Philippe Douste-Blazy

The first United Nations development aid program financed solely by African countries for their own benefit was announced recently at the UN headquarters in New York. Unitlife, which was presented as world leaders convened at the 70th session of the UN General Assembly, will tax the sale of oil, gold and other natural resources in African countries and use the money to buy food supplements for those countries' malnourished children. The Republic of Congo, Guinea, Mali and Niger are the first countries to sign up for the program; all are rich in natural resources but have varying degrees of political and economic stability. Nevertheless, starting in 2017, Congo has said it will contribute 10 cents on each barrel of oil it sells and Mali will contribute 10 cents from each gram of gold it sells to a Unitlife fund managed by Unicef, the United Nations Children's Fund, to be used to buy food supplements. Guinea and Niger will also contribute funds from the sale of their resources to the Unitlife fund, but which resources' sales will be taxed and the size of the taxes are still being discussed. "Africa's and indeed the world's natural resource wealth are part of an endowment for future generations, but what is the use of this endowment if we cannot spend a portion of it on our children immediately and today?" said Denis Sassou N'Guesso, the president of Congo, in a September 2014 Innovative Finance Foundation report tracing the contours of Unitlife. The foundation is a Swiss charity that raises money for social programs. Ibrahim Boubacar Keïta, the president of Mali, said in a separate statement: "I am very pleased that Mali is one of the founders of this innovative financing mechanism because we want to scale-up the fight against child malnutrition in our country and in the region." But activists have expressed concerns about the narrow scope of the scheme, and some research has shown that promoting gender equality is one of the most important ways to reduce malnutrition among children. "It's a very good initiative, but these revenues should also be distributed to meet basic social needs such as health and education, which are essential aspects of child well-being," said Kadidia Sangaré, the head of the Mali National Human Rights Commission, a nongovernmental organization based in Bamako, the capital. "This will have to be implemented in tandem with information and awareness campaigns for women to learn about the healthy foods children need." The UN's Human Development Report for 2014 found that 30 percent of Congolese children, 34.5 percent of Guinean children, 27.8 percent of Malian children and 43.9 percent of Nigerien children under 5 years old are too short for their age -- stunted -- because of a persistent lack of adequate food. Besides giving mothers knowledge about health and nutrition, education can play an important part in enhancing their receptiveness to modern medicine, according to research by a team of malnutrition experts that was published in The Lancet, the British medical journal, in June 2013. Marie T. Ruel, who heads the poverty, health and nutrition division at the International Food Policy Research Institute, a nonprofit group in Washington, D.C., and her co-authors of The Lancet research report also found that a mother's education, as measured by her number of years of schooling, affects a child's nutrition more than does a father's education. Because of this effect, according to the research, children of mothers who have secondary education are 25 percent less likely to be stunted (too short for their age because of chronic undernourishment) than the children of mothers who do not have secondary education. This may explain why South Asia and sub-Saharan Africa, the two regions in which girls receive the least amount of education worldwide, at averages of 3.5 years and 3.7 years respectively, have the highest number of stunted children, according to the UN Human Development Report for 2014. Across the nine countries that make up South Asia -- Afghanistan, Bangladesh, Bhutan, India, Iran, the Maldives, Nepal, Pakistan and Sri Lanka -- 46.7 percent of children who are under 5 years old are at least half as short as the global median for their age group because of undernourishment, the report found. The high percentage in South Asia is mostly sourced to India, which has the world's highest number of stunted children. The percentage for sub-Saharan Africa is 37.8. Research by two US-based economists, Lisa Smith and Lawrence Haddad, published this year in World Development, a top-ranked development studies journal, showed that increasing access to safe water and improving women's education had been the most efficient ways of reducing child malnutrition across 110 developing countries from 1970 to 2010, responsible for 25 percent and 22 percent of reductions in stunting, respectively. Based on their findings, the researchers said that increasing food availability should "not feature near the top of the priorities for accelerating undernutrition reductions in either South Asia or sub-Saharan Africa." Instead, Smith and Haddad advised, gender equality must be a stronger priority for reducing the number of stunted children in South Asia as girls there receive far less food and health care compared with boys. If girls and boys in South Asia had equal life expectancy, stunting there would be reduced by 10 percentage points, the researchers said. Similarly, they noted that improving women's education and gender equality are crucial goals in reducing the number of stunted children in sub-Saharan Africa. Robert Filipp, a creator of Unitlife, said the still-to-be-formed leadership of the new scheme with the four African countries would decide whether it should expand its scope beyond providing supplements. "Policy is to be decided by the board," Filipp, who is president of the Innovative Finance Foundation, said in a Skype call. "Personally, I think that there is some scope to do something on women's health. I think women's education would probably be a stretch. But, again, the board would have to decide." Filipp and the Innovative Finance Foundation will not be involved in running Unitlife. Filipp and