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. 2023 Mar 29;3(3):e0001737.
doi: 10.1371/journal.pgph.0001737. eCollection 2023.

Investing in human development and building state resilience in fragile contexts: A case study of early nutrition investments in Burkina Faso

Chris Desmond  1 , Kathryn Watt  2 , Palwendé R Boua  3   4 , Candice Moore  5 , Agnes Erzse  1 , Hermann Sorgho  3 , Karen Hofman  1 , Toussaint Roumba  3 , Halidou Tinto  3 , Kate A Ward  6   7   8 ; INPreP group
Affiliations

Investing in human development and building state resilience in fragile contexts: A case study of early nutrition investments in Burkina Faso

Chris Desmond et al. PLOS Glob Public Health. .

Abstract

Maternal and early malnutrition have negative health and developmental impacts over the life-course. Consequently, early nutrition support can provide significant benefits into later life, provided the later life contexts allow. This study examines the limits of siloed investments in nutrition and illustrates how ignoring life-course contextual constraints limits human development benefits and exacerbates inequality, particularly in fragile contexts. This case study focuses on Burkina Faso, a country with high rates of early malnutrition and a fragile state. We modelled the impact of scaling up 10 nutrition interventions to 80% coverage for a single year cohort on stunting, nationally and sub-nationally, using the Lives Saved Tool (LiST), and the consequent impact on earnings, without and with a complementary cash-transfer in later life. The impact on earnings was modelled utilising the well-established pathway between early nutrition, years of completed schooling and, consequent adult earnings. Productivity returns were estimated as the present value of increased income over individuals' working lives, then compared to estimates of the present value of providing the cost of nutrition interventions and cash-transfers. The cost benefit ratio at the national level for scaled nutrition alone is 1:1. Sub-nationally the worst-off region yields the lowest ratio < 0.2 for every dollar spent. The combination of nutrition and cash-transfers national cost benefit is 1:12, still with regional variation but with great improvement in the poorest region. This study shows that early nutrition support alone may not be enough to address inequality and may add to state fragility. Taking a life-course perspective when priority-setting in contexts with multiple constraints on development can help to identify interventions that maximizing returns, without worsening inequality.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The impact of nutrition interventions through cognitive development, within the human development framework.
See this image and copyright information in PMC

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