Publication:
An Investment Framework for Nutrition in Kenya: Reducing Stunting and Other Forms of Child Malnutrition

Abstract
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.
Link to Data Set
Citation
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: Reducing Stunting and Other Forms of Child Malnutrition. Health, Nutrition and Population Discussion Paper;. © World Bank. http://hdl.handle.net/10986/26282 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    An Investment Framework for Nutrition in Kenya
    (Washington, DC: World Bank, 2016-12) Eberwein, Julia Dayton; Kakietek, Jakub; de Beni, Davide; Moloney, Grainne; Pereira, Audrey; Akuoku, Jonathan Kweku; Volege, Marjorie; Matu, Sicily; Shekar, Meera
    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.
  • Publication
    An Investment Framework for Nutrition in Zambia
    (World Bank, Washington, DC, 2016-11) Dayton Eberwein, Julia; Kakietek, Jakub; Shekar, Meera; Subandoro, Ali; Pereira, Audrey; Hyder, Zia; Sunkutu, Rosemary; Akuoku, Jonathan Kweku
    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) Shekar, Meera; Hyder, Zia; Subandoro, Ali; Dayton Eberwein, Julia; Pereira, Audrey; Akuoku, Jonathan Kweku
    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 for a More Resilient Mali
    (World Bank, Washington, DC, 2015-02) Shekar, Meera; Mattern, Max; Eozenou, Patrick; Dayton Eberwein, Julia; Kweku Akuoku, Jonathan; Di Gropello, Emanuela; Karamba, Wendy
    This paper builds on the global experience and Mali s context to identify an effective nutrition approach as well as costs and benefits of key nutrition programs, as part of a resilience agenda after the crisis. It is intended to help guide the selection of the most cost-effective interventions as well as strategies for scaling these up. The paper looks at both relevant nutrition-specific interventions, largely delivered through the health sector, and at multisectoral nutrition-sensitive interventions delivered through other sectors such as agriculture, social protection, and water and sanitation that have the potential to strengthen nutritional outcomes in Mali. We first estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Mali would require a yearly public investment of $64 million. The expected benefits are large: annually about 480,000 Disability-adjusted Life Years (DALYs) and more than 14,000 lives would be saved and over 260,000 cases of stunting among children under five would be averted. However, because it is unlikely that the Government of Mali or its partners will find the $64 million necessary to reach full national coverage, we also consider three potential scale-up scenarios based on considerations of their potential for impact, the burden of stunting, resource requirements, and implementation capacity. Using cost-benefit analyses, we propose scale-up scenarios that represent a compromise between the need to move to full coverage and the constraints imposed by limited resources. We identify and cost six nutrition-sensitive interventions that are relevant to Mali s context and for which there are 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 Mali.
  • Publication
    Scaling Up Nutrition in Guinea-Bissau
    (World Bank, Washington, DC, 2017-01) Kakietek, Jakub; Castro Henriques, Antonio; Schultz, Linda; Mehta, Michelle; Dayton Eberwein, Julia; Akuoku, Jonathan Kweku; Menezes Moreira, Ivone; Balde, Fanceni Henriques; Araujo, Edson C.; Shekar, Meera
    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.

