When Communities Pull Their Weight: The Economic Costs of an Integrated Agriculture and Nutrition Home-Grown Preschool Meal Intervention in Malawi

Margolies, Amy; Gelli, Aulo; Daryanani, Roshan; Twalibu, Aisha; Levin, Carol

doi:10.1177/0379572120986693

Cited by 10 publications

(10 citation statements)

References 30 publications

(52 reference statements)

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“…We then mapped costs to the NSV chain typology. We found similar results to the first programme costed with the SEEMS approach: a nutrition-sensitive agriculture programme, with agriculture and nutrition BCC delivered through community-based preschools in Malawi (Margolies et al, 2021) Brauw et al, 2018). A study in Cambodia estimated the costs over ten years of a homestead production intervention at USD$929 per household (Dragojlovic et al, 2020).…”

Section: Discussionsupporting

confidence: 64%

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The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh

Thai

Margolies

Gelli

et al. 2022

Maternal & Child Nutrition

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Bangladesh struggles with undernutrition in women and young children. Nutritionsensitive agriculture programmes can help address rural undernutrition. However, questions remain on the costs of multisectoral programmes. This study estimates the economic costs of the Targeting and Re-aligning Agriculture to Improve Nutrition (TRAIN) programme, which integrated nutrition behaviour change and agricultural extension with a credit platform to support women's income generation. We used the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) approach. The approach aligns costs with a multisectoral nutrition typology, identifying inputs and costs along programme impact pathways. We measure and allocate costs for activities and inputs, combining expenditures and micro-costing. Quantitative and qualitative data were collected retrospectively from implementers and beneficiaries. Expenditure data and economic costs were combined to calculate incremental economic costs. The intervention was designed around a randomised control trial. Incremental costs are presented by treatment arm. The total incremental cost was $795,040.34 for a 3.5-year period. The annual incremental costs per household were US$65.37 (Arm 2), USD$114.15 (Arm 3) and $157.11 (Arm 4). Total costs were led by nutrition counselling (37%), agriculture extension (12%), supervision (12%), training (12%), monitoring and evaluation (9%) and community events (5%). Total input costs were led by personnel (68%), travel (12%) and supplies (7%). This study presents the total incremental costs of an agriculture-nutrition intervention implemented through a microcredit platform.Costs per household compare favourably with similar interventions. Our results illustrate the value of a standardised costing approach for comparison with other multisectoral nutrition interventions.

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Section: Discussionsupporting

confidence: 64%

“…This study used a novel standardised costing approach that contributes to gaps in the literature on the costs of multisectoral nutrition programmes (Margolies et al, 2021 ). The methodology was developed by SEEMS‐Nutrition, led by the University of Washington in collaboration with IFPRI and funded by the Bill and Melinda Gates Foundation.…”

Section: Methodsmentioning

confidence: 99%

The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh

Thai

Margolies

Gelli

et al. 2022

Maternal & Child Nutrition

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“…In the Phu Mo HGSF pilot, the school meals cost was about US$ 0.65/child/d or US$ 13 per month. Margolies et al 55 calculated the complete cost of school meals for nursery school children in Malawi; the costs compared favorably with other integrated agriculture and nutrition interventions. A notable difference with our program was that in their case, the families contributed a substantial proportion of the foods used in the school meals.…”

Section: Discussionmentioning

confidence: 99%

Home-Grown School Feeding: Implementation Lessons From a Pilot in a Poor Ethnic Minority Community in Vietnam

et al. 2022

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Background: Undernutrition threatens the health and future of preschool children in disadvantaged remote communities. Home-grown school feeding (HGSF) in nursery schools could positively impact children’s nutrition while creating multiple benefits for the whole community. However, evidence is lacking on implementation of HGSF within multi-sectoral programs in remote areas. Objective: This study assessed an HGSF pilot intervention, part of a nutrition-sensitive agriculture (NSA) program, in a mountain ethnic minority community in Vietnam. It aimed to identify the changes brought about by the intervention, in particular diversity of children’s food, food sources, barriers and facilitators to change, and future challenges and strategies. Methods: Mixed-methods assessment covered school meal diversity, cost, and food sources but the key focus was on observed changes resulting from the HGSF intervention and perceived barriers and facilitators to its implementation. Data were collected mainly through semi-structured interviews (n = 30) and seven focus group discussions (n = 76). Results: School meals contributed to increasing diversity of food consumed by children. Above 30% of foods used were home-grown. Respondents reported increased school attendance; children’s food preferences and hygiene practices improved as did parents’ caring and feeding practices. Local food systems became less cash-crop-oriented and more self-reliant, contributing to household food security and income generation. Social capital increased. Positive changes were attributed to HGSF and synergy among NSA program components. Poverty and limited resilience to external shocks threatened sustainability. Conclusions: Implementing HGSF within an NSA program in a mountainous ethnic minority area with a high prevalence of undernutrition benefitted children and their communities.

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“…The cost analysis estimated the incremental economic costs of providing an integrated agriculture and nutrition intervention through an ECD platform from a societal perspective. The detailed methods for the cost analysis are published elsewhere (Margolies et al, 2021 ). Briefly, a mixed methods approach was used to measure and allocate costs for program activities and inputs using expenditure data combined with micro-costing to capture all resource inputs and economic costs.…”

Section: Methodsmentioning

confidence: 99%

Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi

Gelli

Margolies

et al. 2021

Food Sec.

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Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.

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When Communities Pull Their Weight: The Economic Costs of an Integrated Agriculture and Nutrition Home-Grown Preschool Meal Intervention in Malawi

Cited by 10 publications

References 30 publications

The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh

The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh

Home-Grown School Feeding: Implementation Lessons From a Pilot in a Poor Ethnic Minority Community in Vietnam

Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi

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