Positive Parenting Cost-Benefit Analysis

The economic analysis assesses the benefits of the PP program through the following channel: increased PP practices reduce lifetime risks of adverse mental health outcomes for the children of PP participants, which interact with the children’s lifetime mortality and morbidity. We do not include within this analysis any physical health outcomes due to a lack of conclusive evidence. Costs include the direct costs of PP implementation and the cost of participants’ time.

The analysis relies on WVC’s implementation data to inform the estimation of benefits and costs. In calculating benefits, we use WVC estimates of the number of participating parents to estimate the number of children reached. On the cost side, we rely on WVC-recorded costs per project to approximate the costs associated with PP-affiliated CPMs. Access to more detailed data on participants and on costs per project component could improve the accuracy of the estimates. 

Note: All results are presented in 2023 USD.

Our analysis indicates that WVC-funded investments in PP have been an effective use of development funding and that PP is, in general, a cost-effective program. Between 2019 and 2021, WVC-funded PP implementations incurred costs amounting to $7,993,779 across 67 projects. These projects reached approximately 149,024 children across 24 countries, costing approximately $54 per child. The portfolio has an overall benefit-cost ratio (BCR) of 4.36, meaning that every $1 invested in PP implementations generated an estimated $4.36 worth of social benefits. WVC’s investments in this portfolio have saved an estimated 16 lives, and have averted 2,842 disability-adjusted life years (DALYs). Table ES1 presents the overall portfolio results.

Table ES1: Headline Results at the Portfolio Level - WVC-Funded PP Implementations

Figure ES1 demonstrates the relative impact of each category of benefits and costs. The financial costs of implementation are the largest cost item in the overall portfolio (81% of total costs), with the remaining cost attributable to the opportunity cost of attending training for parents. All benefits are due to averted mental health outcomes (including reductions in both mortality and morbidity).

Figure ES2 disaggregates the present value of the benefits and costs across the different perspectives involved in this portfolio. It demonstrates that children receive the entire benefit (experienced over their lives) while parents and WVC bear the costs. WVC bears the majority of the costs (81%) as it is responsible for all financial costs of implementation.

Figure ES4 compares the average cost per DALY for each project to the threshold for very cost-effective (GNI per capita) and cost-effective (three times the GNI per capita) projects according to the WHO. The cost per DALY for many projects (27 projects, or 40%) falls within the very cost-effective limit, with a further 19 (29%) projects falling above the very cost-effective threshold but below the cost-effective threshold, meaning they are considered cost-effective. The final 21 (31%) projects are not cost-effective. Of these 21 projects exceeding the cost-effectiveness limit, 20 also have negative NPVs and BCRs, and these results seem to be motivated by a low number of participants relative to the estimated cost. Notably, of the 30 projects that have a negative NPV, 10 are still considered cost-effective per the WHO categorization.

Overall, this analysis finds positive results across the portfolio of 67 WVC-funded investments in the PP programs. These results have been subjected to sensitivity analysis to test their robustness to different assumptions and parameters. This analysis suggests that while PP programs are generally a good investment of WVC funds, this may vary by context.

The analysis raises several considerations for WVC concerning its future investments in PP. Variations in project-level performance suggest that the efficacy of investments in the PP programs is strongly dependent on the cost and number of children reached. Several of the projects with negative economic performance reached a very limited number of children, suggesting that projects may require some minimum scale to deliver sufficient benefits to society.

Finally, this analysis prompts corresponding recommendations for WVC to inform its future data collection and research.

• Collect Disaggregated Cost Data: The tracking of cost data at the sub-project level (ie, by program or at least CPM) will allow for more robust analysis and can be very helpful for in-depth analysis of various cost components. By collecting more granular cost data, WVC can create an evidence base that can help inform future implementations through evaluation of the relative importance of various costs to the program outcomes. The disaggregation of cost data is critical in improving the accuracy of the estimated impact of WVC’s investments in development programming.
• Report Number of Households and Children Reached: If projects consistently collected data on the number of households or children reached, alongside the number of participants, it would significantly strengthen the robustness of the resulting economic analysis. WVC should encourage its WV National Office partners to record basic data, including the number of households or children reached. More data across more projects would help strengthen and improve estimates and conclusions about the impact of the wider portfolio of PP implementations. This data could be further strengthened by noting to which households participating caregivers belong, to allow for a more complex analysis of how the number of household caregivers that are involved in PP may impact the results.
• Support Research to Address Evidence Gaps: This analysis necessarily excluded some potential benefits and costs due to limited supporting evidence and made strong assumptions across others. This analysis excludes any intergenerational transmission of outcomes and has limited scope to consider longer-term outcomes. To help address these gaps, WVC might work with its local partners - particularly in contexts where WV has a long-term presence - to gather anecdotal evidence of such excluded impacts among participants and their household members using informal interviews or established surveys such as the Parent-Child Conflict Tactics Scale (CTSPC). Where feasible, WVC might also join partners to assess hypothesized differences in impact dependent on how many caregivers in a household attend PP training.