DISCUSSION
household‐level, two‐thirds
EVENTS, BCC, SENSITIVITY
Integrated agriculture and nutrition interventions can provide effective platforms to reach vulnerable populations (Ruel et al., For intervention unit costs, the average incremental cost per household was USD$63.10 regardless of the treatment arm. Similar to most nutrition‐sensitive programmes, TRAIN provided benefits beyond the targeted beneficiaries. Factoring in others in the household, unit costs are considerably lower. To gauge the potential range of unit costs, we calculated alternative scenarios for costs per beneficiary based on the average size of participating households. When considering the index female and male as the direct beneficiaries, the unit cost decreases to USD$33.64. When considering the index parents and all childrenUnsurprisingly, total incremental costs and unit costs vary by the level of implementation intensity across the three intervention arms. With an increase in training intensity (frequency of sessions) and/or programme complexity (number of components), the unit cost per household increases. These increases are driven by personnel costs for additional activities such as agriculture extension or gender sessions (Arms 3 and 4). Similarly, beneficiary opportunity costs increased with programme complexity. Opportunity costs increased because beneficiaries spent more time in community events; home visits are longer with additional counselling components. Our results showed the index beneficiary women had higher opportunity costs across all treatment arms in all three scenarios; nearly double the costs of their husbands. This is likely because household visits targeted women. However, if programme impacts do not differ significantly by treatment arm, additional complexity may not be worth the cost.We also examine the costs of incorporating women's empowerment activities. Women's empowerment activities accounted for 30% of programme costs, as part of facilitating the enabling environment for nutrition. As noted, the unit cost per household increased with programme complexity. Thus, Arm 4, which has the most activities, including gender forums and men's sensitisation, had the highest unit costs per beneficiary. Women spent almost twice the amount of time than men; our sensitivity analysis emphasises the range of higher opportunity costs for women (Table Unit cost range estimates from the sensitivity analyses (USD, 2019)Abbreviations: BDT, Bangladesh Taka; HH, household; OOP, out‐of‐pocket costs; PK, Pushti Kormi (nutrition frontline worker); SD, standard deviation.Sensitivity analysis results of varying key inputs on total economic and unit costsExamining costs by activity, the main driver was household nutrition counselling. Coupled with the agricultural household visits, training, and community events, beneficiary outreach accounted for over half of the costs. This finding reflects the intensive nature of activities to reach beneficiaries. Examining costs by input, the main cost driver was personnel. Personnel costs were driven by frontline workers, accounting for over two‐thirds of total personnel costs. Salary data were gathered from BRAC expenditures. We also estimated frontline workers economic costs in overtime work and OOP costs. Our analysis found variations in opportunity costs that have important implications for scale‐up and sustainability. Among frontline workers, PKs spent a substantial amount of their time and resources conducting their work. These costs could limit the ability of PKs to conduct their activities in the long run. BRAC addressed this constraint by increasing PK travel stipends over time.We then mapped costs to the NSV chain typology. We found similar results to the first programme costed with the SEEMS approach: a nutrition‐sensitive agriculture programme, with agriculture and nutrition BCC delivered through community‐based preschools in Malawi (Margolies et al., Currently, comparisons with the literature on the costs of integrated agriculture and nutrition interventions are limited. These limitations are due to the small number of studies available, the heterogeneity in intervention design and the absence of a standardised methodology capturing activities across sectors. We found that for TRAIN, the incremental cost per household is within the range in the literature. The costs of an intervention promoting orange‐fleshed sweet potato (OFSP) production and consumption in Kenya were USD$155 per pregnant woman or USD$110 per beneficiary when mothers and infant children were included (C. E. Levin et al., Incorporating frontline worker opportunity costs in the TRAIN cost analysis highlights the programme's sustainability concerns. Despite the travel stipend provided in the second year, frontline workers shouldered additional OOP costs given the intensive nature of household‐level interventions. SEEMS‐Nutrition is underlining such questions in building evidence on the costs and cost‐effectiveness of nutrition‐sensitive interventions. This study presents full programme costs in the pre‐COVID period and is an important step toward a comprehensive economic evaluation. As noted above, a recent systematic review has found that nutrition‐sensitive agricultural interventions have a significant positive impact on dietary diversity among children 6−60 months old (Margolies et al. 