Treatment of severe acute malnutrition (SAM) has undergone a paradigm shift over the past decade through the introduction of Community-Based Management of Acute Malnutrition (CMAM) in over 60 countries. Under this approach, treatment has moved away from expensive, resource-constrained hospital settings toward the community, where volunteers screen children for signs of SAM. The growing body of evidence for CMAM is encouraging– it points toward the achievement of significant mortality reductions in a cost-effective manner.
In recognition of the life-saving potential of CMAM, as well as the acute malnutrition problem in Nigeria (which has the second number of wasted children globally), the Children’s Investment Fund Foundation (CIFF) invested $35.3 million to support the program in eleven states in northern Nigeria between 2013 and 2014. In order to better understand the costs, cost-effectiveness, and financial sustainability of the CMAM program, CIFF asked Results for Development (R4D) to conduct a data collection exercise. The data collected and ensuing analysis is intended to bolster the existing knowledge base of CMAM costs, while providing neutral analytical inputs for discussions with the government of Nigeria, program implementers, and development partners regarding program expansion.
The study took place over 11 months, between March 2014 and February 2015, in four states: Bauchi, Jigawa, Kano, and Sokoto. All economic and financial costs associated with the program were calculated using data collected during four waves. The cost per child cured was estimated at $219, of which $160 (73%) are financial costs borne by the government and UNICEF and $59 (27%) are economic costs.
The total cost per child cured, which takes into account cost elements not found in other CMAM costing studies, such as community volunteer costs, is nevertheless in line with such studies. In addition, using WHO cost-effectiveness standards, the CMAM program is viewed to be highly cost effective. While the financial sustainability of the program is not assured (total programmatic costs represent 2.3% of the 2014 Federal Health Budget), the cost-effectiveness numbers, coupled with the expected significant reduction in mortality, suggest that further investment in the program is warranted.