About The Common Approach

Combating malnutrition requires a coordinated effort across sectors. And while there is emerging evidence on the impact of nutrition-sensitive interventions within multisectoral programs, evidence on the costs, cost-effectiveness, and costs vs. benefits of nutrition-sensitive interventions is limited. The lack of a standardized approach to generating information on costs, cost-effectiveness and return on investment impedes the ability of funders, policymakers and program managers to make informed decisions about what interventions to prioritize in their resource constrained settings to improve nutrition outcomes and achieve nutrition-related development targets. The SEEMS-Nutrition common approach and tools aim to fill this information gap. The common approach and its outputs have been designed to respond to the needs of decision-makers who use this information in deciding which interventions to invest in, scale-up or recommend.

For completing the cost analysis, analysts will need to collect information on program design, including a program impact pathway or theory of change, and detailed information on intervention or program activities, resource use and costs. For completing a cost-effectiveness analysis or cost-benefit analysis, analysts will need evidence of effectiveness from impact evaluations. The SEEMS-Nutrition costing tools can be an excellent complement to modeling the impact and costs of multisectoral nutrition strategies, for models such as Optima Nutrition and The Lives Saves Tool (LiST).

Ideally, an economist with experience in conducting cost or cost-effectiveness analysis would work closely with the project implementation and evaluation team. They should be experienced in collecting both quantitative and qualitative information on resource use, using interview and focus group discussions. They should be comfortable with using excel and other statistical packages, such as Stata or R.

The time for conducting an economic evaluation using the SEEMS-Nutrition tools will be variable and depend on the type of study and whether or not the economic evaluation is integrated into a larger process or impact evaluation. Typically the economic evaluation will be conducted alongside the impact evaluation, and will be completed once effectiveness results are available.

For example, if costs and benefits are being assessed as part of a three year pilot project that will be implemented and evaluated, then costing activities would occur one or two times over the course of the project. Each cost data collection round may be 5-14 days, depending on the: 

1. Administrative levels of data collection

2. Size of the project

3.  Sampling approach

The cost analysis could be completed after one year. For completing a cost-effectiveness analysis, data analysis would occur at the end of the three-year project, assuming that results from an impact evaluation are available.

Strengths:

The common approach will result in improved measurement of economic evaluation metrics for multisectoral approaches to strengthen food systems, economic, nutrition and health outcomes, including, but not limited to:

• Total and incremental program costs

• Average, incremental and marginal costs

• Benefit cost ratios

• Incremental cost-effectiveness ratios
  
  

Ultimately, improving and standardizing the information on costs and benefits of scaling up integrated multisectoral strategies for health and nutrition, will allow for a more comprehensive comparison of individual interventions or packages and policy levers to address healthy food systems, dietary intake, and improved nutritional status.

Limitations:

• Sampling in large-scale project can be expensive, and smaller samples of frontline workers and beneficiaries may not be representative, and thus may introduce bias into cost estimates. Sensitivity analysis can help explore how this affects results.

• Aggregating multiple outcomes from multisectoral and food system interventions is challenging, and does not fully capture both the tangible and intangible benefits for improved women’s empowerment, livelihood and maternal and child health and nutrition.

• This approach is most cost effective when integrated into an existing impact evaluation, or used with a model that has known effect sizes for a range of nutrition sensitive interventions. For the former, there are always risks of delays in data collection due to the political environment, weather delays, or most recently, the impact of a global pandemic. Such delays affect the availability of information on effectiveness needed for the comparative economic evaluation. For modeling approaches, the effect sizes for nutrition sensitive interventions are not well established or incorporated into current models, such as the Optima Nutrition and The Lives Saves Tool (LiST).