We need to strengthen the evidence base
on the costs and benefits of nutrition programming across sectors
Governments and their partners are constantly faced with decisions on how to prioritize, plan, and implement nutrition interventions. Many important questions are asked through this decision-making process: what budget is available? How much will it cost? What will the impact be? How can I ensure a strong return on investment?
The economic rationale can “make or break” a decision to invest or continue investing, particularly in resource constrained settings. In a survey we conducted of the broader nutrition community (n=112 including I/NGOs, government staff, research institutes, and donors), 75% of respondents said that they evaluate return on investment at least sometimes when making decisions to fund, plan, recommend, or set policy or guidelines for nutrition interventions.
In this blog we unpack how evidence generated by economic analysis — including those on cost-effectiveness, cost-benefit, cost-utility, etc. — can be used to support improved decision-making for multisectoral nutrition program investments.
Why evidence is critical to all phases in the planning cycle
The Scaling Up Nutrition (SUN) policy and budget management cycle serves as a frame of reference to describe how economic evidence can better support the annual planning process in country (see Figure). We used survey results from the nutrition community and consultations from the SEEMS-Nutrition Policy Advisory Group to map use cases of economic evidence along the planning process:
- Policy review: Evidence on return on investment and cost-effectiveness can persuade government leaders and parliamentarians to make new commitments and/or continue to strengthen efforts. This can lead to the formation of new policy agendas that open opportunities for sectors to do more for nutrition.
- Strategic planning: Line ministries are better enabled to formulate annual and multi-year plans with evidence on what interventions work, at what cost, and with what kind of expected return on investment.
- Cost estimation: Cost data is a useful input into budgeting for programs as well as for making allocation decisions for earmarking fiscal transfers.
- Prioritization: Information on cost-effectiveness can help determine which interventions to prioritize, for max
- Budget formulation: Knowing the costs and relative level of prioritization of different interventions (based on steps 3 and 4 above), budget holders can make more informed decisions on how to allocate funding under a constrained envelope with the goal to invest more in programs proven to work, at a low cost, and with a high economic return.
- Budget execution and implementation: Implementation decisions, such as how to deliver services, can be strengthened by knowing whether cost and impact differ depending on the platform used to deliver the service.
- Accounting and monitoring & audit and evaluation: With a stronger idea of which interventions work across sectors, data systems can be targeted to track progress on implementation, impact, and resource mobilization in order to feed information back into the annual planning process. Routine resource tracking across sectors can support strategic planning by identifying and leveraging existing platforms and budgets to add nutrition-sensitive components.
- Resource mobilization, advocacy and communication (throughout): Advocacy for increased action and funding for nutrition is strengthened with evidence of cost-effectiveness and return on investment.
Across the full cycle, the generation and use of economic evaluation data can improve how different sectors work together to plan and implement nutrition interventions and ensure efficient use of funds. Additionally, Improved frameworks on multisectoral actions in nutrition enable strategic analysis of the funding landscape across sectors to identify possible financing pathways — for example, the agriculture budget may have space for new program additions that are proven to have a strong return on investment.
Why unpacking use cases matters
Unfortunately, the evidence base to draw on is limited. In a review of the current level of economic evidence available for nutrition interventions across sectors, researchers found that most of the evidence is in the health sector and mostly for nutrition-specific interventions (types of evidence searched for include cost of the intervention, evidence of cost-effectiveness/return on investment and evidence of economic outcomes).
This points to a clear gap: decision-makers don’t have critical information to support decisions along each of the eight steps in the planning cycle mentioned above.
But more information is on its way
The ANH Academy has introduced a framework to measure the costs and benefits of multisectoral nutrition actions, and it’s being put to use. The Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) initiative is applying this framework to conduct economic evaluations of six multi-sectoral nutrition programs. Projects include Nepal’s multisectoral nutrition program (Suaahara), an integrated poultry value change and nutrition intervention in Burkina Faso (SE LEVER), nutrition-sensitive agriculture interventions in Bangladesh (TRAIN) and Malawi (NEEP), a market-based intervention in the informal dairy sector in Kenya (MoreMilk), and an initiative to boost local markets full of diverse and nutritious foods in Kenya (Marketplace for Nutritious Foods). Additionally, SEEMS-Nutrition is developing methodological guidance in the form of a common approach to help standardize the measurement of costs and benefits for a range of multisectoral projects.
Ensuring evidence generated is fit for purpose
As part of SEEMS-Nutrition, R4D is scoping information needs in the nutrition community in order to ensure a) methodological guidance responds to the needs of researchers, and b) evidence generated is policy-relevant and responds to the needs of decision-makers. Documenting the ways that different stakeholders use economic evaluation data, or “use cases,” serves as a starting point in our user-centered approach to filling the information gap.
We want to hear from you
Are you a nutrition policymaker, researcher, funder, or program implementer?
- When have you used evidence from economic evaluation to support a decision? Does it map to the framework above?
- What challenges have you experienced in using economic evaluation data?
- What additional information do you need in order to make the case for multisectoral approaches to improve nutrition?
Please comment below or contact Mary D’Alimonte (firstname.lastname@example.org) to share and learn more about this work.
The authors gratefully acknowledge comments on this blog post from Carol Levin (University of Washington Department of Global Health), Augustin Flory, Jack Clift, and Kelly Toves (Results for Development).