That’s great, but what does it cost?

Originally published by Georgetown University’s Institute for Reproductive Health.

In a previous blog post, we reflected on the general buzz around social norms at the 2018 International Conference on Family Planning (ICFP) held in Kigali, Rwanda from November 12–15, 2018. In this, our fifth post in the series, we discuss costing of norms-shifting interventions. We often read about exciting interventions that show impressive results and call for wide-scale adoption. Yet all too frequently, there is little to no information to help plan such a replication, let alone determine how much it might cost.

We often read about exciting interventions that show impressive results and call for wide-scale adoption. Yet all too frequently, there is little to no information to help plan such a replication, let alone determine how much it might cost.
Reported or published, normative-change interventions are often described with respect to: the number of people reached; their characteristics; and pre- and post-intervention indicators of attitudes, behaviors or knowledge around social norms of interest.

What is often left out from published studies is a detailed explanation of the process used to move the needle on these social norms. Without detailed information on the methods used to obtain the reported results, those interested in replicating interventions must search elsewhere for sources that document the process. If there was a research protocol posted online in tandem with the published study, a determined reader could at least gain insight into how the intervention was intended to take place. However, even this wouldn’t capture the full story: we live in a complex world and what is intended to happen in social research is often not what ultimately happens. Adjustments between planned and actual events are part of the ground realities of social research. If we truly want to be responsive to the needs of the communities in which we work, such flexibility is necessary. Unfortunately, there is a dearth of documentation or discussion around these adjustments.

By now, you may be wondering why this economist is babbling on about process documentation in a blog post about cost. The answer is that, without good process documentation, it is hard to put cost information into context. Context informs cost decisions about scale-up or replication in another setting. For example, we can’t just double intervention costs in the hope of reaching twice as many people. There may be economies of scale, which allow us to use resources more efficiently if operating at a larger scale. There may be important differences in input costs as we move from one context to another, changing not just the cost but even how an intervention is carried out: for an agricultural intervention, industrial farming may make sense in the U.S. where labor is costly, but not in a low-income country where labor is inexpensive. Finally, there are intervention components that don’t need to be recreated as the intervention expands or replicates, such as developing curriculum or information, education, and communication materials. In this case, a replication plan would be able to bypass or substantially reduce funding for these already-completed activities.

…Without good process documentation, it is hard to put cost information into context.

Good process documentation of normative change interventions provides detailed information on what activities were done, by whom, how often, and using what resources. Such detail is much more useful than a simple accounting of total monetary cost, as it can be used by others to think through what a successful intervention might look like in their context. Activity-based costing approaches can then be applied to estimate the cost of taking a successful intervention and expanding or transferring it to a different context, taking into account the local resource costs and the magnitude of activities required to reach the target population.

As in many pursuits in life, the devil is in the details. Without those details, it is difficult to assess whether a successful social norm intervention can be affordably replicated in a different context. In addition, detailed cost estimates can assist with resource mobilization efforts, as it may be easier to seek external support for up-front, one-time intervention components, as opposed to components that entail ongoing costs.

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