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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)

MeeraShekar, Christine McDonald, Patrick Hoang-Vu Eozenou, and Ali Subandoro

World Bank

October 2013

  • Country context
  • Costing the scale-up of nutrition in Mali
  • Methodology for costing
  • Next steps
  • Country context
  • Costing the scale-up of nutrition in Mali
  • Methodology for costing
  • Next steps
starting point global sun costing 36 priority 32 small countries
Starting point: Global SUN Costing36 priority & 32 small countries

Data Source: Horton, Shekar, et al, World Bank 2009

phase ii country level
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
mali what is n ew
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.
plan d action multisectoriel 2013
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.
  • Country contextual situation
  • Costing the scale-up of nutrition in Mali
  • Methodology for costing
  • Next steps
steps in developing costed scale up plans
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.
potential costing of proven nutrition specific interventions
Potential Costing of Proven Nutrition-Specific Interventions

Three broad intervention groups

Behavior Change

Micronutrients &


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
explore costing of nutrition sensitive interventions in mali
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
  • Country context
  • Costing the scale-up of nutrition in Mali
  • Methodology for costing
  • Next steps


unit costs and delivery platforms
Unit Costs and Delivery Platforms

Source: Nigeria local unit cost and delivery cost estimates, when feasible, otherwise from WB SUNWWIC, 2009

option 4 scaling up by intervention and by state
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

example nigeria comparing cost effectiveness of different scale up options
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.

  • 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:

Consider different individual observations each with a different z-score


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


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


Concentration indices

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



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


Aflatoxin Control