Publication: An Investment Framework for Nutrition in Kenya
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2016-12
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2017-03-16
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This knowledge brief presents the costs of scaling up key effective nutrition interventions in Kenya and compares different scale-up scenarios to determine which one produces the best results for the lowest cost. The goal of the analysis is to inform program planning by identifying the most cost-effective packages of interventions and by leveraging additional resources from domestic budgets and development partners.
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“Eberwein, Julia Dayton; Kakietek, Jakub; de Beni, Davide; Moloney, Grainne; Pereira, Audrey; Akuoku, Jonathan Kweku; Volege, Marjorie; Matu, Sicily; Shekar, Meera. 2016. An Investment Framework for Nutrition in Kenya. Health, Nutrition and Population Global Practice Knowledge Brief;. © World Bank. http://hdl.handle.net/10986/26284 License: CC BY 3.0 IGO.”
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Publication An Investment Framework for Nutrition in Kenya(World Bank, Washington, DC, 2016-12)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.Publication An Investment Framework for Nutrition in Zambia(World Bank, Washington, DC, 2016-11)This paper builds on global experience and Zambia's specific context to identify aneffective nutrition approach along with costs and benefits of key nutrition interventions. It isintended to help guide the selection of the most cost-effective interventions as well as strategiesfor scaling these up. The paper considers both relevant "nutrition-specific" interventions, largelydelivered through the health sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions would require an annual public investment of $40.5 million and would avert over 112,000 DALYs, save over 2,800 lives, and prevent 62,000 cases of stunting. Economic productivity could potentially increase by $915 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 32 percent. However, because it is unlikely that the Government of the Zambia or its partners will find the $40.5 million necessary each year to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The two scenarios that scale up the nine most cost-effective nutrition-specific interventions (excluding the public provision of complementary foods) are the most advantageous in terms of cost-effectiveness and resource requirements and would require $11 million to scale up to partial levels and $23 to scale up to full coverage levels. Among the 8 nutrition-specific interventions we consider, school-baseddeworming is low cost and effective. The interventions we reviewed in the agriculture sector areexpensive when compared to nutrition-specific interventions, although very little cost effectiveness data are available for the nutrition-sensitive interventions to make carefulcomparisons. These findings point to a powerful set of nutrition-specific interventions and acandidate list of nutrition-sensitive approaches that represent a highly cost-effective approach toreducing child malnutrition in Zambia.Publication An Investment Framework for Nutrition in Uganda(World Bank, Washington, DC, 2016-10)This paper builds on global experience and Uganda's specific context to estimate costs,benefits, and cost-effectiveness of key nutrition interventions. It is intended to help guide theselection of the most cost-effective interventions as well as strategies for scaling these up. Thepaper considers both relevant "nutrition-specific" interventions, largely delivered through thehealth sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Uganda would require a yearly public investment of $68 million. The expected benefits are enormous: annually over 8,000 lives would be saved, while at least 375,000 DALYs and 8,700 cases of stunting among children under five would be averted. Economic productivity could potentially increase by $280 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 18 percent. However, because it is unlikely that the Government of Uganda or its partners will be able to find the $68 million necessary to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The most cost-effective scenario considered would provide a subset of key interventions in regions with the highest rates of stunting and would cost between $19 and $60 million, depending on how many regions are covered. We then identify and cost five nutrition sensitive interventions relevant to Uganda for which there is both evidence of positive impact on nutrition outcomes and some cost information. These findings point to a powerful set of nutrition specific interventions and a candidate list of nutrition-sensitive approaches that represent a highly cost-effective approach to reducing child malnutrition in Uganda.Publication Scaling Up Nutrition in Guinea-Bissau(World Bank, Washington, DC, 2017-01)This paper builds on global experience and Guinea-Bissau's 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.Publication An Investment Framework for Nutrition(Washington, DC: World Bank, 2017-04-12)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 $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 $4 and $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.
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