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

BACKGROUND: Community-based preschool meals can provide an effective platform for implementing integrated agriculture and nutrition programs. However, there is little evidence on the costs and cost-efficiency of implementing these types of multisectoral interventions. OBJECTIVES: Assess the economic costs and cost-efficiency of implementing an effective integrated nutrition-sensitive intervention through a preschool platform in Malawi, including community-level contributions. METHODS: The Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) framework and methods were applied to assess financial and economic costs of the intervention. A mixed-methods approach was used to measure and allocate costs for program activities and inputs using financial expenditure data combined with micro-costing. All costs were allocated to input and expenditure categories using the SEEMS-Nutrition framework. To facilitate comparisons with existing school meals programs, activities were also mapped against a standardized school feeding supply chain framework. RESULTS: The total annualized cost of the program was US$197 377, inclusive of both financial and economic costs. The annual economic cost of the program ranged from US$160 per preschool child to US$41 per beneficiary. The principal drivers of cost by program activity were training (46%), school meals provision (19%), monitoring and evaluation (12%), and establishing and running community groups (6.5%). Notably, community contributions accounted for 25% and were driven by food donations and volunteer labor. CONCLUSIONS: Cost per beneficiary estimates of implementing an integrated agriculture–nutrition intervention through an early childhood development platform compare favorably with similar interventions. Further research is needed that applies a standardized economic evaluation framework to such multisectoral interventions.