Global Nutrition Financing: A Beginner’s Guide

Malnutrition has far-reaching and devastating effects: in 2022, 149 million children under the age of five were stunted, and 45 million were wasted, severely impacting their physical growth and brain development. We set out to gain a better understanding of the nutrition landscape, including the key players, interventions, and financing. We soon realized that the data on nutrition financing is complex—arguably more complex than health financing. Nutrition financing and its data are complex due to the diverse interventions for nutrition across sectors and stakeholders, with both direct and indirect benefits. 

In this piece, we walk through what we’ve learned in navigating the basics of nutrition financing from three key sources—the Institute for Health Metrics and Evaluation (IHME), Results for Development (R4D), and the Global Nutrition Report (GNR). The data from these three sources are useful in revealing funding patterns and donor commitments to nutrition interventions. While traditional heavyweights like the US, UK, and Canada have mostly maintained roles in funding nutrition initiatives, emerging leaders such as Germany and Japan are poised to play more prominent roles in the future. Despite existing funding shortfalls and unmet commitments from donors, the upcoming 2025 Nutrition for Growth Summit in Paris represents a potentially pivotal moment to reinvigorate efforts and ensure accountability, including for the Child Nutrition Fund. 

Data sources

We reviewed three different data sources on nutrition financing: IHME, R4D, and the GNR. The IHME Financing Global Health database tracked development assistance for health from 1990 to 2021, and for this review we utilized the “Newborn and child health – nutrition” health focus area data. The R4D analysis, “Tracking aid for the WHA nutrition targets” tracked donor disbursements from 2015 to 2021 for priority nutrition interventions aimed at achieving global nutrition goals set by the World Health Assembly (WHA), and encompassed disbursements in and out of the health sector. The 2022 Global Nutrition Report monitored donor spending between 2010 and 2020, reflecting advancements in reaching financial commitments and pledges made at previous global nutrition stakeholder events called the Nutrition for Growth Summits, with arguably less standardization than the former two sources. 

We focused specifically on nutrition financing for nutrition-specific interventions, a category that refers to nutrition interventions that directly target the immediate causes of malnutrition and are often delivered by the health sector (e.g., micronutrient supplementation). We do not take into account financing for nutrition-sensitive interventions, which mostly address the underlying determinants of nutrition, encompassing a broader range of sectors beyond health, such as education, agriculture, water and sanitation, and social protection. 

Who are the biggest donors of nutrition?

Table 1 highlights donor spending on nutrition based on data from IHME and the GNR in 2019. The top three donors for nutrition from IHME data were the US, Canada, and the UK, respectively, closely followed by Germany. In examining the GNR, the US remained the top donor, followed by Japan and Canada, with the UK in fourth place. While differences in the ranking perhaps reveal more about differences in the definitions of variables, we directly compare the two data sources in order to illustrate the relative importance of each donor. Regardless of data source, the US, Canada, and the UK were consistently top donors in nutrition, with Germany and Japan also playing a significant role. 

The usual caveats of limitations to data sources, methodologies, and formal definitions of the exact variables apply. One key distinction between IHME and GNR is the use of an estimation methodology by IHME, whereas GNR includes what was self-reported directly by donors. The IHME data variable is limited to newborn and child nutrition, whereas the GNR focused on donor spending on nutrition-specific interventions, only. 

Table 1. Donor government spending on nutrition from IHME and GNR data, 2019

Donor contributions are changing over time

Over the period 2015 to 2021, the US and the UK continue to be two of the largest donor governments for nutrition, as shown in the R4D analysis. The average annual percent change was positive for the US (by 6%) but negative for the UK (by 4%), suggesting that UK disbursements have been trending downward in recent years. 

Multilaterals and philanthropies, particularly EU institutions, the World Bank, and the Bill & Melinda Gates Foundation, remain top donors in nutrition-specific interventions. However, Germany, Japan, Australia, and France have had notably high annual percent changes during this period (+16%, +24%, +19%, and +19%, respectively). 

Figure 1. R4D 2023 analyses: Disbursements to priority interventions from major nutrition donors with average annual percent change, 2015–2021 (USD millions)

Donors are not meeting their commitments and pledges

The World Bank’s landmark report in 2017, "An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding and Wasting" emphasized the need for an additional investment of $70 billion over 10 years to achieve global targets put forth by the WHA. But the 2023 R4D report revealed that the world is not on track to meet the financial commitments needed to reach those WHA targets by 2025, further corroborated by the IHME and GNR. 

Table 2 shows the nutrition-specific disbursements reported by donors to the GNR, indicating that the majority of countries have not reached the commitments that they made. Indeed, only three countries—Australia, Ireland, and the Netherlands—had met their commitments by 2020. 

Table 2. Nutrition-specific disbursements reported by donors to the Global Nutrition Report, 2010–2020 (in USD, thousands) 

So what are the consequences if countries fail to reach their commitments? Past research has found that each dollar increase in per-capita nutrition-specific aid was associated with a reduction in the proportion of stunted children, and that this effect is sharper in countries with higher malnutrition burdens. Though stunting is just one measure of nutritional status, together several measures of nutritional status have been the leading aggregate risk factor for child mortality (see annex). Reduced or otherwise unpredictable nutrition financing can have terrible consequences, shortening bodies and lifespans. 

So how can countries and donors sustain, if not increase, levels of nutrition assistance in an era of tight fiscal space? Competing priorities and tight macroeconomic conditions make these financial goals more challenging, but especially so for low- and middle-income countries for whom malnutrition is a matter of life and death as well as long-run economic prospects which depend on a healthy workforce. 

National and global leadership are necessary to raise the priority of malnutrition in ways that overcome short funding cycles and other challenges. Funders often seek immediate outcomes in short-term funding cycles, but effective nutrition interventions require sustained investments over extended periods to achieve substantial and lasting impact. Whereas acute infectious diseases, such as diarrhea or pneumonia, can often be addressed with interventions that yield relatively faster results, nutrition interventions take time to literally gestate, grow and manifest. Policy entrepreneurs and leaders need to address this misalignment between expectations and the inherent needs of nutrition programs. 

Policy windows on the horizon: N4G 2025 and the Child Nutrition Fund 

Looking ahead, the next N4G Summit is slated to take place in Paris in 2025. As a global platform that brings together a diverse array of stakeholders, including governments, philanthropies, NGOs, and private companies, the next N4G presents an opportunity to review progress on targets and to hold stakeholders to account for all commitments made in 2021, including financial commitments. 

Additionally, the recent creation of the Child Nutrition Fund (CNF) represents an opportunity to accelerate efforts to end child malnutrition. This financing mechanism supports government-led initiatives in countries that have developed operational roadmaps as part of the United Nations Secretary-General’s Global Action Plan on Child Wasting. The CNF utilizes three distinct ‘windows’—the Programme Window, the Match Window, and the Supplier Window—to incentivize, increase, and prioritize the allocation of global and domestic resources towards essential programs and supplies for the prevention, detection, and treatment of child malnutrition. How effectively the CNF addresses nutrition financing gaps in the broader nutrition financing architecture is what many in the nutrition financing space are watching closely. 

Annex 1. Leading global risk factors for under-5 child deaths in 2021: grouped risk factors

Annex 2. Leading global risk factors for under-5 child deaths in 2021: detailed risk factors