This presentation was made by Suman Chakrabarti (IFPRI) in the session on ‘Big numbers about small children: Research on nutrition financing’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi. For more information about the conference visit our website: www.poshan.ifpri.info

1. Estimating the cost of delivering direct
nutrition interventions at scale:
National and subnational level insights from
India
Suman Chakrabarti
With
Purnima Menon
Christine McDonald
Poverty Health and Nutrition Division
International Food Policy Research Institute, New Delhi

2. World Health Assembly nutrition targets
to be achieved by 2025 - India
Source: The Rapid Survey on Children (2013/2014) (Ministry of Women and Child Development, Government of India;
District Level Health Survey (DLHS) 4 (2012/2013) & Clinical; Anthropometry and Biometry (CAB) Census Survey (2014).
Notes: Anemia data was pooled from DLHS 4 and Census CAB. India averages for anemia were derived using a weighted mean of women aged 18-49
years. Population weights were taken from Census 2011 data.
Columns represent all India average and each dot is the average for the state.
Targets based on WHA targets on nutrition: Where does India stand? – IFPRI POSHAN blog
73.5
38.7
15.1 18.6
64.9
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
Anaemia in women
of
reproductive age
Children under-5
who are stunted
Children under-5
who are wasted
Low birth weight Exclusive
breastfeeding
in the first 6 months
WHA target

3. The role of costing studies in
implementation research
• Identify the levels, types and composition of costs
required to expand the coverage of an
intervention.
• Identify regions where additional resources may
be required to effectively expand coverage.
• Help policymakers prioritize interventions.
• Standardizing programme domains,
accountability and incentives.

4. Objective
To estimate: national & state-level costs for 14
direct nutrition interventions already included in
GOI policies – we call them the ‘India Plus’
Interventions.

5. Program experience approach:
Total cost = Unit Cost *Target Population
Step 1
• Described each intervention and define associated target
population
• Estimated the size of the target population (TP) in 2017
Step 2
• Obtained local unit cost (UC) data for each intervention
• Multiplied the size of the target population by the unit cost to arrive
at a total cost of implementing each intervention at 100% coverage
Step 3
• Performed necessary adjustments for inflation
• Stratified analysis by state

6. Target populations
projections for 2017
 India’s 2011 Census
 Sample Registration System
 Rapid Survey on Children (2014)
Unit costs derived from
 Ministry of Women and Child
Development (MWCD) - ICDS
 NRHM
 UNICEF-India
 Alive and Thrive
 Micronutrient Initiative
 National Food Security Act (2013)
Data Sources

7. INR 41,464 crore (US$ 6.4 bn) per year is required
to scale-up all costed ENIs in India
4189
21227
16048
Crore INR per year
During pregnancy First 6 months after delivery After six months

8. Costs by intervention (INR crore)
1098
987
197
289
416
12581
154
274
52
1241
19863
122
3269
136
340
170
275
0 5000 10000 15000 20000 25000
Facility based treatment of SAM
Counseling for complementary feeding and WASH
Zinc during diarrhoea
ORS during diarrhoea
Supplementary food for severly underweight…
Supplementary food for children
Deworming
Paediatric IFA
Vitamin A
Supplementary food for lactating women
Cash transfers to support and enable breastfeeding
Counseling for breastfeeding
Supplementary food for pregnant women
IFA during pregnancy
Counseling
Insecticide-treated nets in malaria endemic states
IFA & deworming for adolescents
Post6months0-6monthsPregnancy

9. Costs by state/region (INR crore)
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Pregnancy 0 to 6 months Post 6 months

10. Summary of results
• INR 41.5 thousand crore (US$6.4 billion): Annual
cost to deliver India Plus interventions in 2017
– ~50 percent: Maternity benefits –cash transfers
– ~40 percent: Supplementary food rations
• Lowest cost interventions: Counselling, IFA,
vitamin A supplementation, deworming and
insecticide treated nets
• US $140 per child: A rule of thumb of average
cost to budget for all interventions