Abstract：
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.
摘要：
关于扩大多部门营养计划的成本的证据有限。这些证据对于评估干预价值和可负担性至关重要。也缺乏关于参与社区一级干预措施的实施者和参与者的机会成本的证据。我们通过估计美国国际开发署资助的SuaaharaII（SII）计划的全部财务和经济成本来帮助填补这一空白，尼泊尔扩大的多部门营养计划（2016-2023年）。我们采用了标准化的混合方法成本计算方法来估算3.7年实施期内的总成本和单位成本。国家和国家以下各级的财政支出数据与通过深入访谈和与工作人员的焦点小组讨论评估的经济成本估计数相结合，志愿者,社区成员,以及四个代表区的政府伙伴。每个地区的平均年总费用为908,948美元，经济成本占成本的47%。每个计划参与者（从怀孕到孩子两岁之间的1000天期间的母亲）的年度单位成本为132美元。每个方案参与者的年度费用从152美元(山区)到118美元(平原)不等。人员(63%)是最大的投入成本动因，其次是供应品(11%)。社区活动（29％）和家庭咨询访问（17％）是最大的活动成本驱动因素。志愿者干部为该计划贡献了大量时间，女性社区卫生志愿者在SII活动上花费大量时间(每月27小时)。多部门营养计划可能成本高昂，特别是考虑到志愿者和参与者的机会成本。这项研究提供了急需的证据，证明了扩大的多部门营养计划的成本，以便将来与收益进行比较。
