An investment framework for nutrition in Afghanistan: Estimating the costs, impacts, and cost- effectiveness of expanding high-impact nutrition interventions to reduce stunting and invest in the early years
Investing in Nutrition for a Better Future in Afghanistan
Afghanistan stands to gain enormous benefits by improving nutrition and reducing malnutrition, which can help boost its economic growth, productivity, and human capital development.
Investment in better nutrition is needed at a critical time as more than 40 percent of Afghan children are stunted, or of low height for their age, an indication of malnutrition. Stunting in early life is a marker of poor child growth and development and will reduce their potential to contribute toward their country’s growth and prosperity.
On the other hand, a well-nourished child tends to complete more years of schooling, learns better, and earns higher wages in adulthood, thereby increasing the odds of escaping a life of poverty.
To help the Afghan government invest in better nutrition, the South Asia Food and Nutrition Security Initiative (SAFANSI), the Ministry of Public Health, the World Bank and UNICEF have partnered to determine what it would take to reach more children, women, and their families and provide them with essential nutrition services that would reduce stunting, anaemia, and loss of life.
A recently published working paper, Investment Framework for Nutrition in Afghanistan, provides a start to better understand the cost, impacts, and benefits of expanding the nutrition interventions.
Specifically, the report identifies nutrition activities and services that can reach a realistic number of children and women for greatest impact.
The total public investment required to scale up nutrition interventions is estimated to be $44 million a year for five years. Each dollar invested would yield at least $13 in economic returns and even under conservative assumptions regarding future economic growth, the economic benefits exceed the cost by six times.
This scale-up would prevent almost 25,000 child deaths and over 4,000 cases of stunting and avert a loss of 640,000 disability-adjusted life years (DALYs) and almost 90,000 cases years of anemia. Almost 100,000 more children would be exclusively breastfed.
However, this scale-up would only have a marginal effect—a decrease of less than one-half percentage point—on stunting prevalence because the current government-set target program coverage rates are very low for the preventive interventions that affect stunting.
A substantially greater impact could be achieved if preventive interventions could be scaled to full program coverage levels, which would require less than $5 million more a year. This would triple the number of DALYs averted, double the number of deaths averted and avert almost eight times as many cases of stunting, resulting in a 2.6 percentage point decline in stunting over five years (from 41 percent to 38 percent). The prevalence of anaemia in pregnant women could be reduced by 12 percentage points and the prevalence of exclusive breastfeeding could be increased by 18 percentage points.
To achieve substantially greater impact on reducing malnutrition, prevention interventions in the BPHS package should be scaled up to full program coverage levels, rather than the targets currently set by the government.
To maximize the impact of the BPHS package, the expansion of prevention interventions (in particular the support and promotion of breastfeeding up to 6 months and appropriate complementary feeding education) should be prioritized in the scale-up.
Several interventions that are not currently included in the BPHS nutrition package should be considered for future inclusion due to their high effectiveness and low relative costs. These include interventions that would foster breastfeeding, reduce vitamin A deficiency in children and women of reproductive age, and decrease the high prevalence of anemia in adolescents and women across the country.
The Investment Framework for Nutrition in Afghanistan working paper has been funded thanks to the contributions of United Kingdom's Department for International Development and the European Commission through the South Asia Food and Nutrition Security Initiative (SAFANSI), which is administered by the World Bank.