OBJECTIVES: Malnutrition and Stunting is among prominent public health challenges in Pakistan, particularly in Sindh province. Foreign development assistance was funding nutrition interventions in 21 districts of Sindh. The objective of this research is to estimate the budget impact of taking over and scaling up of nutrition intervention to the Government of Sindh (GoS), once the donor's funding is exhausted.

METHODS: Three interventions were included in the BIA, Out-Patient Therapeutic Centers (OTP), Nutrition Stabilization Centers (NSC), and Community Outreach Programs (COP). Budget Impact Analysis (BIA) was carried out from the perspective of Department of Health, GoS in 2020-21. We used multiple data sources such, National Nutrition Survey 2018, services use data of GoS health facilities, GoS financial statement, market survey to estimate human resource costs, capital costs and operation costs. In the sensitivity analysis, assumption of staff turnover, change in the salaries structure and utilization rates were relaxed to see the change in budgetary requirements.

RESULTS: The budget impact on the provincial exchequer with full population coverage in the year 2021-22 was PKR 4.05 billion (USD 24.85 million) to manage 865 OTPs and 29 NSC and supportive COP across the province of Sindh. The yearly operation cost of an OTP, an NSC, and COP are PKR 0.73 million (USD 4506), PKR 8.6 million (USD 48592), and PKR 7.5 million (USD 46055) respectively. By relaxing the assumption on services use, budget impact showed high volatility from base case estimates.

CONCLUSIONS: Using government-approved financial rules, and internationally recommended protocols for the management of acute and moderate malnutrition, analysis of this research supported efforts of GoS to integrate, and upscale nutrition intervention in the province. Scenario-based financial forecasting provided an opportunity to create fiscal space for the continuity of the activities of nutrition intervention and an exit strategy of the donor's funding