Skip to main content Accessibility help
×
×
Home

Benefit-Cost Analysis of a Package of Early Childhood Interventions to Improve Nutrition in Haiti

  • Brad Wong (a1) and Mark Radin (a2)
Abstract

We conduct a benefit-cost analysis of a package of early childhood interventions that can improve nutrition outcomes in Haiti. Using the Lives Saved Tool, we expect that this package can prevent approximately 55,000 cases of child stunting, 7,600 low-weight births and 28,000 cases of maternal anemia annually, if coverage reaches 90% of the target population. In addition, we expect these nutrition improvements will avoid 1,830 under-five deaths, 80 maternal deaths and 900,000 episodes of child illness every year. Those who avoid stunting will experience lifetime productivity benefits equivalent to five times gross national income per capita in present value terms, at a 5% discount rate. While previous benefit-cost analyses of this specific package have only estimated the lifetime productivity benefits of avoided stunting, this paper also accounts for reductions in fatal and non-fatal health risks. In the base case scenario, the annualized net benefits of the intervention equal Haitian gourdes 13.4 billion (USD 211 million) and the benefit-cost ratio (BCR) is 5.2. Despite these substantial benefits, the package may not be the most efficient use of a marginal dollar, with alternative interventions to improve human capital yielding BCRs approximately three to four times higher than the base estimate.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Benefit-Cost Analysis of a Package of Early Childhood Interventions to Improve Nutrition in Haiti
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Benefit-Cost Analysis of a Package of Early Childhood Interventions to Improve Nutrition in Haiti
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Benefit-Cost Analysis of a Package of Early Childhood Interventions to Improve Nutrition in Haiti
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Footnotes
Hide All

We would like to thank three anonymous referees, Scott Grosse, Jim Hammitt, John Hoddinott, Lynn Karoly, Bjorn Larsen, Carol Levin, Peter Orazem, Roger Perman, Lisa Robinson and Dale Whittington as well as participants at Guidelines for Benefit-Cost Analysis project Methods and Case Studies Workshop, November 2017 at Harvard University, for insightful comments on earlier drafts of this paper. We are also grateful to Victoria Chou and Adrienne Clermont for helpful guidance on LiST and to Steve Vosti and Reina Engle-Stone for help in understanding the coverage of nutrition interventions in Haiti. The lead author is indebted to Bjorn Lomborg for many conversations over the years, which have significantly sharpened his understanding of the craft of benefit-cost analysis. This work was supported by the Bill & Melinda Gates Foundation [OPP1160057]. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Gates Foundation or the Copenhagen Consensus Center.

Footnotes
References
Hide All
AidFlows. 2017. “Foreign Aid Received by Haiti.” http://www.aidflows.org/(accessed on October 30, 2017).
Alderman, Harold and Behrman, Jere A.. 2006. “Reducing the Incidence of Low Birth Weight in Low Income Countries has Substantial Economic Benefits.” World Bank Research Observer, 21(1): 2548.
Aryastami, Ni Ketut, Shankar, Anuraj, Kusumawardani, Nunik, Besral, Besral, Jahari, Abas Basuni, and Achadi, Endang. 2017. “Low Birth Weight Was the Most Dominant Predictor Associated with Stunting Among Children Aged 12–23 Months in Indonesia.” BMC Nutrition, 2017(3): 16.
Bhargava, Santosh K., Sachdev, Harshpal Singh, Fall, Caroline H. D., and Osmond, Clive et al. 2004. “Relation of Serial Changes in Childhood Body-Mass Index to Impaired Glucose Tolerance in Young Adulthood.” New England Journal of Medicine, 350: 865875.
Bhutta, Zulfiqar A., Das, Jai K., Rizvi, Arjumand, Gaffey, Michelle F., Walker, Neff, Horton, Susan, Webb, Patrick, Lartey, Anna, and Black, Robert E.. 2013. “Evidence-based Interventions for Improvement of Maternal and Child Nutrition: What can be Done and at What Cost?Lancet, 382(9890): 452477.
Black, Robert E., Allen, Lindsay H., Bhutta, Zulfiqar A., Caulfield, Laura E., de Onis, Mercedes, Ezzati, Majid, Mathers, Colin, and Rivera, Juan. 2008. “Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences.” Lancet, 371(9608): 243260.
Central Intelligence Agency. 2016. “Budget Listings by Country.” The World Factbook. https://www.cia.gov/library/publications/the-world-factbook/fields/2056.html(accessed on October 20, 2017).
