Budget Analysis Workshop Guatemala

1. Biggest Bang for the Buck:
Maximizing the Impact of
Investing in Nutrition
Meera Shekar, PhD
Lead Health and Nutrition Specialist
World Bank, Washington DC
Presentation for Workshop on Costing and
Financial Tracking for Improved Nutrition
Guatemala, April 28, 2015
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2. 2
The Costs of Malnutrition
161 million children stunted in 2013 worldwide
6.1 million children stunted in Latin America in 2013

3. 3
Stunting in Latin America
0.0 10.0 20.0 30.0 40.0 50.0
JAMAICA
COSTA RICA
CUBA
BRAZIL
ARGENTINA
SURINAME
DOMINICAN REPUBLIC
COLOMBIA
VENEZUELA
MEXICO
PARAGUAY
PERU
PANAMA
BELIZE
GUYANA
EL SALVADOR
HAITI
HONDURAS
NICARAGUA
ECUADOR
BOLIVIA
GUATEMALA
• Guatemala: 48% of children under
5 are stunted
• Bolivia and Ecuador: Over 25% of
children under 5 stunted
• El Salvador, Haiti, Honduras,
Nicaragua: Over 20% stunted

4. 48%
Stunting
Low Birth
Weight
11%
Malnutrition in Guatemala
Overweight
10%
Anemia in
Children
39%

5. -11%
National
Economy
Stunting
contributes to
losses of up to
11% of GDP
45%
Mortality
Malnutrition is
responsible for
45% of all
under-5
mortality
-1 year
Schooling
A stunted child
completes one
year less of
schooling than
a healthy child
20%
Earnings
Adults who
were stunted
as children
earn at least
20% less than
comparable
adults
High Costs of Malnutrition

6. Nutrition Investments In First 1000 Days
Source: Heckman & Masterov (2004)
Investments in
First 1,000 Days
Have GREATEST
IMPACT
First 1,000 days is
tipping point for:
• Childhood
disease
• Chronic disease
• Cognitive deficits
• Economic losses

7. 7
Normal vs. Stunted Brain Cells
Normal brain cells have
extensive branching:
Stunted brain cells have
abnormal and shorter
branches:

8. Stunted children have
7 month delay in
starting school
Stunted children
complete 1 year less of
schooling
Stunted children have
lower IQ & more likely to
repeat a
grade of school
Stunted children less
likely to graduate high
school
Effects of Stunting on Education

9. -33%
Reduce
Poverty
Interventions to
prevent stunting make
children 33% more
likely to escape
poverty as adults
5-50%
Increase
Wages
Nutrition
interventions can
increase wages by
5 to 50%
4-11%
Increase
GNP
Investments in
nutrition interventions
that prevent stunting
can increase the
economy by up to
11%
Economic Benefits of Investing in Nutrition
These investments in human capital are IRREVERSIBLE

10. Save 1.1 M
lives
10.3 B
Save 30 M Life
Years
Nutritional
services for
356 M
children
30 M children
avoid stunting

PUBLIC
INVESTMENT
BENEFITS
Costs & Benefits At Global Level

11. What can we do to address
undernutrition?
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• Package of evidence-based nutrition-
specific interventions
• Mostly through health sector
• Nutrition-sensitive interventions
• through agriculture, social protection, WASH and
education sectors

12. Intervention
Cost/DALY Saved
Cost/Life
Saved
Cost/Stuntin
g Case
AvertedNigeria Global
CNPs (EBF, CF & hygiene
promotion)
12 53-153 783 38
Vitamin A supplementation 29 3-16 433 15
Therapeutic Zinc suppl./ORS 216 73 932
Micronutrient powders 44 12
Deworming 264 n/a
Iron-folic acid
supplementation
43 66-115 974
Iron fortification of staple
foods
n/a
Salt iodization n/a
Public provision of
complementary food for MAM
3,256 500-1000 28,557 206
CMAM for SAM 169 41 3,214
Maximizing Efficiencies: Example Nigeria
Is it possible to maximize impact while minimizing cost?
Certain interventions are more cost-effective than others…
NOT COST
EFFECTIVE

13. Costs & Benefits of Nutrition-sensitive Interventions
Four possible nutrition-sensitive interventions have the potential to improve
nutrition outcomes in Nigeria
School-
based
Deworming
$2.4 million
annual
$4.55/DALY
saved
Biofortification
of Cassava
$25 million
total
$0.30-
$0.50/DALY
saved
School-based
Promotion of
Good Hygiene
$59.5
million
annual
Aflatoxin
Reduction
through
Biocontrol
$65.4
million
annual
1,537,790
DALYs
saved
$43/DALY
saved
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An Example from Nigeria

14. However, Stunting continues to be invisible and
unrecognized…
 By policy makers…
 And by families and
communities…
Hopefully, an
appreciation of
the economic
costs will make it
more “visible”
7 years 7 years 4 years14
The Way Forward

15. Thank you!
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