By Jamila Akweley Okertchiri
Did you know that Ghana loses an estimated GH¢4.6 billion equivalent to 5.8 percent of GDP to the economy as a result of child undernutrition in 2012?
Did you also know that 24 percent of all child mortality cases in Ghana are associated with undernutrition, with the incidence contributing to a 7.3 percent reduction in the country’s workforce?
These staggering figures notwithstanding, 37 percent of the adult population in Ghana today suffered from stunting — a condition which occurs when children miss out on critical nutrients, including proteins, vitamins and minerals while in the womb and in the first two years of life- as children.
The above associated cost of stunting and undernutrition to the domestic economy of the country shows the importance of proper nutrition to the socio-economic development of Ghana.
In other words, Ghana can save as much as GH¢4.6 billion annually and increase its workforce by 7.2 percent if the issue of undernutrition is addressed by positioning nutrition interventions as a top priority for poverty reduction and broad-based development.
The ‘Health Issue’ Myth
A report ‘The Cost of Hunger in Africa: the Social and Economic Impact of Child Undernutrition on Ghana’s Long-Term Development (COHA) which looked at the socio-economic cost of undernutrition found that positioning nutrition interventions as a top priority for poverty reduction and broad-based development is often difficult, partly because of lack of data on their short and long-term returns.
Additionally, the report, initiated by the African Union Commission (AUC), supported by the Economic Commission for Africa and the World Food Programme, and sought to estimate in a given year the additional cases of morbidity, mortality, school repetition, drop-out rates, and
reduced physical capacity that could be associated with a person’s undernutrition status before age five indicated that nutrition is too often regarded narrowly as ‘a health issue’ only, when, in fact, it has broader social and economic implications.
In spite of the compelling economic value of nutrition interventions, the report indicated that the tendency of government is to give priority in social budgets to investments with shorter-term returns.
However, while government seeks short-term solutions to poverty reduction which has undoubtedly improved to an appreciable level, stunting rates have remained high.
According to the 2011 Multiple Indicator Cluster Survey (MICS, 2011), approximately 22.7 percent of Ghanaian children under the age of five were suffering from stunting, and 13.4 percent of children were underweight.
In 2012, there were an estimated 827,533 (of the 3.6 million) children affected by stunting and almost 486,476 children were underweight.
This situation is especially critical for children between 12 and 23 months, where 26.5 percent are affected by stunting, and 16.5 percent were underweight.
Prof Takyiwaa Manuh, Director of the Social Development Policy Division at the Economic Commission for Africa, said stunting is not just a health issue, but needs to be addressed through a multi-sectoral approach and prioritised in all development programmes from community to national level.
“Ensuring a generation free from malnutrition requires significant investments in nutrition strategies and interventions.
There is, therefore, a need for Ghana to forge strategic partnerships with key stakeholders, particularly the private sector and non-state actors, to combat undernutrition holistically,” Prof Manuh said.
Economic Effect
Stunting in childhood tends to result in lower educational attainment, which in turn has an impact on the expected level of income a person would earn as an adult, the report stated.
The report also showed vast amounts being lost through increased healthcare costs, additional burdens on the education system and lower productivity by its workforce.
“People affected by stunting face lifelong consequences starting in childhood such as frequent illness, poor school performance, having to repeat classes or dropping out altogether, and low workplace productivity. Of the 8,230,455 people in Ghana that are engaged in manual activities, 3,384,680 (41 percent) were stunted as children,” the report indicated.
This represented an annual loss in potential income due to lower productivity that surpasses GH¢319 million (US$177.5 million at 2012 prices), equivalent to 0.44 percent of gross domestic product (GDP).
The results further indicate that 2,672,591 people engaged in non-manual activities also suffered from childhood stunting.
The estimated annual losses in productivity for this group are GH¢628 million (US$349 million), equivalent to 0.86 percent of GDP in 2012.
An estimated 1,077,906 working hours were lost in 2012 due to workforce absenteeism as a result of incremental undernutrition-related child mortality.
This represented GH¢3.319 billion (US$1.869 million), equivalent to 4.5 percent of GDP.
Worth noting is the fact that the largest share of productivity loss is attributed to undernutrition-related mortality, which represented 77.8 percent of the total loss.
“The goal of eliminating stunting is key to achieving Zero Hunger, Sustainable Development Goal 2,” Thomas Yanga, Director of the World Food Programme Africa Office, said.
“The losses to the economy can be averted through strategic interventions which ensure adequate nutrition for mothers and young children,” he added.
Health/Social Impacts
Overall, data from the MICS, 2011 show that 1,328,680 clinical episodes in Ghana in 2012 were associated with the higher risk of children being underweight, generating a total cost of GH¢357.8 million.
Cases of diarrhoea, fever, respiratory infections and anaemia totalled 236,256 episodes in addition to the 1,054,902 cases of underweight children. According to the data estimates, only 42.7 percent of these episodes received proper health attention.
Between 2008 and 2012 alone, it is estimated that 71,711 child deaths in Ghana were directly associated with undernutrition, which represent 23.8 percent of all child mortalities for this period.
Overall, 10 percent (16,874) of all repetitions in schools in 2012 were associated with stunting, with a total associated cost of GH¢14.9 million, some 34.4 percent of which was borne by the families.
“In the Northern Region of Ghana, thirty percent of children under five are stunted or chronically malnourished. This not only affects their growth but also their educational development and economic potential, and consequently the future of the country,” Margot van der Velden, WFP Deputy Regional Director for West and Central Africa, said.
Making a Case for Proper Nutrition
As noted by the African Heads of State and Government in 2014, food security without improved nutrition will not deliver the desired socio-economic outcomes; as the number of those affected by hunger and malnutrition has continued to increase over the past few years.
Therefore, if child undernutrition were reduced, there would be a direct improvement in child mortality rates, as undernutrition is the single most important contributor to child mortality.
Further, healthy children would achieve better education, be more productive as adults and have higher chances of breaking the cycle of poverty. Again, if girls were not undernourished, they would be less likely to bear underweight children.
Recently, a panel of expert economists at a Copenhagen Consensus Conference concluded that fighting malnourishment should be the top priority for policymakers and philanthropists.
At that conference, Nobel Laureate Economist, Vernon Smith, stated that “one of the most compelling investments is to get nutrients to the world’s undernourished people. The benefits from doing so – in terms of increased health, schooling, and productivity – are tremendous.”
Dr Margaret Agama Nyetei, the African Union Commission’s Head of Health, Nutrition and Population Division, said the issue of undernutrition which leads to stunting was vital to the AU’s vision and action plan for the next 50 years, known as Agenda 2063.
“At the African Union, we believe that the realisation of Agenda 2063 and the achievement of the Sustainable Development Goals (SDGs) will not be possible without fully harnessing the potential of all sectors of the population and this includes our children,” she said.
Madam Nyetei said achieving nutrition and food security would generate immediate impact on the achievement of the Millennium Development Goals (MDGs) and the future development aspirations of Africa.
Dr Nii Moi Thompson, Director General of the National Development Planning Commission, in his forward to the report, mentioned that it is hoped that the COHA-Ghana Report would help raise awareness among policymakers and development practitioners about the necessity of prioritising nutrition in national development planning and allocating the necessary resources to it as part of a broader strategy for pursuing social and economic transformation in Ghana.