Transcript Cost of hunger study updates - World Breastfeeding Conference

COHA STUDY
2nd World Breastfeeding Conference
11-14 December 2016
by
Wanja Kaaria
STUCTURE OF PRESENTATION
1. Introduction and background of
the Study
2. Findings of the study - 10 Countries
3. Recommendations/Way Forward
4. Questions?
COHA – An African Union Led Initiative in
Nutrition implemented by Member States
The Cost of Hunger in Africa is an African Project, led by the African Union
Commission (AUC), implemented by Members States to improve the lives of
Africa’s children. The AUC provides political leadership and platforms for
advocacy on elimination of child under-nutrition in Africa.
NEPAD provides technical guidance in
nutrition related issues and serves as a
convener to ensure the integration of
complementary regional action.
The technical backstopping by ECLAC
and UNECA through the Social
Development Policy Division, in a SouthSouth partnership to adapt methodology
to African context.
The World Food Programme is technical
lead, and provides oversight of country
level coordination, through its expanded
presence in Africa.
Funding Partners
COHA - Introduction
 COHA was initiated to raise the profile of malnutrition in Africa
– demonstrate its far reaching consequences to social/economic
development – as multi-dimentional implications. – Evidence
base.
 COHA was adapted for African Context, from a model
developed by the Economic Commission for Latin American
Countries – ECLAC & WFP . Initiated in 2010.
 Study is implemented by National Implementation Teams
(NITs) – comprising multi-sectoral representation,
•
uses National Data – DHS, Household surveys, National Census etc.
 It estimates the social and economic impact of child undernutrition by quantifying costs to 3 sectors - Health, Education
and Labour Productivity (and opportunity cost to labour
force, derived from premature death).
COHA Countries
Completed countries
Egypt, Ethiopia, Uganda, Swaziland, Malawi,
Burkina Faso, Rwanda, Ghana, Chad, Lesotho
and Madagascar
Ongoing /Initiated countries
Mauritania, DRC, Mozambique, Zimbabwe, and
Mali, Botswana, Cameroun, Kenya, Niger, Nigeria,
Benin, Togo, Guinea Bissau
Under discussion
Equatorial Guinea, South Africa,
PARTICIPATING COUNTRIES
Phase I
R
R
R
R
R
Egypt
SwazilandS
Ethiopia S
Uganda S
Phase II
Burkina Faso
GhanaS
Malawi
RwandaS
Present Phase
R Chad S
DRC S
Lesotho S
R Mali S
R Mauritania S
Madagascar S
R Mozambique S
Zimbabwe S
ALGERIA
LIBYA
WESTERN
SAHARA
EGYPT
MAURITANIA
MALI
NIGER
CHAD
SENEGAL
GAMBI
A GUINE
ABISSA
U
GUINEA
SIERRA
LEONE LIBER
BENI
N
IA
BURKIN
A
FASO
GHA
NA
NIGERIA
CAMERO
TOGO BENI
ON
N
SAO TOME &
GAB
PRINCIPE
ON
EQUATORIAL
GUINEA
ETHIOPIA
SOUTH
CENTRAL
l
SUDAN
AFRICAN
REPUBLIC
DEMOCRATIC
UGANDA
REPUBLIC OF
THE CONGO
KENYA
RWAND
A BURUND
I
TANZANIA
ANGOLA
R
SUDAN
COMOR
OS
ZAMBIA
MAURITIUS
ZIMBAB
WE
NAMIBIA
BOTSWANA
S
New requests
SWAZILAND
South Africa
LESOTHO
A Brief Recap Of The COHA Status
1st Phase
Reports
Launched
Partnership to
bring the LACCoH to COHA
2010
COHA
Presented
at AU
Summit
2012
AU/ECA
Mandate for
COHA
Declaration
898 at
5th CAMEF
Addis Ababa
2013
2014
Endorsement
of
Methodology
by 4th
Progress
Report on
initial Results
at AU/ECA
ATFFND,
Malawi
6th CAMEF,
Abidjan
Launching of
1st Regional
Report
AU/ECA
7th CAMEF,
Abuja
2nd Phase
Reports
Launched
2015
Launching of
2nd Regional
Report
3rd FfD
By King
Letsie III of
Lesotho
JUNE 2014 – MALABO DECLARATION – HIGH LEVEL ENDORSEMENT OF COHA BY
AFRICAN HEADS OF STATE AND GOVERNMENT - REQUESTING A CONTINENTAL ROLL-OUT
COHA
Methodological
Framework
Methodological Foundations
Universe of Analysis
Variables and Indicators
• Intrauterine: LBW due to
Intrauterine Growth Retardation:
• Infant Underweight – Health:
