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

Autor:	Desmond C; SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa., Watt K; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa., Boua PR; Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.; Sydney Brenner Institute for Molecular Biosciences (SBIMB), University of Witwatersrand, Johannesburg, South Africa., Moore C; Department of International Relations, School of Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa., Erzse A; SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa., Sorgho H; Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso., Hofman K; SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa., Roumba T; Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso., Tinto H; Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso., Ward KA; SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.; Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, United Kingdom.; Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Mar 29; Vol. 3 (3), pp. e0001737. Date of Electronic Publication: 2023 Mar 29 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0001737
Abstrakt:	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. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Desmond et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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