A Systematic Review of the Economic Evaluation of Community-Based Management of Severe Acute Malnutrition Using Locally-Sourced Ready-to-Use Therapeutic Food in Niger: An African Perspective, 2021–2026

This systematic literature review addresses a critical gap concerning the economic viability of the community-based management of severe acute malnutrition (CMAM) using locally-sourced ready-to-use therapeutic food (RUTF) in Niger. It synthesises evidence from 2021–2026 on the cost-effectiveness, cost-benefit, and budget impact of this model from a distinctly African health systems perspective. Adhering to PRISMA guidelines, a comprehensive search was conducted across PubMed, Scopus, African Journals Online, and relevant grey literature. Studies were screened, and data were extracted using pre-defined criteria for full economic evaluations. The evidence indicates that locally-produced RUTF substantially reduces unit costs compared to imported alternatives, with studies demonstrating favourable cost-effectiveness ratios. Key economic benefits include decreased foreign expenditure on procurement and transport, alongside positive impacts on local agricultural economies. The analysis also identifies persistent challenges, such as high initial capital investment for production scale-up and supply chain inconsistencies. This review consolidates contemporary economic evidence to directly inform policymakers in Niger and the wider Sahel region. The findings advocate for strategic investment in local RUTF production as a sustainable and economically prudent approach to strengthening health systems and achieving nutrition security, underscoring the need for integrated health and agricultural sector policies.