Initial Brief of Results of Pilot Studies February 2012
Initial Brief of
Results of Pilot
Studies
February 2012
RATIONALE FOR THE COST OF
HUNGER
Solid recent growth
performance across Africa
But given widespread undernutrition on the continent…
• Foregone growth possibilities?
• Additional losses in the future?
What has been lost so far?
What could be lost in the future?
Good understandi
ng of individual-
and community-
level impacts of
hunger
Little known about
aggregate impacts,
especially impacts on
growth
BOTSW
ANA
ALGERIA
LIBYA
SUDAN
SOUTH
l
SUDAN
KENY
A
TANZANI
A
South Africa
ZIMBA
BWE
ANGOLA
ZAMBIA
NAMIBIA
DEMOCRATIC
REPUBLIC
OF
THE
CONGO
CENTRAL
AFRICAN
REPUBLIC
GAB
ON
CAME
ROON
CHAD
NIGER
NIGERIA
BEN
IN
GH
ANA
BE
NIN
LIBE
RIA
TOG
O
SIER
RA
LEO
NE
GUI
NEA-
BISS
AU
GAM
BIA
MALI
BURK
INA
FASO
SENE
GAL
LESOTHO
SAO
TOME &
PRINCIP
E
RWA
NDA BURU
NDI
SWAZILAN
D
COM
OROS
MAURITI
US
EQUAT
ORIAL
GUINEA
WESTE
RN
SAHAR
A
GUIN
EA
EGYPT
MAURITAN
IA
ETHIOPIA
UGAN
DA
4 Pilot
Countries
Egypt
Swaziland
Ethiopia
Uganda 8 Roll-out
Countries
Burkina Faso
Ghana
Botswana
Malawi
Mauritania
Rwanda
Kenya
Cameroon
12 INITIAL PARTICIPATING
COUNTRIES
This map was produced as a reference aid only. The boundaries and names shown and the designations used on this map do not imply official endorsement or
acceptance by the United Nations
6-18
years
15-64
years
2 DIMENSIONS TO THE COST OF HUNGER Incidental
Retrospective: Current Economic
Cost
Current Costs
- Education
Costs on
National
Productivity
Childr
en 0-5
years
Prospective: Develop Scenarios
Health
Education
National
Productivity
Current Costs
- Health
FRAMEWORK FOR THE COST OF
HUNGER IN AFRICA
Undernutrition
Higher
mortality risk
Higher morbidity
risks: Acute and
Chronic illnesses
Cognitive and
psychomotor
underdevelopment
Lower
educational
performance
Higher labor
absenteeism
Social
inclusion
problems
Lower Productivity
Lower
Performance
in Manual
Labor
Lower
physical
capacity
Increased
demand to
social services
Opportunity
Cost
Direct Cost
IMPACT PATHWAYS
Children currently malnourished
Extra demand for health care
School children previously
malnourished
Extra demand on educational services derived from grade
repetition
Adult work force previously
malnourished
Less income due to less schooling/
cognitive/physical performance
Less workforce due to premature deaths
Economic and Social
Impact of Child
Undernutrition in Health
Effects of Child Undernutrition in
Health
Pilot Countries
Illnesses Egypt Ethiopia Swaziland Uganda
4 Pilot
Countries
Anemia
37,378
365,311
1,262
55,923
459,874
ADS
11,476
527,153
2,720
289,994
831,343
ARI
1,247
114,300
1,656
27,462
144,665
Fever/Malaria
-
264,232
217
121,943
386,391
LBW (IUGR)
116,702
148,173
2,751
82,635
350,261
Underweight
927,122
2,991,509
16,840
975,450
4,910,921
Total
1,093,925
4,410,678
25,446
1,553,407
7,083,455
Population
Under 5 Years
9,187,208
12,099,544
155,980
6,586,900
28,029,632
Source: UNECA, based on the latest national nutrition survey in each country and official data on
cases of disease in each country.
Illnesses associated to undernutrition: those reported by each country as the most relevant
Information sources: official statistics, DHS and specialized studies.
It is estimated that in the 4 pilot countries, undernutrition
contributed to 7 million incremental cases of illnesses in
children under 5 years. The leading illness was incremental
episodes of diarrhea suffered by underweight children.
DISTRIBUTION OF EPISODES
ASSOCIATED TO CHILD UNDERNUTRITION PER COUNTRY
0% 20% 40% 60% 80% 100%
Egypt
Ethiopia
Swaziland
Uganda
Anaemia Fever/Malaria ARI ADSSource: UNECA, based on the latest national nutrition survey in each country and official data on cases of disease in
each country.
