07 November 2011

How much money is invested in nutrition?

It is usually easier to find out how much money is being spent on something than how much money should be spent on it. Not so, nutrition.

Thanks to many cost-effectiveness studies we can isolate the 13 essential nutrition interventions and we know roughly how much it costs to make a big dent in undernutrition rates. For example, the Scaling Up Nutrition movement (SUN) estimates the annual amount to be $10 billion.

But how much is actually spent by donors and by multilateral agencies? It turns out this is a really difficult question to answer, at least for nutrition.

Last week my IDS colleague Stephen Spratt and I were at Action Against Hunger at their London offices. We are working with them on a project on innovative financing for nutrition.

Stephen is an expert in development finance and has ideas about how to finance nutrition scale ups, drawing on ideas from climate financing and a range of transactions taxes.

But to do this modelling of financing and taxes, we need to have accurate and specific nutrition resoruce data.

There are two types of intervention to assess current investment flows for: direct and indirect.

The direct interventions are things like breastfeeding promotion, complementary feeding promotion (for infants post weaning) and micronutrient supplementation. It should be easy to get resource flow data for this tangible category, right? Wrong. It turns out that the CRS data held at OECD DAC for donor countries has a category "basic nutrition programme", but when you trawl it project by project, only about a third of that spend is actually on one of the 13 essential nutrition interventions. Interestingly other CRS line items, not labelled with nutrition but with obvious connections to nutrition, contain more spending on the essential nutrition interventions than the "basic nutrition programme" line item.

For the indirect interventions such as agriculture, social protection, health, water, sanitation, women's empowerment it gets even more complicated. Do we use indirect intervention spending (a) only from CRS categories that have something to do with nutrition, (b) from all CRS categories, but only for indirect projects that have nutrition outcome aspirations or (c) from all CRS categories for all indirect projects, whether or not they have nutrition outcome aspirations? I favour the second and the third, because the second gives us the full amount that is being spent on nutrition-focused indirect interventions and the third gives us the potential resource flows that could be supercharged for nutrition.

On top of all this, the range of helpfulness from the 6 bilaterals and the 5 multilaterals approached by Action Against Hunger for clarifications was very wide, with some being right on top of resource flows, some not knowing, and some unhelpful.

The bigger point to be made here is how on earth are we going to be able to track SUN's progress if we cannot even get a fix on resources flows to nutrition? Moreover what are the obligations on agencies to share their resource flow information by issue? There is a clear job for Publish What You Fund and International Aid Transparency Initiative here.

For nutrition, the CRS clearly needs a revamp and on transparency part of the SUN initiative should be to get some sunlight onto nutrition resources flows. Otherwise the SUN will be operating in the dark.


Lawrence said...

A reader has written in to comment that:

"It is not the SUN framework, but a World Bank publication that estimated the scale up cost needs for the 13 direct interventions (Scaling Up Nutrition - What will it cost?" Sue Horton, Meera Shekar et al, World Bank, 2009--from Worldbank.org/nutrition.

The problem with estimating costs for the indirect interventions is much larger than you suggest. The challenge is that, as you know, there is very little evidence on what works, and so impossible to know what to cost.

Third on the issue of the challenges with the OECD coding and resource tracking. It is not that agencies are willing/otherwise to track the info --the challenge is that each agency is using different ways of classifying and reporting on what indirect actions are "nutrition sensitive" and what are not."

Elif said...

Dear Lawrence, I'd be curious to hear if you have found out more about how classify nutrition expenditures. I'm currently working on a nutrition expenditure review for a SSA country and it appears that in the past judging whether certain activities are nutrition sensitive or not has mostly been done on a case-by-case country specific basis. Did you find any more sensible /general rules of thumb. Also as for multi-sectoral investments, any ideas as how to assign % of spending counted towards nutrition etc.?

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Anonymous said...

Sadly, not enough. Nutrition is in direct lineage to agriculture where we know that a strong economy credits agricultural production as its backbone. Investors would rather invest in sure bond deposits for gold bars instead of doling out grants to farm groups.

Johnny McFarland said...

If this question is directed towards a country's government budget and finance department, they should be able to answer with a standard formula in consideration of the present need. It should not be based on approximations only.