Composition of expenditures

• Expenditures per person (or per child under the age of five). On the basis of existing nutrition spending data, Shekar et al. (2017) report that government spending on nutrition is, on average, US$0.85 per child under age five in 15 low-income countries, US$4.66 per child under age five in 13 lower-middleincome countries, and US$8.15 per child under age five in 3 upper-middleincome countries. The same study notes that to reach global nutrition targets would require an additional US$10 per child under age five (beyond current expenditures) for high-impact, nutrition-specific interventions in countries that carry the highest burden of stunting, anemia, and wasting and the lowest rates of breastfeeding. • Share of total government expenditures. In the agriculture sector in Sub-

Saharan Africa, the African Union–led Comprehensive Africa Agriculture

Development Programme has a target that African countries allocate 10 percent of their total annual budgets toward boosting agricultural productivity.

Despite weak compliance, the goal is regularly monitored and reported widely to encourage governments to increase spending on agriculture.14

Unlike in agriculture, no agreed-on benchmark or tracking systems exist for how much governments should spend on nutrition as a percentage of total expenditures. Countries can, however, look at existing NPERs for relevant comparators. • Percentage of GDP. NPERs can calculate the share of nutrition expenditures in the country’s GDP. This value can be referenced against estimates of GDP due to reductions in stunting. Galasso and Wagstaff (2017) estimate that stunting costs 7 percent and 9–10 percent of per capita GDP in Africa and

South Asia, respectively; Horton and Steckl (2013) estimate the effect to be about 4–11 percent of per capita GDP in Africa and Asia.

COMPOSITION OF EXPENDITURES

Indicative questions that the NPER could address:

• What are the main financing sources and their mix? • Who finances what? • What is the broad share of financing for nutrition-specific and nutritionsensitive interventions? • Which sectors have the highest financing levels for nutrition?

An important contribution of the NPER is to help the government understand nutrition financing in a multitude of different ways. Most PERs also present the economic composition of expenditures by separating recurrent (that is, wages, salaries, goods, and services) and capital (that is, works and capital goods) expenditures. Such an exercise can provide insights into imbalances in the distribution of expenditures (for example, insufficient funds to cover recurring expenses to maintain existing investments). However, except for vertically administered nutrition interventions for which data on the economic composition of expenditures may be available, most nutrition-related interventions are cross-sectoral or part of larger service delivery systems, which makes it difficult