Julia Dayton Eberwein

An investment framework for nutrition : reaching the global targets for stunting, anemia, breastfeeding, and wasting

The report 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

Breastfeeding in the 21st century

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

An investment framework for nutrition in Afghanistan : estimating the costs, impacts, and cost-effectiveness of expanding high-impact nutrition interventions to reduce stunting and invest in the early years

4 and

Scaling up nutrition in Guinea-Bissau : what will it cost?

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.

An investment framework for nutrition in Kenya : reducing stunting and other forms of child malnutrition

The breastfeeding Series papers by Cesar Victora and colleagues and Nigel Rollins and colleagues are a notable contribution to the maternal and child nutrition fi eld. Both papers comment that the World Health Assembly’s target aiming to increase the rate of exclusive breastfeeding globally in the first 6 months up to 50% by 2025 is achievable, if not unambitious. However, the flaws of the target indicator itself were not addressed. Pullum argued that the commonly used 0–5 month exclusive breastfeeding indicator, which accounts for any infants in that age range, is misaligned with the WHO and UNICEF recommendation of breastfeeding all children exclusively until 6 months. This discrepancy might infl ate the perception of breastfeeding levels nationally and globally. We know that rates decline rapidly between 0 months and 5 months, thus the target as it stands is eff ectively aiming for a fraction of children being exclusively breastfed until 6 months rather than the majority. In Ethiopia for example, the rate of exclusive breastfeeding until 6 months was 23%, much lower than the reported 52% figure for 0–5 months. We recommend that alternatives for computing the percentage of infants exclusively breastfed until 6 months, with existing data from the Demographic and Health Services and Multiple Indicator Cluster Surveys, be explored or more accurate proxies be used. This skewed global nutrition target can mislead policy makers and risks undermining the need to invest in breastfeeding strategies. The world needs a clear breastfeeding target that translates to meaningful improvement in infa nt and young child nutrition.

Scaling up nutrition in the Democratic Republic of Congo : what will it cost?

This paper examines the costs, impacts, and cost-effectiveness of scaling up over five years the nutrition interventions included in Afghanistan’s Basic Package of Health Services (BPHS) as a first step in investing in the early years to build human capital. The total public investment required for the scale up to government-set program coverage levels is estimated to be 44 million US dollars per year over five years, or 1.49 US dollars per capita per year. Each dollar invested would yield at least 13 US dollars in economic returns and even under conservative assumptions regarding future economic growth, the economic benefits exceed the cost by six times which is 815 million US dollars over the productive lives of the beneficiaries. This scale up would prevent almost 25,000 child deaths and over 4,000 cases of stunting and avert a loss of 640,000 disability-adjusted life years (DALYs) and almost 90,000 cases years of anemia. Almost 100,000 more children would be exclusively breastfed. However, this scale-up would only have a marginal effect, a decrease of less than one-half percentage point on stunting prevalence because the current government-set target program coverage rates are very low for the preventive interventions that affect stunting. A substantially greater impact could be achieved if preventive interventions could be scaled to full program coverage levels, which would require less than 5 million US dollars more a year. This would triple the number of DALYs averted, double the number of deaths averted and avert almost eight times as many cases of stunting, resulting in a 2.6 percentage point decline in stunting over the five year period (from 41 percent to 38 percent). The prevalence of anemia in pregnant women could be reduced by 12 percentage points and the prevalence of exclusive breastfeeding could be increased by 18 percentage points. In addition, this investment is projected to generate economic benefits of 815 million US dollars over the productive lives of the beneficiaries. Each dollar invested would yield more than 13 US dollars in economic returns. Sensitivity analysis was conducted for the total cost, cost-effectiveness, and economic returns on investing in the BPHS nutrition interventions.

Financing Needs to Reach the Four Global Nutrition Targets: Stunting, Anemia, Breastfeeding, and Wasting

This paper builds on global experience and Guinea-Bissaus specific context to identify an effective nutrition approach along with 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 these up. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Guinea-Bissau would require a public investment of USD 17 million over five years (with about USD 3 million needed to maintain the current coverage of the interventions and USD 14 million needed to expand the coverage to reach 90 percent of the population). The two key conclusions of this paper are, first, that investing in nutrition in Guinea-Bissau is cost-effective based on international standards and, second, that investments in nutrition can generate very substantial health and economic benefits, with one dollar spent on nutrition interventions resulting in about 10 dollars of returns over the productive lives of children covered by high-impact nutrition interventions. Economic productivity could potentially increase by USD 120 million (discounted at 3 percent) over the productive lives of the beneficiaries, with an impressive internal rate of return of 9 percent annually. Theses findings point to a powerful set of nutrition-specific interventions that represent a high cost-effective approach to reducing child malnutrition and stunting in Guinea-Bissau.

Reaching the Global Target for Breastfeeding

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.

Scaling up nutrition for a more resilient Mali : nutrition diagnostics and costed plan for scaling up

This policy brief presents cost estimates for implementing key nutrition interventions in the Democratic Republic of Congo (DRC) and compares the cost-effectiveness of several scale-up options. The goal of the analysis is to aid the Government of the DRC in setting priorities by identifying the most cost-effective packages of interventions and by leveraging additional resources from domestic budgets and development partners.