Letter to the Editor on the Article by Caroll GJ, Buccini GS, and Pérez-Escamilla R Titled “Perspective: What Will it Cost to Scale-Up Breastfeeding Programs? A Comparison of Current Global Costing Methodologies”

Dear Editor:

We read with much interest the article by Caroll, Buccini, and Pérez-Escamilla, titled “Perspective: What will it cost to scale-up breastfeeding programs? A comparison of current global costing methodologies” (1). We appreciate the efforts the authors have made to raise the important subject of cost for breastfeeding programs, highlighting the strengths and weaknesses of the 2 principal approaches, namely, the World Breastfeeding Costing Initiative (WBCi) (2) and the World Bank costing methodology (3).

We would like to submit some comments on the article as follows:

1. The WBCi and the World Bank costing methodologies may not provide comparable results as they were developed with different objectives and goals.

2. Whereas the WBCi refers to implementation of the Global Strategy for Infant and Young Child Feeding (GSIYCF), which includes specific interventions for optimal breastfeeding and complementary feeding for 0–36 mo, the World Bank method refers only to the World Health Assembly (WHA) Maternal, Infant and Young Child Nutrition target of enhancing rates of exclusive breastfeeding in the first 6 mo, and does not include many crucial interventions such as community support (i.e., strengthening connections between health facilities and communities).

3. Both methods serve well for informing decision makers, but the World Bank method gives a fixed estimate, whereas the WBCi estimate is flexible and allows countries to calculate more precise costs through the use of the WBCi tool (4).

4. Although the WBCi tool can be used to estimate global financial needs for scaling-up GSIYCF interventions, it is also a planning tool that can help develop annual plans for implementing IYCF policies and programs on a continuous basis and based on the use of local estimates and information. On the other hand, the World Bank method is a tool to estimate the global financing needs required to achieve the WHA targets over a given period of time.

5. We consider that country-level costing exercises should be supported, as adapting global estimates to different countries may be of limited use because of variable nutrition and health services, and socioeconomic conditions. The results of such an exercise may help governments generate figures that can be used to increase the resources available for breastfeeding and IYCF agendas.

6. We disagree with the authors’ conclusion that the World Bank costing methodology is “the most comprehensive framework for estimating the financial needs to scale-up breastfeeding programs.” The method only makes estimates to meet WHA goals, within a specified time frame, and only for exclusive (not continued) breastfeeding, and does not fully cover the relevant child population of individual countries.

7. Since the authors have acknowledged utility of both these methods for specific purposes, both should have been recommended for specific situations.

Notes

The authors reported no funding received for this study.

Author disclosures: None of the authors report any conflict of interest.