Biggest Bang for the Buck:

Maximizing the Impact of

Investing in Nutrition

Meera Shekar, PhDLead Health and Nutrition Specialist

World Bank, Washington DC

Presentation for Workshop on Costing and

Financial Tracking for Improved Nutrition

Guatemala, April 28, 2015 1

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The Costs of Malnutrition

161 million children stunted in 2013 worldwide

6.1 million children stunted in Latin America in 2013

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Stunting in Latin America

0.0 10.0 20.0 30.0 40.0 50.0

JAMAICA

COSTA RICA

CUBA

BRAZIL

ARGENTINA

SURINAME

DOMINICAN REPUBLIC

COLOMBIA

VENEZUELA

MEXICO

PARAGUAY

PERU

PANAMA

BELIZE

GUYANA

EL SALVADOR

HAITI

HONDURAS

NICARAGUA

ECUADOR

BOLIVIA

GUATEMALA

• Guatemala: 48% of children under

5 are stunted

• Bolivia and Ecuador: Over 25% of

children under 5 stunted

• El Salvador, Haiti, Honduras,

Nicaragua: Over 20% stunted

48%Stunting

Low Birth

Weight

11%

Malnutrition in Guatemala

Overweight

10%

Anemia in

Children

39%

-11%

National Economy

Stunting

contributes to

losses of up to

11% of GDP

45%

Mortality

Malnutrition is

responsible for

45% of all

under-5

mortality

-1 year

SchoolingA stunted child

completes one

year less of

schooling than

a healthy child

20%

Earnings

Adults who

were stunted

as children

earn at least

20% less than

comparable

adults

High Costs of Malnutrition

Nutrition Investments In First 1000 Days

Source: Heckman & Masterov (2004)

Investments in

First 1,000 Days

Have GREATEST

IMPACTFirst 1,000 days is

tipping point for:

• Childhood

disease

• Chronic disease

• Cognitive deficits

• Economic losses

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Normal vs. Stunted Brain Cells

Normal brain cells have

extensive branching:

Stunted brain cells have

abnormal and shorter

branches:

Stunted children have

7 month delay in

starting school

Stunted children

complete 1 year less of

schooling

Stunted children have

lower IQ & more likely to

repeat a

grade of school

Stunted children less

likely to graduate high

school

Effects of Stunting on Education

-33%

ReducePoverty

Interventions to

prevent stunting make

children 33% more

likely to escape

poverty as adults

5-50%

IncreaseWages

Nutrition

interventions can

increase wages by

5 to 50%

4-11%

Increase GNP

Investments in

nutrition interventions

that prevent stunting

can increase the

economy by up to

11%

Economic Benefits of Investing in Nutrition

These investments in human capital are IRREVERSIBLE

Save 1.1 M

lives10.3 B

Save 30 M Life

Years

Nutritional

services for

356 M

children

30 M children

avoid stunting

PUBLIC

INVESTMENT

BENEFITS

Costs & Benefits At Global Level

What can we do to address

undernutrition?

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• Package of evidence-based nutrition-

specific interventions• Mostly through health sector

• Nutrition-sensitive interventions• through agriculture, social protection, WASH and

education sectors

Intervention

Cost/DALY SavedCost/Life

Saved

Cost/Stuntin

g Case

AvertedNigeria Global

CNPs (EBF, CF & hygiene

promotion)12 53-153 783 38

Vitamin A supplementation 29 3-16 433 15

Therapeutic Zinc suppl./ORS 216 73 932

Micronutrient powders 44 12

Deworming 264 n/a

Iron-folic acid

supplementation43 66-115 974

Iron fortification of staple

foodsn/a

Salt iodization n/a

Public provision of

complementary food for MAM 3,256 500-1000 28,557 206

CMAM for SAM 169 41 3,214

Maximizing Efficiencies: Example Nigeria

Is it possible to maximize impact while minimizing cost?

Certain interventions are more cost-effective than others…

NOT COST

EFFECTIVE

Costs & Benefits of Nutrition-sensitive Interventions

Four possible nutrition-sensitive interventions have the potential to improve nutrition outcomes in Nigeria

School-based

Deworming

$2.4 million annual

$4.55/DALY saved

Biofortificationof Cassava

$25 million total

$0.30-$0.50/DALY

saved

School-based Promotion of Good Hygiene

$59.5 million annual

AflatoxinReduction through

Biocontrol

$65.4 million annual

1,537,790 DALYs saved

$43/DALY saved

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An Example from Nigeria

However, Stunting continues to be invisible and

unrecognized…

By policy makers…

And by families and communities…

Hopefully, an appreciation of the economic costs will make it more “visible”

7 years 7 years 4 years14

The Way Forward

Thank you!

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