Investing in Nutrition: How much will it cost and how to pay for it? = Mary D'Alimonte

1. Investing in Nutrition:
How much will it cost
and how to pay for it?
Mary D’Alimonte, R4D
CORE Group Global Health Practitioner
Conference - Community Health
Transitions: Leading for Impact
Oct 12th 2016

2. Malnutrition is a pervasive problem, while good nutrition builds
human capital and shared prosperity, and improves health outcomes
SCHOOLING
Early nutrition
programs can
increase school
completion by
one year
EARNINGS
Early
nutrition
programs can
raise adult
wages by 5-
50%
POVERTY
Children who
escape stunting
are 33% more
likely to escape
poverty as
adults
ECONOMY
Reductions in
stunting can
increase GDP
by 4-11%
in Asia &
Africa
HEALTH
3.3 million child
deaths annually
attributed to
malnutrition,
45% of total
number deaths

3. 3
How to intervene and support scale-up of life saving
nutrition interventions?
To intervene, we know which interventions to prioritize…
– Unicef conceptual framework and two-pronged approach
– Lancet Series 2008 & 2013 on maternal and child nutrition
…But we know less about current investments, how they are
mapped to priority programs, and where the financing gaps are
– How much is invested in nutrition specific activities?
– Are investments aligned with priority areas, high risk geographic areas,
or high risk groups?
– What resources are required to scale-up these interventions? Where
are we today and what is the resource gap?

4. 4
We estimated the cost and financing needs to achieve four of
the World Health Assembly nutrition targets
Low birth weight Overweight
NOT INCLUDED:
Wasting
Anemia
Breastfeeding
Stunting
TARGET: 40% reduction in the number of children
under-5 who are stunted
TARGET: 50% reduction of anemia in women of
reproductive age
TARGET: Increase the rate of exclusive breastfeeding
in the first 6 months up to at least 50%
TARGET: Reduce and maintain childhood wasting to
less than 5% from 8% by 2025

5. 5
Included in the analysis: high-impact nutrition-specific
interventions
For the General Population:
• Staple food fortification
• Pro-breastfeeding social policies
• Media strategy for breastfeeding promotion
• Breastfeeding counseling
• Complementary feeding education
• Iron and folic acid supplements
• Micronutrient powders in pregnancy
• Balanced protein-energy supplementation in pregnancy
• Intermittent preventative treatment of malaria for pregnant
women
• Vitamin A supplements
• Prophylactic zinc supplementation
• Micronutrient powders
• Public provision of complementary food
• Treatment of severe acute malnutrition
Success and scale up of these
interventions requires a strong
enabling environment

6. 6
Achieving the four WHA targets require an additional $70B
globally between 2016-2025
6
IPTp 0.4
Breastfeeding promotion*** 1.0
Promotion of IYCF & hygiene**
M&E, policy, capacity development
6.8
Balanced Energy-Protein Supp.
7.4
Micronutrients* 26.4
69.9All interventions
12.8
6.9
Treatment of SAM 8.1
Provision of comp. foods
*Includes zinc proph., weekly IFA, MMP in pregnancy, vitamin A, food fortification.
**Promotion of IYCF includes 2 years of education for stunting and 1 year for EBF
***Includes media strategy for EBF and pro-breastfeeding social policies
The global impact of
investing over 10 years:
• 3.7 million child lives
saved
• 105 million more
children exclusively
breastfed
By 2025:
• 65 million fewer cases of
stunting
• 265 million fewer women
with anemia

7. 7
Current global investments on
nutrition specific interventions by target
Note – the sum of all targets does not equal the total figure for all four targets combined due to intervention
overlap. The figure for all four target corrects for overlap & counts each dollar once.
$0.6
0.5
0.1
2.2
Stunting
$2.5
0.3 0.1
EBF
$0.4
0.1
0.30.6
Wasting
$0.6
AnemiaAll Four
Targets
1.0
2.9
$3.9
Government
Donor
US$ billions

8. 8
Development assistance for nutrition by region and income
group of recipient country
173
43
379
125
114
321
Middle East &
North Africa
0
12
151
25
563
Sub-Saharan
Africa
11
5 3
East Asia
& Pacific
64
1424 30
Latin America
& Caribbean
18
Europe &
Central Asia
168
47
South Asia
7
US$ millions
LMIC
LIC
UMIC

