title: The costs and cost-efficiency of providing food through schools in areas of high food insecurity.
abstract: BACKGROUND
  The provision of food in and through schools has been used to support the education, health, and nutrition of school-aged children. The monitoring of financial inputs into school health and nutrition programs is critical for a number of reasons, including accountability, transparency, and equity. Furthermore, there is a gap in the evidence on the costs, cost-efficiency, and cost-effectiveness of providing food through schools, particularly in areas of high food insecurity.
  
  
  OBJECTIVE
  To estimate the programmatic costs and cost-efficiency associated with providing food through schools in food-insecure, developing-country contexts, by analyzing global project data from the World Food Programme (WFP).
  
  
  METHODS
  Project data, including expenditures and number of schoolchildren covered, were collected through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms.
  
  
  RESULTS
  The average yearly expenditure per child, standardized over a 200-day on-site feeding period and an average ration, excluding school-level costs, was US$21.59. The costs varied substantially according to choice of food modality, with fortified biscuits providing the least costly option of about US$11 per year and take-home rations providing the most expensive option at approximately US$52 per year. Comparisons across the different food modalities suggested that fortified biscuits provide the most cost-efficient option in terms of micronutrient delivery (particularly vitamin A and iodine), whereas on-site meals appear to be more efficient in terms of calories delivered. Transportation and logistics costs were the main drivers for the high costs.
  
  
  CONCLUSIONS
  The choice of program objectives will to a large degree dictate the food modality (biscuits, cooked meals, or take-home rations) and associated implementation costs. Fortified biscuits can provide substantial nutritional inputs at a fraction of the cost of school meals, making them an appealing option for service delivery in food-insecure contexts. Both costs and effects should be considered carefully when designing the appropriate school-based intervention. The costs estimates in this analysis do not include all school-level costs and are therefore lower-bound estimates of full implementation costs.
authors.affiliation: United Nations World Food Programme, Rome. aulo_gelli@yahoo.com
authors.forename: Aulo
authors.initials: A
authors.lastname: Gelli
authors.forename: Najeeb
authors.initials: N
authors.lastname: Al-Shaiba
authors.forename: Francisco
authors.initials: F
authors.lastname: Espejo
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003906:Developing Countries; D005260:Female; D005502:Food; D005522:Food Services / Q000191:economics*; D006293:Health Promotion / Q000191:economics; D006801:Humans; D007390:International Agencies; D007391:International Cooperation; D008297:Male; D012574:Schools