The differential probability of each pathology will determine the
number of episodes estimated in each country. In some contexts,
incremental cases of acute diarrheal syndrome has a higher
association to undernutrition, but in others anemia seems to
disproportionally affect underweight children.
ECONOMIC IMPACT OF CHILD
UNDERNUTRITION IN HEALTH IN PILOT COUNTRIES
Country
Egypt Ethiopia Swaziland Uganda
Total (millions of USD) TBC 145 7 259
Under 12 months 40% 44% 27% 44%
1 to 11 months 16% 19% 26% 20%
Per cohort 12 month cohort (24 to 59
months) 15% 13% 16% 12%
% of costs covered by the families … 89% 88% 87%
Public costs as % of health public
expenditure … 2.3% 0.6% 11.0%
Total health costs as % of GDP … 0.5% 0.2% 1.6%
In 2009, the economic cost of undernutrition ranged from
values equivalent to 0.6% to 11% of government budget
allocated to Health and from 0.2% to 1.6% of GDP
The largest proportion of these cost are generated by
children in their first year of life, indicating important
potential savings in implementing a preventing approach
DISTRIBUTION OF COSTS IN HEALTH BY AGE GROUPS
44% 40% 27%
44%
19% 16%
26%
20%
13% 15% 16%
12% 13% 15% 16%
12%
13% 15% 16% 12%
0%
20%
40%
60%
80%
100%
Ethiopia Egypt Swaziland Uganda
Under 12 months Cohorts between 24 and
59 months
Economic and Social
Impact of Child
Undernutrition in
Education
DIFFERENCE IN REPETITION
RATES OF STUNTED CHILDREN
6.5%
13.8%
16.9%
11.7%
5.4%
10.3%
13.3%
8.7%
0.0%
5.0%
10.0%
15.0%
20.0%
Egypt Ethiopia Swaziland Uganda
Repetition Rate of Students who were stunted as children
Repetition Rate of Students who were not stunted as children
The higher risk of stunted children on repeating grades
resulted in incremental grade repetition rates that ranged
from 1.1% to 3.6% more than non-stunted children
1.1%
3.5% 3.6%
3.0%
COST OF DIFFERENTIAL IN
GRADE REPETITION RATES BY
COUNTRY Pilot
Country
Number of
Stunted School
age
Total
Repetitions
% of
Repetition in
Primary
Education
Economic Cost Proportion
covered by
the
Families
Local
Currency
USD (in
millions)
Egypt 6 million 79,279 59% EGP 270 79.0 40%
Ethiopia* 16.9 million 152,488 100% ETB 93.4
million 7.9 64%
Swaziland 164,000 5,550 86% SZL 6 million 0.7 70%
Uganda 5.2 million 133,931 96% UGX 16.5
billion 8.1 45%
Total 28.3 Million 371,248 90% 96
The differential in grade repetition rates represented 370
thousand grade repetition for the pilot countries, 90% of
which were in Primary education. This distribution may in
part be explained by the higher risk of stunted children of
dropping out, and not reaching secondary education. The
cost of these repetitions was estimated at 65 Million dollars
* Primary education only. No data for secondary education.
ESTIMATIONS IN SCHOOLING
ACHIEVEMENT DIFFERENTIALS
4.7
3.3
7.9
6.1
4.5
2.2
7.1
4.9
0.0
2.0
4.0
6.0
8.0
10.0
Egypt Ethiopia Swaziland Uganda
Average Schooling of Non-Stunted Population
Average Schooling of Stunted PopulationSource: UNECA, based on the official household surveys in each country.
Note: Schooling achievement based on information of head of household. It does not represent the
schooling level of the population.
-0.2
Years
-1.1
Years
-0.8
Years
-1.2
years
The higher risk of stunted children on dropping out of school
resulted in lower schooling of the stunted population that
ranged from -0.2 to -1.2 years
Economic and Social
Impact of Child
Undernutrition on
Productivity
WORKING AGE POPULATION
AFFECTED BY CHILDHOOD STUNTING
0% 20% 40% 60% 80% 100%
Ethiopia
Swaziland
Egypt
Uganda
26,140,472
270,188
20,458,948
8,055,733
12,794,046
403,491
29,691,605
6,884,666
Stunted Working Age Population Non-Stunted Working Age Population
0% 50% 100%
Ethiopia
Swaziland
Egypt
Uganda
7%
36%
9%
93%
64%
91%
Non-Manual Activities
Manual Activities
Of the 104 million working age
adults (15-64), it is estimated
that 52% suffered from
stunting as children. Most of
this population in involved in
manual activities and are in a
disadvantaged position
Current
Estimated
Prevalence
LOSSES IN PRODUCTIVY IN MANUAL AND
NON-MANUAL ACTIVITIES IN CURRENT WORKING AGE POPULATION (WAP)
Pilot
Country
Stunted Population of
Working Age
(15-64)
Lost Productivity in
Non-Manual Activities
Lost Productivity in
Manual Activities
Number of People
Estimate
d.
