The Cost of Malnutrition

An estimated 180 million children under the age of five years in the world are about 15 cm shorter than their peers. This phenomenon is not caused by genetics or disease, but a condition called stunting. Stunting is caused by chronic nutritional deficiencies during the first 1,000-day window of a child’s life.

According to the World Health Organization, around 35% of children under five in Kenya are stunted through malnutrition, with food insecurity widespread in many rural parts of the country. Similarly, a food security, vulnerability and nutrition assessment conducted by the government of Kenya in 2010 revealed that more than 25% of urban children were stunted while 13% of urban households had unacceptably low levels of food consumption.

A new report, Food for Thought, by Save the Children shows that malnutrition is the underlying cause of 2.3 million children’ deaths a year and contributes to failures in cognitive and educational development for millions more. The report notes that the poorest 40% are 2.8% more likely to suffer long-term effects of malnutrition than the richest 10%.

When you consider that a lack of adequate nutrition can cause a five-year-old to lose up to 15 cm growth, it is hardly surprising that the effects of malnutrition would undermine the immune system and cause permanent cognitive impairment, limiting an individual’s capacities and opportunities throughout life. A report by Uwezo, an education advocacy group, revealed that among standard 3 pupils only 28% from the poorest households had achieved expected numeracy and literacy, compared to 48% in the richest households among grade 3 pupils.

The report by Save the Children identifies for the first time the impact of malnutrition on educational outcomes.  Compared to normal children, stunted children: are 19% less likely to be able to read a simple sentence; score 7% lower grades on math tests; are 13% less likely to be in the appropriate grade for their age at school. The report further argues that the effects of malnutrition on cognitive development, physical stature and ability to do physical work can trap children in poverty and cause enduring social and economic inequality.

The Cost of Hunger in Uganda launched on June 18, 2013 shows that some 15% of all child mortality cases in Uganda are attributable to malnutrition. 7% of repeated school years in Uganda are associated stunting costing the education sector about $9.5 million. The report estimates that premature mortality associated with malnutrition reduced Uganda’s labor force by 3.8%, costing the country $317 million. The study also found that treating diarrhea, anemia, respiratory infections and other diseases related to malnutrition cost Uganda $254 million, while losses in productivity reached $201 million in manual sectors like agriculture and $116 million in non-manual activities. What is most disconcerting, according to the report, is that malnutrition in the first 1,000 days has reduced Uganda’s national income by 5.6%

These depressing statistics are not unique to Uganda. Given the similar prevalence patterns for poverty, hunger, stunting and learning outcomes these statistics represent the broad patterns, which obtain in Kenya and other African countries. Although IMF, the World Bank and AfDB have projected rapid economic growth, malnutrition could be the tripwire that stymies Africa’s growth momentum; stifling human flourishing and undermining long-term equitable economic growth.

The negative effects of malnutrition on education achievement, labor productivity, per capita income, income inequality and life expectancy in our society will in turn generate increased governance problems, reduced economic growth and political instability. Investing now in robust nutrition interventions, along with policy reform to address underlying causes of malnutrition, would enable millions of children in Kenya to develop into healthy and productive members of society.

Malnutrition robs future generations of their earning potential and stands in the way of Kenya’s economic development. All stakeholders must understand the link between nutrition and learning achievement, and ensure that nutrition is integrated as a critical component of both early childhood education and the free primary education program.  Investments in nutrition at the national level are limited and nutrition often falls in the cracks, between agriculture and health, with no political or institutional constituency.

Kenya should introduce a targeted conditional cash transfer program for poor mothers of children younger than 7 years who comply with specific nutrition, health and education-related conditions. These should include prenatal and postnatal visits, immunization, health check-ups, growth monitoring and participation in health educational programs. We must secure the future for posterity, our children.

The East African hydrocarbon age: Are we primed for a resource curse?

