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

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.

Girls' schooling is important but insufficient to promote equality for boys and girls in childhood and across the life course

“…By so doing, it complements the work of the economist James Heckman and others on the mechanisms driving high returns on investments in early childhood (Cunha & Heckman, 2007). It highlights how the process described by Heckman and colleagues of skills acquired in one life stage helping individuals to acquire more of the same and other skills in subsequent life stages (self-productivity and dynamic complementarity) only leads to high returns on early investment if the context in later life stages allows (Desmond, Erzse et al, 2021;Desmond, Watt et al, 2023). Without a supportive context across a person's life, the benefits of investments in early life wane, leading to lower rates of return (Alderman & Fernald, 2017;Rea & Burton, 2020).…”

“…The HDF highlights the process of human development over the life course, with a view to discerning how life stage(s) drive gender inequality. The framework has been used previously to demonstrate how the returns to investments in early nutrition are shaped by the context over a person's life, and how a failure to improve the context in later life may lead the most vulnerable populations to benefit very little from improved nutrition (Desmond, Erzse et al, 2021;Desmond, Watt et al, 2023). The framework is designed to draw attention to the benefits of looking beyond outcomes in a single life stage when human development is a consequence of interactions across life stages.…”

Undernutrition in children aged 0–59 months by region and over time: secondary analysis of the Burkina Faso 2012–2018 National Nutrition Surveys

“…The persistent prevalence of undernutrition translates a need, not just for the community management of wasting programmes which have been shown to be effective, but for effective prevention programmes as well as structural changes allowing reduction of inequalities. [33][34][35][36] Sahel region had the highest risk of stunting and underweight. Prior to the recent threats from terrorism, Burkina Faso had already endured a decade of a fragile food security situation due to droughts and floods, affecting food security and nutrition, especially in the northern part of the country.…”