According to a position paper by UK charity Save the Children, the figure required is more than three times the €5.7bn ($7bn) that the World Bank Investment Framework suggests.
“While we acknowledge that this figure is not precise – it uses rudimentary extrapolation and makes multiple assumptions – it demonstrates that, even with a significant margin for error, the resources required are far beyond the capabilities of the current funding paradigm,” the paper says.
Furthermore, the paper explains that the additional $7bn only accounts for four out of the six World Health Assembly (WHA) targets, a set of six global nutrition goals outlined in 2012 to be achieved by 2025.
Further endorsements of these targets form part of the United Nations’ 17 Sustainable Development Goals (SDG) drawn up in 2015.
The paper claims that the WHA targets would only go part of the way to achieving SDG2, which strives to eradicate all forms of malnutrition by 2030. It cited targets on wasting was for a reduction of less than 5% prevalence by 2025, rather than to eliminate it completely by 2030.
Acceptance of the financial asks for the WHA targets therefore entails an implicit acceptance that SDG2 will not be achieved, the paper said.
Responding to the position paper, a spokesperson for the Word Bank said, “The World Bank Investment Framework on Nutrition is evidence-based, and focuses on four of the six WHA targets (stunting, anaemia, breastfeeding and wasting) for which evidence on interventions, potential impacts and costs are available. Information on other targets can be added and updated once more evidence is available.
"With wasting, for example, the framework clearly states that based on available evidence, we know how to treat wasting, but there is very little to no evidence on how to prevent wasting. Targets for child overweight and low birth weight are also not included because of lack of evidence or insufficient data.
"On nutrition-sensitive interventions from other sectors, all of the reviews that have been done to date by DFID and partners starting in 2010, including the most recent review by IFPRI (Ruel et al 2018), conclude that agriculture has not and will not be able to deliver on the stunting targets.
"Similarly, the three recent WASH studies (WASH-Benefits in Bangladesh and Kenya and SHINE trials in Zimbabwe) show disappointing results with regard to the impact of water, sanitation and/or hygiene on stunting. Hence, these are not currently included in the framework.
"In an effort to maintain rigour in our analyses, we are unable to estimate impacts or costs without getting ahead of the evidence, and fully support building upon the Investment Framework as the evidence base grows. We hope that all partners will work together to help generate the needed evidence so that we can collectively move the nutrition agenda forward.
"Finally, the framework focuses on WHA targets on nutrition as they preceded the SDGs, though there is strong overlap-- both stunting and wasting, for example, are also SDG targets. The World Bank is a strong supporter of the SDGs and as the largest financier of nutrition investments globally, is committed to putting the full weight of the institution behind the attainment of all globally-agreed targets.”
Unequal portions
The United Nations (UN) has recently expressed disappointment at the progress made in achieving the agency’s SDG2.
In a blog written by Christopher Twiss, Save the Children’s nutrition advocacy & policy adviser on hunger, the chronic inequity examined two years ago in the charity’s Unequal Portions paper is a factor that explains why efforts are so far behind.
“But there’s one factor that underpins all others,” he continued. “The inability to provide the financing that the fight against malnutrition demands.
“And I think perhaps the Investment Framework’s narrative does not help our case here, as it doesn’t tell the full story.
“Critically, it excludes the financial requirements for nutrition-sensitive investments. This is understandable, as there’s minimal data in this area. But we must be ambitious. If we’re serious about achieving SDG2 and ending malnutrition for all by 2030, we need to think about larger numbers that include those vital nutrition-sensitive interventions.”
Funding spend is key
The paper identifies two elements to the step change needed in nutrition financing, one of which advocates the diversification of nutrition financing sources.
Here, increased efforts in domestic resource mobilisation (DRM) is essential with not only a focus on basic needs but also a commitment to widen the revenue base through progressive tax reform.
The expansion and reform of existing mechanisms, such as the Global Financing Facility and Power of Nutrition is also recommended as a way to enable innovative financing.
In its current state, official development assistance (ODA) is vital, but limited. The paper asks for more focus on the most excluded children, and on catalysing new domestic resources.
The paper also sets out four pillars with which new ways of financing for nutrition should abide by.
Plans to support and fund national nutrition plans are “the key to delivering sustainable, country-driven change,” offering “a costed, multi-sectoral, multi-stakeholder strategy that identifies where funding is needed in the local context and the size of the local funding gap”.
The paper also believes nutrition financing must prioritise the ‘Leave No One Behind’ agenda, acknowledging the financial and social implications of this principle and moving away from the “uneven picture of achievement” that characterise the Millennium Development Goals.
All nutrition financing must be transparent and accountable, both domestically, through the timely release of allocations and disbursement, and globally, through the tracking of aid flows and pledges, the paper added.
Finally, investment in flexible and shock responsive nutrition development work needs to be allied with sustained post-humanitarian response funding to lock in developmental gains and mitigate against recurrence.
‘Worth striving for’
“Those methods are all paramount, but to my mind far more important is the second element – the ways in which increased funding is spent,” said Twiss.
“No matter how much finance is available, we believe success will not be achieved without following these four key pillars rigorously.”
“If we can get these right, SDG2 will be within reach again. Now that’s something worth striving for.”
The Global Nutrition Paper, the World Health Organization’s (WHO) ‘paper card’ on the world’s nutrition states that 155 million children are stunted, 52 million are wasted and obesity in young children has risen.
In addition, 2 billion people lack key micronutrients like iron and vitamin A with 88% of countries facing the burden of either two or three forms of malnutrition.