world bank meera shekar

MQSUN

Stocktaking

Planning, Costing and FinancingCommunity of Practice

FAO

WHO

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World Bank

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Strictly Confidential © 2014

Scaling Up Nutrition: What Will it Cost at the Country Level? World

Bank Group TA to SUN Member Countries

Dr. Meera Shekar

Lead Health and Nutrition Specialist

World Bank Group

Countries Planned or in Progress

Countries in Progress: • Nigeria• DRC• Uganda• Zambia• Mali• Togo• Niger

Countries Planned:

• Tanzania• Kenya• Madagascar• Cote De Ivoire• Burundi• Others TBD

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Examples of Nutrition-Specific Interventions

Micronutrient Supplementation

Deworming

Fortification of Staple Foods

Prevention/treatment of acute malnutrition (CMAM,

Public Provision of Complementary Foods)

Examples of Nutrition-Sensitive Interventions

Agriculture (e.g. Biofortification, Aflatoxin

Control)

Education (e.g. Hygiene promotion, school-based

deworming)

WASH

Social Protection (e.g. CCTs)

Step 1: Consultations with government and partners to identify nutrition-specific interventions and to explore potential nutrition-sensitive interventions

Step 2: Data Collection (Coverage rates and unit costs)

Step 3: Costing Calculations (Cost of scaling up interventions from current coverage rates)

Step 4: Benefit Calculations (DALYs saved, Lives saved, Cases of stunting averted, Return on investment)

Step 5: Cost-effectiveness analysis, elaboration of scale-up scenarios for prioritizing resource allocation, and capacity building for government officials

Methods

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Scenarios Annual Public Investment

(US$ million)

# DALYs Saved

(cost/DALY saved)

# LivesSaved

(cost/life saved)

# Cases of Stunting Averted(cost/case averted)

A) All Interventions Scaled to Full National Coverage

$840 15,269,856($55)

248,997 ($3,584)

1,786,291 ($469)

B) Micronutrients, deworming, CNPs and CMAM at “full coverage” in states with >25% stunting

$337 10,513,601($32.1)

131,093($2,817)

1,187,304($284)

C) Micronutrients, deworming, CNPs and CMAM at full coverage in states with >35% stunting

$271 8,426,707($32.2)

96,686($2,806)

889,322($305)

D) All interventions in all states at “partial coverage” rates

$353 7,892,586($44.7)

127,774($2,763)

889,657($417)

E) Micronutrients & Deworming in all states plus CMAM and CNPs at in 13 high burden states (partial coverage)

$184 4,598,018($39.3)

70,305($2,612)

405,926($453)

F) Micronutrients & Deworming in all states (partial coverage) plus CMAM and CNPs in 13 high burden states (full coverage)

$328 7,705,748($42.5)

112,591($2,911)

712,736($460)

Example of Results: Nigeria

School-based Deworming

$2.4 million annually

$4.55/DALY saved

Biofortification of Cassava

$25 million total

800,000 DALYs saved

$7.90-$137.40/DALY

saved

School-based Promotion of Good Hygiene

$59.5 million annually

Aflatoxin Reduction through

Biocontrol

$65.4 annually

1,537,790 DALYs saved

$43/DALY saved