Count the real cost of malnutrition on a country’s economy, says Prof Simba Sibanda

by Engela Duvehage

​Too many food-related policies in Africa end up being nothing more than mere wish lists. These need to be turned into actionable pieces of legislation that are supported with adequate funding on a national and sub-national level. This will help to safeguard people on the continent from hunger and a lack of nutritious foodstuffs, according to Prof Simba Sibanda, who leads the theme Nutrition-Sensitive Agriculture (NSA) at the Food, Agriculture and Natural Resources Policy Analysis Network (FANRPAN).


He was the invited speaker at the recent Southern African Food Dialogue of Stellenbosch University. The series regularly brings together diverse, influential stakeholders in Southern Africa’s food systems to discuss systemic issues in creative ways and to inspire change in the thinking and action around complex social challenges. It is presented jointly by the Southern Africa Food Lab, an initiative of the Faculty of AgriSciences at Stellenbosch University, and SU faculties such as Law, Medicine and Health Sciences, and Economic and Management Sciences.


Prof Sibanda spoke on the disconnect that all too often exists between the agricultural sector and the supply of adequate nutrition. These are issues that he is well versed in, as his role at FANRPAN is to provide technical assistance to countries so that they can integrate nutrition into agriculture development programmes, strategies and policies. This is done to strengthen agriculture programmes and policies in Africa so that these can deliver positive nutrition outcomes.


Prof Sibanda said that while slight improvements in global statistics around food security were seen up to 2014, “things have gone southwards” since. According to the Global Nutrition Report of 2023, 2.37 billion people (29.3%) experienced moderate to severe food insecurity in 2021. Africa remains the only region in the world where malnutrition is on the increase in absolute numbers. Severe food insecurity, in particular, is increasing, with the poor becoming poorer.


One positive from the Report is that stunting in under five-year-olds has dropped from 33.1% in 2000 to 22% in 2020.


For Prof Sibanda, food insecurity “has a feminine face”, as the Report states that 31,9% of women around the world experience it in some form, compared to 27.6% of men.


It further states that malnutrition has a major impact on the global burden of disease, as 20% (11 million) of deaths relate to poor diets. The other extreme is of people consuming too much food. The percentage of overweight children under five years of age increased from 5.4% in 2000 to 5.7% in 2020. Among adults it rose from 8.7% in 2000 to 13.7% in 2016. This creates other problems, such as non-communicable diseases.


Poor nutrition as an economic hazard

Having enough food to eat does not automatically mean that people will gain enough nutritional value from it, Prof Sibanda added.

“It is actually possible to in the same household have children who are stunted, as well as a parent who is overweight or obese.”


One of the consequences of poor nutrition and subsequent stunting among children is a decrease in cognitive development. This plays out in adulthood, with those who bore the brunt of it not performing as well in the workplace as those who have benefitted from good nutrition.


“Our populations are not performing to their maximum. It is causing massive losses to the economy. It costs extra to the health sector to treat the consequences of malnutrition,” Prof Sibanda noted.


He said it is important to look at the impact of malnutrition in terms of the real cost that it has on a country’s economy and potential for growth.


“In Africa there is an average loss of 11% of gross domestic product (GDP). In some countries this can be up to 20%. Countries could be losing billions. Unfortunately, this does not ring any (warning) bells with policymakers,” he added.


The flipside paints a much better picture, with a dollar of investment in nutrition translating into 16 dollars’ worth of value to the economy.


“There is no question about it: countries cannot afford not to invest in nutrition. They must do so to stop potential losses to their economies,” he underlined.


Prof Sibanda added that many promises made by countries represented at the recent UN Food Summit on how to improve on matters have “not yet translated into much”. Capacity problems and weak technical expertise are issues. These make it difficult to translate even the best of plans into practical nutrition-sensitive tools. This is despite nutrition standing central in achieving the Sustainable Development Goals, and it being highly relevant to at least 12 of the 17 SDG goals.


He says that improving nutrition will have a positive impact on health, education, the empowerment of women and the reduction of poverty and inequality. Conversely, poverty and inequality, a lack of water, sanitation and hygiene resources, poor education, food systems, climate change, social protection, and agriculture all affect nutrition outcomes.

Targets related to nutrition must therefore be incorporated into the developmental and social sectors in which many governments spend more than 30% of their budgets. Prof Sibanda is however worried about how governments spend these budgets and the quality of the programs and instruments that it is spent on.