Philippe Douste-Blazy, the UN under secretary-general for innovative financing for development and a former French foreign minister, came up with the idea for Unitlife. They modeled Unitlife on Unitaid, a World Health Organization-hosted program that Douste-Blazy created in 2006. Unitaid funds efforts to fight HIV/AIDS, malaria and tuberculosis, mostly through a $1 surcharge on plane tickets sold in France and 11 other countries. The program has raised more than $2.4 billion and has financed projects in 105 developing countries since its inception. Unitaid now finances the treatment of 80 percent of children with AIDS, and through long-term bulk buying reduced the price of HIV drugs by 10,000 percent and malaria drugs by 85 percent from 2006 to 2014. Last year, Douste-Blazy and Filipp visited African countries that have significant mineral or oil wealth but large numbers of malnourished children. Through face-to-face conversations, they convinced the presidents of these countries that child undernourishment -- which impairs brain development and causes other permanent growth defects -- is a pressing problem that they need to address. At least one of the countries, Mali, is emerging from a conflict. Guinea is still contending with lingering effects of the 2014 Ebola epidemic. "Just imagine you are president of a country that has oil or gas or gold mines, but 30 percent of your future generation could basically be mentally retarded -- what kind of future would you have? That convinced them that they really have to do something about it immediately," Filipp said. The initiative is expected to generate at least $100 million a year starting in 2017, when it becomes fully operational. The UN says that $50 billion needs to be raised over the next 10 years to reduce the number of children under age 5 who are stunted by 40 percent by 2025. Unicef will manage the collected funds, provide administrative support to Unitlife and buy and deliver the supplements. A Unitlife committee will evaluate proposals on what supplements should be bought. Unicef will hire the head of Unitlife and its staff later this year. The program's headquarters will be based in Geneva to coordinate efforts with Scaling Up Nutrition, a pressure group led by David Nabarro, the new UN special envoy for food security, which aims to strengthen political commitments to fight child and maternal malnutrition. Nabarro, who is British, most recently served the UN as special envoy for Ebola. Sangaré, the head of the Mali human-rights group, is concerned that Unicef may use Malian funds given to Unitlife to pay Unicef's administrative costs. "The funds allocated for this program should not, in any case, be spent on managerial tasks to ensure the functionality of Unicef or other organizations," she said. "The funds should be used directly to fight malnourishment." Najwa Mekki, a Unicef spokeswoman in New York, said in an e-mail: "Unitlife would only support projects directly related to nutrition interventions. Implementing partners will be allowed to recover overhead costs, but only for those costs that arise in the context of nutrition interventions supported by Unitlife." "Every agency," she added, "has an applicable rate for overhead costs that is approved by its board. For Unicef, that rate is 8 percent." Sangaré also expressed concern that the new program could remove the pressure that local activists are putting on the Malian government to solve childhood malnutrition through eradicating corruption. "Corruption costs Mali 100 billion CFA annually," Sangaré said. "These funds that are lost because of corruption could contribute considerably to the fight against malnourishment -- they could be even enough to eradicate it. Fighting corruption, therefore, goes hand in hand with fighting against malnourishment and other obstacles to the well-being of the Malian child. Filipp said Unitlife would not supplant efforts to fight corruption. " job is to use collective bargaining power to reduce prices," he said. "There are other donors and other players and advocates and NGOs who monitor governments all the time. I don't think that we can pretend to solve everybody's problems." Mali has consistently ranked among the most corrupt countries in the world, according to Transparency International, a nonprofit organization based in Berlin. In 2014, Mali was 115th on a list of 175 least-corrupt countries published by the organization. Corruption, population increases, climate-change related drought and a lack of educated farmers have all led to long-term food shortages across Mali, according to a 2011 report by a group of food security researchers at Michigan State University. The UN in August this year said that more than a fifth of Malians lack food, including 715,000 of the country's 2.6 million children under 5 years old. "The fight against corruption in Mali will be a long-term effort, and to make malnourished children wait until that battle is won strikes me as very unfair to those children," John Staatz, an economics professor and member of the research group at Michigan State University, said in an e-mail. "Fighting corruption is very important for Mali's long-term human development and economic growth, but one step in that is ensuring, through collaboration between government ministries and organizations like Unicef, that funds from such efforts as this one, are spent correctly." Regardless of its perceived shortcomings, Unitlife is a potentially more effective way for African governments to use their own funds to improve their people's lives, as it uses the experience and expertise of Unicef and other UN agencies while relying on a new, possibly enduring revenue stream with no strings attached. As Staatz said: " is a way of putting more of the financing to fight malnutrition on the government budget rather than relying, as in the past, primarily on donor funds to support those efforts. Often, when the donor projects end, so do these efforts to reduce malnutrition. So this type of effort may make the fight against malnutrition more financially sustainable."

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Philippe Douste-Blazy

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