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Author Notes:

Carol E Levin: Department of Global Health, University of Washington, NJB Box #359931, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. E-mail: clevin@uw.edu

We are grateful to the guidance from our agricultural colleagues at the Appropriate Rural Development Agriculture Programme (ARDAP) and the Community Research in Environment and Development Initiatives (CREADIS) in accessing, reviewing and interpreting the expense report data for the project period.

We also thank Victor Akelo for clinical-based observations; and Haile Selassie Okuku for providing information on project outputs from the analysis of the monitoring data.

We also acknowledge Kristy Cook and Christopher Kemp, who provided useful input into revised versions of the original paper.

Authors declared no conflicts of interest.


Research Funding:

This research was funded by the International Potato Center, under the Sweetpotato Action for Security and Health in Africa grant provided by the Bill & Melinda Gates Foundation.

Funding was provided by the Bill & Melinda Gates Foundation [Grant ID OPP53344]; and PATH.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Health Care Sciences & Services
  • Health Policy & Services
  • Agriculture
  • costs
  • food-based strategies
  • health
  • integration
  • nutrition
  • HIV

What is the cost of integration? Evidence from an integrated health and agriculture project to improve nutrition outcomes in Western Kenya

Journal Title:

Health Policy and Planning


Volume 34, Number 9


, Pages 646-655

Type of Work:

Article | Final Publisher PDF


Integrated nutrition and agricultural interventions have the potential to improve the efficiency and effectiveness of investments in food security and nutrition. This article aimed to estimate the costs of an integrated agriculture and health intervention (Mama SASHA) focused on the promotion of orange-fleshed sweet potato (OFSP) production and consumption in Western Kenya. Programme activities included nutrition education and distribution of vouchers for OFSP vines during antenatal care and postnatal care (PNC) visits. We used expenditures and activity-based costing to estimate the financial costs during programme implementation (2011-13). Cost data were collected from monthly expense reports and interviews with staff members from all implementing organizations. Financial costs totalled US$507 809 for the project period. Recruiting and retaining women over the duration of their pregnancy and postpartum period required significant resources. Mama SASHA reached 3281 pregnant women at a cost of US$155 per beneficiary. Including both pregnant women and infants who attended PNC services with their mothers, the cost was US$110 per beneficiary. Joint planning, co-ordination and training across sectors drove 27% of programme costs. This study found that the average cost per beneficiary to implement an integrated agriculture, health and nutrition programme was substantial. Planning and implementing less intensive integrated interventions may be possible, and economies of scale may reduce overall costs. Empirical estimates of costs by components are critical for future planning and scaling up of integrated programmes.

Copyright information:

© 2019 The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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