27 February 2015

Want to Sustain Zambia’s Economic Progress? Invest in Nutrition

EDITORIAL From the Zambian Post, Feb 28.

by William Chilufya and Lawrence Haddad

Economic growth in Zambia over the past 10 years has been strong.  GNP per capita in real terms has increased by 50% between 2000 and 2013.  And some social indicators such as under 5 mortality rates (which have declined by half) have responded well.  But not malnutrition.  There has certainly been steady progress in the past few years.  For example, under 5 stunting rates, a measure of chronic malnutrition, have declined from 53% in 2002 to 40% in 2014 or about 1 percentage point a year, but this is slow given the relatively positive economic context.  The government, too, seems highly committed to improving the nutrition of Zambians.  It is a member of the Scaling Up Nutrition (SUN) movement and made meaningful commitments at the Nutrition for Growth pledging event in London in 2013.

The benefits of addressing malnutrition are clear.  For example, 45% of all under 5 mortality would be avoided by ending malnutrition.  This means preventing the deaths of 40 under 5’s per 1000 live births, year in year out.  Economically the returns are large as well.  According to analysis in the just-released Global Nutrition Report, the benefit-cost ratio of scaling up nutrition interventions for Zambia is 17:1.  In other words, for every Kwacha spent on nutrition programmes, the nation gets back 17.  Over a 40 year period this is equivalent to a 10% compound rate of interest—a fantastic rate of return on any investment.
So given a positive economic and political context for nutrition and the strong health and economic benefits flowing from improved nutrition, what needs to be done to accelerate malnutrition reduction?  The new Government brings a fresh pair of eyes to the issue.  What should it do?  First, it must not be overwhelmed by the nature of the challenge.  The Global Nutrition Report highlights many examples of countries and states that have taken on this challenge and won.  Second, there needs to be a recognition that there is no silver bullet for nutrition improvement, only a series of golden alliances: between health, agriculture, water and sanitation; between government, civil society and the private sector; and between those dealing with under and over nutrition.  There are many weak links in the malnutrition chain.   If water and sanitation do not improve fast, then efforts in agriculture and poverty reduction will be undermined. 

Malnutrition is such an entrenched condition, governments cannot do it on their own—they need civil society to help with behavior change and they need businesses to help create a more positive environment for nutrition improvement.  And undernutriton is not the only problem on the Zambian horizon, overweight is too.  In fact Zambia is one of only 17 countries that have serious public health problems in all three of the following: stunting (low height for age), wasting (low weight for height) and overweight (high weight for height).

So what should the priorities be in Zambia?  This is for the Government to determine, but we would suggest a few key things:

* Make nutrition improvement a signature initiative of this new Government.  The issue affects half of all Zambian children.  It will be popular with voters.  President Lungu has the opportunity to speak out about malnutrition and to reset norms and expectations around how quickly it should be reduced
* Make it clear how much money is going to the fight against malnutrition—establish line items in various government departments and find ways to bring these departments together under and newly empowered NFNC in a unified fight against this scourge.

* Have a plan to increase the coverage of proven nutrition interventions such as breastfeeding promotion, efforts to improve the diets of 6-23 month year of infants and young children and the micronutrient supplementation and fortification programmes, especially those targeted to adolescent girls.

* Find ways of making signature programmes like FISP and the Cash Transfer Programme even more effective in reducing malnutrition

* Strengthen legislation on the promotion and marketing of breastmilk substitutes and ready to use therapeutic foods these are so essential to prevent and treat the particularly acute forms of malnutrition

These changes are not easy to make, either fiscally or politically.  There will be many demands placed on the new government.  Why should they take nutrition seriously amongst the clamor?  Well, when you look at the long term economic picture, it becomes clear.  The copper will not last forever.  And while it does the Zambian economy will be held hostage to fluctuations in world commodity prices (see figure at the top of the post).  The tax rate on extractive industries was raised by the previous government and was bravely upheld by the new government.  Now is the time to start investing that tax revenue into something that will endure long after the copper stores diminish, and is not subject to world commodity prices: nutrition.
Investing in infant nutrition improvement now is a way of turning mining resources into human resources.  But can politicians wait 20-30 years for the economic payoffs?  It is well known that Zambia 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 sustain Zambia’s economic progress deep into the 21 century. 

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