27 February 2015

Editorial: Nutrition is an incredible investment opportunity for Ethiopia’s present and future

By Lawrence Haddad

Economically, Ethiopia has made spectacular progress in the past 10 years: economic growth has been strong and extreme poverty rates have almost halved. 

However, progress in reducing malnutrition has been steady rather than spectacular.  In the past few years stunting rates (children with very low heights for their age) for children under 5 have fallen from 58% in 2000 to 44% in 2010 and to 40% in 2014. That is a very respectable rate of decline --more than one percentage point a year.  But this rate of reduction is much slower than the rate of reduction in poverty.  What needs to be done to accelerate malnutrition reduction?

First, let’s remind ourselves why we care about stunting rates of children under 5.  It is not the height per se we care about, it is the crucial things that height gain is a marker for early in life.  Height gains in the first 2-3 years of life are strongly linked to improved immune system and cognitive system development.  Weight gains in the same period are not nearly as strongly linked. 

We know that 45% of all under 5 deaths are associated with malnutrition.  The Ethiopian under 5 mortality rate has dropped steadily in the past 10 years, but still 64 of every live births in the country will not make it to their 5th birthday.  So 30 out of every 1000 under 5 deaths in Ethiopia will be avoided by addressing malnutrition.

We know what to do to address and prevent malnutrition: scale up nutrition-specific programmes to improve, for example, exclusive breastfeeding rates, improve the diets of infants between 6 and 23 months and improve the diets of adolescent girls and women of reproductive age.  We also know we need to improve underlying drivers of food security, access to improved water, sanitation and health services and continue to support the empowerment of women.  The prospects are good.  Ethiopia is a world leader in making safety nets productive in terms of skill development and infrastructure development -- and now in terms of building the human capital of the youngest by making the Productive Safety Net Programme more nutrition sensitive through an increased focus on the first 1000 days of life.  

And the economic returns are enormous.  The Global Nutrition Report estimates that for Ethiopia, for every Birr spent improving the coverage of nutrition programmes, 12 Birr are generated in terms of improved productivity in the labour force.  That is equivalent to a 9% compound rate of interest earned on an investment over a thirty-year period—surely a better return than any other investment opportunity in Ethiopia today.  In fact the African Cost of Hunger project estimates that the total economic cost of malnutrition in Ethiopia is equivalent to 16% of current GDP. 

What are the Ethiopian investment priorities in nutrition?  The Global Nutrition Report brings together a wide array of data on nutrition outcomes, programmes, underlying drivers, policies, spending and legislation to provide some signposts to action.   

The data in the Ethiopia Nutrition Profile suggest the following areas are priorities for action:  improve infant and young child feeding through complementary feeding programmes; dramatically improve secondary enrolment rates of girls and strengthen the population density of doctors and nurses/midwives.  Other opportunities for action relate to policy and legislation: few provisions of the international code of marketing of breast milk substitutes are enshrined in law; nutrition does not feature as much in national development plans and economic policies as it does in many other countries, wheat fortification legislation is rated as in the planning phase, and maternity protection, so crucial for child feeding by working mothers is “partial”.

It is, of course, for Ethiopian policymakers to set investment priorities for nutrition.  The evidence reassures that these investments will pay off--they are proven interventions.  But can politicians wait 20-30 years for the economic payoffs?  It is well known that Ethiopia is undergoing a demographic transition.  Mortality rates are falling and the ratio of working age to non-working age people is increasing and will peak around 2050.  This is the so-called “demographic dividend”.  But it will only be a dividend if the infants of today can get good jobs in 2050.  That means investing in their nutrition today.  As the African saying goes: the best time to plant a tree is 30 years ago.  The next best time is today.”  If the investments are not made in nutrition of infants today, the demographic dividend of 2050 could turn into a demographic “nightmare”, with widespread unemployment, disillusionment and a loss of development momentum. 

Making nutrition a policy priority is not only good health policy, it is a fundamental plank of economic policy and will propel Ethiopia’s economic progress now and in the future. 

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