrition cluster at all levels is of great importance The lessons learned from previous emergency responses when documented, will inform better preparedness planning The cluster needs to invest time and resources in preparedness planning that is inclusive and not limited to the CLA and other UN agencies Linkages between National and Sub-National PRP are facilitated by coherent timeframes The capacity of Nutrition Cluster partners in preparedness planning must be supported, through capacity building opportunities and an inclusive approach The Preparedness Plan can be used as an effective advocacy tool