Low Weight for Age (< -2sd)
• Stunting – Educational
Performance and Productivity:
Low Height for Age (< -2sd)
• Children under 5
years of age who
suffered or are
suffering from
undernutrition
Effect
Life cycle step
Age (Years)
Health
Intrauterine and preschool
0 to 5
Education
School Performance
6 to 18
Productivity
Adult at working age
15 to 64
Results from
COHA
Effects on HEALTH
“Undernourished children have
lower resistance to infection
and are more likely to die of
common childhood illnesses
such as diarrhea and lower
respiratory-tract infections.”
Increased cases related
pathologies (diarrhoea,
anaemia, acute respiratory
infection, fever etc)
For every additional case of
child illness, both the families
and health system are faced
with additional economic costs.
Episodes of illness
Egypt
Ethiopia
Swaziland
Uganda
Burkina
Faso
Malawi
Ghana
Rwanda
Chad
Lesotho
Total
Anemia
102,965
365,311
1,262
55,923
158,112
72,713
33,303
15,743
0
2,924
808,256
Diarrhea
18,342
527,153
2,720
289,994
87,783
67,407
112,644
22,874
118,175
3,723
1,250,815
ARI
4,915
114,300
1,656
27,462
21,100
5,739
51,911
718
65628
504
293,933
-
264,232
217
121,943
65,536
30,887
38,399
7,729
78,213
0
607,156
LBW (IUGR)
116,702
148,173
2,751
82,635
58,452
44,506
37,521
8,880
71,277
2,809
573,706
Underweight
658,516
2,991,509
16,840
975,450
1,613,538
641,222
1,054,902
224,441
1,114,599
40,211
9,331,228
Total
901,440
4,410,678
25,446
1,553,407 2,004,521
862,474
1,328,680
280,385
1,447,892
50,171
12,865,094
Pathologies
Fever/Malaria
Undernutrition contributed to about 13 million incremental cases of illnesses in children under
5 years, in ONE year, in the studied countries
Public and private costs of treating pathologies associated to undernutrition
% of costs covered by families
Rwanda
% of costs covered by the public system
74%
Malawi
26%
49%
51%
Ghana
70%
Burkina Faso
30%
58%
Chad
42%
49%
0%
10%
20%
51%
30%
40%
Cost of families
50%
60%
70%
80%
90%
Cost of system
Rwanda_ 74% of costs of treating pathologies associated to
undernutrition are covered by families/private
100%
Children undernourished under five, average for
10 countries
70.00%
60.00%
24.5%
50.00%
62.23%
40.00%
30.00%
37.77%
20.00%
10.00%
0.00%
0-23 months
23-59 months
% of undernourished children under <23 months old is lower than the % of
those between >23- 59 months old
Malawi_ The cost of health for children under two years old is almost 4 times
higher than the cost of health for a childen of > 23months.
How much on Health?
Country
Egypt
Ethiopia
Swaziland
Uganda
Rwanda
Ghana
Malawi Burkina Faso
Chad
Lesotho
Total
(millions of
USD)
213
154
7
259
106
199
46
63
340
4.2
% of costs
covered by
the families
73%
90%
88%
87%
74%
70%
49%
58%
49%
43%
Public costs
as % of
health public
expenditure
1.62%
2.30%
0.60%
11.00%
26.10%
4.10%
19.50%
4.50%
28.90%
0.10%
Total health
costs as % of
GDP
0.11%
0.55%
0.24%
1.60%
1.50%
0.49%
0.80%
0.6%
2.80%
0.10%
The economic cost of undernutrition ranged from values equivalent to 0.1% to 30% of
government budget allocated to Health and from 0.1% to 2.8% of GDP
A child who is undernourished is at risk of
suffering from cognitive and
physical impairment, which
have impact on quality of life
as a child and an adult within
the society.
Stunted children are more
likely to repeat grades in
school or even drop out.
Effects on EDUCATION
Economic costs of grade repetitions associated with stunting, 2012
Population 5-18 ans
suffering from stunting
Total repetitions
% of repetition associated
with undernutrition
Number of repetition
associated with stunting
% repetition in
primary school
Chad
2,5 million
748 139
14.1 %
105 732
Burkina Faso
3,2 million
229 002
5.8%
Ghana
2,8 million
160 576
Malawi
3,2 million
Rwanda
2.1 million
Countries
Economic costs
