Are the children are "worth" saving?

There is a clear dichotomy between rising malnutrition in Pakistan despite falling poverty levels over the years. Clearly, the progress made in reducing absolute poverty should be taken with a grain of salt. As it stands, according to the Ministry of Plannings Cost of Basic Needs (CBN) method; 30 percent of the population is poor (from 58% in 1990s) while, by another measure; multidimensional povertywhich takes into account health, education and living standardsevery one in four Pakistani is multidimensionally poor. (Read our detailed story: The mystery of falling poverty; rising malnutrition, published Feb 14, 2017).

Perhaps, less Pakistanis are going to bed hungry but how many are well-fed and are living healthy, long, productive lives? The answer to that is sobering. Nearly 22 percent of the population in Pakistan is undernourished with no improvement since 1999 (15% in India; 16% in Bangladesh). Meanwhile, 45 percent of the children under 5 are stunted today (38% in India; 36% in Bangladesh) having increased from 41 percent in the 1990s.

What does that mean, though? To explain malnourishment and stunting in terms of economic costs: Pakistan loses $7.6 billion every year as a result of malnutrition alone, according to a new study conducted by Pakistan Scaling Up Nutrition (SUN). This cost amounts to 3 percent of the countrys annual GDP.

The study estimates that the loss of future workforce costs the country $2.24 billion every year because of the high mortality rate of children suffering from malnourishment; $1 billion in healthcare expenditure of these children. Meanwhile, $3.7 billion is estimated to be the loss to productivity every year since undernourished or stunted children have physical and mental development problems and are unable to be productive members of the society. An additional, $657 million is a loss attributed to the decline in economic output as a result of those working adults who are fatigued and anemic. These are staggering losses to a country that can afford none.

In its latest development update report, the World Bank reports that stunted children start schooling later, are less likely to go on to higher education or graduate, and they earn 40 percent less than non-stunted children. In fact, non-stunted children are 33 percent more likely to escape poverty, compared with stunted children. Indeed, if malnutrition numbers keep climbing, how can one take the decline in poverty levels seriously?

As this column has argued earlier, the food economy in Pakistan is a matter of grave concern. As a result of replacing direct subsidy with wheat support price mechanism, wheat prices have skyrocketed over the years while the food price index in Pakistan has more than doubled since 2008 without a proportionate increase in per capita income. This lends credence to the theory that Pakistanis are just not well-fed. The column argued: It is getting harder for non-farm poor in Pakistan to afford basic food; and hence nutrition and stunting indictors are shaping badly. A rethinking of policy at this point should be imminent.

There has been progress on some fronts. Programs like wheat fortification to improve nutrition and increase consumption of fortified food have been initiated in Punjab and AJK since 2015 while a DFID program was launched in late 2016 to increase the micronutrient content of flour and edible oil or ghee through fortification. These could provide the necessary boost, but it cannot be done by the federal government alone. Healthcare is a devolved issue and this should be a major development agenda for all provincial and district level governments.

Tackling malnourishment and stunting might not be cheap but estimates indicate that the return on investment to reduce malnourishment is $30 to every $1 invested. By all measures of costs and benefits, surely, the children are worth saving?