Social value of a nutritional counselling and support program for breastfeeding in urban poor settings, Nairobi

Abstract

BackgroundIn Kenya, poor maternal nutrition, suboptimal infant and young child feeding practices and high levels of malnutrition have been shown among the urban poor. An intervention aimed at promoting optimal maternal infant and young child nutrition (MIYCN) practices in urban poor settings in Nairobi, Kenya was implemented. The intervention involved home-based counselling of pregnant and breastfeeding women and mothers of young children by community health volunteers (CHVs) on optimal MIYCN practices. This study assesses the social impact of the intervention using a Social Return on Investment (SROI) approach.MethodsData collection was based on SROI methods and used a mixed methods approach (focus group discussions, key informant interviews, in-depth interviews, quantitative stakeholder surveys, and revealed preference approach for outcomes using value games).ResultsThe SROI analysis revealed that the MIYCN intervention was assessed to be highly effective and created social value, particularly for mothers and their children. Positive changes that participants experienced included mothers being more confident in child care and children and mothers being healthier. Overall, the intervention had a negative social impact on daycare centers and on health care providers, by putting too much pressure on them to provide care without providing extra support. The study calculated that, after accounting for discounting factors, the input ($USD 419,716) generated $USD 8 million of social value at the end of the project. The net present value created by the project was estimated at $USD 29.5 million. $USD 1 invested in the project was estimated to bring USD$ 71 (sensitivity analysis: USD$ 34–136) of social value for the stakeholders.ConclusionThe MIYCN intervention showed an important social impact in which mothers and children benefited the most. The intervention resulted in better perceived health of mothers and children and increased confidence of mothers to provide care for their children, while it resulted in negative impacts for day care center owners and health care providers.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5334-8) contains supplementary material, which is available to authorized users.

Valuing the impact of health and social care programs using social return on investment analysis: how have academics advanced the methodology? A systematic review

“…Unlike in the grey literature where the majority of SROI studies are published,11 word count limitations are a reality of academic publishing. The included papers varied from approximately 2900 words,25 to approximately 7500 words 27. However, we identified no relationship between word count and quality ratings (Online supplementary appendix II).…”

“…Though there have been considerable efforts by SROI practitioners to collate social value banks such as HACT33 and Global Value Exchange,34 these studies did not access these resources. Only one study conducted value games in order to derive financial proxies that considered the values of stakeholders 27. However, given that this study was the only eligible study conducted in a developing country, existing financial proxies from developed countries would likely be less relevant and appropriate in this context, necessitating this additional work to develop bespoke financial proxies.…”

Social return on investment of emergency obstetric care training in Kenya

“…No sensitivity analysis was reported by the authors 35. A forecast SROI for a baby-friendly community initiative conducted in Kenya reported a much higher ratio (71:1), but the study included findings that were expected to occur in the future rather than those documented to have occurred 36…”

Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study

“…The current SROI method further includes principles and processes typically used in evaluations of economic and financial return on investment [26]. The SROI method has not been applied to the management of MS previously, however, the methodology has been used in the area of neurology [27,28], as well as other areas such as dermatology, cardiology, rheumatology, and oncology within the SNHS [29][30][31][32][33], and other health-related areas in other countries (nephrology [34], old age [35,36], or maternity [37,38], among others [39,40]).…”

“…The SROI method has hardly been used to evaluate different interventions in the area of public health, and never in relation to MS [37,39,40,48,49]. The challenge is not only to assess the current situation and create value around the management of patients with MS, but also to reflect on how decision making is performed in the SNHS and how the challenge of sustainability and efficiency is faced, since cutting back on health benefits represents a false economy [40].…”