The discovery of commercially significant quantities of oil in Uganda in 2006 was consequential. The discoveries in Uganda have been followed by discoveries in Kenya in 2012. Tanzania has seen world-class offshore gas discoveries. Experts believe more hydrocarbons have been discovered in East Africa in the last couple years than anywhere else on the planet. East Africa has entered a veritable hydrocarbon epoch.

Africa’s experience with oil and minerals has not been rosy. In a majority of Africa’s resource-rich countries, exploitation of natural resources is invariably linked to corruption, economic stagnation, conflict, social inequality and widespread poverty. This apparent paradox is commonly referred to as the Resource Curse. Economists have long held that resource rich countries are prone to rent seeking, conflict, corruption, and weak public institutions. Paul Collier, Oxford University Economist, has argued that poor management of large inflows of natural resource revenues makes other export activities uncompetitive and stifles economic diversification, leading to lower economic growth.

Angola and Nigeria are prime examples of the curse natural resource can bring to a country.

Angola is considered the archetypal case of the resource curse. The proceeds of this vast wealth financed two and half decades of civil war, just two years after independence. Millions of dollars in concessionaires’ bonuses are stashed abroad and much of the revenue is sequestered in a secret “parallel budget” with no public accountability. Angola’s poverty rate is estimated at 68%. Angola also ranks among the lowest in the world on other social indicators. According to a UNDP report of 2007, its combined school enrollment ratio was 25.6% and life expectancy was about 42 years

 Similarly, 50 years of oil production has not produced growth and prosperity in Nigeria. Nigeria’s annual per capita income of US$1,400 is less than that of Senegal, which exports mainly fish and nuts. Armed, rebels operating under the name of the Movement for the Emancipation of the Niger Delta (MEND), have intensified attacks on oil platforms and pumping stations. According to leaked internal financial data accessed by the Guardian, Royal Dutch Shell paid Nigerian security forces tens of millions of dollars a year to guard their installations and staff in the Niger delta about $383 million. A significant amount of Shell funding is paid through senior military officials, exacerbating corruption and elite rent seeking.

Is East Africa prepared to navigate the slippery slope of the hydrocarbons bonanza? Going by history as well as recent events – social and political – the spectre of the "resource curse" looms large in East Africa.

The Albertine Rift is a picturesque expanse of forested mountains and home of the rare Mountain Gorilla. Along with gorillas, the Ugandan stretch of the Albertine Rift is home to breathtaking biodiversity, nine national parks and four game reserves. However, in 2006, geologists discovered treasure underneath the Albertine Rift; oil. The Lake Albert region is therefore ecologically sensitive. It is also politically sensitive because it lies between two countries with a history of conflict. Environmental fragility and conflict is the quintessential witches brew.

There are growing worries that Uganda’s oil may exacerbate official corruption. Italian company ENI has been accused of trying to bribe senior government officials to secure oil rights. In December 2012, the Ugandan parliament passed the Petroleum Bill to regulate the country's emerging oil sector. The law grants the oil minister the power to grant and revoke licenses, including negotiating production sharing agreements without parliamentary oversight. Transparency is largely seen as an affront to long-term social cohesion. Diplomats and key players in the oil sector think the new law amounts to handing an “ATM Machine to the government. 

The gas rich region of Mtwara in southern Tanzania carries an inordinate burden of malaria, diarrhea and respiratory infections, which are the leading causes of morbidity and mortality. Infant and maternal mortality in Mtwara is one of the highest in the country. Similarly, at 48, life expectancy in Mtwara is among the lowest in the country. Here is how one resident characterized Mtwara; “since independence, we have had no roads, schools, hospitals or access to water, and employment is nightmare. Mtwara is a symbol of poverty in our country."

As one would imagine, expectation among the communities of Mtwara is very high; everyone expects instant, dramatic change in fortunes. From jobs, better public infrastructure and improved services. More importantly, the local communities expect to retain and control significant proportions of revenues accruing from the sale of resources. Contestation over revenue from gas resources has been characterized by violence in the recent weeks as local communities march in protest against the construction of a pipeline to transport gas from Mtwara to Dar-es-Salaam.

