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UNICEF Malawi Nutrition Budget Brief 2020-2021.Pdf

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UNICEF Malawi Nutrition Budget Brief 2020-2021.Pdf NUTRITION BUDGET BRIEF 2020/21 MALAWI Halting intergenerational stunting through public investments in nutrition: Towards Achieving Malawi’s Vision 2063 KEY MESSAGES AND RECOMMENDATIONS The identifiable budget allocated to ‘on-budget’ nutrition programmes declined in both nominal (21%) and real terms (29%) compared to 2019/20, and remains at very low levels in relation to the total budget (0.28%) and GDP (0.03%). Recommendation: Government is encouraged to protect, and to the extent possible, progressively increase, budget allocations to nutrition programmes in the medium term expenditure framework (MTEF). In parallel, Government should ensure the development and implementation of a comprehensive and coherent nutrition sector financing plan, that also covers financing of nutrition services at district level. Besides health, nutrition interventions are not adequately covered in annual plans and program based budgets (PBBs) of ministries such as Education and Agriculture. Recommendation: Government, through the Department of Nutrition and HIV/AIDS (DNHA), is encouraged to mainstream nutrition interventions in sector plans and budgets for ministries, departments and agencies (MDAs) with delegated nutrition responsibilities, such as Education and Agriculture. Government is yet to devolve the nutrition budget to Local Government Authorities (LGAs), despite having devolved some nutrition services and activities and placing Principal Nutrition and HIV/AIDS Officers (PNHAOs) in every district. Recommendation: Government should devolve nutrition resources to LGAs to effectively support the delivery of delegated nutrition functions. The devolved budgets should be aligned to financial needs of each district, based on cost estimates. The procurement of nutrition supplies such ready-to-use therapeutic food (RUTF) has been almost entirely funded by donors since 2014/15. This arrangement is unsustainable and leads to unpredictability of funding. Recommendation: The Government is encouraged to re- introduce funding for procurement of nutrition supplies under the health budget. There are several bottlenecks affecting the financing of nutrition supplies across the budget process continuum, including weak budget planning and limited capacity for nutrition supplies financing and accountability. Recommendation: The Government, with support of Development Partners, should develop tools and standard operating procedures (SOPs) for nutrition supplies quantification and costing and enhance the capacity of relevant staff to effectively manage nutrition supplies procurement and reporting processes. UNICEF MALAWI NUTRITION © UNICEF/2020 1. Introduction This budget brief assesses the extent to which the The analytical approach used in this brief was inspired 2020/21 National Budget contributes to address the by the Lancet framework outlined in Black et al. nutrition needs for children in Malawi. It provides an (2013)1, and further unpacked by the World Bank (2020). analysis of the size and composition of budget allocations Pursuant to the Lancet framework, the brief categorized to nutrition-focused programmes and insights on key nutrition interventions into “nutrition-specific”, nutrition- public financing issues connected to adequacy, allocative sensitive” and “enabling environment”, as defined in Table efficiency, effectiveness and equity of the current and past 1. In addition, the analysis significantly benefitted from the spending. background budget scoping and analysis done by UNICEF Malawi in 2018/19. The methodology is also aligned The budget analysis is based on in-depth review of with the approach proposed in the Nutrition Budget government budget documents, especially the Detailed Brief Guidelines produced by the UNICEF Eastern and Budget Estimates (DBEs) and programme-based budgets Southern Africa Regional Office (ESARO). The situational (PBBs), including for Local Government Authorities overview also benefitted from several reports on nutrition, (LGAs), as published by the National Local Government including the Cost of Hunger in Africa (COHA) report of Finance Committee (NLGFC). The analysis primarily 2015 as well as recent papers on the COVID-19 impact focused on ministries, departments and agencies (MDAs) on nutrition. The financing section significantly benefitted with key nutrition-related responsibilities as assigned by from the immunization and nutrition supplies bottleneck the National Multi-Sectoral Nutrition Policy (NMNP) (2018). analysis study (UNICEF Malawi, 2021). The analysis focuses on the period from 2016/17 (year the PBB was rolled out) to 2020/21, with 2016/17 used as the 1 Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., et base year for inflation adjustments. al (2013). Maternal and Child Undernutrition and Overweight in Low- income and Middle-income Countries. The Lancet, 382 (9890). 