Claxton, Karl, Asaria, Miqdad, Chansa, Collins, Jamison, Julian, Lomas, James, Ochalek, Jessica, and Paulden, Michael. 2019. “Accounting for Timing when Assessing Health-Related Policies.” Journal of Benefit-Cost Analysis, 10(S1): doi:10.1017/bca.2018.29.
Clermont, Adrienne and Walker, Neff. 2017. “Nutrition Interventions in the Lives Saved Tool.” Journal of Nutrition, 147(11): S2132S2140.
Engle-Stone, Reina, Stewart, Christine P., Vosti, Stephen A., and Adams, Katherine P.. 2017. Preventative Nutrition Interventions. Haiti Priorise, Copenhagen Consensus Center.
Feenstra, Robert, Inklaar, Robert, and Timmer, Marcel. 2015. “The Next Generation of the Penn World Table.” American Economic Review, 105(10): 31503182.
Fishman, Steven M., Caulfield, Laura E., de Onis, Mercedes, Blössner, Monika, Hyder, Adnan A., Mullany, Luke, and Black, Robert E.. 2004. “Childhood and maternal underweight.” In Ezzati, Majid, Lopez, Alan D., Rodgers, Anthony, and Murray, Christopher J. L. (Eds.), Comparative Quantification of Health Risks – Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Vol. 1). Geneva: World Health Organization.
GBD 2015 Risk Factors Collaborators. 2016. “Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015.” Lancet, 388(10053): 16591724.
Grajeda, Rubén, Behrman, Jere R., Flores, Rafael, Maluccio, John A., Martorell, Reynaldo, and Stein, Aryeh D.. 2005. “The Human Capital Study 2002–04: Tracking, Data Collection, Coverage, and Attrition.” Food Nutrition Bulletin, 26(2_Suppl 1): S15S24.
Guh, Soyeon, Xingbao, Chen, Poulos, Christine, Qi, Zhang, Jianwen, Cao, von Seidlein, Lorenz, Jichao, Chen, Wang, XuanYi, Zhanchun, Xing, Nyamete, Andrew, Clemens, John, and Whittington, Dale. 2008. “Comparison of Cost-of-illness with Willingness-to-pay Estimates to Avoid Shigellosis: Evidence from China.” Health Policy and Planning, 23(2): 125136.
Haas, Jere D. and Brownlie, Thomas. 2001. “Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship.” Journal of Nutrition, 131(2): 676S690S.
Hammitt, James K. 2017. “Extrapolating the Value per Statistical Life Between Populations: Theoretical Implications.” Journal of Benefit-Cost Analysis, 8(2): 215225.
Hoddinott, John, Alderman, Harold, Behrman, Jere R., Haddad, Lawrence, and Horton, Susan. 2013a. “The Economic Rationale for Investing in Stunting Reduction.” Maternal and Child Nutrition, 9(Suppl. 2): 6982.
Hoddinott, John, Maluccio, John A., Behrman, Jere R., Flores, Rafael, and Martorell, Reynaldo. 2008. “Effect of a Nutrition Intervention During Early Childhood on Economic Productivity in Guatemalan Adults.” Lancet, 371(9610): 411416.
Hoddinott, John, Maluccio, John, Behrman, Jere R., Martorell, Reynaldo, Melgar, Paul, Quisumbing, Agnes R., Ramirez-Zea, Manuel, Stein, Aryeh D., and Yount, Kathryn M.. 2011. “The Consequences of Early Childhood Growth Failure Over the Life Course.” Discussion Paper 1073. Washington, DC: International Food Policy Research Institute.
Hoddinott, John, Rosegrant, Mark, and Torero, Maximo. 2013b. “Hunger and Malnutrition.” In Lomborg, B. (Ed.), Global Problems, Smart Solutions: 332367. New York: Cambridge University Press.
Horton, Sue, Alderman, Harold, and Rivera, Juan A.. 2009. “Hunger and Malnutrition.” In Lomborg, B. (Ed.), Global Crises, Global Solutions: Costs and Benefits: 305354. New York: Cambridge University Press.
Horton, Susan and Hoddinott, John F.. 2014. “Benefits and Costs of the Food Security and Nutrition Targets for the Post-2015 Development Agenda.” Post-2015 Consensus, Copenhagen Consensus Center.
Hutton, Guy, Haller, Laurence, and Bartram, Jamie. 2007. “Global Cost-benefit Analysis of Water Supply and Sanitation Interventions.” Journal of Water and Health, 5(4): 481502.
