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Tackling chronic malnutrition effectively, and in particular improving the diet of children in the critical period up to the age of two years, remains a major challenge to the international community. Recent years have seen nutrition policy-makers focus heavily on addressing non-food related causes of malnutrition in developing countries (health status and caring practices), rather than tackling food insecurity. Furthermore, progress made in measuring food insecurity has largely involved measuring access to food energy, rather than aspects of dietary quality.

Whilst there has also been progress in the measurement of children’s diets, few tools have been available to date to examine whether communities are able to secure enough resources to feed their children properly with the quality of diet necessary to ensure healthy growth and development. In the context of growing momentum behind the development of social protection schemes, and in particular those centred around regular cash transfers in low-income countries, an understanding of the minimum cost of a healthy diet could help policy-makers determine how to achieve the best nutritional outcomes for children and families with these programmes.

In 2006, Save the Children initiated a pilot research programme to quantify the extent to which households could afford to feed their children under the age of 2, and a whole family of 5 people, with a diet meeting minimum requirements of macro and micronutrients. This involved expanding and refining some existing linear programming software (originally developed by WHO) for the analysis, and initiating data collection in selected communities in four countries - Bangladesh, Myanmar, Ethiopia and Tanzania - to trial the methodology and develop case study examples. This report presents the findings relating to the cost and affordability of the cheapest possible diet in the four study locations.

Work of this kind has not been conducted in the developing world, and the approach taken here was ground-breaking by: (i) attempting to determine the minimum cost and affordability of a diet for the whole family rather than just an individual child, (ii) taking into account seasonal variation in prices an availability of food and (iii) including costs and availability of food at the local level.

The specific research objectives were as follows:
(i) to develop a methodology for estimating the cost of the diet for the family;
(ii) to determine the minimum cost of a healthy diet by season in four locations;
(iii) to determine the affordability of a healthy diet by household type and season in four locations.

Background data on the study areas is presented from studies previously conducted by Save the Children in the study locations to contextualise the results of the analysis.

This report outlines the methodology and tool used for the modelling, assumptions built into the analysis, and highlights some of the limitations of the methodology used. Before this method can be used on larger populations and by governments, NGOs, donors and others, there are a number of ways in which it needs to be developed: the software needs to be refined further, the methods for determining affordability need to be consolidated and streamlined, and agreement on the parameters of different diet types (physiological, environmental and cultural) need to be reviewed.

However, the initial findings indicate that there is a substantial shortfall in household’s ability to feed their children adequately in the four countries of the study. Diets in Ethiopia and Myanmar cost more than a dollar a day (US $1.27 and US $1.15 respectively); in Tanzania and Bangladesh, they cost 72 cents and 91 cents respectively. In practice, the minimum cost of a healthy diet is likely to be higher than the results presented in this report due to environmental and cultural factors which mean the diet costed is unlikely to be practically consumable.

However, even with the conservative estimates presented, the diet remains unaffordable for large proportions of the population in all four study locations. While it is technically affordable in Myanmar and Tanzania, it remains unaffordable for a significant proportion of the population in Bangladesh and Ethiopia. Once estimates take into account basic non-food items needed for households to maintain a minimum standard of living, a healthy diet would become unaffordable for the majority of the population in all four locations.

In all the study locations, large proportions of children do not receive the frequency of feeding and dietary diversity they need. The findings also point to marked seasonal variation in costs, which has important implications for the cash flow of poor families who may not have a steady income through the year.

This research points to the need for much greater attention to tackling the economic causes of malnutrition in strategies to achieve MDG1. Particular attention needs to be paid to ensuring that the poorest, who face the constraints most profoundly, are reached and that the significant effects of seasonality are taken into account. The findings of this report point to a specific role for cash-based social protection programmes which could offer a particular intervention opportunity to help overcome economic constraints during crucial periods in a child’s development. The findings also point to an increased role for micronutrient supplementation and fortification policies.

Backed by these and other research findings, Save the Children UK continues to call on:
• National governments and the international donor community to recognise that poverty is a critical cause of chronic malnutrition, and to therefore design accordingly interventions to address the economic constraints that limit poor people’s access to food.
• The international donor community to prioritise social protection programmes, including regular cash benefits to the poor, towards eradicating severe poverty and hunger.
• Donors to pledge support to low-income countries wishing to implement programmes providing direct cash benefits to the poor, by putting in place innovative mechanisms for channelling long-term, predictable aid.
• Richer countries to fulfil their commitment to increase (untied) aid to meet the 0.7 per cent of GNI target by 2010.

Contents
Acknowledgements
Acronyms
Glossary of terms
Executive Summary
Introduction
Methods
The cost of the diet
The affordability of the diet
Methodological limitations
Cost of the diet estimation
Affordability estimations
Background to the study areas
Bangladesh
Ethiopia
Myanmar
Tanzania
Results
Number of food items available
Cost and affordability of diet: Bangladesh
Cost and affordability of diet: Ethiopia
Cost and affordability of diet: Myanmar
Cost and affordability of diet: Tanzania
Discussion
Cost and affordability
Absolute costs
Comparing real and model diets
Compared with rates of malnutrition
Implications for policies to tackle malnutrition
Future research
Conclusion.

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The Minimum Cost of a Healthy Diet: Findings from piloting a new methodology in four study locations