The Cost of Home Delivery Schemes for Lipid-based Nutrient Supplement Products: A Policy Experiment from Rural Malawi

Abstract

Background and objectives: Public policy makers may play a role in promoting products demonstrated to be efficacious in addressing hidden hunger. Home delivery reduces the outof- pocket costs of accessing these products, to zero if they are provided for free. However, home delivery is not cheap, especially in rural areas; little is known costs. This paper provides evidence based on a home-delivery scheme undertaken by the International Lipid-Based Nutrient Supplements (iLiNS) Project research team in rural Malawi. Methods: Estimates of home delivery costs for lipid-based nutrient supplements (LNS), including product procurement, transportation, staffing and storage costs, are based on those faced by the iLiNS-DOSE Project. A cost model was developed and used to run a hypothetical five-year policy experiment to provide nationally produced LNS to 60% of the approximately 12, 000 young children aged 6-24 months. LNS is delivered biweekly to all children in the targeted age bracket; thus, older early-enrollees and young late-enrollees would not receive the full 18-month intervention. Results: Total cost of the hypothetical five-year intervention would be approximately US$3.3m. Cost per treated-child is US$69; cost per fully-treated-child is US$89. 63% and 21% of the total cost is attributable to product purchases and personnel costs, respectively. Conclusions: Low effective demand for products proven to combat hidden hunger may prod delivery of these products directly to targeted children's homes. A five-year hypothetical policy experiment suggests that the cost of procurement, storage and weekly home delivery of a nationally produced LNS product can be large. Changes to intervention protocol (target population, frequency of delivery, etc.) will affect costs. The expected health and other benefits associated with each proposed intervention strategy would have to be compared to these costs in order to set priorities.