© 2019 - International Centre for Investigative Reporting
ANALYSIS: FG has cut funding for nutrition — and the consequences will be ‘long-lasting’
The Federal Government has cut funding for a nutritional programme designed to save thousands of lives among an estimated 2.5 million children suffering from severe acute malnutrition.
Last year, the Federal Government earmarked N1.2 billion as a contribution to Unicef, the UN children’s agency, to buy ready-to-use therapeutic food to treat malnourished children. Although it was the first ever financial contribution by the Federal Government for the treatment of children with severe acute malnutrition since Unicef began the programme in 2009, the government trimmed the allocation for this year to N1.1 billion.
Even before the cut, Nigeria was spending far less than needed to address its nutrition crisis. The World Bank estimates that Nigeria would have to spend N301 billion ($837 million) annually to combat malnutrition effectively. Compared to that need, the Community Management of Acute Malnutrition (CMAM) programme, which is being cut, represents a veritable drop in the bucket.
The cost of treating a malnourished child under CMAM is N57, 600 ($160), according to Unicef. This means that the provision in the budget can only cater for 19,274 children, out of the estimated 2.5 million children under the age of five who suffer from severe acute malnutrition. About 420,000 children die annually from the complications arising from malnutrition.
According to the Federal Government, the allocation will be for “co-funding to Unicef for the procurement of ready-to-use therapeutic food to be distributed to six geopolitical zones, including the establishment of CMAM sites”.
The ready-to-use therapeutic food is a peanut-based paste that also contains milk powder, sugar, and multiple micro-nutrients. It gives malnourished children the nutrients they need to recover from malnutrition. Treatment of malnourished children with therapeutic food usually lasts about eight weeks.
More than two-thirds of children under five who need treatment for severe acute malnutrition are not being reached. Even in states where Unicef is supporting CMAM, many affected children are being left out. For example, Kano State has just 30 CMAM centres in six out of the 44 local government areas.
Officials in the Ministry of Health did not give any reason for the budget cut, but the ICIR gathered that the N1.2 billion earmarked for the purchase of nutritional supplements in 2017 was never released by the Federal Government.
The ministry officials say there is little they can do about the low level of spending to address malnutrition. “Ministries are given envelopes within which they work,” Chris Isokpunwu, Head of Nutrition at the ministry, told the ICIR last year. “So, the Ministry of Finance says, ‘health, this is your envelope; you can’t exceed this envelope.’ You have to allocate resources within that envelope that you’ve been given.”
Isokpunwu adds: “We also must realise that in health, nutrition is not the only priority. There are lots of competing priorities. I will not say because I am the head of nutrition, all the money must go to nutrition.”
Unicef started CMAM in 2009 as a pilot programme in Gombe State and later expanded it to 12 other states in the northern part of the country where childhood malnutrition is very high. Over 2 million children have been treated under this programme and hundreds of thousands of deaths have been prevented through this intervention.
Since 2013, the Children’s Investment Fund Foundation (CIFF) has provided about N21 billion to cover the cost of CMAM, but the programme may be scrapped because the states are unable to make their counterpart funding.
For example, when the ICIR visited Kano State in October, CMAM centres were facing acute shortage of the ready-to-use therapeutic food, as the state had not made its monetary contribution to the programme. As indicated in Kano State’s 2017 budget, the state was expected to contribute N320 million of the N826 million for the implementation of CMAM in 2017.
CIFF, a British charity, had challenged governors of the 12 states where CMAM is being implemented that it would match their monetary contribution dollar-to-dollar to ensure the sustainability of the programme. If the states would commit N5.7 billion to the fund for 2017 and 2018, CIFF pledged to provide a matching sum of N5.7 billion.
NOT GOVERNMENT’S PRIORITY
The Federal Government’s spending on nutrition seriously undermines its own policy. The government joined international movements to fight malnutrition in 2011 and 2013. In 2015, it adopted a five-year plan, the National Strategic Plan of Action on Nutrition, NSPAN 2014 – 2019, which would have cost N328 billion to implement.
The plan was projected to reduce stunting (children who are too short for their age) by 20% and wasting (children who are too thin for their age) by 15%, and increase exclusive breastfeeding by 50%. But four years after, the Federal Government has yet to make any financial provision for it.
Consequently, malnutrition among children under age five has worsened nationwide with high concentration in northern states, according to the Multiple Indicator Clusters Survey (MICS) released in November. Child wasting has increased from 24.2% to 31.5%, while child stunting has increased from 34.8% to 43.6% since 2011.
Nigeria’s investment in nutrition is a far cry from meeting the overwhelming threat of malnutrition. More than 11 million children are stunted. But solving the problem would pay big dividends. The World Bank estimates that N301billion ($837 million) in annual spending would save 183, 000 lives and avert more than 3 million cases of stunting among children under five.
“For those malnourished children who survive, there are long-lasting health and schooling consequences, including cognitive deficits and poorer schooling outcomes,” the bank warned. “Children with impaired cognitive skills have lower school enrolment, attendance and graduation, which in turn results in lower productivity, earnings and economic well-being.”
A report by Save the Children shows that malnourished children score 7% lower in mathematics tests, are 19% less likely to be able to read at age 8 and are 13% less likely to be in the appropriate grade for their age than those who are well nourished.
Clearly, failure to invest in nutrition will translate into high costs in the future.