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Supporting Uganda to prioritise cost-effective investments in nutrition.

Undernutrition imposes a staggering cost worldwide in human and economic terms. It leads to increased risk of mortality and is the underlying cause of one-third of all deaths in children under five years old.

Equally, undernourished women are at greater risk of dying from pregnancy complications and have a higher risk of delivering low birth-weight babies, who in turn are at higher risk of physical and cognitive impairments and nutrition-related chronic diseases.

While the global prevalence of children who are stunted has decreased since 1990, the rate of decline has varied across regions, with Africa as the only region with an increase in the number of children stunted.

Recognising the importance to urgently improve nutrition outcomes, the Government of Uganda is developing a multi-sectoral national nutrition policy with an associated action plan, the Uganda Nutrition Action Plan - UNAP II, both covering the period 2019-2025. The action plan is built around nutrition-specific, nutrition-sensitive, and institutional and governance related activities.

Although a multi-sectoral policy and action plan are being developed, there will not be enough fiscal space to put the plan into practice, as intended, from the start.

The scope of the plan, with 88 separate activity areas, exceeds budgetary room available across the public budget and partners. At the same time, the return on investment (in whichever way measured) is not the same for all the activities comprised in UNAP II. The scope of the plan exceeds budgetary room available across the public budget and partners.

For this reason, the Human Development practice has been appointed to support UNICEF and the Government of Uganda to develop an investment case to guide stakeholders on where to focus limited resources. We are using treatment effects, established in peer-reviewed journals, with Uganda-specific unit costs of nutrition interventions.

Alongside the investment case, Genesis is costing UNAP II according to different roll-out scenarios that depend on varying levels of resources. Three separate baseline scenarios are also considered, which account for the undetermined level of welfare loss suffered as a result of the COVID-19 pandemic.

The focus of this work is not on the production of evidence alone, but also - and importantly - on the use of this high-quality evidence to support decision-making that ensures the available resources are targeted at the most cost-effective components of the Uganda Nutrition Action Plan.

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