An Investment Framework For Nutrition In Uganda

An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding, and Wasting estimates the costs, impacts, and financing scenarios to achieve the World Health Assembly global nutrition targets for stunting, anemia in women, exclusive breastfeeding and the scaling up of the treatment of severe wasting among young children. To reach these four targets, the world needs US$70 billion over 10 years to invest in high-impact nutrition-specific interventions. This investment would have enormous benefits: 65 million cases of stunting and 265 million cases of anemia in women would be prevented in 2025 as compared with the 2015 baseline. In addition, at least 91 million more children would be treated for severe wasting and 105 million additional babies would be exclusively breastfed during the first six months of life over 10 years. Altogether, achieving these targets would avert at least 3.7 million child deaths. Every dollar invested in this package of interventions would yield between US$4 and US$35 in economic returns, making investing in early nutrition one of the best value-for-money development actions. Although some of the targets—especially those for reducing stunting in children and anemia in women—are ambitious and will require concerted efforts in financing, scale-up, and sustained commitment, recent experience from several countries suggests that meeting these targets is feasible. These investments in the critical 1000-day window of early childhood are inalienable and portable and will pay lifelong dividends—not only for children directly affected but also for us all in the form of more robust societies—that will drive future economies.

This paper builds on global experience and Uganda's specific context to estimate costs, benefits, and cost-effectiveness of key nutrition interventions. It is intended to help guide theselection of the most cost-effective interventions as well as strategies for scaling these up. Thepaper considers both relevant "nutrition-specific" interventions, largely delivered through thehealth sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Uganda would require a yearly public investment of USD 68 million. The expected benefits are enormous: annually over 8,000 lives would be saved, while at least 375,000 DALYs and 8,700 cases of stunting among children under five would be averted. Economic productivity could potentially increase by USD 280 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 18 percent. However, because it is unlikely that the Government of Uganda or its partners will be able to find the USD 68 million necessary to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The most cost-effective scenario considered would provide a subset of key interventions in regions with the highest rates of stunting and would cost between USD 19 and USD 60 million, depending on how many regions are covered. We then identify and cost five nutrition sensitive interventions relevant to Uganda for which there is both evidence of positive impact on nutrition outcomes and some cost information. These findings point to a powerful set of nutrition specific interventions and a candidate list of nutrition-sensitive approaches that represent a highly cost-effective approach to reducing child malnutrition in Uganda.

An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding, and Wasting estimates the costs, impacts, and financing scenarios to achieve the World Health Assembly global nutrition targets for stunting, anemia in women, exclusive breastfeeding and the scaling up of the treatment of severe wasting among young children. To reach these four targets, the world needs US$70 billion over 10 years to invest in high-impact nutrition-specific interventions. This investment would have enormous benefits: 65 million cases of stunting and 265 million cases of anemia in women would be prevented in 2025 as compared with the 2015 baseline. In addition, at least 91 million more children would be treated for severe wasting and 105 million additional babies would be exclusively breastfed during the first six months of life over 10 years. Altogether, achieving these targets would avert at least 3.7 million child deaths. Every dollar invested in this package of interventions would yield between US$4 and US$35 in economic returns, making investing in early nutrition one of the best value-for-money development actions. Although some of the targets--especially those for reducing stunting in children and anemia in women--are ambitious and will require concerted efforts in financing, scale-up, and sustained commitment, recent experience from several countries suggests that meeting these targets is feasible. These investments in the critical 1000-day window of early childhood are inalienable and portable and will pay lifelong dividends--not only for children directly affected but also for us all in the form of more robust societies--that will drive future economies.

This paper builds on global experience and Kenya's specific context to identify an effective approach to scaling up nutrition and provide an estimate of costs and benefits of key nutrition interventions. It is intended to help guide the selection of the most cost-effective interventions as well as strategies for scaling up a package of interventions tailored to Kenya's specific needs. The paper considers high-impact nutrition-specific interventions that largely rely on typical health sector delivery mechanisms. The authors estimate that the costs and benefits of implementing 11 critical nutrition-specific interventions will require a yearly public and donor investment of 76 million dollars. The expected benefits will be substantial: annually more than 455,000 disability adjusted life years (DALYs) will be averted, over 5,000 lives saved, and more than almost 700,000 cases of stunting among children under five averted. This investment will be very cost-effective with an estimated cost per DALY averted of 207 dollars cost per life saved of about 18,600 dollars and a cost per case of stunting averted of 135 dollars. Economic productivity can potentially increase by 458 million dollars over the productive lives of beneficiaries. However, the authors also calculate intermediate scale-up scenarios since it may not be feasible for the Government of Kenya or its partners to achieve full coverage in the near term. The authors compare the costs and benefits associated with three different scenarios: first, prioritizing counties, focusing the investment on counties with a high burden of stunting; second, prioritizing interventions, focusing on only a subset of the most effective interventions; and third, prioritizing both counties and interventions, delivering only the most effective subset of interventions to high-burden counties. The authors determined that the third scenario is the most cost-effective and least costly. Scaling up the most cost-effective interventions in 37 high-burden counties will avert almost 295,000 DALYs and save over 3,000 lives per year for an annual public and donor investment of 48 million dollars.

