Journal Article

The costs of Suaahara II, a complex scaled‐up multisectoral nutrition programme in Nepal

Rana, Pooja Pandey, Paudel, Uttam, Levin, Carol, Cunningham, Kenda, Kemp, Christopher G., Choo, Esther M., Wun, Jolene, Acharya, Pushpa, Sagun, K. C.

2026

Overview

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. The average unit cost of Suaahara II, a scaled up multisectoral nutrition programme covering 42 of 77 districts in Nepal, was US $132 per programme participant (mother in the 1000‐day period) and US$ 76 per mother–child pair reached per year. Community events designed to improve access to and demand for nutritious foods accounted for the largest share of activity costs (29%). Opportunity costs of volunteer and participant time are high, accounting for 47% of total costs. Female Community Health Workers, already engaged in community nutrition activities, spent significant time on implementing Suaahara II activities at 27 h per month. Complex multisectoral programmes often require significant resources to ensure coordination and sufficient technical support at national and subnational levels.

• Publisher: Wiley
• Subject: costing / economic evaluation / Female / Health Promotion - economics / Humans / multisectoral nutrition / Nepal / Program Evaluation - economics / Supplement / time use