The Cost of Hunger Report that was launched at the 3rd Food and Nutrition Conference early last week, presented a few worrying facts. Malnutrition had cost Rwanda Rwf503.6 billion in 2012. The sum that is equivalent to 11.5% of the country’s GDP was divided into health, educational and productivity costs.

The methodology used in crunching the numbers considered that individuals suffering from under-nutrition proportionally caused an increase in the cost of health care sector generating health costs. For educational costs, the reduced attention and learning capacity of those have at some point in their lives suffered under-nutrition as children increased the cost in the education system.

Cost of malnutrition

Productivity costs were quantified as the loss of human capital incurred by a society resulting from lower education levels achieved from malnourished children, lower productivity in manual labour by individuals who suffered from stunting and loss of productive capacity resulting  from a high number of deaths resulting from under-nutrition.

The report revealed that the largest costs were incurred in loss of productivity to a total of Rwf436.1 billion. Lower productivity due to mortality cost 309.2 billion, while manual activities related to low productivity cost Rwf 86.5 billion. Lower productivity caused by under-nutrition cost Rwf 40.4 billion.

"National productivity is significantly affected by historical rates of child under-nutrition. Firstly, stunted people on average have fewer years of schooling than non-stunted people. In non-manual activities, high achievement is directly correlated with high income. Research shows that stunted workers engaged in manual activities tend to have less lean body mass and are more likely to be less productive in manual activities than those who were never affected by growth retardation. Finally, population lost due to child mortality hinders economic growth as they could have been healthy productive members of the society,” the report part reads.

The research also shows that 49.2% of the working population suffered growth retardation due to under-nutrition before the age of five, representing an estimated three million people.

"The treatment of under-nutrition and related illnesses is a critical recurrent cost for the health system. Treating a severely underweight child, for example, is more costly than preventing under-nutrition.  These costs pose a serious burden, not just to the health sector but to society as a whole. More than half the cost is incurred during the first 1,000 days of the life of the child, particularly before the child turns two years. 

"The economic cost of each episode is often increased by inefficiencies when such cases are treated without proper guidance from a health care professional. It is estimated that there were about 280,385 clinical episodes in 2012 which took us back by Rwf 65.1 billion,” Dr. Fidel Ngabo, the maternal and child health director at the Ministry of Health, said while presenting the report.

The doctor noted that 74.1% of the cost is incurred by families of under-malnourished children while the rest is shouldered by the health system.

He noted that education had also stalled due to malnutrition. Out of the 327 students who repeated a class in 2012, the study estimated that 44,255 were aassociated with stunting and that most of them were at primary or preparatory level. 

Repetition, according to the study, also had direct cost implications on families and the education system as students who retake a grade generate incremental cost to the system as they require twice as many resources compared to those not affected by stunting.

Government intervenes

In a bid to lessen the burden that malnutrition poses, the government through the social cluster ministries that comprise of the ministries of gender and family promotion, health, agriculture and education, last September embarked on a campaign dubbed "the first 1000 days” that seeks to promote benefits of proper nutrition during pregnancy and in the first two years of a child’s life.

Dr. Agnes Binagwaho, the health minister who also doubles as the social cluster chairperson, said eradication of malnutrition was now a huge priority to the government and they had employed a multi-stakeholder approach that brought on board several ministries.

"Malnutrition is now a huge priority to the government. It became an issue at governance level (through the prime minister’s office), education level because of feeding at school, the ministry of agriculture and the ministry of gender and family promotions for us to change family practices. The strategies and policies we have now make it a holistic approach. All this is in line with our vision 2020 and EDPRS 2 goals especially elimination of poverty which will enable more people access better nutrition,” Binagwaho says.

Direct interventions

"The Girinka project will see each family get a cow as one of the interventions to increase the quality of diet. There is also the ‘one cup per child’ drive for school going children to be provided with milk to help improve their nutrition. We are also trying to make milk available for children who are out of school. We have also embarked on a kitchen garden programme which will enable households provide balanced diet to children by growing of vegetables,” Raphael Rurangwa, the director general of policy and planning at the ministry of agriculture and animal resources, said.

The ministry of finance has also allocated close to Rwf 23.8 billion for the facilitation of the various intervention strategies.

Dr. Octave Semwaya from the ministry said they were giving malnutrition the priority it deserved by allocating funds and were still looking for ways they can intervene further.  

"Eradicating malnutrition is our priority. For the One Cow per Household programme (Girinka), we have allocated it Rwf3.3bn in this year’s budget (2013-2014). The One cup of milk per child programme has been allocated Rwf223m. We have further allocated Rwf6bn to irrigation interventions and Rwf20bn for crop intensification programme. There is also Rwf242m for poultry development in the country.”