The Cost of Hunger in Africa (COHA) study is an African Union Commission (AUC) led initiative through which countries are able to estimate the social and economic impact of child undernutrition in a given year. The Gambia has registered some progress in improving the nutritional status of children, particularly the reduction of the prevalence of stunting, wasting and underweight among children under five years of age. Despite this overall progress, child undernutrition remains unacceptably high in The Gambia as concluded by a Study was spearheaded by Government Ministries, Departments and Agencies (MDAs) including the National Nutrition Agency under the Office of the Vice President, The Gambia Bureau of Statistics, Ministry of Finance and Economic Affairs.
Child undernutrition unacceptably high in The Gambia
The Cost of Hunger in Africa study for Gambia used the year 2018 as a reference. It found that there was an increase of 64,094 episodes of illnesses related to diseases that are associated with underweight. In addition, pathologies related to calorie and protein deficiencies and low birth weight associated with Intrauterine Growth Retardation (IUGR), totaled to more than 4,462 episodes. As a result, The Gambia had to address 68,557 illnesses in children that required medical attention and generated costs both to families and to the Health sector.
Between 2013 and 2018, it is estimated that 6,316 child deaths in The Gambia were directly associated with undernutrition. These deaths represent 20.3 % of all child mortalities for this period. Thus, it is evident that under nutrition significantly exacerbates the rates of death among children and limits The Gambia’s capacity to reduce child mortality.
In the last five years preceding 2018, it is estimated that 68,557 illnesses in children that required medical attention in The Gambia were directly associated with the incremental risk to illnesses associated with children being underweight. This generated an estimated cost of GMD 280.7 million.
The report underscores the importance of nutrition in human capital development and by extension the socio-economic transformation of The Gambia. It particularly demonstrates that for children, undernutrition has adverse implications for school performance, health and for workers it reduces productivity and ultimately earnings.
The model estimates that an equivalent of 35.3 % of the current workforce has been lost due to the contribution of under nutrition to child mortality rates. This represents 48,066 people who would have been 15-64 years old by 2018, and part of the working age population of The Gambia.
Heavy burden on families of undernourished children
The study showed that in The Gambia, it is estimated that in 2018 families bear 38% of the costs associated with undernutrition, while the remaining 62% are borne by the health system. Although the families of undernourished children incur a high percentage of the health costs related to undernutrition, the burden of this phenomenon is still an important expenditure component in the public sector.
In 2018, the annual estimated cost to the public sector was equivalent to 9.7% of the total budget allocated to health. In summary, the economic impact of undernutrition in health-related aspects was equivalent to 0.4 % of total GDP in 2018.
The dramatic cost of undernutrition in children’s education
A total number of 23,429 children repeated grades one to twelve in 2018 (representing 4.6% repetition rate in 2018). Using data on increased risk of repetition among stunted students, the model estimated that out of the 23,429 children of grades one to twelve who repeated in 2018, the repetition rate for stunted children was 8.3 %, while the repetition rate for nonstunted children was 3.4 %. Thus, given the proportion of stunted students, the model estimates that 8,106 students, or 34.6 % of all repetitions in 2018 were associated with stunting.
The social cost of undernutrition in education is shared between the public sector and the families (Households). Of the overall costs, a total of GMD 37 million (USD 780,261) are being covered by the caretakers, while GMD 22.6 million (USD 476,592) is borne by the public education system.
Nevertheless, the distribution of this cost varies depending on whether the child repeated grades in primary or secondary education. In primary and lower secondary education, the families respectively cover – 58.4 % and 56.7 % of the associated costs of repeating a year, whereas in upper secondary education the burden on the families is increased to 71.2 %. In both cases, the households cover a larger proportion of the burden.
Undernutrition causes a loss up to GMD 1.305 billion to Gambia’s GDP
The model estimated that 35.3 % of the working-age population in The Gambia got their development inhibited when they were children. Research shows that adults who suffered from stunting as children are less productive than non-stunted workers and are less able to contribute to the economy. This represents 399,694 people whose potential productivity is affected by undernutrition in The Gambia.
The model estimated that 537,268 people in The Gambia are engaged in manual activities, of which 446,088 were stunted as children. This represented an annual loss in potential income that surpasses GMD 1.305 billion or USD 27.5 million equivalent to 1.7 % of the GDP in potential income lost due to lower productivity. Overall, The Gambia is estimated to have lost an equivalent of about GMD 3.956 billion in 2018, which represented 5.1 % of the GDP. Productivity related losses contributed the largest costs at 4.7 % of GDP followed by Health and Education at 0.4 % and 0.002 % respectively.
The specific objectives of undertaking the Cost of hunger in Africa Gambia Study included estimating the social and economic impacts of child undernutrition. The purpose is tap from the findings to generate policy evidence that will justify the need for the government of The Gambia to increase investment in nutrition, and recommending actions to inform human capital development that will help bolster implementation of The Gambia’s National Development Plan (NDP) and other commitments.