How much is the world spending on the treatment and prevention of childhood malnutrition? This Médecins Sans Frontières (MSF) report aims to answer this complex question.

An understanding of the precise levels of funding dedicated to malnutrition is essential for two reasons:

• to assess the trends in the financing of malnutrition, the only costing exercise previously undertaken only covered the years 2000-2004
• to compare what is being spent with what is needed

Funding levels are flat and insufficient

Malnutrition should in recent years have benefited both from the global renewed interest in the problem, and from the emergence of a broad consensus within the nutrition community enabling the scale up of activities in high-burden countries. Yet this analysis of the international funding flows dedicated to nutrition finds that funding has remained more or less flat, stuck at roughly the same level since 2000-2004.

The previous review, by Morris, Cogill and Uauy and published by The Lancet in 2008, estimated that the ‘total donor investment in basic nutrition in low-income and middle-income countries probably did not exceed US$250-300 million a year’ for the period 2000-2004.

For the period 2004-2007, based on data collected from the OECD, ECHO, the World Bank and other sources, we estimate international funding of nutrition programmes fell within a range of $185 million to $511 million a year. We have concluded that $350 million a year is the most realistic estimate of funding for nutrition within that range. Exact figures are not possible, as existing funding reporting mechanisms were found to contain, within nutrition reporting lines, activities with little or no nutrition objective.

Our estimate of $350 million at first glance appears to reveal a modest rise of $50 million in funding since the analysis published in The Lancet. Not so: if the same scope as the study published in The Lancet had been used, nutrition funding would have remained unchanged.

Not only is the amount dedicated to malnutrition stagnating, it is also falling drastically short of the needs. The World Bank’s most recent costing exercise puts at $12.5 billion the yearly funding needs to enable the scale up of the nutrition package in the 36 high-burden countries3 and the 32 small countries4 with high prevalence rates. Funding dedicated to nutrition will need to be increased considerably if malnutrition is to be overcome. This will require political commitment from donors, recipient countries and international organisations.

Money is not being spent on the right things

We found that barely 1.7% of interventions reported as ‘development food aid-food security’ and ‘emergency food aid’ in the OECD database actually address nutrition. If interventions such as these are to be considered as a means to address malnutrition, then food security and food assistance projects (namely food transfer, cash or voucher programmes) must be targeted more precisely on nutrition as a main objective and be designed accordingly.

The World Bank recommended a package of interventions for the treatment and prevention of malnutrition. Agreement must now be found to determine which interventions should be delivered at country level and how to scale up prioritised interventions. Both are essential if we are to alleviate malnutrition blighting the lives of so many children and their families. Such an agreement would ensure a better allocation of funding resources and guide both donors and recipient countries in determining policy. Much of the nutrition funding gap could be filled not only by raising extra resources, but also by improving existing food aid funding practices.

Money can be spent more efficiently

Food assistance must focus on addressing recipient countries needs and not be based on donors’ interest. Our analysis suggests that donors could maximise the funds they do spend, by ceasing in-kind donations and instead providing cash to finance food aid interventions, thereby allowing delivery of the most adapted interventions based on medical needs and at a cheaper cost. This is particularly true for the U.S., for whom such a shift could save approximately $600 million – close to double the global amount estimated to focus on malnutrition in any given year.

Data collection and reporting need to be improved

The lack of a transparent funding tracking system to assess how much is dedicated to malnutrition must be addressed. There is a great need to improve not only the data collection and classification, but also measures to determine the specific outcomes – in terms of malnutrition – of interventions described or classified as ‘food security’ or ‘food aid’. More reliable and robust indicators, enabling donors to assess their contribution to the treatment and prevention of malnutrition, are essential to ensure evidence-based and outcome-orientated policy making. In addition, more research must be done to assess the levels of funding granted at domestic level by non-OECD countries.