Politicians have weighed in on the question of resource revenue. Musoma MP, Hon. Mkono, fully supports Mtwara residents opposition to the construction of the gas pipeline to Dar-es-Salaam arguing that Mtwara residents’ have learned from the Buhemba Gold Mine in the Mara region a private company extracted gold from Mara between 1994 and 2004, but years later the region continues to be among the least developed in the country with few schools, no tarmacked roads and no hospitals. Mtwara MP, Hasnain Mohamed Murji also supports agitation for more equitable distribution of natural resource revenues. In Hon Mukono’s view, Tanzania’s economic policies have failed to protect local interests.

Politicians with a national purview have a different view. Wading into the acrimonious debate, President Jakaya Kikwete argued that Mwanza and Shinyanga “have been producing gold, but they have never claimed to enjoy alone all benefits from gold." According to Energy and Minerals Minister Sospeter Muhongo, “the gas issue is being politicized and Tanzanians should avoid injecting politics into serious matters of national interest”.

For the Turkana people of northern Kenya, pastoralism, the main source of livelihood has become exceptionally untenable in the past two decades. The drought of 2011 was particularly devastating. More than a quarter million of people in Turkana county live on food aid and 9 out of 10 people live below $1.25 a day. Completion of Ethiopia’s Gibe III Dam on the Omo River could transform Lake Turkana into Africa’s Aral Sea, destroying vital ecosystems and the fragile livelihoods they support.

According to experts it took 58 wells to find the first commercially viable oil discovery in the North Sea. For Turkana, it took only three. But can oil really be a game changer; a sign that a big payday for the Turkana people is at hand? Kenya’s key sectors, from agriculture and power generation to forestry and fuel imports, have all been appropriated by the powerful vested interests always jostling to control the country. The question on everyone’s mind is who will control the country’s oil? Moreover, ethnic identity, including control of communal resources, especially has often been at the center of Kenya’s historical socio-economic and political troubles. Politicians have fostered economic opportunities for their acolytes. The pressure valve last blew in 2007, when accusations of vote rigging in a general election exploded into ethnically charged violence. More than 1,000 people died and many more were displaced.

What is clear is that there is a high correlation between resource curse and unaccountable institutions of governance. Kenya, Uganda and Tanzania are all characterized by weak institutions of private property, a weak bureaucratic capacity, a proclivity for strong presidential rather than parliamentary democracy. These characteristics make all three countries highly vulnerable to the resource curse despite honest efforts, with the help of the World Bank and the African Development Bank, to institute strong policy and legal regimes.

MIT economist Daron Acemoglu argues that institutions of private property ensure protection of property rights of investors, provide political stability, and ensure the political elites are restrained while also promoting participation of the citizens. A culture of democratic political competition, a strong parliamentary democracy and a broad based participation at the local level can provide safeguards against a resource curse.

Accountable democratic governance buttressed by competitive democratic politics and a vibrant parliamentary system is something of a sine qua non for effective natural resource governance. Kenya’s vibrant political competition along with devolved governance structures presents a starting point for building strong technical and institutional capacity to ensure separation of policy, regulatory and commercial development roles for effective natural resource governance.

Although strong institutions of private property are lacking, better outcomes on hydrocarbon governance may result from strengthening transparency. Each country must sign up to the Extractive Industries Transparency Initiative, which requires companies to publish all payments to the government and the government to publish all payments received from extractive companies. All stakeholders must demand public disclosure of spending, revenue accrued from extractive industries and establishment of a sovereign wealth fund to regulate reckless spending of such revenues, which could undermine competitiveness in non-hydrocarbon sectors.

East Africa can avoid the resource curse. But there is no silver bullet legislation and no right advise, beyond the overriding imperative of political accountability and inclusive competitive parliamentary democratic governance. 

