Although great strides have been made in the last 25 years to reduce maternal and child mortality, malnutrition continues to remain stubbornly high. Poor nutrition is thought to be associated with at least half of all child mortality, and poorly nourished children who survive to adulthood are left with cognitive deficits, which in turn leads to reduced educational attainment, low productivity, and ultimately fewer chances to escape the cycle of poverty.

Nutrition International (NI), a Canadian NGO, has been working for the last 25 years to reduce malnutrition, and maternal and child mortality attributable to poor nutrition. NI, with support from the Canadian government and in partnership with Unicef, currently provide about 80% of the children in developing countries with Vitamin A and helped countries to achieve high coverage of iodized salt.

NI has been growing, and as part of its most recent strategic review, the organization is planning to boldly build upon its legacy of success and scale up to do even more to help the world’s disadvantaged and malnourished. To do this, NI is seeking additional funding, and to diversify its donor base.


In order to help NI attract more support for its vital work, Pharos was engaged to help NI develop a compelling investment case, estimating the cost to achieve NI’s ambitious targets, the impact that achieving those targets would provide in terms of both health impact and human capital, and finally, estimating the return on investment that donors could expect.

Although the investment case approach has been commonly used in other health sectors, particularly by the Global Fund for AIDS, TB and Malaria and by Gavi for childhood immunizations, an investment case had never been developed for a nutrition organization.

Phase 1: Building a dynamic model that would estimate impact with a given resource envelope and allocation

In the first phase of the project, Pharos developed a model, using NI’s own cost and achievable coverage approximations, and the Lives Saved Tool developed by Johns Hopkins University, that would estimate the number of lives saved and negative health outcomes averted (e.g., anemia, low birth weight, stunting). This allowed NI to strategically maximize the deployment of its resources across its 10 countries and towards the most cost-effective interventions, to determine the optimal spending pattern that would save the most lives and prevent the most negative health outcomes. From the coverage estimates, Pharos also estimated the amount of human capital developed per intervention, as measured in the value of increased educational attainment and resulting lifetime productivity.

Phase 2: Estimation of Return on Investment

Taking into account the total value of lives saved, health outcomes averted, and economic productivity gained from both averted disease and averted death, Pharos was able to estimate that NI is one of the most cost-effective, highest-impact lifesaving organizations in the world, returning CAD $47 for every $1 invested.

Phase 3: Drafting of Investment Case

Pharos drafted the investment case, making use of the evidence generated from the impact model, as well as NI’s strategic plan, to make a strong and compelling argument for why NI would be a cost-effective and highly impactful steward of additional financing to improve the nutrition status of the world’s most disadvantaged.

NI is now equipped to make a robust, evidence-backed appeal to donors, who are seeking partners who can make the best use of increasingly scarce dollars in the face of ever-growing need.


Our unique approach and modeling expertise was able to equip Nutrition International with the evidence and confidence to make the case for more funding, and to also help the organization make more strategic choices on how resources were allocated, and to make hard choices between interventions. Our expertise would be valuable to any organization seeking to better understand the value of the impact that they are achieving, and how their return on investment compares to their peers.

Status: Completed

Team Members Involved: Shan Soe-Lin, Lindsey Hiebert, Kelly Flanagan, Robert Hecht

For more information, contact us at [email protected].

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