The Nigeria Context

The prevalence of malnutrition continues to pose a challenge to economy and human capital development in Nigeria ^[1]. According to the Global Nutrition Report, Nigeria ranks among the top three countries in the world with the highest estimated number of children (under the age of five) that are stunted (India – 46.6 million, Nigeria – 13.9 million, and Pakistan – 10.7 million), and wasted (India – 25.5 million, Nigeria – 3.4 million, and Indonesia – 3.3 million) ^[2]. Furthermore, evidence shows that an estimated 37percent of children in Nigeria are stunted whereas 19 percent are severely stunted ^[3].

To buck this trend, the Nigerian Government in 2020, created the National Multi-sectoral Plan of Action for Food and Nutrition (NMPFAN) 2021–2025. Since then, some states have utilized the NMPFAN to develop context-specific Multi-sectoral Plan of Action for Nutrition to guide nutrition financing and interventions.  However, meeting the national and state nutrition targets require a sizable financial investment which may not be readily available due to multiple country and state priorities, which in turnhinder the realization ofnutrition targets.

The Optima Nutrition

To address these fiscal constraints, the World Bank supported the Federal Government of Nigeria to assess, quantify and model scenarios for prioritization of a sub-set of nutrition-specific interventions using the Optima Nutrition Tool. The tool is an innovative approach which utilizes mathematical modelling to achieve allocative efficiency in nutrition investments. This allocative efficiency analysis enables the country to maximize impact by allocating resources across a set of interventions so that greater nutrition results are achieved within the current fiscal space[AF1] . The analysis focuses on nutrition-specific interventions which account for up to 80% of the drivers of improvement in undernutrition. This way, Nigeria will be able to make significant progress towards achieving nutrition outcomes and longer-term impact.

Typically, national plans inform state-specific plans, which may be further influenced by the specific drivers of malnutrition within the states. Additionally, as state fiscal health varies, the amount of resources allocated to nutrition reflects both the level of agenda prioritization as well as the amount of available financial resources. Therefore, it is importantfor states to consider whether or not treatments are “fit-for-purpose” and ascertain the adequacy of resources required to achieve the  targets articulated within plans. Furthermore, modelling scenarios could offer states the added advantage of re-calibrating, should financing realities evolve in the short term. It is on this premise that the Federal Government (led by the Federal Ministry of Budget and National Planning), with support from World Bank through the Health Strategy and Delivery Foundation (HSDF), cascaded the allocative efficiency analysis to four (4) states towards achieving two overarching objectives: i) providing an evidence base for the development of multi-sectoral plans (for states who have not yet done so) and ii) equipping states with existing plans with evidence to prioritize the efficient allocation of resources in annual budgeting cycles.

Program Description

The Optima project seeks to equip states with the data they need to prioritize the efficient allocation of resources in annual nutrition budgeting cycles with the aim of achieving optimal results irrespective offiscal constraints. The project is currently being implemented across four states in Nigeria, namely Abia, Kano, Kaduna, and Oyo. Additionally, the ongoing Accelerating Nutrition Result in Nigeria (ANRiN) Project is being implemented in these states. [AF2] 

There is a multi-phased process for conducting optimization analysis which includes:

1. establishing a mechanism for multisectoral stakeholder engagement and participation (Expert Working Group);
2. collecting, collating, and validating data on the coverage and unit costs of delivering key nutrition interventions;
3. developing government capacity for goal setting, validation, review and dissemination of analyses once conducted, and domestication of innovation; and
4. conducting analyses to inform budgeting cycles.

The cascade was inaugurated leveraging a two-day Training of Trainers (ToT) workshop facilitated by the World Bank in Abuja (the Federal Capital Territory) between the 14^th and 15^th of October 2022. Afterwards, HSDF in collaboration with the Federal Ministry of Budget and National Planning commenced engagement with stakeholders across all four (4) states.

