In order to better understand the costs, cost-effectiveness, and financial sustainability of the community management of acute malnutrition (CMAM) programme in Northern Nigeria, CIFF asked Results for Development Institute (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, programme implementers, and development partners regarding programme 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 programme 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. Of this cost, Ready-to-Use Therapeutic Food (RUTF) occupies $76 or 35%. Staff costs are the second largest driver at 34% with the remaining 31% comprised of out-of-pocket costs (which at 16% remain high relative to other studies), supply chain (5%), CMAM drugs (4%), opportunity costs (3%), overhead (2%), monitoring (1%), MIS tools (less than 1%), training (less than 1%) and other (less than 1%).

Using financial costs, the cost per life saved is estimated to be $1,117 and the cost per DALY gained $30.