Imdad, Aamer, Jabeen, Afshan, and Bhutta, Zulfiqar A.. 2011a. “Role of Calcium Supplementation During Pregnancy in Reducing Risk of Developing Gestational Hypertensive Disorders: A Meta-analysis of Studies from Developing Countries.” BMC Public Health, 11(Suppl 3): S18.
Imdad, Aamer, Yakoob, Mohammad Yawar, Sudfeld, Christopher, Haider, Batool A., Black, Robert E., and Bhutta, Zulfiqar A.. 2011b. “Impact of Vitamin A Supplementation on Infant and Childhood Mortality.” BMC Public Health, 11(Suppl 3): S20.
Institut Haı̈tien de l’Enfance (IHE) and ICF. 2017. Enquête mortalité, morbidité et utilisation des services, Haïti, 2016–2017: Indicateurs Clés. Rockville, Maryland, and Pétion-Ville, Haïti: IHE and ICF.
International Monetary Fund. 2015. World Economic Outlook: Uneven Growth – Short- and Long-Term Factors. Washington (April).
Jamison, Dean T., Breman, Joel G., Measham, Anthony R., Alleyne, George, Claeson, Mariam, Evans, David B., Jha, Prabhat, Mills, Anne, and Musgrove, Philip (Eds.). 2006. In Disease Control Priorities in Developing Countries (2nd ed., Oxford and New York: Oxford University Press).
Khan, Wasiq N. 2010. “Economic Growth and Decline in Comparative Perspective: Haiti and the Dominican Republic, 1930–1986.” Journal of Haitian Studies, 16(1): 112125.
Kligerman, Maxwell, Walmer, David, and Merrell, Sylvia Bereknyei. 2017. “The Socio-economic Impact of International Aid: A Qualitative Study of Healthcare Recovery in Post-earthquake Haiti and Implications for Future Disaster Relief.” Global Public Health, 12(5): 531544.
Kozuki, Naoko, Katz, Joanne, Clermont, Adrienne, Walker, Neff and the Child Health Epidemiology Reference Group SGA-Preterm Birth Working Group. 2017. “New Option in the Lives Saved Tool (LiST) Allows for the Conversion of Prevalence of Small-for-Gestational Age and Preterm Births to Prevalence of Low Birth Weight.” Journal of Nutrition, 147: 2141S2146S.
Lamberti, Laura M., Zakarija-Grković, Irena, Fischer Walker, Christa L., Theodoratou, Evropi, Nair, Harish, Campbell, Harry, and Black, Robert E.. 2013. “Breastfeeding for Reducing the Risk of Pneumonia Morbidity and Mortality in Children Under Two: A Systematic Literature Review and Meta-analysis.” BMC Public Health, 13(Suppl 3): S18.
LiST. 2016. “Birth Outcomes and Stunting at Age One Month.” Lives Saved Tool Technical Note. http://livessavedtool.org/images/documents/Technical_Notes/Birth%20outcomes%20on%20stunting%20at%201%20mo.pdf(accessed on May 31, 2018).
LiST. 2017. “Breastfeeding and Effect Sizes on Mortality in LiST.” Lives Saved Tool Technical Note. http://livessavedtool.org/images/documents/Technical_Notes/Breastfeeding-effect-sizes-on-mortality.pdf(accessed on May 31, 2018).
Lomborg, Bjorn, Dubosse, Nancy, and Wong, Brad. 2018. Haïti Priorise Un Plan de Développement Alternatif. Copenhagen Consensus Center.
Martorell, Reynaldo, Behrman, Jere R., Flores, Rafael, and Stein, Aryeh D.. 2005. “Rationale for a Follow-up Study Focusing on Economic Productivity.” Food Nutrition Bulletin, 26(2_Suppl 1): S5S14.
McBain, Ryan K., Hutchinson, Brian, Kwan, Gene F., and Nugent, Rachel. 2017. Cost-benefit Analysis of Three Non-Communicable Disease Interventions in Haiti. Haiti Priorise, Copenhagen Consensus Center.
McEwan, Patrick J. 2015. “Improving Learning in Primary Schools of Developing Countries: A Meta-analysis of Randomized Experiments.” Review of Education Research, 85(3): 353394.
McGovern, Mark E., Krishna, Aditi, Aguayo, Victor M., and Subramanian, S. V.. 2017. “A Review of the Evidence Linking Child Stunting to Economic Outcomes.” International Journal of Epidemiology, 46(4): 11711191.
