Stunting — a $10 billion problem

In the world’s fifth-largest country that boasts having state-of-the-art motorways, cutting-edge safe cities and modern RLNG-based power plants, 45% of children remain stunted on account of malnutrition. There are 155 million stunted children globally and Pakistan accounts for one out of every 15 such children. Nutrition deficiencies in Pakistan are estimated to result in 3% of GDP loss annually, or as much as $10 billion. Why is it that we can build ports, dams and economic corridors seamlessly but find it hard to feed our children well?

Stunting does not relate only to the health sector and is rather a crosscutting multi-sector problem similar to gender inequality, low levels of FDI and declining exports. These are the problems for which multiple departments and agencies are responsible but no one is truly accountable.

If stunting has to be avoided, health departments need to focus on preventive healthcare, education departments to increase literacy levels especially amongst women, local governments to provide good sanitation services and hygienic neighbourhoods, poverty-alleviation programmes to design targeted conditional cash-transfer programmes and the food authorities to ensure supply of fortified food and enforce standards. But unfortunately, there is no one driving this agenda across these different government organisations.

In a country like Pakistan, it’s hard even to track resource allocation and expenditure on nutrition, let alone assign targets, measure progress and implement a coherent strategy. Governance is not a forte for Pakistan but it is in these complex multi-sector challenges, that governance failures become too apparent.

Stunting is compromised physical growth in children under five years of age, primarily due to chronic under-nutrition during the early years. It is associated with underdeveloped brain, with lifelong effects such as diminished mental ability and learning capacity, poor school performance, reduced earnings and increased health risks.

Stunting has a strong link with economic wellbeing and every 10% increase in income per capita results in decline of stunting by 3.2%.
It is therefore no surprise that stunting is most common in poor households in rural areas and urban slums, where the rearing of children is left to illiterate mothers, in unhygienic environments and with limited access to nutritious food.

Stunted children of today are likely to be low performing and underproductive labour force of tomorrow. The cost of inaction today therefore will continue to cost us during the next 50-60 years. On the upside however, every rupee invested in addressing malnutrition results in benefits of 16 rupees. Well-nourished children are 33% more likely to escape poverty as adults and each added centimetre of adult height can lead to an almost 5% increase in wage rate.

No wonder that the UN has declared 2016-2025 the ‘Decade of Action on Nutrition’. Yet, there was no mention of stunting on political manifestos of the three largest political parties — the PML-N, PPP and PTI — in 2013. Neither was it mentioned in the most recent 100-day plan launched by the PTI. The only manifesto that did mention ‘nutrition’ was that of the PPP.

There is no problem without a solution and the challenge of stunting can also be addressed, if enough attention and resources are given to it. Peru’s example is frequently cited, which reduced the incidence of stunting by half in merely 7 years, from 2007 to 2014, through conditional cash transfers and other interventions. Perhaps we could learn from them.

But more importantly what we need to realise is that stunting is only one head of the proverbial Hydra. With due focus and timely action, we might be able to cut one head of the monster, but many others will be surfacing in the years to come, unless we address the underlying issues of misgovernance, poor public-sector management and worsening state capability.

Published in The Express Tribune, May 29^th, 2018.

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