Ghana is considered one of the few success stories on the African continent regarding child nutrition.

1. Target population
• 174,000 more women (20% of mothers)
Costs = 26m cedis
• Direct cost of breastfeeding promotion is
60 cedis per woman
• Assumed to require 6 consultations of 30
min each
• Breastfeeding promotion would lead to
roughly 27,000 women spending an extra 1
hour per day on breastfeeding and
associated inconvenience
• Limited evidence for this cost
• However, many studies in Ghana and around the
world show that breastfeeding is impacted by
constraints such as work or household
responsibilities
Breastfeeding promotion would cost GHS 26m if
it could reach 174,000 more women
13.7
1.4
10.4
-
5.0
10.0
15.0
20.0
25.0
30.0
GHS
millions
Cost of breastfeeding promotion annually
(174,000 mothers)
Government cost to promote breastfeeding
Cost of mother's time to receive counselling
Cost of mother's time breastfeeding
Cost to govt
Cost to
mothers

2. BCR = 24
Benefits = 623m cedis
• 50% increase in likelihood of EBF -> 43,000 extra
women exclusively breastfeeding
• 24% increase in likelihood of continued
breastfeeding -> 20,600 continuing to
breastfeed up to 2 years
• 745 lives saved per year from reduced infection
(60%-70% risk reduction)
• 135,000 cases of respiratory infection avoided
• 43,000 cases of diarrhea avoided
• Benefits drawn from correlative studies
between breastfeeding and child illness or
mortality around the world
Intervention would lead to 43,000 extra women
exclusively breastfeeding and 745 lives saved
51%
76%
18%
9%
30%
15%
1%
0
0.2
0.4
0.6
0.8
1
1.2
Without intervention With intervention
Expected changes in
breastfeeding from
intervention
Exclusive Predominant Partial None
-
100
200
300
400
500
600
700
GHS
millions
per
year
Annual benefits
from
breastfeeding
Cases of illness avoided
Lives saved

3. Target population
• 174,000 more women (20% of mothers)
Costs = 5m cedis
• Direct cost of complementary feeding
promotion is 28 cedis per woman
• CHW provide 1-to-1 counseling at home
• CHW are inexpensive – assumed to cost GHS 9
per hour or GHS 1,600 per month
• Comparable to costs in other countries
• Assumed to require 6-7 consultations of 15
min each
Complementary feeding promotion is cheap –
costing GHS 28 per mother or GHS 5m
4.6
0.3
-
1.0
2.0
3.0
4.0
5.0
6.0
GHS
millions
Cost of complementary feeding
promotion for 174,000 women
Maternal time
Govt cost of complementary feeding promotion

4. BCR = 36
Benefits = 178m cedis
• 16% reduction in stunting -> 4,350 children
avoiding stunting
• 30% increase in lifetime wages from avoided
stunting = 30,000 cedis in today’s value
• Based on studies linking stunting to height
reduction and height to wages across developing
world
• Lower than estimate from Guatemala in 1970s
(66%)
• 65 child deaths avoided due to better nutrition
CF promotion would reduce (moderate and
severe) stunting by 16% (3pp) + avoid 65 deaths
52%
47%
17%
14%
3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Without
intervention
With
intervention
Percent
of
child
Stunting
Changes in stunting
prevalence from
intervention
Mild Moderate Severe
0
20
40
60
80
100
120
140
160
180
200
Benefits from intervention (millions
cedi)
Millions
of
GHS
Benefit from interventions
Short run health benefit
Long run productivity benefit

5. Target population
• 174,000 HH with young children (20% of
mothers)
Costs = 1,400m cedis
• Costs 8,025 cedis per HH
• Very resource intensive – requires transfer of 40
chickens per HH
• Large amounts of intense training (50%+ of cost)
Benefits = GHS 2,174m
• Income boost of 4,000 cedis per year
• 29% reduction in stunting
• 120 child deaths avoided
Nutrition sensitive agriculture has a BCR of 1.6
1,394
-
1,823
261
89
-
500
1,000
1,500
2,000
2,500
Costs Benefits
GHS
millions
Costs and benefits of nutrition sensitive
agriculture program for 174k HHs
Income earned Productivity benefits Health benefits
BCR
1.6

6. SUMMARY BCR TABLE
INTERVENTION BENEFITS
(GHS
MILLION)
COSTS
(GHS
MILLION)
BCR
Multiple micronutrients and
Calcium in pregnancy
3,585 203 18
Breastfeeding promotion 623 26 24
Complementary feeding
promotion
178 4.9 36
Nutrition sensitive agriculture 2,174 1,394 1.6