2017年-世界发展银行全球_Scaling_Up_Nutrition_in_Guinea-Bissau___What_Will_it_Cost__64页_2mb

Summary of "Scaling Up Nutrition in Guinea-Bissau: What Will It Cost?"

Core Content

This discussion paper evaluates the cost and potential benefits of scaling up nutrition-specific interventions in Guinea-Bissau, aiming to support the Government in developing a costed plan for improving maternal and child nutrition. The analysis is based on the National Nutrition Strategic Plan (PEN) and global evidence on nutrition interventions.

Main Objectives

• To estimate the costs of implementing 10 high-impact nutrition interventions across all regions of Guinea-Bissau over five years.
• To assess the cost-effectiveness and potential economic returns of these interventions.
• To inform policy decisions on which interventions to prioritize for scaling up.

Key Interventions

The following 10 nutrition-specific interventions were selected for analysis due to their high impact on child health and nutrition:

1. Iron and Folic Acid Supplementation during Pregnancy
2. Vitamin A Supplementation for Children
3. Deworming for Children
4. Breastfeeding Counseling
5. Complementary Feeding Education
6. Treatment of Severe Acute Malnutrition (SAM) with Complications
7. Treatment of Severe Acute Malnutrition (SAM) without Complications
8. Management of Moderate Acute Malnutrition (MAM)
9. Therapeutic Zinc Supplementation for Diarrhea
10. Salt Iodization

Cost Estimates

• Total estimated cost for scaling up these interventions over five years: USD 17 million
• Cost to maintain current coverage: USD 3 million
• Cost to expand coverage to 90% of the population: USD 14 million

These investments are expected to prevent:

• Over 2,400 child deaths
• 4,300 cases of stunting

Economic Benefits

• Estimated economic benefit: USD 120 million over the productive lives of children receiving interventions (discounted at 3%).
• Benefit-Cost Ratio (BCR): 9.8, indicating that for every dollar invested, about 10 dollars of economic returns are expected.
• Internal Rate of Return (IRR): 9% annually, showing the high economic value of these interventions.

Key Findings

1. Cost-Effectiveness: Investing in nutrition in Guinea-Bissau is cost-effective according to international standards.
2. Health and Economic Returns: One dollar spent on nutrition interventions results in about 10 dollars of returns over the productive lives of children.
3. Impact on Productivity: Malnutrition leads to reduced cognitive abilities, lower educational attainment, and diminished economic productivity.
4. Human Capital Loss: Stunting can reduce lifetime wages by up to 20%, and undernutrition contributes to 40% of under-five child deaths and 20% of maternal deaths in developing countries.
5. Regional Variations: Stunting rates are highest in Bafata and Oio, while Bolama, Bijagos, and Bissau have the lowest rates, suggesting a need for targeted regional strategies.

Policy Implications

• Intervention Prioritization: Different interventions may be prioritized based on the policy focus. For example:
  • To reduce mortality and acute morbidity, prioritize treatment of SAM and breastfeeding counseling.
  • To reduce stunting prevalence, focus on complementary feeding education in Bafata and Oio.
• Human Capital Development: Early nutrition interventions are crucial for long-term human capital development, including improved schooling, higher adult earnings, and reduced poverty.
• Economic Growth: Investing in nutrition can boost GDP by 4–11% in Asia and Africa, contributing to shared prosperity.
• Health Expenditure: Preventing malnutrition can reduce health spending, as fewer children would require treatment for illnesses.

Methodology Overview

• The study uses a costing framework from the World Bank's "Scaling Up Nutrition: What Will It Cost?" (Horton et al. 2010).
• Cost-Benefit Analysis (CBA) and Cost-Effectiveness Analysis (CEA) were used to evaluate the impact and efficiency of interventions.
• LiST (Lives Saved Tool) was employed to estimate mortality reduction and cases of stunting averted.
• Discount Rate: Used to calculate the net present value of benefits.
• Sensitivity Analysis: Conducted to test the robustness of findings under varying assumptions.

Conclusion

The paper concludes that scaling up nutrition interventions in Guinea-Bissau is both cost-effective and highly beneficial for health and economic outcomes. The analysis provides a roadmap for policymakers to make informed decisions on resource allocation and intervention prioritization.

Key Information

• Country Context: Guinea-Bissau faces political instability, extreme poverty, and a rising disease burden.
• Nutrition Status: Stunting rates have decreased from 40.9% in 2006 to 27.6% in 2014, but over 25% of children remain stunted.
• Investment Returns: A 1 dollar investment in nutrition leads to 10 dollars of returns.
• Regional Focus: Interventions should be tailored to regional needs, with Bafata and Oio prioritized for stunting reduction and Bissau for mortality reduction.
• Sustainability: The study emphasizes the long-term benefits of early nutrition investments, including improved health, economic productivity, and reduced poverty.

Technical Terms

• DALYs: Disability-adjusted life years, a metric combining mortality and morbidity.
• Cost-Benefit Analysis (CBA): Compares costs and benefits of interventions.
• Cost-Effectiveness Analysis (CEA): Evaluates cost per outcome.
• LiST: Tool used to estimate lives saved and stunting averted.
• Z-Score: A statistical measure of deviation from a reference value.
• Unit Cost: Cost per unit of output, such as per child treated or per person sensitized.

References

• Bhutta, Z. A., et al. (2013). "Nutrition-sensitive interventions and the reduction of anemia and undernutrition in women."
• Black, R. E., et al. (2008, 2013). "Maternal and child undernutrition and the risk of chronic disease in adulthood."
• Heckman, J. J., and Masterov, D. V. (2004). "The productivity of investing in early childhood nutrition."
• Horton, S. J., et al. (2010). "Scaling Up Nutrition: What Will It Cost?"
• World Bank (2006). "Scaling Up Nutrition: What Will It Cost?"