Nutrition As A Transformative Investment Agenda

Ziauddin HyderWorld BankOctober 24, 2013zhyder@worldbank.org

Country Resource Allocation Likely to be Associated With Stunting Reduction

Poverty reduction is not automatically translated in nutrition improvement. Public financing reviews lead us to believe that inadequate stunting decline in Africa is linked to poor public resource allocation in nutrition

Rate of under-five stunting

The “Window of Opportunity” for High Impact Investment is narrow…

-2.00

-1.75

-1.50

-1.25

-1.00

-0.75

-0.50

-0.25

0.00

0.25

0.50

0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

Age (months)

Wei

ght f

or a

ge Z

-sco

re (N

CH

S)

Latin America and CaribbeanAfricaAsia

…pre-pregnancy until 24 months of age (1000 days)

Actions after age twoToo expensiveToo littleToo late

But, nutrition narratives are often too technical to be conceived by national politicians and top decision makers for resource allocation

We need to build on this evidence to drive investment priorities in human capital

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-Take advantage of malleability

- Build foundations for further learning

-Prevent early damage and avoid irreversible

loss

EARLY CHILDHOOD PROGRAMS APPEAR PROFITABLE, EVEN IF PAYOFF IS ONLY 20+ YEARS FROM TODAY

• Malnutrition leads to high rates of maternal and child mortality (MDGs 4 & 5) and dramatically increases expenditure on health

• Malnutrition in early years is linked to 7 month delay in starting school and diminishes return on education via reducing quality

• Iodine deficient children lose 13 IQ points; anemic adults have lower work and earning capacity• > 10% reduction in lifetime earnings for each malnourished individual• Collectively, GDP losses is around 8% via poorer cognition and reduced schooling

Why Invest in Nutrition: Getting the right start

But, many arguments are based on global estimates, inadequate efforts to generate local evidence, driven by international bodies:

leading to poor ownership by national policy makers

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Investment opportunities increases by moving to a wider “development lens”

Financing envelope

Health sector

Narrow nutrition lens

Multisectoral nutrition lens

Education sector

Agriculture sector

Private sector

Financial and credit sector

Trade and tax policies sector

Transportation sector

Multiple other sectors

But, efforts are limited to involve multiple sectors to achieve nutrition outcomes

The cost of inaction is high, ANDaction at scale is achievable

Costs of action at scale is:

$ About 10 billion/year globally; of which only $3-$4 billion from external partners

Costs of inaction:• 3.1 million child deaths annually

(45% of all child deaths)• 11% annual loss in GDP (= $140 b in 2011)

• 10-46% loss in individual life-time incomes

• Increase in NCDs & higher health-care costs

HD & SD working together to scale-up evidence-based interventions

Evidence base

“Nutrition-specific” Interventions

“Nutrition-sensitive” Interventions

• Community based programs for behavior change for infant feeding, hygiene, sanitation

• Vitamin A & Zinc suppl.• Micronutrient powders• Deworming • Iron-folic acid supplements

for women• Iron fortification • Salt iodization• Complementary foods • Treatment of Severe

Malnutrition

Scaling these up will save 1 m lives annually, reduce stunting by 20% over existing trend

• Technologies to reduce women’s work• Aflatoxin control• Biofortification of crops• Nutrition education via Agric. Extn.

workers• Technologies to reduce post-harvest

losses• Reducing costs of high nutrient foods• Zinc fertilisers• Hygiene education via WATSAN projects• eat, dairy, fish.

Agriculture

Education• School-based deworming,

Iron suppl for girls, Nutrition/health education in schools

SP• SSNs to target

women/children• CCTs to increase demand for

nutrition services

Scale-up likely to improve nutrition impacts; but documented evidence to-date is limited

Health

Actions Show Results………..

30

35

40

45

50

55

60

2009 2010 2011

Stun

ting

Pre

valenc

e

Stunting prevalence in children 0-35 months

Tranche 2

DHS Expected Trend (1.4ppts/yr)

Tranche 3

DHS Expected Trend (1.4ppts/yr)

Ethiopia Child Stunting Trends

1990 1995 2000 2005 20100

10

20

30

40

50

60

Africa Asia

Senegal

Senegal Child Stunting Trends

…on track for achieving MDG 1c (nutrition)

Governments Adopting Nutrition As A Transformative Investment Agenda

•Benin, Malawi, Madagascar, Senegal, The Gambia, Uganda

Multisectoral

• Angola, Burundi, Burkina Faso, Ethiopia, Ghana, Kenya, Mozambique, Tanzania, Uganda, Zambia, Nigeria, Togo

Health

• Burundi, Cameroon, DRC, Ethiopia, Tanzania, Mozambique, Niger, Nigeria, Zambia

Agriculture/SP/Education

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