2 BUDGET BRIEF 2020/21 Table 1 Definition of Key Terms used to Categorize Nutrition-focused interventions Category Description of interventions Nutrition- Nutrition-specific interventions refer to interventions and programs that address the immediate specific determinants of fetal and child nutrition and development. For the purposes of this brief, such interventions include management of severe acute malnutrition (SAM), school meals, behavior change (specific); deworming; fortified based food; micro-nutrient supplementation, nutritional assessment and community-based promotion activities. Nutrition- Nutrition-sensitive interventions or programmes are those aimed at addressing the underlying sensitive determinants of fetal and child nutrition and development and may incorporate nutrition- related goals and actions. These can also serve as delivery platforms for nutrition-specific interventions. For the purpose of this brief, these are defined to include behavior change (sensitive), water, sanitation and hygiene (WASH) components, early childhood development (ECD), food security; immunization services; community gardening, reproductive health; social protection, livelihoods and women empowerment. Building Defined as services that are desgned to support the functioning and delivery of nutrition and Enabling services. For Malawi, this was defined to include nutrition supervision and coordination, environment policy setting and implementation, monitoring and evaluations, as well as capacity building, research and knowledge management, which largely fall under the Department of Nutrition and HIV/AIDS (DNHA) at the national level. Others include food security (research); operational expenditures, and women empowerment. Source: Adapted from the World Bank (2020), unpacking of the Lancert Framework While the above clearly identifies the scope of nutrition interventions considered in the analysis, the Malawi budget is insufficiently disaggregated to allow for a clear identification of the corresponding budget lines. The current status of the integrated financial management information system (IFMIS) does also not allow for a clear- cut identification/disaggregation of nutrition-related budget lines/codes. For that reason, the analysis specifically tracked nutrition-related budget lines of relevant MDAs, guided by two main factors, “visiblility” and “granularity”, which entails sufficient disaggregation. The primary budget lines of focus are presented in Table 2. Although “visible”, several nutrition-sensitive programmes/sub-programmes2 were excluded in the analysis, as they did not satisfy the “granularity” principle. The estimated nutrition budget allocations could therefore be an understatement of the actual size of public investments on nutrition in Malawi. 2 For example, for social cash transfer programme (SCTP) under the MoGCDSW (Vote 320) and NLGFC (Vote 121), public works programme (PWP) under NLGFC, gender equality and women empowerment (MoGCDSW), livestock and food security under the © UNICEF/2020 Ministry of Agriculture (Vote 190). 3 UNICEF MALAWI NUTRITION Table 2 Nutrition-specific budget lines accounted for in the Analysis Ministry, Department or Agency (MDA) Project/Sub-programme/Cost Centre Ministry of Health (MoH) (Vote 310) Department of Nutrition and HIV/AIDS (DNHA) Food and Nutrition Security Programme (019) Malawi Nutrition and HIV/AIDS Project (023) Ministry of Agriculture (Vote 190) Afikepo Nutrition Programme3 Adolescent Nutrition-Sensitive Agricultural Pilot Project Ministry of Education (MoE) (Vote 250) Nutrition and Access to Primary Education (NAPE) Ministry of Gender, Community Family Nutrition and HIV (sub-programme 99.03) Development and Social Welfare Resilience, Livelihoods, and Nutrition (sub-programme 70.03) (MoGCDSW) (Vote 320) 3 The programme focuses on achieving optimal nutrition for women of child bearing age, adolescent girls, infants and young children with the overall objective to enhance nutrition and food security in Malawi. It is funded by the EU, United Nations Food and Agriculture Organization (FAO) and the German Cooperation and is implemented in 10 districts, namely Chitipa, Karonga, Mzimba, Nkhata Bay, Kasungu, Nkhotakota, Salima, Chiradzulu, Thyolo and Mulanje. 2. Context and Overview of Nutrition in Malawi Nutrition is a priority area (7.7) in the third Malawi Growth and Development Strategy (MGDS) III. The MGDS III recognizes that eliminating all forms of malnutrition plays a catalytic role in building a resilient, productive and competitive nation. The Constitution of Malawi also recognizes the need to attain adequate nutrition in Malawi. Recognizing its importance
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