Establishment of a multisectoral Expert Working Group

As a prerequisite for kick-starting the project, The Federal Ministry of Finance, Budget, and National Planning sent letters of introduction to the Permanent Secretaries of the relevant State Budget and Economic Planning Commissions.. Subsequently, HSDF visited key stakeholders in each state, introducing the project to them with the aim of securing their buy-in. Using a set of criteria and leveraging the already existing State Committees on Food and Nutrition, potential members for the EWG in each state were selected with amandate to ensure the successful implementation of project activities.

Across the states, the EWG members were chosen from relevant MDAs, and academic institutions. They include the State Budget and Economic Planning Commission;  Ministry of Health, State Primary Health Care Development Agency/Board;  ANRiN Project Implementation Unit;  Ministry of Finance; Ministry of Agriculture/ Agricultural Development Agency; Ministry of Education; Ministry of Women Affairs; Civil Society Organization; Ministry of Human Services and Social Development; State AIDS Control Agency; Ministry of Water Resource; State Rural Water Supply and Sanitation Agency; State Emergency Management Agency, State Bureau of Statistics; implementing partners (UNICEF, CS-SUNN); as well as members of academia from respective states – Michael Okpara University of Agriculture, Bayero University Kano, Kaduna State University, Covenant University, and the University of Ibadan.

The Oyo State EWG was inaugurated on November 10, 2022 with 10 members in attendance with Dr Adeyanju Olusoji, Permanent Secretary (PS), Oyo State Ministry of Health presiding over the occasion. During the meeting, the PS pledged the support of the state to ensure the success of the Optima Nutrition project. He also charged all EWG members to dedicate their time and expertise to ensuring a smooth implementation of all planned activities.On November 14, 2022 the EWG in Kano was established, with the Permanent Secretary of the Kano State Ministry of Planning & Budget serving as its chair. 17 of the 20 members from the appropriate MDAs who were nominated attended the inauguration. The PS, who also serves as the EWG chairwoman, highlighted the Ministry’s function as a coordinating body in her inauguration speech and reaffirmed the Ministry’s commitment to ensuring the success of the Optima capacity building and the eventual institutionalization of the process in the state. She expressed the desire of the state to employ the Optima model across board in future planning and decision-making processes.

All 17 members of the Kaduna State Optima Nutrition Expert Working Group were present at the group’s inauguration on November 15, 2022. The event which held at the Amina J. Mohammed Data Lab of the Planning and Budget Commission, was presided over by the Permanent Secretary of the Planning and Budget Commission, Bashir Muhammed mni. The PS reiterated the state’s commitment to ensuring better financing and efficient utilization of nutrition funds. He also highlighted the many strides the state has already made as well as the plan to learn and adopt the use of the Optima tool in the state for efficient budgeting and planning of Nutrition funds.The Abia State EWG was also established on November 15, 2022, and was presided over by the Permanent Secretary of the Abia State Planning Commission, Dr. Nnenna Chikezie. The 18 EWG members were in attendance for the ceremony.. In her inauguration speech, the Executive Secretary expressed gratitude to the World Bank and the Federal Ministry of Budget and National Planning (FMBNP) for the inclusion of Abia State in the Optima Nutrition project and pledged the state’s unwavering support towards achieving the project objectives.

Next steps

HSDF will continue to work with the EWGs and stakeholders across all four states to build their capability for utilizing and domesticating the Optima tool for nutrition investment decision-making.

References

1. This Day. 2022. “Malnutrition and Its Alarming Endemic Situation in Nigeria.” Health and Wellbeing, July 21 14. Available at:  https://www.thisdaylive.com/index.php/2022/07/21/malnutrition-and-its-alarming-endemic-situation-in-nigeria/#  (accessed January 20, 2023).
2. The Global Nutrition Report 2018.  Available at: https://globalnutritionreport.org/reports/global-nutrition-report-2018/ )accessed February 6, 2023)
3. National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF.