Menu ENN Search

Research Study of the cost, cost-efficiency and cost-effectiveness of three cash-based interventions in Pakistan

Research snapshot1

Cash-based interventions (CBIs) are increasingly being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash transfers for preventing undernutrition in emergency contexts. The objectives of this study were to assess the costs, cost-efficiency and cost-effectiveness in achieving nutrition outcomes of three CBIs in southern Pakistan: a 'double cash' (DC) transfer, a 'standard cash' (SC) transfer and a 'fresh food voucher' (FFV) transfer. Cash and FFVs were provided to poor households with children aged 6 to 48 months for six months in 2015. The SC and FFV interventions provided US$14 per month and the DC provided US$28 per month. Cost data were collected via institutional accounting records, interviews, programme observation, document review and household survey. Cost-effectiveness was assessed as cost per case of wasting, stunting and disability-adjusted life year (DALY) averted.

Beneficiary costs were higher for the cash groups than the voucher group. Net total cost transfer ratios (TCTRs) were estimated as 1.82 for DC, 2.82 for SC and 2.73 for FFV. Yet, despite the higher operational costs, the FFV TCTR was lower than the SC TCTR when incorporating the participation cost to households, demonstrating the relevance of including beneficiary costs in cost-efficiency estimations. The DC intervention achieved a reduction in wasting, at US$4,865 per case averted; neither the SC nor the FFV interventions reduced wasting. The cost per case of stunting averted was US$1,290 for DC, US$882 for SC and US$883 for FFV. The cost per DALY averted was US$641 for DC, US$434 for SC and US$563 for FFV without discounting or age weighting. These interventions are highly costeffective by international thresholds. While it is debatable whether these resource requirements represent a feasible or sustainable investment given low health expenditures in Pakistan, the findings may provide

Read more...

Endnote

1Lani Trenouth, Timothy Colbourn, Bridget Fenn, Silke Pietzsch, Mark Myatt, Chloe Puett; The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan, Health Policy and Planning, Volume 33, Issue 6, 1 July 2018, Pages 743–754, https://doi.org/10.1093/heapol/czy045

More like this

Resource: The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan

Abstract Cash-based interventions (CBIs) increasingly are being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash...

FEX: A cluster RCT to measure the effectiveness of cash-based interventions on nutrition status, Sindh Province, Pakistan

By Bridget Fenn View this article as a pdf Bridget Fenn is an epidemiologist with a background in nutrition. She is currently a consultant for the Emergency Nutrition Network...

Blog post: Food Assistance and Nutrition- a recent presentation of our research findings in Pakistan

Hello, I am Bridget Fenn, ENN's long standing lead research investigator. I recently I gave a virtual presentation about the REFANI to participants at a research conference in...

FEX: Costs, cost-effectiveness, and financial sustainability of CMAM in Northern Nigeria

By Sasha Frankel, Mark Roland and Marty Makinen Sasha Frankel worked for the Results for Development Institute as a Senior Programme Associate focusing on health financing and...

FEX: Cost effectiveness of CMAM in Malawi

Government of Malawi guidelines Summary of published research1 A recent study assessed the cost-effectiveness of community-based management of acute malnutrition (CMAM) to...

Resource: Cost Effectiveness of Community-Based Management of Acute Malnutrition (CMAM) in Malawi

Reference: Health and Policy Planning, 2011: 1-11. Published March 4th 2011. This study assessed the cost-effectiveness of community-based management of acute malnutrition...

FEX: The cost of implementing the C-MAMI tool to treat nutritionally vulnerable infants in Bangladesh

By Natasha Lelijveld, Mostofa Sarwar, Golam Mothabbir, Sarah Butler and Nicki Connell View this article as a pdf Natasha Lelijveld is a Research Fellow at the Centre for...

FEX: What affects the cost of delivering cash transfers in humanitarian settings?

By Clare O'Brien and Fidelis Hove Clare O'Brien is a senior consultant in the Poverty and Social Protection team at Oxford Policy Management, a development...

FEX: Literature review on impact of cash transfers on nutritional outcomes

By Bridget Fenn and Ellyn Yakowenko Bridget Fenn is an epidemiologist with a background in nutrition. She is currently a consultant for the Emergency Nutrition Network (ENN)...

en-net: Appropriate effect size in estimating sample size

What is the minimum rate of reduction in GAM in order to determine if an intervention is worth the investment? In other words, I am trying to get a sense of the appropriate...

FEX: How many lives do our CMAM programmes save? A sampling-based approach to estimating the number of deaths averted by the Nigerian CMAM programme

By Assaye Bulti (UNICEF), Stanley Chitekwe (UNICEF), Chloe Puett (ACF), and Mark Myatt (Brixton Health) Assaye Bulti is responsible for managing routine nutrition programme...

Resource: Cost Effectiveness of Community-Based Therapeutic care for Children with Severe Acute Malnutrition in Zambia: decision tree model

Reference: Cost effectiveness and Resource Allocation, 7:2 Abstract Background: Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have...

FEX: Comparing cash and food transfers: findings from a pilot project in Sri Lanka

By Lili Mohiddin (Oxfam GB), Manohar Sharma (IFPRI), Anette Haller (WFP Rome) Lili Mohiddin, Manohar Sharma & Anette Haller Lili Mohiddin has been an Emergency Food Security...

en-net: Cost per DALY averted for CMAM programs

I am just looking at cost per DALY averted for a CTC/CMAM program. I have a few questions: (1) Has anyone here done that? What advice do you have? What are the pratfalls? What...

en-net: NCA

The current CMAM program has just entered its third year, it has one more year to wrap up. One SMART and a KAP was conducted during the second half of the last year, NCA was...

FEX: Cash, food or vouchers? Evidence from a randomised experiment in northern Ecuador

Summary of research1 Location: Northern Ecuador What we know: There is ongoing debate on the most effective form of food assistance: cash, food vouchers or food...

FEX: Impact evaluation of cash, food vouchers, and food transfers among Colombian refugees and poor Ecuadorians in urban Ecuador

Summary of evaluation1 Evaluation headlines: Levels of food insecurity and associated anaemia are high amongst Columbian refugees and poor Ecuadorians in the northern...

FEX: Technical brief on the cost of malnutrition

Summary of research1 Location: Global What we know: Poor nutrition carries a significant economic burden at individual, national and global levels and prevents poverty...

FEX: The REFANI Project in Pakistan: adapting research to a multi-sectoral programme for impact measurement

By Zvia Shwirtz, Bridget Fenn, Riccardo Mioli, Ghulam Murtaza Sangrasi and Maureen Gallagher Zvia Shwirtz is currently the REFANI Communications and Research Uptake Officer,...

en-net: Cost of RUTF

1. What is the cost of RUTF (US $)
2. What is the average complete dose of SAM case? (number of RUTFs per SAM case).
3. What is the average cost of treatment of...

Close

Reference this page

Research Study of the cost, cost-efficiency and cost-effectiveness of three cash-based interventions in Pakistan. Field Exchange 58, September 2018. p13. www.ennonline.net/fex/58/cashbasedinterventionspakistan

(ENN_6095)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.