Ministry of Public Health and Population [le Ministère de la Santé Publique and de la Population] (MSPP), Haitian Childhood Institute [l’Institut Haı̈tien de l’Enfance] (IHE) and ICF International. 2013. “Haïti 2012 Mortality, Morbidity, and Service Utilization Survey: Key Findings.” Calverton, Maryland: MSPP, IHE, and ICF International.
Mujica-Coopman, María F., Brito, Alex, de Romaña, Daniel López, Ríos-Castillo, Israel, Cori, Héctor, and Olivares, Manuel. 2015. “Prevalence of Anemia in Latin America and the Caribbean.” Food Nutrition Bulletin, 36(Suppl 2): S119S128.
NEOVITA Study Group. 2016. “Timing of Initiation, Patterns of Breastfeeding, and Infant Survival: Prospective Analysis of Pooled Data from Three Randomised Trials.” Lancet Global Health, 4(4): e266e275.
Olofin, Ibironke, McDonald, Christine M., Ezzati, Majid, Flaxman, Seth, Black, Robert E., Fawzi, Wafaie W., Caulfield, Laura E., and Danaei, Goodarz. 2013. “Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies.” PLoS ONE, 8(5): e64636. https://doi.org/10.1371/journal.pone.0064636 (accessed on May 31, 2018).
Ord, Toby. 2013. “The Moral Imperative Toward Global Cost-effectiveness in Global Health.” Center for Global Development Essay. https://www.cgdev.org/publication/moral-imperative-toward-cost-effectiveness-global-health(accessed on May 31, 2018).
Ota, Erika, Hiroyuki, Hori, Mori, Rintaro, Tobe-Gai, Ruoyan, and Farrar, Diane. 2015. “Antenatal Dietary Education and Supplementation to Increase Energy and Protein Intake.” Cochrane Database Systematic Review 2015 (6): CD000032.
Panjwani, Anita and Heidkamp, Rebecca. 2017. “Complementary Feeding Interventions Have a Small but Significant Impact on Linear and Ponderal Growth of Children in Low- and Middle-income Countries: A Systematic Review and Meta-analysis.” Journal of Nutrition, 147(11): 2169S2178S.
Peña-Rosas, Juan Pablo, De-Regil, Luz Maria, Dowswell, Therese, and Viteri, Fernando E.. 2015. “Daily Oral Iron Supplementation During Pregnancy.” Cochrane Database of Systematic Reviews 2015(7): CD004736.
Prendergast, Andrew J. and Humphrey, Jean H.. 2014. “The Stunting Syndrome in Developing Countries.” Paediatrics and International Child Health, 34(4): 250265.
Rabbani, Atonu. 2017. Human Capital Investments in Haiti: Benefit-Cost Analyses of Some Selected Education Interventions. Haiti Priorise, Copenhagen Consensus Center.
Rahman, M. Shafiqur, Howlader, Tamanna, Masud, Mohammad Shahed, and Rahman, Mohammad Lutfor. 2016. “Association of Low-birth Weight with Malnutrition in Children Under Five Years in Bangladesh: Do Mother’s Education, Socio-economic Status, and Birth Interval Matter?PloS One, 11(6): e0157814.
Ramachandran, Vijaya and Walz, Julie. 2015. “Haiti: Where Has All the Money Gone?Journal of Haitian Studies, 21(1): 2665.
Robinson, Lisa A. and Hammitt, James K.. 2018. “Valuing Nonfatal Health Risks Reductions in Global Benefit Cost Analysis.” Guidelines for Benefit-Cost Analysis Project, Working Paper No. 2.
Robinson, Lisa A., Hammitt, James K., and O’Keeffe, Lucy. 2019. “Valuing Mortality Risk Reductions in Global Benefit-Cost Analysis.” Journal of Benefit-Cost Analysis, 10(S1): doi:10.1017/bca.2018.26.
Ronsmans, Carine and Campbell, Oona. 2011. “Quantifying the Fall in Mortality Associated with Interventions Related to Hypertensive Diseases of Pregnancy.” BMC Public Health, 11(Suppl 3): S8.
Sachdev, Harshpal S., Fall, Caroline H. D., Osmond, Clive, Lakshmy, Ramakrishnan, Dey Biswas, Sushant K., Leary, Samantha D., Srinath Reddy, Kolli, Barker, David J. P., and Bhargava, Santosh K.. 2005. “Anthropometric Indicators of Body Composition in Young Adults: Relation to Size at Birth and Serial Measurements of Body Mass Index in Childhood in the New Delhi Birth Cohort.” American Journal of Clinical Nutrition, 82(2): 456466.
