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Project Goal
To develop and use a suite of tools that allows decision-makers to design and manage more effective, cost-effective, and sustainable national and sub-national micronutrient intervention programs.
Context
Micronutrient deficiencies are major contributors to morbidity and mortality among children and women globally. Major intervention strategies for addressing micronutrient deficiencies include: 1) micronutrient supplementation; 2) large-scale food and condiment fortification; 3) social and behavior change communications to promote dietary changes and/or breastfeeding; and 4) agricultural interventions, including agro- and biofortification, to increase the supplies of foods rich in micronutrients such as vitamin A, vitamin B, folic acid (B9), zinc, and iron.
However, little guidance is available to decisionmakers on how to select the most effective, cost-effective, and sustainable national intervention programs, or combinations of programs, to reach the greatest number of individuals at risk of deficiency or inadequate intake, and do so within the budget and human resource constraints that they face. Likewise, information is lacking on how best to plan and manage sub-national strategies to help meet the micronutrient needs of women and children to the extent possible when program funds, time, or trained personnel are limited.
MINIMOD Project Objectives
- Use nationally representative dietary intake and biomarker data (where available) and/or secondary data from household consumption and expenditure surveys to identify the levels and spatial patterns of inadequate intake or deficiencies of selected micronutrients within the population, or sub-groups at greatest risk, especially young children or women of reproductive age.
- Develop models to predict the effects of ongoing and alternative (hypothetical) micronutrient intervention programs, and combinations of them, on adequacy of dietary intake of key micronutrients, over a 10-year planning time horizon (the “MINIMOD nutritional needs/benefits models”).
- Develop models to predict the costs of existing and alternative (hypothetical) micronutrient intervention programs, and combinations of them, over a 10-year planning time horizon (the “MINIMOD cost models”), with particular focus on which stakeholders will be called upon to cover which programmatic and other costs.
- Develop an economic optimization model that can identify the most cost-effective strategies (which may include more than one intervention program) for addressing inadequate micronutrient intake, subject to funding and other constraints, over a 10-year planning time horizon.
- Use the economic optimization model to identify national and sub-national policy strategies for transitioning from current micronutrient intervention programs to more cost-effective sets of programs.
- Use these data and tools, and the results of model simulations, to inform policy discussions around micronutrient deficiencies around inadequate micronutrient intakes, and programs to address them..
Focus Micronutrients to Date
Vitamin A, Vitamin B12, Folate, Iron, Zinc, Calcium and Iodine
Target Beneficiary Groups
Children aged 6-59 months; women of reproductive age
Measures of Program Impacts
Reach, coverage, effective coverage, supplemental intake, minimum additional intake, fuctional outcomes such as lives saved and anemia cases avoided (in collaboration with the LiST model), and intakes above established micronutrient-specific upper limits (UL).
Measures of Costs, Cost Burdens, and Cost-Effectiveness
For all stakeholders participating in/impacted by micronutrient intervention programs, the MINIMOD tool provides estimates of total costs, start-up costs, operational costs, premix costs (with scope for assessing the impacts of alternative premix formulas on premix costs), monitoring and evaluation costs, etc. Results can be tailored to highlight the cost burdens for specific stakeholders. Cost-effectiveness estimates include cost/kg of premix, cost/MT of food fortified, cost/individual, cost/consumer, cost/individual effectively covered, and cost/life saved (for micronutrients with pathways in LiST).
Expected Outcomes
Assessments of inadequate micronutrient intake at the national and subnational levels, and by target beneficiary groups; impacts on nutritional and fuctional outcomes of alternative intervention programs; costs of alternative intervention programs; linking nutritional and functional outcomes with intervention program costs to generate estimates of cost-effectiveness; rankings of micronutrient intervention programs based on impacts and on cost-effectiveness; evidence-based suggestions regarding effective and cost-effective national and sub-national micronutrient intervention programs over 10-year planning time horizons; cadres of in-country collaborators trained in the use of MINIMOD tools and in the distillation and delivery of policy messages from model results.
Country Projects
Burkina Faso, Cameroon, Ethiopia, Ghana, Haiti, Malawi, Nigeria, Senegal
Suite of Models Available
- MINIMOD-Full model making use of individual dietary intake and other primary data to assess levels of inadequate micronutrient intake, nationally and subnationally, and to estimate the impacts on inadequate intake of alternative micronutrient intervention programs.
- MINIMOD-SD model making use of household dietary intake and other data to assess levels of inadequate apparent micronutrient intake, nationally and subnationally, and to estimate the impacts on inadequate apparent intake of alternative micronutrient intervention programs.
- MINIMOD Cost model making use of detailed primary data on fortification and supplementation intervention programs, and secondary demographic and other data, to estimate the costs of alternative micronutrient intervention programs during the start-up and operational phases of programs, and for different stakeholder groups for all programmatic phases.
For more information: Contact Dr. Stephen A. Vosti (vosti@primal.ucdavis.edu), or Dr. Reina Engle-Stone (renglestone@ucdavis.edu), Dr. Katherine Adams (kpittenger@ucdavis.edu).
Project Partners
Helen Keller International Headquarters and Country Offices in Burkina Faso, Cameroon, Nigeria, and Senegal; Ethiopian Public Health Institute; University of Ghana, Legon; Johns Hopkins University Bloomberg School of Public Health; Federal Ministries of Health and collaborating organizations in all project countries; and Nutrition International.
The MINIMOD Project is supported in part by several grants from the Bill & Melinda Gates Foundation to the University of California, Davis. Additional support has been provided by the Michael and Susan Dell Foundation, Sight and Life, the Nutrition Program of the New York Academy of Sciences, and by a gift from Mars Incorporated to UC Davis to support training and research in the economics of human nutrition.
