Budget Analysis Exercise Guatemala

1. Nutrition and the post-2015
Development Agenda
Meera Shekar, PhD
Lead Health and Nutrition Specialist
World Bank, Washington DC
Launch of the Global Nutrition Report
Guatemala, April 2015
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2. Where are we coming from - nutrition and the pre-2015
development agenda
The Millennium Declaration (2000): 8 Millennium
Development Goals
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• Underweight – prevalence of children under 5 who
are underweight
• Undernourishment – proportion of the population
below minimum level of dietary energy consumption
Nutrition buried in MDG1 on poverty and hunger
• MDGs1C: “Halve, between 1990 and 2015, the proportion of
people who suffer from hunger.”
Indicators:

3. MDGs and nutrition: an unfinished & incomplete agenda
Goal not reached
MDG agenda for nutrition is incomplete:
• Mostly health sector focus
• In accurate indicators & focus on quantity rather than quality of
• Not inclusive of multiple aspects and burdens of malnutrition
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Source: MDG Progress Report 2014
26 52 13 4 8 35
Insufficient
data
Seriously off target Moderately
off target
Insufficient
progress
Sufficient
progress
MGD met
Progress toward achieving the nutrition MDG (prevalence of undernourishment), by number of
countries:

4. Overlapping burdens of malnutrition: 20 countries with highest
absolute burden and 17 countries with highest prevalence
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5. Overlapping burdens of malnutrition: 20 countries with
highest absolute burden
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Iraq
Sri Lanka
South
Sudan
NigerMali
Chad
Madagascar
Mozambique
Uganda
Myanmar
Vietnam
Russia
Japan
Uzbekistan
Thailand
Iran
Turkey
USA
Brazil
Myanmar
Mexico
Yemen
DRC
Kenya Ethiopia
Sudan
India China
Philippines
Indonesia
Egypt
Tanzania
Bangladesh
Pakistan
Nigeria
Algeria
Ukraine
South AfricaSouth AfricaColombiaMoroccoSyria
ANEMIA
WASTING
STUNTING
BREASTFEEDING

6. Post-2015 – Sustainable Development Goals (SDGs)
Oct. 2013 UN :adoption of a post-
2015 development agenda
September 2014 – UN Open
Working Group recommended 17
SGDs & 169 targets
SDGs will be finalized & adopted at
the UNGA September 2015
Indicators will be finalized by the UN
Statistical Committee by March 2016
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169 proposed targets
17 Sustainable
Development Goals
(SDGs)
Up to 2 proposed
indicators per targets

7. Nutrition and proposed SDGs
SDG 2: “End hunger, achieve food
security and improved nutrition, and
promote sustainable agriculture.”
Target 2.2: “By 2030 end all form of
malnutrition, including achieving, by
2025, the internationally agreed
targets on stunting and wasting in
children under 5 years of age, and
address the nutrition needs of
adolescent girls, pregnant and
lactating women, and older persons.”
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Nutrition mentioned explicitly
(unlike MDGs)
Need to ensure that it is not
limited to hunger and food
quantity but also addresses
nutrition quality
WHA nutrition targets
Only 2 out of 6 WHA targets
currently included

8. Nutrition and proposed SDGs (cont.)
3 Key recommendations for
revising SDG 2 and Target 2.2:
• Include all 6 WHA nutrition
targets
• Add dietary quality indicator–
Minimum Dietary Diversity for
Women (MDD-W): % of women
15-49 who consume at least 5 out
of 10 defined food groups.
• Measure of political
commitment – percentage of
overall national budget allocated
to nutrition.
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Area Recommended Indicator
Global WHA
Nutrition
Targets
Prevalence of stunting in
children <5yrs
Prevalence of wasting in
children <5yrs
% infants <6mo who are
exclusively breast fed
Percentage of women 15-
49 with anemia
Prevalence of overweight
in children <5yrs
% of infants born with low
birth weight
Dietary
Diversity
% women 15-49 who
consume at least 5 out of
10 defined food groups
Political
Commitment
% national budget
allocated to nutrition

9. WHA Nutrition Targets
Adopted at the 65th World Health Assembly in 2012
To be achieved by 2025
Current WHO proposal to extend the targets to 2030 to harmonize
with the SDGs 9
40% REDUCTION IN THE
NUMBER OF CHILDREN
UNDER-5 WHO ARE
STUNTED
50% REDUCTION
OF ANAEMIA IN WOMEN OF
REPRODUCTIVE AGE
30% REDUCTION IN
LOW BIRTH WEIGHT
NO INCREASE IN
CHILDHOOD VERWEIGHT
INCREASE THE RATE
OF EXCLUSIVE
BREASTFEEDING
IN THE FIRST 6 MONTHS UP TO
AT LEAST 50%
REDUCE AND MAINTAIN
CHILDHOOD WASTING
TO LESS THAN 5%

10. Informing discussion on nutrition and development:
SDGs and beyond
Key opportunities to inform the discussion:
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• Financing for Development conference, Addis Ababa,
July 2015 – placing nutrition at the center of the
development agenda
• Civil Society consultations – reinforcing the position of
nutrition
• UN General Assembly, September 2015 - adopting the
SDGs
• Global nutrition summit in Rio de Janeiro – securing
development funding for nutrition

11. Phase 1
Draft outputs
for:
Addis FfD
July 2015
Rio Nutrition
Summit
June 2016
Others
Phase 2
Phase 3
(Potential)
Estimating the costs and financing required to meet the
WHA targets: 3 phases
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Stunting Breastfeeding
WastingAnemia
Low birth weight Overweight
Partnership:

12. Approach:
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Estimate
Costs and
potential for
impact
Estimate
current
financing
Estimate
resource
gaps
Identify
potential
future
financing
pathways
Estimate
impact on
nutrition
outcomes
under
different
scenarios
For scale-up
of evidence-
based
interventions
across all
targets
From all
sources:
• Domestic
• Donor
• Private
Subtract
available
financing from
costs
Estimate
under
different
financing
scenarios &
assumptions
Estimate
impact of
scale-up per
scenario
1 2 3 4 5
Flat-lining of
funds
Max.
effort
WHA
targets
achieved
Slow
progress
Resource
Gap
Costs Available
Financing for
Nutrition

13. Costing methodology
We will cost the highest possible
impact that can be modelled using
LiST (20-30% reduction in stunting, rather than 40%).
•At 90-100% scale up and/or at a more
realistic level
•Estimate the impact of the scale-up on
stunting using LiST
•Estimate the cost of the scale up
Overlay these impacts with secular
trends in underlying determinants of
stunting
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Maximum
scale up of
interventions
Estimated
impact on
stunting
Cost of scale
up

14. Financing and fiscal space analysis methodology
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Estimate baseline
financing for nutrition
Assess the
funding gap
Analyze future
financing pathways
Objectives
Understand baseline nutrition
financing by source:
• Domestic spending
• Donor spending
• Household
contributions
Understand nutrition specific &
sensitive financing contributions
Link stunting
cost estimates
with baseline
stunting
financing
estimates
Predict possible future
financing scenarios that
could close the gap &
achieve the desired impact
on stunting
1 2 3

15. Informing discussion on nutrition and development:
SDGs and beyond
Key opportunities to inform the discussion:
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• Financing for Development conference, Addis Ababa,
July 2015 – placing nutrition at the center of the
development agenda
• Civil Society consultations – reinforcing the position of
nutrition
• UN General Assembly, September 2015 - adopting the
SDGs
• Global nutrition summit in Rio de Janeiro – securing
development funding for nutrition

16. THANK YOU
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