9. 9
Future financing scenario assumptions
Assumption Details Comments
Businessas
Usual
Share of current
nutrition spending stays
constant
Government spending as a share of health, and donor
investments as a share of health ODA remain
constant
• Nutrition prioritization (in terms of % of budgets) remains
at 2015 levels
Economic growth
expected based on WEO
& OECD projections
Domestic, donor, and household spending increase by
GDP growth
• Slight increase in absolute financing available only
N4G commitments fully
realized
Commitments for nutrition specific investments made
at N4G 2013 are realized and attributed to each
target proportional to current donor investments
• Small donor investments in addition to increase due to
economic growth
GlobalSolidarity
No reduction in current
spending
The $3.9 billion of current annual financing is
continued, so that the additions described below are
truly incremental
• If current levels of support cannot be counted on to
continue, it would be extremely difficult to close the
resource gap
Country-driven spending
benchmarks
By 2021, governments increase spending on nutrition
as a share of total government expenditure linearly to
the median in their income group; those above the
benchmark increase spending by 1% per year.
• Governments that have been lagging behind their peer
countries in prioritizing nutrition will have to step up more
if the resource gap is to be closed.
• ODA and other sources will still be needed to fill in where
required.
Countries with higher
ability contribute more
UMICs pay for 100% of annual cost 2016-2025
By 2025:
•LMICs pay for 70% of annual cost. Those already
above 70% in 2016 maintain
•LICs pay for 50% of annual cost
• ODA will need to give priority to low and lower-middle
income countries and focus on supporting the five-year
scale-up period.
• Countries with greater ability to pay—even those with high
burdens such as China and Mexico—will completely cover
their own costs.
New mechanisms for
nutrition financing are
optimized
Commitments made by the Power of Nutrition and
other innovative financing mechanisms are assumed
to be fully realized and distributed among recipient
countries proportionally on the basis of stunting
burden
• The new mechanisms will help attenuate the cost pressure
on governments and ODA. Countries benefitting from The
Global Financing Facility and the Power of Nutrition will
make maximum use of those new funds.
Private sector
engagement
Private sector stakeholders are engaged in the scale-
up of food fortification, supply of micronutrient
supplements, and other interventions
• Partnerships across stakeholders, including public-private
collaboration, will be needed.

10. 10
Business As Usual: Results in a shortfall of US$ 56 billion
10
2018
13.0
8.5
11.3
7.4
3.93.9
2020
5.1
2022
12.8
3.9
2021
6.2
7.5
2019
1.1
10.0
3.9
2025
13.5
3.9
1.20.9
7.5
0.7
1.6
2024
13.4
2023
3.9
1.8
7.4
3.9
13.2
1.4
7.4
6.9
3.9
3.8
2.4
3.9
2016 2017
1.1
3.9
Remaining gap Additional donor BaselineAdditional household Additional domestic
 Financial
commitments made
at Nutrition for
Growth N4G are
realized
 Current spending as
a share of
government or donor
budgets constant
 Economic growth
based on WEO &
OECD projections
US$ billions
Does not include intermittent presumptive treatment of malaria in pregnancy costs (total cost = $416 M), as it is currently being funded by other
sources, including the President Malaria's Initiative, the Global Fund to Fight AIDS, TB and Malaria, and to some extent country governments.

11. 11
Global Solidarity: achieving the four WHA targets would
require coordinated effort by all sources
13.4
2025
3.9
2024
7.1
3.9
2019
4.5
3.9
2.8
3.9
2.2
3.9
3.9
2021
12.8
8.5
5.1
11.3
3.5
3.5
10.0
2017 2018
6.9 2.9
2.0
2020
13.5
2.1
3.9
0.4
1.4
5.4
3.93.9
1.5
2016
3.5
2023
3.9
3.1
6.4
13.2
3.9
5.7
2022
2.6
13.0
Additional householdInnovative sources BaselineAdditional donorAdditional domestic
US$ billions
Does not include intermittent presumptive treatment of malaria in pregnancy costs (total cost = $416 M), as it is currently being funded by other
sources, including the President Malaria's Initiative, the Global Fund to Fight AIDS, TB and Malaria, and to some extent country governments.
• Additional $70 B is mobilized
• Annual investments increase 3.5-fold by 2025 to $13.5 B/y
• Governments contribute 3% of health budgets on nutrition by 2025
• Donors spend 2.8% of ODA on nutrition in 2021, taper to 1.8% by 2025

12. 1212
Global Solidarity financing scenario by income group
Upper-middle income countries (UMICs)Lower-middle income countries (LMICs)
Low-income countries (LICs)
8
6
4
2
0
3.02.9
2020
2.8
2024
3.1
2025
3.0
202320222021
2.11.7
2.4
2017
1.30.9
201920182016
Innovative sources BaselineAdditional donorAdditional domesticAdditional household
US$ billions
2
8
6
4
0
3.3
4.2
2.5
2016 2017
6.9
2022
5.0
6.7
20242023
6.6
20252021
6.56.4
2020
5.6
20192018
4
2
0
8
6
202520242023
3.63.6 3.6
2022
3.0
2021
1.9
3.6
2.6
3.3
2.3
2017 2018
3.6
202020192016
Income group
Country share
of total costs
Donor share
of total costs
LIC 24% 70%
LMIC 56% 36%
UMIC 98% 0%
Remaining share comes from households and innovative financing.

13. 13
Key policy messages for 2016 and beyond
FINANCIAL
COMMITMENTS
PRIORITY
SETTING
RESOURCE
MOBILIZATION
WIDESPREAD
IMPLEMENTATION
EXPENDITURE
TRACKING
Leaders
commit to new
financial and
policy pledges for
nutrition at
Nutrition for
Growth
Prioritize
nutrition-
specific
spending and
programming in
donor and
country budgets
in order to
reach all global
goals
Unlock
additional
financing from
domestic &
donor sources
Accelerate
the pace of scale-
up and invest in
implementation
science to
improve delivery
and efficiencies
Make all
stakeholders
Accountable
through better
tracking,
analysis, and
reporting