Users also downloaded

Showing related downloaded files

  • Publication
    Women, Business and the Law 2024
    (Washington, DC: World Bank, 2024-03-04) World Bank
    Women, Business and the Law 2024 is the 10th in a series of annual studies measuring the enabling conditions that affect women’s economic opportunity in 190 economies. To present a more complete picture of the global environment that enables women’s socioeconomic participation, this year Women, Business and the Law introduces two new indicators—Safety and Childcare—and presents findings on the implementation gap between laws (de jure) and how they function in practice (de facto). This study presents three indexes: (1) legal frameworks, (2) supportive frameworks (policies, institutions, services, data, budget, and access to justice), and (3) expert opinions on women’s rights in practice in the areas measured. The study’s 10 indicators—Safety, Mobility, Workplace, Pay, Marriage, Parenthood, Childcare, Entrepreneurship, Assets, and Pension—are structured around the different stages of a woman’s working life. Findings from this new research can inform policy discussions to ensure women’s full and equal participation in the economy. The indicators build evidence of the critical relationship between legal gender equality and women’s employment and entrepreneurship. Data in Women, Business and the Law 2024 are current as of October 1, 2023.
  • Publication
    Digital Progress and Trends Report 2023
    (Washington, DC: World Bank, 2024-03-05) World Bank
    Digitalization is the transformational opportunity of our time. The digital sector has become a powerhouse of innovation, economic growth, and job creation. Value added in the IT services sector grew at 8 percent annually during 2000–22, nearly twice as fast as the global economy. Employment growth in IT services reached 7 percent annually, six times higher than total employment growth. The diffusion and adoption of digital technologies are just as critical as their invention. Digital uptake has accelerated since the COVID-19 pandemic, with 1.5 billion new internet users added from 2018 to 2022. The share of firms investing in digital solutions around the world has more than doubled from 2020 to 2022. Low-income countries, vulnerable populations, and small firms, however, have been falling behind, while transformative digital innovations such as artificial intelligence (AI) have been accelerating in higher-income countries. Although more than 90 percent of the population in high-income countries was online in 2022, only one in four people in low-income countries used the internet, and the speed of their connection was typically only a small fraction of that in wealthier countries. As businesses in technologically advanced countries integrate generative AI into their products and services, less than half of the businesses in many low- and middle-income countries have an internet connection. The growing digital divide is exacerbating the poverty and productivity gaps between richer and poorer economies. The Digital Progress and Trends Report series will track global digitalization progress and highlight policy trends, debates, and implications for low- and middle-income countries. The series adds to the global efforts to study the progress and trends of digitalization in two main ways: · By compiling, curating, and analyzing data from diverse sources to present a comprehensive picture of digitalization in low- and middle-income countries, including in-depth analyses on understudied topics. · By developing insights on policy opportunities, challenges, and debates and reflecting the perspectives of various stakeholders and the World Bank’s operational experiences. This report, the first in the series, aims to inform evidence-based policy making and motivate action among internal and external audiences and stakeholders. The report will bring global attention to high-performing countries that have valuable experience to share as well as to areas where efforts will need to be redoubled.
  • Publication
    Fiscal Incidence Analysis for Kenya
    (World Bank, Washington, DC, 2018-06-29) World Bank
    Kenya has made satisfactory progress in reducing poverty and inequality in recent years. Economic growth in Kenya between 2005-06 and 2015-16 averaged around 5.3 percent, exceeding the average growth of 4.9 percent observed for Sub-Saharan Africa. This robust economic growth resulted in a reduction in poverty, whether measured by the national or international poverty line. The proportion of the population living beneath the national poverty line fell from 46.8 percent in 2005-06 to 36.1 percent in 2015-16, showing a modest improvement in the living standards of the Kenyan population. Similarly, poverty under the international poverty line of US$ 1.90 a day declined from 43.6 percent in 2005-06 to 35.6 percent in 2015-16. At this level, poverty in Kenya is below the average in sub-Saharan Africa and is amongst the lowest in the East African Community (World Bank, 2018b). However, the proportion of the population living in poverty remains comparatively high in Kenya and the rate at which growth translated into poverty reduction was lower than elsewhere. At twice the average, Kenya’s poverty rate is still high for a lower-middle income country, a group that Kenya joined only in 2015. In addition, the Kenya’s growth elasticity of poverty reduction, the percentage reduction in the poverty rate associated with a one-percent increase in mean per capita income is only 0.57, lower than in Tanzania, Ghana, or Uganda (World Bank, 2018b). This leads to the obvious question of what can be done to make economic growth more pro-poor in Kenya. This study assesses the distributional consequences of Kenya’s system of taxes and transfers, covering 60 percent of revenue and between 25 and 30 percent of government spending. The analysis of fiscal incidence and distributional consequences of Kenya’s tax and transfer system is an important input for designing pro-poor policies and potentially for influencing the rate at which economic growth translates into poverty reduction. In this study, direct taxes and transfers, indirect taxes (VAT and excise duties), as well as public health and education spending are assessed in terms of their distributional impacts. Overall, these taxes and transfers account for about 60 percent of revenue and between 25 and 30 percent of government spending.
  • Publication
    Business Ready 2024
    (Washington, DC: World Bank, 2024-10-03) World Bank
    Business Ready (B-READY) is a new World Bank Group corporate flagship report that evaluates the business and investment climate worldwide. It replaces and improves upon the Doing Business project. B-READY provides a comprehensive data set and description of the factors that strengthen the private sector, not only by advancing the interests of individual firms but also by elevating the interests of workers, consumers, potential new enterprises, and the natural environment. This 2024 report introduces a new analytical framework that benchmarks economies based on three pillars: Regulatory Framework, Public Services, and Operational Efficiency. The analysis centers on 10 topics essential for private sector development that correspond to various stages of the life cycle of a firm. The report also offers insights into three cross-cutting themes that are relevant for modern economies: digital adoption, environmental sustainability, and gender. B-READY draws on a robust data collection process that includes specially tailored expert questionnaires and firm-level surveys. The 2024 report, which covers 50 economies, serves as the first in a series that will expand in geographical coverage and refine its methodology over time, supporting reform advocacy, policy guidance, and further analysis and research.
  • Publication
    Digital Public Infrastructure and Development
    (Washington, DC: World Bank, 2025-03-11) Clark, J.; Marin, G.; Ardic Alper, O.P.; Galicia Rabadan, G.A.
    DPI is an approach to digitalization focused on creating “foundational, digital building blocks designed for the public benefit.” By providing essential digital functions at society scale that can be reused across sectors, DPIs enable public and private service providers to build on these systems, innovate, and roll out new services more quickly and efficiently. Common systems built as DPIs include digital identity and electronic signatures, digital payments, and data sharing. However, to provide DPI functionality, these systems must embed principles such as inclusion, openness, modularity, inclusivity, user-centricity, privacy-by-design, and strong governance. This paper provides a common framework and primer on DPI for policymakers, practitioners, WBG staff, and the broader development community, including: • DPI Concepts and Theory of Change: This includes a working definition of DPI and its core characteristics, including the role of the private sector, how DPI differs from past approaches to digitalization, and the relationship between core DPI systems, sector-specific systems, other digital technologies, and broader ecosystem enablers and safeguards. The paper also articulates the potential benefits of DPI across a range of public and private sector services, as well as risks and challenges for implementation and adoption. • Considerations for Implementation: Drawing on the experiences of a diverse set of countries across different regions, income levels, and DPI approaches, the paper identifies common trends for building, scaling, and using DPIs that are safe and inclusive. This includes identifying what we know (and do not yet know) around different DPI design choices and models, implementation strategies, procurement, issues around use case integration and sequencing of DPI, and more. • Principles and Practical Lessons: Finally, it summarizes key lessons from countries’ experiences with DPI to date, highlighting critical success factors and risk mitigation strategies for policymakers, practitioners, and development partners. A separate volume provides examples of DPI from countries around the globe. By leveraging the opportunities presented by DPI, countries can accelerate their digital transformation journeys and achieve more inclusive and sustainable development. The World Bank Group is committed to supporting this crucial endeavor. The WBG’s new Global DPI Program will address key knowledge gaps and support countries in building safe, inclusive, and transformative DPI.