Integration of Child Nutrition Services into ESP Delivery by Urban Clinics: Cost Analysis

 Funded by: USAID

Bangladesh continues to have one of the most severe problems of child malnutrition in the world.  Nation-wide, 48 percent of children under five are underweight and 45 percent are stunted.  In urban slums, rates of child malnutrition are even higher.  Malnutrition rates rise very steeply and peak among children of weaning-age (6 to 23 months) and are clearly related to inappropriate feeding practices and to the high burden of disease particularly in this age group.

The GOB's current approach to the prevention and management of child malnutrition in rural Bangladesh is based on a "vertical" approach that requires the establishment of a separate, NGO-managed infrastructure for nutrition status assessments and nutrition counselling and for targeted supplementation of severely malnourished and growth-faltering children.  Replicability and affordability of this approach in urban Bangladesh is doubtful.  ICDDR,B has therefore tested the feasibility and effectiveness of an alternative, clinic-based approach that focuses on the identification and outpatient management of severe malnutrition among clinic-attending children of weaning age.  This approach has succeeded in rehabilitating 60 percent of such children from severe to only moderate malnutrition, even though three-fourths of them came from slum households.  Eighty-four percent of improved children who could still be contacted six months later had sustained or even further improved on their nutrition status at recovery.

If cost-efficient, outpatient management of severe child malnutrition could be considered for replication at all urban NGO clinics funded under NIPHP.  ICDDR,B is, therefore, also analyzing the costs of this intervention.  This cost study considers both the provider costs incurred by the participating clinics and the costs incurred by the children's caretakers and households.  For provider costs, the study looks at the time costs of existing staff and at the costs of incremental inputs, such as salaries and allowances of clinic-based Nutrition Counsellors, and costs of supplies and equipment.  With respect to caretakers and households, the study considers their time costs as well as the incremental costs of children's improved diets.

Results of the cost analysis will be reported by the end of September 2003.