Scaling Up Nutrition, What will it cost?

Despite the evidence suggesting that nutrition interventions have the potential to have a positive impact in health and education and on preserving human capital in crises-stricken countries for generations to come, official development assistance for nutrition remains minimal. This report estimates the cost of scaling up a minimal package of 13 proven nutrition interventions from current coverage levels to full coverage of the target populations in the 36 countries with the highest burden of undernutrition. These countries account for 90 per cent of all children whose growth has been stunted by inadequate nutrition. Adding another 32 smaller high-burden countries with levels of stunting and/or underweight exceeding 20 percent would increase these cost estimates by 6 percent. It states that undernutrition imposes a staggering cost worldwide, both in human and economic terms. It is responsible for the deaths of more than 3.5 million children each year (more than one-third of all deaths among children under five) and the loss of billions of dollars in forgone productivity and avoidable health care spending. Individuals lose more than 10 percent of lifetime earnings, and many countries lose at least 2–3 percent of their gross domestic product to undernutrition. The current economic crisis and its potential impact on the poor make investing in child nutrition more urgent than ever to protect and strengthen human capital in the most vulnerable developing countries.

The 13 direct nutrition interventions selected for this costing exercise that have demonstrated effectiveness in many countries by reducing child mortality, improving nutrition outcomes, and protecting human capital are categorised into one of three groups: i) Behaviour change interventions; ii) Micronutrient and deworming interventions; and iii) Complementary and therapeutic feeding interventions. It was concluded that an additional US$10.3 billion from domestic and donor resources for the proposed scale-up. Investments in micronutrient supplementation and fortification were found to have the lowest unit cost (a cost per child per year of about US$5) and to have high cost-effectiveness (US$10 per disability-adjusted lifeyear for vitamin A supplementation, and US$73 per disability-adjusted life year for therapeutic zinc supplementation) and high benefit: cost ratios (8:1 for iron fortification of staples; 30:1 for salt iodization). These micronutrient interventions are also known to work well, even when capacities are constrained. Complementary feeding for children 6–23 months of age is more expensive, between US$40 and US$80 per child per year. Complementary feeding programs have had only a modest effect on deaths.

The most costly intervention per child is treatment of SAM, at US$200 per child treated, which has a cost-per-death averted of US$1,351, corresponding to around US$41 per disability adjusted life-year saved. The reason this intervention is the last priority relates to weak national capacities and delivery systems, as well as the high cost and implementation difficulties of scaling it up. However, when the scale-up becomes tractable with enhanced capacities, this is a high-priority intervention to save lives. Conditional cash transfers can provide additional demand-side support to nutrition interventions, although research on them is currently lacking. Conditional cash transfers are not an alternative to nutrition interventions; rather they can be complementary. Transfers set up to be social safety nets for the poor, for example, can require the use of critical nutrition services, thereby increasing demand for them.

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