Expenditures on Strengthening Large Scale Breastfeeding Counseling Programs in Bangladesh, Ethiopia, and Vietnam.

Timely support given to breastfeeding mothers can result in life-saving benefits for both mothers and infants. Progress in achieving results from existing efforts to improve breastfeeding practices can be accelerated with adequate investments in effective interventions. We aimed to document expenditures incurred by three diverse programs in Bangladesh, Ethiopia, and Vietnam that demonstrated improved breastfeeding outcomes. Based on expenditure records, we retrospectively calculated annual and per participant expenditures. The results represent the incremental financial needs of strengthening existing efforts in low- and middle-income countries to inform budget planning. The programs reached between 400,000 to 1.2 million pregnant women, infants, and mothers annually at an average expenditure of USD 0.55 to 1.90 per woman and infant. The largest proportion of expenditures were incurred for training frontline workers and delivering interpersonal communication or counseling. These ranged from 73.4% of total expenditures in Bangladesh to 63.9% in Ethiopia and 55.1% in Vietnam. Management and administration expenditures ranged from 13.3% and 19.6% across countries; the range in expenditures for planning and strategy development was 2.5%-9.9%; for materials development and production was 1.1%-15.1%; and for monitoring was 1.7%-18.7%. The results show that existing cadres of facility and community workers can deliver effective breastfeeding counseling on a large scale with substantial economies of scale. Budgetary needs will differ by country due to delivery system strengths and weaknesses, pre-existing coverage, and demand for counseling services. The study provides a basis for realistic budget estimates for strengthening breastfeeding counseling in large-scale programs.