Scaling Up Nutrition. 2014. “An Introduction to the Scaling up Nutrition Movement.” http://scalingupnutrition.org/wp-content/uploads/2015/06/Orange_Internal_InOutline_ENG_20140415_web.pdf(accessed on May 31, 2018).
Sinha, Bireshwar, Chowdhury, Ranadip, Upadhyay, Ravi Prakash, Taneja, Sunita, Martines, Jose, Bahl, Rajiv, and Sankar, Mari Jeeva. 2017. “Integrated Interventions Delivered in Health Systems, Home, and Community Have the Highest Impact on Breastfeeding Outcomes in Low- and Middle-income Countries.” Journal of Nutrition, 147(11): 2179S2187S.
Sklar, Rachel. 2017. Pit Latrines or Container Based Toilets? A Cost-Benefit Analysis Comparing Two Approaches to Improving Sanitation Access in Urban Areas of Haiti. Haiti Priorise, Copenhagen Consensus Center.
Smith, Emily R., Shankar, Anuraj H., Wu, Lee S. F., Aboud, Said, Adu-Afarwuah, Seth, Ali, Hasmot, and Agustina, Rina et al. 2017. “Modifiers of the Effect of Maternal Multiple Micronutrient Supplementation on Stillbirth, Birth Outcomes, and Infant Mortality: A Meta-analysis of Individual Patient Data from 17 Randomised Trials in Low-income and Middle-income Countries.” The Lancet Global Health, 5(11): e1090e1100.
UNICEF. 2014. “Low Birthweight Database.” https://data.unicef.org/topic/nutrition/low-birthweight/(accessed May 31, 2018).
Victora, Cesar G., Adair, Linda, Fall, Caroline, Hallal, Pedro C., Martorell, Reynaldo, Richter, Linda, and Sachdev, Harshpal Singh. 2008. “Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital.” Lancet, 371(9609): 340357.
Victora, Cesar G., Barros, Fernando C., Lima, Rosângela C., Behague, Dominique P., Gonçalves, Helen, Horta, Bernardo L., Gigante, Denise P., and Patrick Vaughan, J.. 2003. “The Pelotas Birth Cohort Study, Rio Grande do Sul, Brazil, 1982–2001.” Cadernos de Saude Publica, 19: 12411256.
Vosti, Stephen A. and Adams, Katherine P.. 2017. “Expanding Community Based Management of Children Suffering from Moderate and Severe Acute Malnutrition Using a Standard and a Local RUTF Formula.” Haiti Priorise, Copenhagen Consensus Center.
Walker, Neff and Clermont, Adrienne. 2017. “Nutrition Interventions in the Lives Saved Tool (LiST).” Journal of Nutrition, 147(11): 2132S2140S.
Whittington, Dale and Cook, Joseph. 2019. “Valuing Changes in Time Use in Low and Middle-Income Countries.” Journal of Benefit-Cost Analysis, 10(S1): doi:10.1017/bca.2018.21.
Wilkinson, Thomas, Sculpher, Mark J., Claxton, Karl, Revill, Paul, Briggs, Andrew, Cairns, John A., Teerawattananon, Yot, Asfaw, Elias, Lopert, Ruth, Culyer, Anthony J., and Walker, Damian G.. 2016. “The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought.” Value in Health, 19(8): 921928, doi:10.1016/j.jval.2016.04.015 (accessed May 31, 2018).
World Bank. 2016. “World Development Indicators.” Washington, D.C.: World Bank.
World Bank. 2018. “World Bank Open Data.” https://data.worldbank.org/(accessed May 31, 2018).
World Health Organization. 2017. “Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025.” Geneva: World Health Organization.
Yakoob, Mohammad Yawar, Theodoratou, Evropi, Jabeen, Afshan, Imdad, Aamer, Eisele, Thomas P., Ferguson, Joy, and Jhass, Arnoupe et al. 2011. “Preventive Zinc Supplementation in Developing Countries: Impact on Mortality and Morbidity due to Diarrhea, Pneumonia and Malaria.” BMC Public Health, 11(Suppl 3): S23.g.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of Benefit-Cost Analysis
  • ISSN: 2194-5888
  • EISSN: 2152-2812
  • URL: /core/journals/journal-of-benefit-cost-analysis
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed