Project: IFAS or MMS Cost-Benefit Tool


Due to concerns regarding MMS’s potential harms to neonates, the World Health Organization’s 2016 antenatal care guideline did not recommend transitioning from IFAS to MMS. This guideline serves as a leading document and source for public health policymakers and implementers and managers of local maternal and child health programs regarding improving the quality of routine health care during pregnancy.

Since the release of the 2016 guideline, emerging evidence suggested that MMS may be appropriate in low- and middle-income countries. However in addition to the concerns regarding potential harms, there were uncertainties regarding the cost and ultimate cost-effectiveness of MMS. Limestone Analytics and Nutrition International conducted research to close these knowledge gaps and developed the MMS Cost-Benefit Tool. The tool applies a rigorous methodology to calculate the incremental benefits and costs of transitioning from IFAS to MMS in LMICs (Kashi et al., 2018). More information about the original work with Nutrition International that informed the development of this tool can be found here. In this context, the term “transition” refers to substituting IFAS with MMS for pregnancy care in a government’s antenatal service package. 

Figure: MMS Cost-Benefit Tool Interface

Since launching the tool, a number of country offices worldwide have used the MMS cost-benefit tool to evaluate whether transitioning in their context is cost-effective. The tool can be accessed here.

This analysis was a critical component in informing the WHO’s 2020 antenatal guideline, where the WHO position regarding MMS shifted from “not recommended” to “recommended in the context of rigorous research”. This provides a path forward regarding the use of MMS and highlights the areas for future research and the role of tools and cost-effectiveness in guiding global policy-making. 

Clients / Partners



  • Development and piloting of the IFAS or MMS Cost-benefit tool


  • Completion of the IFAS or MMS Cost-benefit tool