Dr. Paulin Basinga on Causes, Solutions to Malnutrition in Africa
The Gates Foundation’s eighth annual Goalkeepers report, which reveals new insights into the world’s worst child health crisis – malnutrition, was launched today. The 2024 Goalkeepers Report calls for increased investments to prioritize nutrition for a healthier future. It notes that malnutrition is the world’s worst health problem, and recent estimations have demonstrated that when a child dies, malnutrition is the underlying cause half the time. The report predicts that by 2050, climate change will condemn nearly 40 million more children to stunting and 28 million more to wasting. The Goalkeepers Report explores the simple solutions the Foundation is helping to develop and deploy to reduce malnutrition and ensure long-term food security in Africa. Before the report’s publication, Science Africa’s Deputy Executive Director Daniel Otunge spoke with the Bill & Melinda Gates Foundation Africa Director, Dr Paulin Basinga, about the Foundation’s role in fighting child malnutrition in Africa.
Interview with Paulin Basinga, the Gates Foundation Director for Africa on the Causes and Solutions to Malnutrition including the Foundation’s role in fighting child malnutrition in Africa.
Daniel: The 2024 Goalkeepers Report states that only about 25% of foreign aid goes to Africa, which is almost a 50% drop. What is the scope of the Foundation’s health philanthropy in Africa?
Paulin: Thank you for the question, Daniel. As you know, the Foundation is a private philanthropy, and we take our role seriously. We don’t want to replace governments, nor do we want to replace other donors. So, the way we think about our contribution is to be catalytic, to ensure that our small philanthropy funds can be as impactful as possible. What we do is fund a number of innovations, especially in nutrition. We conduct a lot of research on new ways to tackle malnutrition and then bring those innovations to scale by working with other donors and domestic resources mobilized by governments. Our contributions are significant in this space. While I don’t have specific figures with me, we can provide details on how much we invest in Africa. We have been steadily increasing our contributions and have not reduced our support to Africa. We also track global aid money to ensure sustained interventions alongside governments. We are very concerned, which is why we are urging donor countries to maintain their support at a high level.
Daniel: Yes, I understand that around 400 million children globally are not getting the nutrients they need, which is a huge number. So, what is the current state of child nutrition in Africa?
Paulin: Nutrition is a major issue in Africa. When we look at maternal and child mortality, malnutrition is the underlying cause in 50% of under-five mortality cases. A malnourished child’s ability to fight infectious diseases and benefit from vaccines is severely compromised. Close to one-third of children in Africa are stunted due to malnutrition. People often notice acute malnutrition, such as children with bloated bellies, but chronic malnutrition is just as prevalent, affecting 30-40% of children in some countries. The true impact will be felt over the next 20 years when some of these children reach working age. The ability of malnourished children to lift themselves out of poverty is significantly lower than that of well-nourished children.
Daniel: We see a lot happening in East Africa, like wars, climate change impacts, and rising food prices. Countries like Sudan, Somalia, and Congo are dealing with issues like smallpox, and it seems that children are the most affected. How does your advocacy work address these challenges for children and their mothers, especially pregnant mothers?
Paulin: Absolutely. The bulk of the Gates Foundation’s work is in global health, although we also focus on agricultural development and women’s empowerment. Global health is the largest part of our work, and we track progress by looking at mortality rates of children under five. From 2000 to 2015, there was a significant drop in child mortality—about 50%—from 10 million to 5 million deaths per year. However, progress has stagnated since 2015. We work closely with governments, from heads of state to health ministers, and across sectors like agriculture and local planning to prioritize health and nutrition in their budgets. We engage at both the national and local levels, such as in Nigeria, where we work to ensure that even small government resources are used effectively to reduce under-five mortality and improve future productivity.
Daniel: You mentioned funding, particularly the Child Nutrition Fund. What is the legal and institutional framework of this fund? Where does it currently stand?
Paulin: We are building on partnerships we’ve had for many years, like those with GAVI and the Global Fund. For over 20 years, we’ve worked with these organizations because they provide a coordinated approach to funding specific issues, such as immunization. The donor countries pool their money, and a global secretariat negotiates with pharmaceutical companies to buy vaccines at lower costs. Governments are also expected to allocate budget lines for co-funding vaccines, making them accountable for implementation. The Child Nutrition Fund operates on a similar model, with UNICEF playing a key role in coordinating government and donor contributions. We are already working with governments in countries like Mauritania and Indonesia, but we will need more donors to fully realize the fund’s potential in low- and middle-income countries.
Daniel: Will the Gates Foundation have a specific role in the Fund going forward?
Paulin: Yes, we are one of the founding partners of the Child Nutrition Fund, and we will continue to allocate resources to it.
Daniel: Talking about Multiple Micronutrient Supplements—MMS—, it’s fascinating to learn that a mother isn’t just feeding two but trillions. Why is it difficult for low- and middle-income countries to access this pill that costs just about $2.6?
Paulin: This is where the Gates Foundation steps in to address market failures in low- and middle-income countries. In wealthier countries, pregnant women can easily access multivitamins, but in rural areas of Africa, there is no market for such products because most women cannot afford them. Providing MMS, which contains 15 essential vitamins and minerals, can make a significant difference. Countries like Rwanda and Nigeria have already included MMS in their health programs, with Rwanda distributing it to more than 50,000 women. Nigeria has procured it and will begin distribution soon.
Daniel: Could lack of awareness or political will also be factors contributing to this market failure? Does your advocacy focus on these issues?
Paulin: Definitely. Advocacy and awareness are crucial for governments to update their service offerings based on new evidence. We work to ensure that governments are aware of the latest innovations and policies to adapt their programs accordingly.
Daniel: Does the Foundation address debt in Africa, given its direct impact on poverty and child malnutrition?
Paulin: From 2000 to 2015, progress was made thanks to political and economic stability in many African countries, which attracted private sector investment and helped governments raise revenue. However, today, many African countries are spending more on debt servicing than on health and education combined. This is a serious concern for us, as our impact depends on governments having the fiscal space to sustain innovations in health and education. We provide targeted technical assistance to governments that need advice on managing the debt crisis, working to protect as much of their health and education budgets as possible.
Daniel: Lastly, what are the key messages from the Goalkeepers Report?
Paulin: First, people need to understand the long-term impact of malnutrition. It’s like an invisible disability, particularly stunting, which affects up to 40% of children in low- and middle-income countries. By 2050, Africa will be the most populous region in the world, and if we don’t address malnutrition now, we won’t have a healthy and productive workforce. Second, donor countries need to see their contributions to GAVI, the Global Fund, and the Child Nutrition Fund as investments not just for Africa but for humanity. Ensuring children are well-nourished will help secure a brighter future for the entire world.