An investment framework for nutrition: Reaching the global targets for stunting, anaemia, breastfeeding and wasting

Summary of research^*

Location: Global

What we know: Child malnutrition has lifelong consequences for heath, human capital, economic development, prosperity and equity. Global nutrition targets (2012) focus on stunting, anaemia, low birthweight, childhood overweight, breastfeeding and wasting; the cost of achieving this is unknown.

What this article adds: A recent comprehensive analysis by the World Bank estimates an additional investment of $70 billion (£62 billion approx) over ten years is needed to achieve global targets for stunting, anaemia in women, exclusive breastfeeding and scaled-up treatment of severe wasting. This would avert 3.7 million child deaths; every dollar invested would yield between $4 and $35 in economic returns. Investment in a subset of priority interventions would cost $23 billion (£19 billion approx); global targets would not be reached, but 2.2 million lives would be saved. Achieving global goals is feasible but concerted efforts in financing, scale-up and sustained commitment are needed. Research priorities include scalable strategies for delivering high-impact interventions, how to improve the technical efficiency of nutrition spending, and costs and impacts of nutrition-sensitive interventions.

In 2015, 159 million children under the age of five were chronically malnourished or stunted, underscoring a massive global health and economic development challenge (UNICEF, WHO, and World Bank 2015). In 2012, in an effort to rally the international community around improving nutrition, the 176 members of the World Health Assembly endorsed the first-ever global nutrition targets, focusing on six areas: stunting, anaemia, low birthweight, childhood overweight, breastfeeding and wasting. Some of the targets (stunting and wasting) are further enshrined within the United Nations Sustainable Development Goal 2 (SDG 2), which commits to ending malnutrition in all its forms by 2030.

Nutrition targets: Investment case and constraints

Ending malnutrition is critical for economic and human development. Childhood stunting has lifelong consequences not just for health, but also for human capital and economic development, prosperity and equity. Reductions in stunting may increase overall economic productivity. Nutrition interventions are consistently identified as one of the most cost-effective development actions. However, although the investment case for nutrition is strong, factors limiting achievement of nutrition SDG targets include insufficient financing, complexity of implementation, difficulty determining the methods and costs involved in monitoring SDG targets, and the resources required for scale-up. There is little evidence on the estimated costs of achieving the global nutrition targets, including the SDG targets. No previous study has systematically linked the costs with the potential for impact and the interventions’ returns on investment, nor assessed the financing shortfall between what is required and global spend. Finally, no prior study has presented a comprehensive global analysis of domestic financing from governments and official development assistance.

This report aims to close these knowledge gaps by providing a more comprehensive estimate of costs as well as financing needs, linking them both to expected impacts, and laying out a potential financing framework. An in-depth understanding of current nutrition investments, future needs and their impacts, and ways to mobilise the required funds, are included.  

Estimated financing needs

An additional investment of $70 billion (£62 billion approx) over ten years is needed to achieve the global targets for stunting, anaemia in women, exclusive breastfeeding and scaled-up treatment of severe wasting. The expected impact of this increased investment is the prevention of 65 million cases of stunting and 265 million cases of anaemia in women in 2025, as compared with the 2015 baseline. In addition, at least 91 million more children under five years of age 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. Such investment would also result in at least 3.7 million child deaths being averted. Every dollar invested in this package of interventions would yield between $4 and $35 in economic returns.

In an environment of constrained resources, prioritisation of a subset of interventions is necessary – scaling-up of interventions with the highest returns, that are scalable now, with the strong caveat that global targets would not be reached. Costing $23 billion (£19 billion approx) over next 10 years, when combined with other health and poverty reduction efforts, an estimated 2.2 million lives would be saved and there would be 50 million fewer cases of stunting in 2025 than in 2015.

A mix of domestic on-budget allocations from national governments, oversees development aid (ODA), newly emerging innovative financing mechanisms and household contributions could finance the remaining gap. A society-wide effort is needed for financing the achievement of the nutrition targets; this mix of financing is also in line with other SDG challenges. Not only do investments in nutrition make one of the best value-for-money development actions, they also lay the groundwork for the success of investments in other sectors.

Recent country experiences suggest that meeting global nutrition targets are feasible, although some, especially those for reducing stunting in children and anaemia in women, are ambitious and will require concerted efforts in financing, scale-up and sustained commitment. On the other hand, the target for exclusive breastfeeding has scope to be much more ambitious.

Priority research areas include:  

Research on scalable strategies for delivering high-impact interventions, including how to address bottlenecks to scaling-up.

The assessment of allocative efficiency, i.e. identifying the optimum funding allocation among different interventions or an allocation that maximises the impact under a specific budget constraint.

Research to improve the technical efficiency of nutrition spending, including identifying new strategies for addressing complex nutritional problems such as stunting and anaemia, as well as technologies to help take these solutions to scale more rapidly and at lower cost.

Strengthening the quality of surveillance data, unit cost data for interventions in different country contexts, and building stronger data collection systems for estimating current investments in nutrition (from both domestic governments and ODA). Further research is needed on the costs of interventions and significant resources will be required to build a living database of current investments, including closely monitoring spending and ensuring accountability, and to undertake national-level public expenditure reviews.

Research on which interventions prevent wasting is urgently needed. It is also essential to learn more about cost-effective strategies for managing moderate acute malnutrition, and whether or not these can contribute toward the prevention of wasting.

Costs and impacts of nutrition-sensitive interventions; i.e. interventions that improve nutrition through agriculture, social protection and water and sanitation sectors, among others. It is evident that stunting and anaemia have multiple causes and can be improved through increasing quality, diversity and affordability of foods; increasing the control of income by women farmers; and reducing exposure to faecal pathogens by improved water, sanitation, and hygiene practices. However, the attributable fraction of the burden that can be addressed by these interventions is unknown.

The authors end with a call to action. Investments in the critical 1,000-day window of early childhood will pay lifelong dividends, not only for the children directly affected but also for us all in the form of more robust societies that will drive future economies.

References

UNICEF, WHO, and World Bank (United Nations Children’s Fund, World Health Organization and World Bank). 2015. Joint Child Malnutrition Estimates: Levels and Trends. Global Database on Child Growth and Malnutrition. www.who.int/nutgrowthdb/ estimates2014/en/ (accessed October 2015).