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Costed Plan for Scaling Up Nutrition (SUN)

Mali. Costed Plan for Scaling Up Nutrition (SUN). Meera Shekar , Christine McDonald, Patrick Hoang-Vu Eozenou , and Ali Subandoro World Bank October 2013. Agenda. Country context Costing the scale-up of nutrition in Mali M ethodology for costing Next steps.

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Costed Plan for Scaling Up Nutrition (SUN)

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  1. Mali Costed Plan for Scaling Up Nutrition (SUN) MeeraShekar, Christine McDonald, Patrick Hoang-Vu Eozenou, and Ali Subandoro World Bank October 2013

  2. Agenda • Country context • Costing the scale-up of nutrition in Mali • Methodology for costing • Next steps

  3. Prevalence of Child Undernutrition

  4. Prevalence of Child Undernutrition

  5. Prevalence of Child Undernutrition

  6. Prevalence of Child Undernutrition

  7. Prevalence of Child Undernutrition

  8. Severity of Child Undernutrition

  9. Agenda • Country context • Costing the scale-up of nutrition in Mali • Methodology for costing • Next steps

  10. Starting point: Global SUN Costing36 priority & 32 small countries Data Source: Horton, Shekar, et al, World Bank 2009

  11. Phase II: Country Level • Nigeria, Zambia, Togo, Uganda, Burundi, DRC, Mali, Madagascar, Kenya • Changing burden of disease • National priorities • Existing coverage of interventions • Delivery platforms • Phasing of interventions based on • Geographic targeting/scale-up • Cost-effectiveness considerations • Capacity & commitment considerations • Strong collaboration with all sectors and partners using a consensus-building approach • Build in-country capacities to do costing and develop scale-up plans

  12. Mali: What is new? • Customized costed scale up plan to country context and needs • Conduct cost effectiveness analysis to assess different scaling up options for nutrition-specific interventions – provides solid evidence on what the government can “buy” given available resources • Explorecosting for potential “nutrition-sensitive” interventions in Agriculture, Social Protection, and Education schemes.

  13. Plan d’ActionMultisectoriel (2013) • A multi-sectoral National Nutrition Policy has been established. The NNP was adopted by the government in January 2013 and will serve as the policy framework for coordinating action on scaling up nutrition. • The NNP outlines a process for forming the National Nutrition Council and the Intersectoral Technical Committee for Nutrition • Mali has developed a national road map that will guide them through the process of establishing a costed multi-sectoral nutrition action plan to ensure effective implementation of the NNP. • The Ministry of Health is in charge of several nutrition-specific programs including the management of acute malnutrition, vitamin A, and IYCF.

  14. Agenda • Country contextual situation • Costing the scale-up of nutrition in Mali • Methodology for costing • Next steps

  15. Steps in Developing Costed Scale-Up Plans • Consultations with all sectors and partners to gather costing data and seek input on the optimal costing strategy; • Conduct the cost calculations, cost-effectiveness analysis, propose scaling up options and review findings with all parties involved; • Consultation with donors and government to draft a roadmap to increase national resources for nutrition over the period 2014-2016.

  16. Steps in Developing Costed Scale-Up Plans

  17. Potential Costing of Proven Nutrition-Specific Interventions Three broad intervention groups Behavior Change Micronutrients & Deworming Complementary & Therapeutic Feeding • Breastfeeding and complementary feeding • Growth monitoring and promotion • Handwashing • Micronutrients for children: • Vitamin A • Therapeutic zinc as part of diarrhea treatment • Multiple micronutrient powders • Deworming • Supplements for pregnant women: • Iron-folic acid • Iodized oil capsules • Fortification for general population: • Salt iodization • Iron fortification of staple foods • Treatment of severe acute malnutrition • Prevention/treatment of moderate malnutrition

  18. Explore Costing of Nutrition-Sensitive Interventions In Mali Some possible interventions • Biofortification • Agricultural technologies to reduce women’s workloads • Zinc fertilizers (improve both agriculture productivity and child growth) • Aflatoxin control through biocontrol • Incorporating nutritional considerations in to agriculture extension (training , job descriptions, etc.) • CCTs (incremental cost of the nutrition conditions) • School-based deworming • Promotion of good hygiene behaviors

  19. Agenda • Country context • Costing the scale-up of nutrition in Mali • Methodology for costing • Next steps

  20. Next Steps

  21. Annex ANNEX SLIDES

  22. Unit Costs and Delivery Platforms Source: Nigeria local unit cost and delivery cost estimates, when feasible, otherwise from WB SUNWWIC, 2009

  23. Option 4: Scaling Up by Intervention and by State The proposed option is to scale up step 1 and step 2 interventions in states where stunting rates is higher than 25% (Step 1 and step 2 states) which amounts to $224.9 million

  24. Example Nigeria: Comparing Cost-Effectiveness of Different Scale-up Options * Using LIST tool, based on 5 years projection Recommendation: Comparing across all four options, option 4 is the most cost-effective and feasible option, with an annual investment of US$224 million, a cost/DALYs saved of $30.3, more than 7.4 million DALYs saved, and a very conservative estimate of over 200,000 lives saved over five years.

  25. Annex • Trends and maps in stunting, wasting and underweight prevalence using DHS 2001, DHS 2006 and DHS 2010 (moderate and severe). • Trends and maps in stunting, wasting and underweight gapusing DHS 2001, DHS 2006 and DHS 2010 (moderate only). • Both the prevalence and the gap are Foster-Greer-Thorbecke indices and can be written as:

  26. Annex

  27. Annex Consider different individual observations each with a different z-score

  28. Annex The prevalence measure will count the red dots, irrespective of their distance to the reference line.

  29. Annex The undernutrition gap takes into account the distance between the undernourished and the reference line.

  30. Annex

  31. Annex Concentration indices Inequalities in undernutrition (both prevalence and severity) have decreased between 2001 and 2006, but then increased again between 2006 and 2010

  32. Annex Biofortification According to a recent Biofortification prioritization tool developed by IFPRI, Mali could be considered a top priority country for vitamin A maize, vitamin A sweet potato, and zinc rice

  33. Annex Aflatoxin Control

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