He sees nutrition as requiring a multi-sectoral approach, as it cannot be solved by input from one sector alone. It is a mistake to group food-related issues under one sector or department. The example of many countries have shown that when this is done so, other departments do not want to work together. Countries that place food councils in the office of their presidents or a similar higher office, see much better outcomes. Leadership is therefore crucial.


Ensuring enough nutritious food

Ensuring that enough nutritious food is available is not merely the responsibility of farmers, but of all who are involved along the food value chain.

A successful “farm to fork” food sector comprises many interlinked aspects along the value chain – from primary production on farms to postharvest and processing aspects, food safety and the infrastructure required to ensure the success of each of these links.


Prof Sibanda worried about cases in which wholesome foodstuffs are processed to such an extent that it no longer holds much nutritious value, and then has to be fortified again at a price. He also said that the provision of supplements should not be how countries try to combat poor nutrition; ensuring that enough healthy foods are produced should be.


“We need to go back to basics. Supplements are not food; they are supplement to food.”


Prof Sibanda said that despite the agricultural sector’s very significant role in delivering safe, nutritious and affordable food, there is a disconnect between agricultural development programs and nutrition. These traditionally tend to focus on ways to increase productivity, production and income streams, rather than on how to improve nutrition.


“The assumption is that if you have enough money, you will have enough food, and that nutrition is solved. That is not always the case. Agriculture must transform to become nutrition-sensitive and deliver on many of the SDG.”

This could be done by improving food production on a household level (for instance through food gardens and urban gardening projects), ensuring the income-oriented production of food, health and other non-food items and empowering women as agents.


“It is good for a family and especially for the children in a household if women make more decisions about food,” he explained.


Governments that invest appropriately in increased agricultural production could help to drive real food prices down, without farmers’ bottom line being influenced. Opportunities for nutrition-sensitive agricultural growth exist throughout the agricultural value chain.


“When there is a general improvement in agricultural growth, helped by policies, the whole population will benefit,” he added.

Poor policies

Prof Sibanda placed Africa’s non-delivery on food and nutritional security at the door of poor policies and strategies: “If policies are not in place and supported with appropriate resources, you are not going to see much change once pilot projects are completed.”


To prove his point, he pointed to assessments done before COVID-19 that pointed to key gaps in the food and nutrition security strategies of 11 Southern African Development Community member states, and how these align with regional strategies.


“By 2020 most countries had not yet considered climate change adaptation into their strategies,” he added.


A study of policies in sub-Saharan Africa showed that ones that focus too much on energy-dense cereals rather than on nutrient-dense foods could cause increased malnutrition, including overweight, obesity and non-communicable diseases.


“Policymakers tend to put more focus on caloric food security rather than on nutrition,” he said.


A lack of women empowerment and youth engagement further deters efforts to improve food and nutrition security, as does inadequate leadership and governance. When indicators for nutrition, women and youth are not included in monitoring frameworks, accountability in terms of whether related targets are met will be lacking.


Prof Sibanda warned against monoculture crop production. He asked the production of a greater diversity of foods, and a greater focus on ensuring adequate nutrition for children between 6 and 17 years old.


He reiterated that a lack of funding will always compromise the implementation of even the most nutrition-sensitive policies, strategies and programmes.


“Without it, you cannot expect policy to be implemented, and Africa will only have its wish lists. Without investment, there is no implementation of policy. Legislation must go through parliament to get resource allocated and to keep account of it.”


He however noted that all too often ownership in programs is not focused when their funding comes from donor agencies. Not surprisingly, the plans that many consultants are paid top dollar for are not implemented when the people these are supposed to serve are not part of the consultancy process.


Prof Sibanda took the example of South Africa, where “plans look good on a national level, yet fall apart on a sub-national level at the scale of municipalities. This often happens because of a lack of adequately specified funding, and champions at a sub-national level who can drive implementation processes.


He said that a transformed food systems approach is needed to deliver low cost and safe nutritious foods. It should allow for women and youth empowerment, and public engagement. While on the one hand all actors in the food system should receive capacity building training, they must also be held more accountable and challenged to take their jobs seriously. Efforts should be lodged under one national leadership and governance structure to ensure adequate coordination and monitoring. Incentives should be provided to promote the production of diverse and nutritious foods, while the taxing of unhealthy foods should be considered more often.

Further research in related fields is also needed to strengthen each of these recommendations.