The Cost of Hunger in Africa (COHA) is an African Union Commission (AUC)-led initiative through which countries can estimate the social and economic impact of child undernutrition in a given year. Twenty-three (23) African countries have to date embarked on the COHA study and Kenya is among them. So far, seventeen (17) countries have completed and launched the study.
The COHA study shows that undernutrition among children is not only a social issue, but also affects the whole economy, because countries are losing significant sums of money and output as a result of current and past cases of child undernutrition. It is with this background that in March 2012, a regional COHA study was presented to African Ministers of Finance, Planning and Economic Development, in Addis Ababa, Ethiopia. From this meeting, the Ministers issued a resolution confirming the importance of the study and recommended that the COHA study be replicated across African countries.
The COHA study in Kenya was led by the National Treasury and Planning, with support from the Kenya Institute for Public Policy Research and Analysis (KIPPRA); Kenya National Bureau of Statistics (KNBS); Ministry of Health (MoH); Ministry of Education (MoE); Ministry of Labour and Social Protection; Ministry of Agriculture Livestock and Fisheries; Kenya Medical Research Institute (KEMRI); development partners, namely: World Food Programme (WFP)-Kenya; United Nations Children Fund (UNICEF); Nutrition and Health Program plus and Nutrition International (NI), Kenya. At regional level, the COHA project is led by the African Union Commission (AUC) with technical leadership from VVorld Food Programme -Africa Office (VVFP).
Methodology The methodology used adopted the COHA model which estimates additional cases of morbidity2, mortality3, school repetition, school dropout and reduced physical capacity that can be directly associated with undernutrition in children under the age of five. To estimate these social and economic effects for a single year, the model focused on the current1 population, identifies the percentage of that population who were undernourished before the age of five, and then estimates the associated impacts experienced by the population in the study year. Using this information and economic data provided by the National Implementation Team (NIT), the model then estimated the associated economic losses incurred by the economy in health, education, and in potential productivity in the year of study.
The data for the Kenya study was collected from national data sources, which include: Kenya Demographic Health Survey 2014, 2014 Basic Education Statistical Booklet, Economic Surveys, Statistical Abstracts, Kenya Integrated Household Survey 2015/2016, Labour Force Basic Report 2018, Central Bank of Kenya, primary data collected from Mbagathi Hospital-Nairobi, and relevant international sources. The report outlines the social and economic costs of child undernutrition affecting health, education, labour and economic productivity.
The model set 2014 as the base year, given the availability of data for that year and in order to insure the continuity of the study. As it is the most recent possible study year, it is referred to as “current” in this report.
Morbidity; the number of cases of any disease in an area.
Mortality; the number of deaths in an area.
Kenya has made progress in reducing stunting in children. However, stunting rates remain high. In 2014, it was estimated that 12.9 million of the working age population (15-64 years) suffered from growth retardation before reaching five years.This represented 41.4 per cent of the entire working age population who were in a disadvantaged position compared to those who were not undernourished as children. Further,the study confirmed that undernutrition can also be associated with low progression in the education system, with only 3 out of every 10 learners enrolled in grade 1 progressing (pass level) to Form Four. This can be attributed to lower cognitive ability.
Trends in child undernutrition: Kenya has made significant progress in reducing child malnutrition. Stunting reduced from 35.3 per cent in 2008-09 to 26 per cent (1.8 million) in 2014. Underweight reduced from 16.1 per cent in 2008-09 to 11 per cent (767,927) children in 2014, and wasting reduced from 6.1 per cent to 4 per cent (290,000 Children) in 2014. However, there is need for continuous concerted efforts to further reduce the levels of child undernutrition.
Social and economic effects on health: Based on the differential probability analysis undertaken using KDHS data in Kenya, the study confirms the hypothesis that undernourished children are more susceptible to recurring illness. Underweight children under 5 years had an increased risk of diarrhoea (increased risk equal to 4.1 percentage points), and an increased risk of fever and malaria (increased risk equal to 1.8 percentage points).
The study estimated that in 2014, out of the 2.4 million incremental episodes of illness related to undernutrition, 2.1 million were associated with higher risk of children being underweight. The estimated cost for underweight was Ksh 13.1 billion or US$ 148.51 million. In addition, morbidities related to low birth weight were estimated at 52,194 episodes, with associated cost at approximately Ksh 4.8 billion or US$ 54.1 million. Further, the study estimated 176,277 episodes associated with acute respiratory infections (ARI), acute diarrhoea syndrome (ADS), fever and malaria with associated cost of Ksh 808.5 million or US$ 9.2 million. Most of these costs were associated with treatment protocol for management of undernutrition among children.
Overall, the economic impact of undernutrition in health-related aspects was equivalent to 0.34 per cent of GDP in 2014, which was equivalent to Ksh 18.6 billion or US$ 211.8 million.
Social and economic effects on education: Stunting has an impact on grade repetition, performance and school dropouts. This can be attributed to low cognitive ability. In 2014, it was estimated that only 16.9 per cent of stunted working age people completed primary school compared to 62.2 per cent of the non-stunted. Further, 17.5 per cent of repetitions were associated with stunting. Overall grade repetition rate was 4.4 per cent, with stunted children having a higher-grade repetition rate at 6.7 per cent than non-stunted children at 2.8 per cent. Due to stunting, an additional 94,708 cases of grade repetition occurred. This was at a cost of Ksh 3.2 billion or US$ 36.8 million to the education system and the families and 0.06 per cent of GDP. Overall 56.8 per cent of the costs were born by private budget and the rest by the public education system.
Social and economic effects to productivity: Stunting effects on productivity are discussed based on effects attributed to mortality due to child undernutrition and effects attributed to lowered productivity as a result of child undernutrition. Persons in the working age population suffered from stunting as children are less productive than the non-stunted population and were less able to contribute to the economy. It was estimated that 41.4 per cent (12.9 million) of the working age population in 2014 was stunted as children. 65.8 per cent (20.3 million) of the working age population were engaged in manual activities, of whom 41.2 per cent (8.4 million) of this population were stunted as children. The results further indicate that 34.2 per cent of the working age population engaged in non-manual activities, out of whom 14.4 per cent (4.5 million) suffered from childhood stunting. The losses on productivity from the manual and non-manual labour associated with childhood stunting were estimated to be Ksh 96.7 billion (US$ 1,099.5) and Ksh 66.6 billion (US$ 757.9 million) equivalent to 1.8 and 1.23 per cent of GDP in 2014, respectively.
It was further estimated that the country lost 3.8 per cent (1.2 million) of working age from the workforce in 2014 due to child mortality associated with undernutrition. Taking into account the productive levels of the population, by age and sector, the model estimated that in 2014, economic losses (measured by working hours lost due to undernutrition-related child mortality) was Ksh 188.8 billion or US$ 2.1 billion. As a result, productivity loss was estimated at Ksh 352 billion or 6.5 per cent of GDP.
Overall, results of the total effect of health, education and productivity show that Ksh 373.9 billion or US$ 4.2 billion was lost in the year 2014 in Kenya as a result of child undernutrition. This was equivalent to 6.9 per cent of GDP in 2014.
Analysis of Scenarios for Potential Savings
In addition to calculating retrospective cost for 2014, the model also projected potential savings in future, based on different scenarios for reducing child undernutrition in Kenya. These scenarios are constructed based on the estimated net present value of the costs associated with undernutrition of children born each year from 2014 to 2025. The methodology follows each group of children and, based on each scenario, estimates a progressive path towards its achievement.