A case for subnational nutrition financing: The development and use of county-level investment cases in Kenya

This paper aims to emphasize the significance of creating subnational nutrition action plans in regions with high variation in nutrition challenges and evaluates their projected return on investment in Kenya. Despite steady progress, undernutrition in Kenya remains high, costing the country an estimated US$ 4.2 billion or 7% of its GDP annually. Under Kenya’s decentralized government system, numerous counties developed sectoral County Nutrition Action Plans (CNAPs) in 2018 to identify and prioritize essential nutrition actions to target undernutrition at the subnational level. In this paper, the authors present findings from county investment cases (CICs) in five counties — Nandi, Busia, Makueni, Vihiga, and Elgeyo Marakwet—including the costs, health impacts, and benefit to cost ratios of implementing high-impact nutrition interventions. Data was collected on the target coverage and cost of interventions prioritized in each county’s CNAPs for the 2018 to 2022 period. A monetized DALY approach, using the value of a statistical life methodology was used for cost-benefit analysis and the Optima Nutrition tool was used for cost-effectiveness analysis. The estimated cumulative impact of the five CNAPs was projected as 1,800 child and 115 maternal deaths averted; preventing and treating 19,000 cases of stunting and 4,700 cases of wasting in children under five and averting 67,000 cases of anaemia in pregnant women and adolescent girls. The county-level benefit-cost ratios range from $5:1 to $14:1 (at a default 3% discount rate). This analysis demonstrates that localized subnational plans can be advantageous for policymaking and prioritization to better address subnational disparities in undernutrition and offer a high return on investment.