Local
(in millions)
USD
(in millions)
91%
CFA 9, 064
18
13 201
74%
FCFA 853
2
12.3%
19 720
57%
GHC 23
13
818 138
18.0%
147 044
89%
MWK 3 418
14
327 500
13.5%
44 255
96%
RWF 2380
4
Malawi-18 % of class repetitions are due to the high risk of children with stunting
% of costs covered by families
Rwanda
% of costs covered by the public system
67%
Malawi
33%
65%
35%
47%
Ghana
Burkina Faso
53%
25%
75%
54%
Chad
0%
10%
20%
30%
46%
40%
Cost of families
50%
60%
Cost of system
70%
80%
90%
100%
How much on Education?
Country
% Repetitions associated
with Stunting
Economic Cost
Local Currency
USD (in millions)
Egypt
Ethiopia
Swaziland
Uganda
10%
16%
12%
7%
EGP 271 million
ETB 93 million
SZL 6 million
UGX 19.7 billion
49.2
7.9
0.7
9.7
Burkina Faso
Ghana
Malawi
Rwanda
6%
12%
18%
13.5%
FCFA 853 million
GHC 23 million
MWK 3,4 billion
RWF 2,4 billion
1.7
13
13.9
3.9
Chad
Lesotho
14%
17.7%
FCFA 9,1 billion
LSL 115 million
18.3
11.7
Various studies have shown
that when a child is stunted,
this will have an impact on
him/her when he/she enters
the labour force.
In general, stunted workers
are less productive in
manual and non-manual
labour than non-stunted
workers, and are less able to
contribute to the national
economy.
Effects on PRODUCTIVITY
Incremental mortality associated with child
undernutrition
Chad
Burkina Faso
Malawi
42.6%
40.4%
23.0%
Ghana
23.8%
Rwanda
21.9%
Chad – 42.6% of child mortality is associated with child undernutrition
How much on Productivity?
Economic Cost
Countries
Egypt
Ethiopia
Swaziland
Uganda
Burkina Faso
Ghana
Malawi
Rwanda
Chad
Lesotho
Annual Working
Hours Lost (in National Currency
(in billions of local US$ (in Millions)
millions)
currency)
857
4,786
37
943
2.646
1.078
0.801
943
1,558
1.078
5
40
0.3
657
319
3.3
90.8
309
334.5
1,516
988
3,396
40
344
624
1.869
368
503
675
154.6
% of GDP
0.50%
11.90%
1.40%
2.10%
6.00%
4.54%
6.37%
7.10%
5.50%
5.5%
THE AGGREGATE LOSS
EconomicLosses
Impact
in Localof Child
AnnualUndernutrition
Losses in
Country
Percent of GDP
Currency
USD
Ethiopia
ETB 55.5 billion
$4.7 billion
16.5%
Egypt
EGP 20.3 billion
$3.7 billion
1.9%
Ghana
GHC 4.6 billion
$2.6 billion
6.4%
Chad
FCFA 575.5 billion
$1.2 billion
9.5%
Uganda
UGX 1.9 trillion
$899 million
5.6%
Rwanda
RWF 503.6 billion
$820 million
11.5%
Burkina Faso
FCFA 409.7 billion
$802 million
7.7%
Malawi
MWK 147 billion
$597 million
10.3%
Lesotho
LSL 1.96 billion
$200 million
7.1%
Swaziland
SZL 783 million
$92 million
3.1%
The aggregate cost estimation for Health, Education and
Productivity are equivalent to between 1.9% to 16.5% of GDP
What are the
potential
savings of a
reduction in
child
stunting
prevalence?
Summary of Savings Scenarios
Total Savings by 2025
Country
Scenario #2: The ‘Goal’ Scenario: “10%
Scenario #1: Halving the Prevalence of Child
Stunting and 5% Underweight by 2025” (in
Under-nutrition by 2025 (in million USD)
million USD)
Egypt
2,129
2,639
Ethiopia
6,010
12,544
Swaziland
47
60
Uganda
1,413
2,103
Burkina Faso
851
1,452
Ghana
2,463
3134
Malawi
800
1,117
Rwanda
149
183
Chad
2,393
4,811
Lesotho
185
292
Recommendations
This results largely emphasize the importance
of focusing the interventions on the prevention
of child malnutrition, in accordance with the
1,000 Days campaign and working with
mothers before and during pregnancy to
ensure that children are born and develop with
proper weight and health during this most
critical stages of life.
Recommendations
 Effort to focus on the first 1000 days of a child’s life,
marketing policies must consider actions to emphasize the
importance of exclusive breastfeeding for children under 6
months, and continued to 2 years, and avoid its
replacement with milk formula.
 Promote strengthening of awareness of good practices
