Funding Nutrition: Building a Healthier Future in Uganda

The Value of Investing in Nutrition

Nutrition is vital for social and economic improvements in Uganda. Hence, critical actions are needed to strengthen policy and financing to improve nutrition.

• 15% of child mortality is caused by malnutrition, and almost 82% of childhood undernutrition cases go untreated by the health care system in Uganda.
• Childhood undernutrition and hunger cost Uganda up to 5.6% of the Gross Domestic Product (GDP) or UGX 1.8 trillion every year.
• Stunted children have a higher risk of grade repetition, costing 19,655 million UGX in 2009 or 1.8% of the total national investment in education.
• Greater dollars (or shillings) for nutrition will turn into gains in healthy and productive life years. Uganda’s Cost of Hunger study found that for every USD $1 spent on nutrition, Uganda can save USD $30 through improved health and economic benefits.

The Current Context

Between 2013 and 2015 the USAID-funded multisectoral SPRING project conducted a rigorous analysis of publicly available data on funding and expenditures for nutrition. The “Pathways to Better Nutrition” study revealed important details about the status of nutrition financing in Uganda.

*Footnote: SPRING was unable to validate the amount of unconditional funding allocated to nutrition, and therefore took the average of conditional transfers (13 percent).

• Funding did not increase over time.
  • Despite a growing need for support, onbudget nutrition funding (managed by the Ministry of Finance, Planning and Economic Development.) stayed about the same (27.2 billion UGX in the 2013-2014 budget and 29.5 billion UGX in the 2014-2015 budget).
• Nutrition funding was minimal compared to spending in other areas.
  • The government of Uganda spent $9 per child under 5 on nutrition-specific activities.
  • Nutrition funding was only 1% of nationallevel government budget (not including transfers to the district).
  • Nutrition funding made up 5% of the total development assistance to Uganda from external development partners.
• Most nutrition funding was not provided by the government and was off-budget
  • 63% of the funds available for nutrition in 2014-2015 were provided by nongovernment actors and were not included in the government budgets or managed through the treasury.
• The single largest contributions to on-budget nutrition funding were through central transfers.
  • However, there is significant confusion in how those funds were spent and how ministries contributed.
• Government funding for nutrition was underspent
  • As illustrated in the graphic only around 50% to 60% of allocated government funding was spent each year, due to delayed release of funds or procurement delays. Onbudget spending by external development partners varied greatly from year to year.
• Spending on nutrition at the district level is constrained - Only about 6% to 7% of spending in districts was on nutrition activities since the vast majority of district funds are earmarked at the national level.Spending on nutrition at the district level is constrained - Only about 6% to 7% of spending in districts was on nutrition activities since the vast majority of district funds are earmarked at the national level.

Strengthening the Power of Nutrition Funding in Uganda

There are a number of actions stakeholders can take to improve funding for nutrition:

• Increase opportunities for nutrition staff and budget staff to communicate at the national level, within sectors, and at the district level to improve work planning and budgeting for nutrition.
• Train district officials on why and how to include nutrition in district work plans, institutionalizing the National Nutrition Planning Guidelines for Uganda.
• Reduce restrictions on district funding and improve reporting on the allocation of these funds.
• Include nutrition as a priority in each sector’s investment and development plans, and within each district’s development plans.
• Institutionalize nutrition funding into the Ugandan budget to allow for more consistent and transparent funding from year to year by-
  • including the new nutrition planning guidelines in the budget-call circulars each year
  • naming nutrition as a budget line
  • applying tracking codes across sectors
  • setting targets for the percentage of a sector’s yearly budget that should go toward nutrition.
• Approve and implement the Uganda Nutrition Action Plan (UNAP) monitoring and evaluation framework, which includes nutrition-specific and sensitive indicators, o be able to track and compare progress.