This paper builds on global experience and Zambia’s specific context to identify an
effective nutrition approach along with costs and benefits of key nutrition interventions. It is
intended to help guide the selection of the most cost-effective interventions as well as strategies
for scaling these up. The paper considers both relevant “nutrition-specific” interventions, largely
delivered through the health sector, and multisectoral “nutrition-sensitive” interventions, delivered
through other sectors such as agriculture, education, and water and sanitation. We estimate that
the costs and benefits of implementing 10 nutrition-specific interventions would require an annual
public investment of $40.5 million and would avert over 112,000 DALYs, save over 2,800 lives,
and prevent 62,000 cases of stunting. Economic productivity could potentially increase by $915
million annually over the productive lives of the beneficiaries, with an impressive internal rate of
return of 32 percent. However, because it is unlikely that the Government of the Zambia or its
partners will find the $40.5 million necessary each year to reach full coverage, we also consider
scale-up scenarios based on considerations of their potential for impact, burden of stunting,
resource requirements, and implementation capacity. The two scenarios that scale up the nine
most cost-effective nutrition-specific interventions (excluding the public provision of
complementary foods) are the most advantageous in terms of cost-effectiveness and resource
requirements and would require $11 million to scale up to partial levels and $23 to scale up to fullcoverage
levels. Among the 8 nutrition-specific interventions we consider, school-based
deworming is low cost and effective. The interventions we reviewed in the agriculture sector are
expensive when compared to nutrition-specific interventions, although very little costeffectiveness
data are available for the nutrition-sensitive interventions to make careful
comparisons. These findings point to a powerful set of nutrition-specific interventions and a
candidate list of nutrition-sensitive approaches that represent a highly cost-effective approach to
reducing child malnutrition in Zambia.