The Nile basin states are the gift of the Nile

"Egypt is the gift of the Nile." This 5^th Century BC pronouncement of Greek Historian Herodotus was reaffirmed when Egyptian President Mohamed Morsi declared that his country was keen not to risk losing a “single drop of Nile water” on which their civilization is based.

Speaking to supporters, President Morsi declared that Egypt had no intentions to wage war against Ethiopia but vowed to keep all options open. According to Ayman Shabaana, political science professor at Cairo University, the Nile is the state and a threat to the river constitutes a threat to national security.

President Morsi’s remarks came following a move a by Ethiopian authorities to divert the waters of the Blue Nile to in advance of its planned $4.7 billion dollar Grand Renaissance Dam. This will be Africa’s largest hydropower plant, producing 6,000 megawatts of electricity and creating a reservoir with a capacity of 63 billion cubic meters.

A report of a tripartite technical committee comprising Egypt, Ethiopia and Sudan has announced that its findings are inconclusive on the planned dam's effects on Egypt and Sudan. However, it is estimated that Egypt could lose up to 20% of its “water share” over the 3–5 years needed to fill the dam. Over the last couple of weeks, bellicose rhetoric, including talk of hostile acts to force Ethiopia to halt the dam has raised concerns of conflict over the waters of the Nile.

With an annual discharge of 2,830 cubic meters per second, just 6% of the mighty Congo River, the Nile basin is worryingly water constrained. The population of its upstream neighbors are growing rapidly, fueling increased demand for more water and food. Projections by the UN show that the combined population of the Nile Basin countries will grow to circa 340 million by 2030. The enduring ghosts of the colonial agreements, which preclude inclusive upstream cooperation, aggravate this grim reality. The agreements are absurd. For example, Ethiopia, the source of the Blue Nile, which contributes an estimated 85% of the Nile River, has no rights over the water to the extent that it infringes the natural and historical rights of Egypt in the waters of the Nile. 

A 1929 agreement with Britain – representing East African colonies – gave Egypt the right to veto upstream projects that would affect its “water share”. With the posturing in Cairo, Egypt is essentially defending its unbridled historic rights over the Nile waters. The enduring binding nature of the treaty beyond the British colonial rule is largely because of the compulsory transmission of all the rights and obligations of the predecessor upstream colonial state to the successor independent states.

Egypt’s natural and historical rights over the Nile waters was challenged in 2010 when a new water-sharing agreement, Nile Cooperative Framework Agreement (CFA), was signed among six upstream states, including Ethiopia, Kenya, Uganda, Rwanda Burundi and Tanzania. Congo and South Sudan have signaled that they will sign the CFA. Last week Ethiopia's parliament ratified the Nile Cooperative Framework Agreement (CFA); an agreement intended to replace colonial-era agreements that gave Egypt and Sudan the biggest share of the Nile waters. Buoyed by this ratification, Ethiopia has indicated that it is happy to talk with the Egyptians but such talks would not entertain any consideration to halt or delay the construction of the dam.

Unanimous agreement and ratification of the CFA has not been achieved largely because of unhelpful inclusion of the nebulous notion of “water security” and the insistence by Egypt and Sudan that Article 14 (b) should obligate upstream states not to adversely affect their water security and current uses and rights. Egypt and Sudan are also unyielding in their demand for early notification mechanism before upstream countries undertake any irrigation or hydropower projects. Egypt wants the CFA to guarantee its access to the historical 55.5 billion cubic meters based on the 1959 agreement with Sudan. Given the enduring colonial legacy, the Nile is the only major river basin without a permanent legal and institutional framework for its use and management.

Herodotus was wrong. All the Nile basin states are the gift of the Nile. 

Egypt and Sudan must return to the negotiating table. They must work cooperatively with the upstream Nile basin states on inclusive binding rights and responsibilities, beyond distracting and unattainable delusions such as water security. Relinquishing exclusive rights over the waters of the Nile is the bitter but necessary pill Egypt and Sudan must swallow.