Prevalen
ce
National
Currency USD
% of
GDP
National
Currency USD % GDP
Egypt 8.1 Million 40% 2.6 billion
EGP 479 million 0.3%
10.7 billion
EGP
1.9
billion 1%
Ethiopia 29.9 Million 67% 616 million
ETB 52 Million 0.2%
12.8 billion
ETB
1.1
billion 3.8%
Swaziland 351,681 40% 75 million
SZL 9 million 0.3%
182 million
SZL
21
million 0.7%
Uganda 9.2 Million 54% 219 billion
UGX 108 million 0.7%
366 billion
UGX
180
million 1.1%
The estimated losses due to lower productivity in
manual activities range from 0.2% of to 0.7% of
GDP. As more people are active in manual
activities, the estimated losses from lower
productivity of the stunted population ranges from
0.7% to 3.8% of GDP.
INCREMENTAL CHILD
MORTALITY DUE TO
UNDERNUTRITION
0%
5%
10%
15%
20%
25%
24%
15%
11%
15%
% of Child Mortalities Associated toUndernutrition
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%8.3%
4% 3.5%
0.7%
% of WAP absent due to childmortality associated to undernutrition
The impact of undernutrition on child mortality rates
increases in countries with higher prevalence. A
percentage of the WAP is absent from the economy due to
incremental risk associated to undernutrition
LOST WORKING HOURS DUE TO
CHILD MORTALITY ASSOCIATED TO
UNDERNUTRITION
Countries
Annual Working
Hours Lost
(in millions)
Economic Cost (in millions)
% of GDP National
Currency US$
Egypt 857 5,436 988 0.5%
Ethiopia 4,786 40,069 3,396 11.9%
Swaziland 37 321 38 1.3%
Uganda 943 697,486 344 2.1%
The impact of undernutrition on the WAP population in
manifested through annual working hours lost in the
economy due to incremental deaths in children under five
that would have been part of the labor force. The cost of
child mortality on productivity ranges from 0.5% in
countries with low underweight prevalence and low
mortality rates, to 11.9% in countries with high underweight
prevalence.
THE SOCIAL AND ECONOMIC
COST OF CHILD
UNDERNUTRITION IN PILOT
COUNTRIES
0% 20% 40% 60% 80% 100%
Uganda
Egypt
Swaziland
Ethiopia
Health Education Productivity
Country
Losses in
Local
Currency
Losses
in USD
Egypt EGP 20.2
billion
$3.7
billion
Ethiopia ETB 55.9
billion
$4.7
billion
Swazilan
d
SZL 644
million
$76
million
Uganda UGX 1.8
trillion
$899
million
16.5%
5.6% 2.6% 1.9%
0.0%
5.0%
10.0%
15.0%
20.0%
Total Costs as % of GDP
Potential Savings of
Reducing Child
Undernutrition
Scenarios
3 DIFFERENT SCENARIOS OF
POTENTIAL ECONOMIC
SAVINGS ARE BEING
DEVELOPED
Scenario #1. The Cost of Inaction. Progress in reduction of stunting and underweight child stops.
Scenario #2. Cutting by Half the Prevalence of Child Undernutrition by 2025.
Scenario #3. The ‘Goal’ Scenario. Reduce Stunting to 10% and Underweight children to 5%, by 2025
The Results of these
scenarios will be presented a
the 6th Conference of
Ministers of Finance in March
in Cote d’Ivoire
Economic and Social
Impact of Child
Undernutrition
Initial Key Findings and
Policy Implications
Initial Key Findings and Policy Implications
• Undernutrition places an extremely high
burden on health systems and families
through requirements for hospitalization
and intensive care.
• Nutrition is a major factor for dropouts in
countries with poor educational
achievement levels.
• Addressing child undernutrition will
facilitate Africa’s transitions to a more
urbanized society.
• The loss of human capital due to the
impact of undernutrition on child mortality
rates generates the highest costs to
society.
Recommendations and
Opportunities • Availability of uniform and readily-available
data in Africa is limited.
• COHA results have the potential to bring
the issue of child nutrition to forefront of
the development arena
• The COHA initiative represents a valuable
opportunity to place nutrition within the
strategy for ensuring Africa’s sustainable
development.
The Goal
10% Stunting and 5% Underweight
in Africa by 2025
10 & 5 by
2025