regarding feeding, nutrition and hygiene, while encouraging
practices such as exclusive breastfeeding and food
diversification from the perspective of nutrition, food hygiene
and preservation of the environment.
– A parallel complement with strengthening health education
for optimal child weaning practices is critical and reinforce
general Nutritional and Educational Communication.
Recommendations
 Ensure diversified and adequate diet to pregnant
and lactating women in geographical areas of high
vulnerability. This could be done through monetary
top-up to existing subsidized commodities that are
made available in-kind
 (Enriched- fortified/blended foods).
 Enhance/Initiate engagement with the Scaling Up
Nutrition (SUN) movement.
Progress after
COHA Results
Strategic Wins
AUC/ CONTINENTAL LEVEL
 Raised profile of malnutrition at highest level – Heads of state and
Government – set 1st standalone nutrition goals of 10% and 5%
 King of Lesotho, King Lestie III – as Africa Nutrition Champion
launched the COHA results – FFD#3, and recently in Lesotho.
 Positioning Nutrition as a multi - sectoral development issue –
concerted multi-sectoral response – Ministers of Finance and
Economy
 ARISE – AFRICA’S RENEWED INITIATIVE FOR STUNTING
ELIMINATION BY 2025 – Rally efforts, campaigns to address
stunting
 Global and Continental leaders are making reference to COHA
results. UNSG, AfDB president, Global Panel on F/N security –
EVIDENCE
Going Forward
1. Complete studies in about 15 more Countries
(2016 -17)– including Nigeria, DRC, South Africa
– undertake regional comparisons. 26-30
Countries
2. Expand the continental analytical capacity –
CoHA
3. Rally efforts around AUC/ Member States ARISE.
4. Expand partnerships – FAO, WHO, UNICEF,
REACH/SUN others…. ???
Going Forward
6. Online Data repository – with a dataset of over 26-30
Countries, data can be made available for “public
good” - additional analysis and research - inform
policy.
7. AUC/WFP/ ECLAC – adapt the methodology to
analyze “cost of closing the gap” – identify and cost
nutrition specific/nutrition- sensitive response.
8. Analyzing cost of Obesity- Double burden
9. Continue with M&E and progress reviews of the
countries to ensure COHA is creating sustained
impact on nutrition issues.
Progress After COHA Results
Ethiopia Example

Stunting prevalence is monitored with short intervals. MICS
every two years – instead of the DHS which was every 5yrs.

Widely recognized report at national and sub-regional Level.

Study was presented jointly with the National Nutrition Plan.

Strongly recognized by the Ministry of Economy.

Supported the revision of the National Nutrition Plan.
Uganda Example

Study contributed to scaling up existing interventions,
especially in fortification.

The government embarked on awareness raising campaigns
through the New Vision newspaper.

Stunting is recognized as a key development indicator and included in the
draft National Development Plan II.
Progress After COHA Results
Swaziland Example

Momentum generated by COHA to reduce under-nutrition.

Stunting reduction targets included in Swaziland Development Index
(SDI) COHA paved way for Swaziland to join SUN Movement.

Swaziland National Agriculture Investment Plan (SNAIP)
incorporated nutrition targets for the first time, including
reduction of stunting and wasting.

SDI final target for stunting reduction set at 10% by 2022.

WFP and the MoH started a gap analysis to prioritize interventions to
address causes of stunting and develop national guidelines for a
national stunting reduction programme.

Moving the first national strategy for food and nutrition (National Food
and Nutrition Policy) from draft stage closer to development.
THANK YOU
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