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