Esther M. Choo, Christopher G. Kemp, K. C. Sagun, Uttam Paudel, Jolene Wun, Kenda Cunningham, Pushpa Acharya, Pooja Pandey Rana, Carol Levin
Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded Suaahara II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016–2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.
{"title":"The costs of Suaahara II, a complex scaled-up multisectoral nutrition programme in Nepal","authors":"Esther M. Choo, Christopher G. Kemp, K. C. Sagun, Uttam Paudel, Jolene Wun, Kenda Cunningham, Pushpa Acharya, Pooja Pandey Rana, Carol Levin","doi":"10.1111/mcn.13658","DOIUrl":"https://doi.org/10.1111/mcn.13658","url":null,"abstract":"Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded <i>Suaahara</i> II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016–2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.","PeriodicalId":501646,"journal":{"name":"Maternal & Child Nutrition","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maternal and child undernutrition remain major public health problems in Nepal. Suaahara is a USAID-funded multi-sectoral nutrition programme aiming to strengthen local nutrition governance to reduce maternal and child undernutrition, among other objectives. The purpose of this study is to present findings from a recent qualitative evaluation of Suaahara II's influence on the decentralised implementation of Nepal's Multi-sectoral Nutrition Plan (MSNP) and identifying gaps and areas for improvement at the federal, provincial, and local levels to strengthen nutrition governance. This study employed multiple qualitative methods, engaging over 100 multi-sectoral nutrition stakeholders across three levels of government and eight districts. Thematic qualitative analysis was employed to identify emergent and salient themes, which were triangulated with other secondary data sources. Suaahara II had a positive influence on strengthening horizontal coordination for implementing the MSNP and effectively leveraged existing networks to strengthen implementation of nutrition-focused activities at the municipal level. Although there was an observable increased demand for nutrition budgets attributable to Suaahara II activities, sufficient allocation and utilisation, particularly in non-health sectors, did not meet these levels. Nepal's shift to federalism hindered vertical coordination of MSNP implementation. Some formal coordination mechanisms were strengthened, but variation in their effectiveness to strengthen horizontal and vertical coordination to implement MSNP activities continues. Finally, limited government ownership over nutrition activities and facilitating multi-sector coordination to implement the MSNP threatened sustainability of Suaahara II's outcomes on nutrition governance. Future programmes should continue to build on the progress made under Suaahara II, and specifically aim to address challenges in vertical coordination to strengthen nutrition governance in Nepal.
孕产妇和儿童营养不良仍然是尼泊尔的主要公共卫生问题。Suaahara 是美国国际开发署（USAID）资助的一项多部门营养计划，旨在加强地方营养管理，以减少孕产妇和儿童营养不良等问题。本研究旨在介绍最近对 Suaahara II 对尼泊尔多部门营养计划（MSNP）分散实施的影响进行定性评估的结果，并找出联邦、省和地方各级在加强营养管理方面存在的差距和需要改进的地方。本研究采用了多种定性方法，与三级政府和八个县的 100 多名多部门营养利益相关者进行了接触。采用专题定性分析来确定新出现的突出主题，并与其他二手数据来源进行三角验证。Suaahara II 对加强实施 MSNP 的横向协调产生了积极影响，并有效地利用了现有网络，加强了以营养为重点的活动在市一级的实施。尽管由于开展了 Suaahara II 活动，对营养预算的需求明显增加，但分配和使用的充足资金，特别是在非卫生部门，并没有达到这些水平。尼泊尔向联邦制的转变阻碍了《营养计划》实施工作的纵向协调。一些正式的协调机制得到了加强，但这些机制在加强横向和纵向协调以实施 MSNP 活动方面的有效性仍然存在差异。最后，政府对营养活动的自主权和促进多部门协调以实施 MSNP 的能力有限，威胁到 Suaahara II 计划在营养管理方面成果的可持续性。未来的计划应继续巩固在 Suaahara II 计划下取得的进展，并特别致力于应对纵向协调方面的挑战，以加强尼泊尔的营养治理。
{"title":"A qualitative study of Suaahara II influence on nutrition governance in Nepal","authors":"Sarah Eissler, Shraddha Manandhar, Kabita Shah, Bishow Neupane, Pooja Pandey Rana, Kristine Garn","doi":"10.1111/mcn.13659","DOIUrl":"https://doi.org/10.1111/mcn.13659","url":null,"abstract":"Maternal and child undernutrition remain major public health problems in Nepal. <i>Suaahara</i> is a USAID-funded multi-sectoral nutrition programme aiming to strengthen local nutrition governance to reduce maternal and child undernutrition, among other objectives. The purpose of this study is to present findings from a recent qualitative evaluation of <i>Suaahara II's</i> influence on the decentralised implementation of Nepal's Multi-sectoral Nutrition Plan (MSNP) and identifying gaps and areas for improvement at the federal, provincial, and local levels to strengthen nutrition governance. This study employed multiple qualitative methods, engaging over 100 multi-sectoral nutrition stakeholders across three levels of government and eight districts. Thematic qualitative analysis was employed to identify emergent and salient themes, which were triangulated with other secondary data sources. <i>Suaahara II</i> had a positive influence on strengthening horizontal coordination for implementing the MSNP and effectively leveraged existing networks to strengthen implementation of nutrition-focused activities at the municipal level. Although there was an observable increased demand for nutrition budgets attributable to <i>Suaahara II</i> activities, sufficient allocation and utilisation, particularly in non-health sectors, did not meet these levels. Nepal's shift to federalism hindered vertical coordination of MSNP implementation. Some formal coordination mechanisms were strengthened, but variation in their effectiveness to strengthen horizontal and vertical coordination to implement MSNP activities continues. Finally, limited government ownership over nutrition activities and facilitating multi-sector coordination to implement the MSNP threatened sustainability of <i>Suaahara II</i>'s outcomes on nutrition governance. Future programmes should continue to build on the progress made under <i>Suaahara II</i>, and specifically aim to address challenges in vertical coordination to strengthen nutrition governance in Nepal.","PeriodicalId":501646,"journal":{"name":"Maternal & Child Nutrition","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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