Malawi Public Expenditure Review: Nutrition

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Malawi Public Expenditure Review Nutrition

• 21 November 2007

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• MALNUTRITION A SILENT CRISIS IN MALAWI
• INVEST NOW!!!!!

UNICEF/Pirozzi
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Malnutrition A Silent crisis in Malawi

• Malnutrition is underlying cause in over 50 of
  child deaths under the age of 5 in the world, and
  is therefore key to reaching MDG4 (reducing
  child mortality rate)
• Malnutrition diminishes future productivity and
  therefore has long-term impact for society
• In Malawi 48 of children under-5 are stunted
  (2004 DHS), i.e. one in every two children
• 22 of children under-5 are severely stunted,
  i.e. they will suffer permanent physical and
  mental retardation that may lead to reduced
  productivity and intellectual ability
• Micronutrient deficiency disorders especially of
  Vit A, iron and iodine are also a public health
  problem that undermine human capital development
  in the country
• Data shows that little progress has been made in
  combating malnutrition in Malawi since 1992

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Consequences of malnutrition

• The consequences of malnutrition, though abstract
  are overwhelming and could significantly
  undermine Malawis development efforts.
• Reduced intellectual ability (failure to reach
  academic and professional potential) (MDG 2 -
  education)
• Lowered immunity
• Increased frequency severity of infectious
  diseases (MDG 4)
• Increased absenteeism Reduced concentration at
  school
• Reduced performance at school

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What have been the key expenditure trends?

• Nutrition has for a long time received very
  little attention at all levels insipite of its
  direct impact on human capital development
• Government spends less than 0.05 of GDP on
  alleviating malnutrition
• Total annual expenditures on direct nutrition
  interventions are about 1.5 percent of GDP,
  almost entirely funded by donors
• More than one-third of all expenditures are on
  therapeutic and school feeding programs

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Main Findings
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(1) Most of the nutrition expenditure is on
programs that are costly and do not have a
lasting impact

• Almost half (44) of nutrition expenditures are
  curative in nature will therefore have no
  lasting effects on feeding practices and reducing
  malnutrition
• Examples of curative programs are supplementary
  and therapeutic feeding. Malawi is also
  implementing school feeding programmes aiming at
  increasing enrollment and reducing dropout rates
  especially among girls while promoting nutrition
  among school aged and adolescent children.
• These programs are very expensive to run do not
  change peoples dietary patterns (e.g. School
  feeding costs around US15 per child per year
  but Government only spends US17 per pupil in
  primary education)
• Preventive programs are needed to tackle
  malnutrition, such as programs to increase
  dietary diversification, nutrition education,
  micronutrient supplements, lactation, growth
  promotion as stipulated in the Essential
  Nutrition Actions (ENA) package recently adopted
  by government to promote women and child nutrition

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(2) Current nutrition programs do not adequately
target priority groups

• High priority groups include children under-5,
  pregnant and postpartum mothers
• Few interventions specifically target the
  under-2s, which is the period when most
  malnutrition occurs.
• Initiatives to promote appropriate Infant and
  young child feeding such as BFHI and ENA have not
  received adequate support.
• Only a third of nutrition expenditures target
  young children and pregnant mothers
• School feeding programs are not properly
  integrated in other nutrition promotion
  interventions

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(3) There is little coordination between
government and donors in tackling malnutrition

• Nutrition is considered as a cross cutting issue
  such that nutrition programs are carried out by
  various ministries (education, agriculture,
  health, trade and industry)
• There has been no clear coordination and
  rationalization of the nutrition programs over
  the years
• Each donor is working with government on
  supporting a nutrition program without properly
  coordinating with other development partners
• The creation of the dept. of Nutrition HIV and
  AIDS in OPC, however, is aimed at spearheading
  coordinated implementation of Nutrition
  Programmes in the country

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(4) There seems to be inadequate knowledge of
determinants of malnutrition

• The 2006 Poverty Vulnerability Assessment
  showed similar incidence of malnutrition among
  children from all income categories of households
  
• i.e. malnutrition is a problem in poor as well as
  rich households.
• Therefore, in addition to income, other factors
  are also critical determinants of malnutrition
• Resources for care, Mothers education, feeding
  practices
• Water and sanitation
• Need more in-depth analysis knowledge of
  determinants of child malnutrition at household
  level

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Recommendations
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Need to invest in nutrition for long lasting
benefits

• Prevention of malnutrition in various population
  groups with emphasis on under 2 is crucial for
  economic growth, development and prosperity.

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(1) There is need to reduce expenditure invested
in nutrition programs that are costly and not
expected to have a lasting impact

• There is need to scale up and strengthen
  nutrition programmes that promote maternal,
  infant and young child nutrition and that of
  other vulnerable groups such as ENA, Behaviour
  Change Communication and Education programs,
  micronutrient promotion and supplementation,
  diet diversification
• School feeding programs adult food distribution
  should be scaled down

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(2) There is need to focus on programs that
target the under-5s

• Institute a national community nutrition program
  to target the priority age groups in a low cost
  and effective manner. (This could be facilitated
  with presence of adequate numbers and trained
  Community Workers unlike volunteers)
• Malawi could replicate the Honduras
  Community-Based Integrated Child Care program
  which focuses on the under-2s.
• Community service providers monitor monthly
  growth of under-2s.
• If they notice that growth is not normal, they
  identify the underlying problem deal with it
• Education about diet diversification and good
  nutrition practices must be part of the response
  to combat malnutrition

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(3) There is need to improve coordination between
government and donors

• Government should take the lead to rationalize
  and coordinate the many existing programs
  addressing nutrition within a prioritized set of
  interventions (Govt has already taken steps to
  improve coordination, monitoring, joint planning,
  supervision and focused implementation of
  nutrition programmes, MGDS, UNDAF, Creation of a
  coordinating Dept within OPC),
• This will ensure that more appropriate approaches
  to dealing with malnutrition are being used, in
  order to provide an effective response to the
  malnutrition crisis

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(4) There is need to embark on a research agenda
to better understand the determinants of
malnutrition in Malawi

• Given the findings of the poverty and
  vulnerability analysis that child malnutrition is
  not highly correlated with poverty levels, there
  is need to deepen our understanding of non-income
  factors linked to the underlying and basic causes
  of malnutrition
• There is a need to deepen the understanding of
  non-income factors, design evidence-based
  policies and programs that would promote
  prevention other than cure.