This paper builds on global experience and Zambia's specific context to identify aneffective nutrition approach along with costs and benefits of key nutrition interventions. It isintended to help guide the selection of the most cost-effective interventions as well as strategiesfor scaling these up. The paper considers both relevant "nutrition-specific" interventions, largelydelivered through the health sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions would require an annual public investment of USD 40.5 million and would avert over 112,000 DALYs, save over 2,800 lives, and prevent 62,000 cases of stunting. Economic productivity could potentially increase by USD 915 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 32 percent. However, because it is unlikely that the Government of the Zambia or its partners will find the USD 40.5 million necessary each year to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The two scenarios that scale up the nine most cost-effective nutrition-specific interventions (excluding the public provision of complementary foods) are the most advantageous in terms of cost-effectiveness and resource requirements and would require USD 11 million to scale up to partial levels and USD 23 to scale up to full coverage levels. Among the 8 nutrition-specific interventions we consider, school-baseddeworming is low cost and effective. The interventions we reviewed in the agriculture sector areexpensive when compared to nutrition-specific interventions, although very little cost effectiveness data are available for the nutrition-sensitive interventions to make carefulcomparisons. These findings point to a powerful set of nutrition-specific interventions and acandidate list of nutrition-sensitive approaches that represent a highly cost-effective approach toreducing child malnutrition in Zambia.

This brief examines estimates produced by several recent model simulations and frameworks that focus on the cost of ending hunger as well as progress toward other development goals—estimates that range from US$7 billion to US$265 billion per year. The differences among these estimates are largely attributable to the different targeted objectives and policy questions of each modeling exercise, different investment strategies considered, and varying assumptions about the role of different sectors in reducing hunger.

Focusing the 2015 Annual Trends and Outlook Report (ATOR) on nutrition will contribute to a broader understanding of the critical role of nutrition in achieving international, continental, and national economic growth targets through agriculture, food security, and nutrition. This report presents information and analysis in support of evidence-based policy making that should inform the second generation of CAADP national investment plans now being developed. This is an important moment for shaping the region’s future and ensuring that the much-needed agriculture-led growth and development agenda can simultaneously deliver on improving nutrition, saving lives, improving productivity and health, and curbing nutrition-related diseases and the associated public health expenditures. These investment plans should address not only the usual elements of undernutrition but also widespread micronutrient deficiencies (termed “hidden hunger”) and the growing problem of overweight and obesity that is associated with economic growth.

Many development programs that aim to alleviate poverty and improve investments in human capital consider women’s empowerment a key pathway by which to achieve impact and often target women as their main beneficiaries. Despite this, women’s empowerment dimensions are often not rigorously measured and are at times merely assumed. This paper starts by reflecting on the concept and measurement of women’s empowerment and then reviews some of the structural interventions that aim to influence underlying gender norms in society and eradicate gender discrimination. It then proceeds to review the evidence of the impact of three types of interventions—cash transfer programs, agricultural interventions, and microfinance programs—on women’s empowerment, nutrition, or both. Qualitative evidence on conditional cash transfer (CCT) programs generally points to positive impacts on women’s empowerment, although quantitative research findings are more heterogenous. CCT programs produce mixed results on long-term nutritional status, and very limited evidence exists of their impacts on micronutrient status. The little evidence available on unconditional cash transters (UCT) indicates mixed impacts on women’s empowerment and positive impacts on nutrition; however, recent reviews comparing CCT and UCT programs have found little difference in terms of their effects on stunting and they have found that conditionality is less important than other factors, such as access to healthcare and child age and sex. Evidence of cash transfer program impacts depending on the gender of the transfer recipient or on the conditionality is also mixed, although CCTs with non-health conditionalities seem to have negative impacts on nutritional status. The impacts of programs based on the gender of the transfer recipient show mixed results, but almost no experimental evidence exists of testing gender-differentiated impacts of a single program. Agricultural interventions—specifically home gardening and dairy projects—show mixed impacts on women’s empowerment measures such as time, workload, and control over income; but they demonstrate very little impact on nutrition. Implementation modalities are shown to determine differential impacts in terms of empowerment and nutrition outcomes. With regard to the impact of microfinance on women’s empowerment, evidence is also mixed, although more recent reviews do not find any impact on women’s empowerment. The impact of microfinance on nutritional status is mixed, with no evidence of impact on micronutrient status. Across all three types of programs (cash transfer programs, agricultural interventions, and microfinance programs), very little evidence exists on pathways of impact, and evidence is often biased toward a particular region. The paper ends with a discussion of the findings and remaining evidence gaps and an outline of recommendations for research.