The Devil is in the Smallholder Farm

According to Kenya’s Treasury Cabinet Secretary, Henry Rotich, low agricultural productivity is caused by use of inappropriate technology, inaccessible farm inputs, weak extension support services, and over reliance on rain-fed agriculture.

Mr. Rotich’s analysis of the problem of low agricultural productivity reminds me of the Indian fable of the blind men and an elephant. Six blind men were asked to determine what an elephant looked like by feeling different parts of the elephant’s body. The one who felt the tail said the elephant is like a rope; the one who felt the trunk said the elephant is like a tree branch; the one who felt the leg said the elephant was like a pillar; the one who felt the ear said the elephant was like a hand fan; the one who felt the belly said the elephant was like a wall; the one who held the tusk said the elephant was like a solid pipe.

Based on the counsel of “four blind men” Kenyan taxpayers will spend Ksh. 245 billion to improve agricultural productivity over the next five years. The fable of the elephant and the reductionist diagnosis of what ails Kenya’s agriculture exemplify the relativism, the hubris of experts and a lack of integrative systemic thinking around complex public policy questions. As experts, often woefully narrowly trained in our respective disciplines, we fail to admit that what we observe is not reality, but slivers of reality that submit to our constrained methods of inquiry.

Mr. Rotich’s spending plan to revitalize Kenya’s agriculture is not novel. Based on the same premises, Tanzania launched Kilimo Kwanza, its green revolution to transform agriculture in 2009. A recent review of implementation of Kilimo Kwanza has revealed fundamental failures. The growth rate of Tanzania’s agricultural sector was only 3.63% in 2012, significantly below the 6% target set by the Agricultural Sector Development Strategy. Tanzanian scholars argue that Kilimo Kwanza has marginalized small-scale farmers. According to the 2011 Tanzanian Human Rights Report, 67.6% of farmers interviewed reported that they had not benefited from Kilimo Kwanza. Kenya can and must learn from Tanzania’s experience.

I have worked in the field of agriculture for over two decades. I now believe that improving agricultural productivity is a “wicked”, “untamed” problem. It is one of the most dynamically complex, ill-structured public policy problems. Agricultural productivity is influenced by a legion of complex and dynamic, often connected, social, institutional, political and biophysical factors, including climate. Often, what we think are causes of low agricultural productivity such as use of inappropriate technology or inaccessible farm inputs are symptoms of other deep structural problems.

The New Alliance for Food Security and Nutrition (New Alliance) was launched in 2012 under the US G8 Presidency to lift 50 million people out of poverty by 2022. The New Alliance seeks to mobilize responsible private sector investment in agriculture in Africa. So far, Benin, Burkina Faso, Cote D’Ivoire, Ethiopia, Ghana, Tanzania, Malawi, Mozambique and Nigeria have joined the New Alliance. The New Alliance works closely with the Grow Africa partnership, the African Union, New Partnership for Africa’s Development and the World Economic Forum.

In my view, the New Alliance is a blind man holding a part of the elephant that is Africa’s low agricultural productivity problem. And the New Alliance says it feels like a lack of huge private sector investment. When they meet this week at Lough Erne in Northern Ireland, the G8 must be reminded that private sector investment in Africa’s agriculture will not be responsible or sustainable.

The New Alliance is prioritizing unfettered access to Africa’s land resources for multinational companies. The New Alliance cooperation framework is unnerving. For instance, the framework actions for Ethiopia require that the government incentivize international seed companies to operate in Ethiopian seed markets and refine the law to encourage long-term leasing.

Large-scale agriculture with a focus on industrial production models is highly destructive of the natural capital and allied ecosystem services. Furthermore, large agricultural estates covering millions of hectares give too much power and influence to agro-industry at the expense of smallholder producers. Invariably, private sector investments will target international export markets with little commitment to local food and nutritional security goals.

The approach of the New Alliance and Mr. Rotich’s plan are limited tactile abstractions. However, how they engage with and support smallholder farm families’ transition to commercially viable operations could have a huge impact on poverty, food and nutritional security. The devil is in the smallholder farm households.