18 December 2014

New Paper from UN SCN: 10 Nutrition Indicators for the SDGs

The Standing Committee on Nutrition just released a useful new paper with recommendations for nutrition indicators to be embedded into the SDGs. 

They recommend the inclusion of:

1. The 6 WHA indicators

2. Two diet diversity indicators: minimum diet diversity (6-23 month old children) and minimum diet diversity for women of reproductive age
3. Adult overweight and obesity rates
4. Government spending on nutrition

I really like these 10 indicators.  They include the 8 I had suggested in my blog earlier this week, plus minimum diet diversity for infants and young children and government spending on nutrition. 

The indicators meet scientific credibility standards (do they measure what we think is most important?), have political legitimacy (e.g. the WHA indicators) and are measurable (although we currently do not have many data points for government spending, as the Global Nutrition Report notes, we could). 

What do others think?

The quicker we reach a consensus the quicker we can organise and influence as one community with one voice.  

15 December 2014

Positioning Nutrition Within the SDGs: A Proposal

As the SDG deadline day in September 2015 fast approaches, a consensus position needs to emerge on how to position in nutrition in the SDGs.

Without such a consensus lobbying activities will be unfocused.

Here is one proposal to react to.

Criteria for indicator inclusion:
  1. WHA indicators (all 6)
  2. Other indicators of adult nutrition (women's diet diversity, adult obesity)
  3. Indicators where there is a demonstrated association with under or over nutrition (about 10)
  4. Parsimony (18 indicators: 8 nutrition indicators, 10 nutrition relevant)
  5. Diversity: 8 nutrition indicators are in 3 Goals; 10 nutrition relevant indicators are in 7 Goals. Overall, 8 of 17 Goals are involved.
I don't know how we reach consensus, but more people need to be talking about how to position nutrition in the SDGs.

After 2015 the SDGs will be the main game in the development town.

Climate Change and Nutrition: What do we do differently?

It is good news that an agreement has been sketched out in Peru at the COP20 climate talks for a roadmap to longer lasting deal in Paris at the end of 2015.

Despite the criticisms from some groups that it is watered down, at least it keeps hope alive that something effective and realistic can be finalised in a years time.

But what does this mean for the way nutrition programmes and initiatives are designed and planned?

We think that climate change affects food production in a way that is not good for nutrition.  We also think that climate change increases the incidence of diarrheal diseases and other infectious diseases that negatively impact on nutrition. This set of slides from the London School of Hygiene and Tropical Medicine provides a good primer and summary of key studies.

Clearly, our nutrition strategies are going to have to adapt, but how?

On the adaptation side the changes that nutrition strategies will have to make will vary country by country and region by region, but the need to adapt means an ever greater emphasis on the need to link food and nutrition data with climate data such as temperature and rainfall data at the subnational level.

The problem is, we don't have much subnational nutrition data.  I wonder if there is a benefit to modelling nutrition outcomes much as we modelled poverty rates by combining surveys and censuses in the poverty mapping domain?

Climate change also places a greater value on the diversity of the location of production and on the diversity of crops and products within production systems.  Diversity is one way of spreading the risks that a changing and uncertain climate brings.  Diversity of production should also have a positive impact on diet diversity where food markets are weak.

Social protection programmes should play an even bigger role in a context of more shocks and uncertainty as they help families smooth consumption without having to take kids out of school or forgoing health care.

WASH programmes will have to become more alert to changes in water tables and drainage systems.

The emphasis on prevention will be stronger and this strengthens the case for things like exclusive breastfeeding and fortification/supplementation with iodine, iron, folic acid, zinc and vitamin A.

On the mitigation side, we don't really know what the emissions consequences are of different nutrition strategies.  A first step in this regard is to measure the resource use and emission consequences of different strategies.  Technical Note 4 from the Global Nutrition Report was produced by the Standing Committee on Nutrition (SCN) and I think it represents a good summary of where we are and provides some good ideas of where we need to go and how to get there (see Table from the note, below).

The climate debate may seem a world away from the nutrition community, but the world where climate and nutrition interact is already here.  Just like everyone else, we need to be prepared.

11 December 2014

Don't kill off the data revolution before it has even started: review of new paper

There are many people, me included, who are calling for a data revolution nutrition. 

This means considering data as an essential rather than a luxury item, not tolerating data gaps when they are a block to effective action and not making do with old data. 

But the assumptions behind this are that (a) data are not prohibitively expensive to collect and (b) they actually have returns that are several multiples of the cost.

So I really welcome a new paper by Morten Jerven, under the Copenhagen Consensus banner, which asks the general question: is a data revolution for the SDGs a good investment? His answer is a resounding no.  However I think there are some fundamental problems with his analysis.

How does he come to this conclusion?
He proposes, for every country, a population census every 10 years, a demographic and health survey every 5 years, a living standards measurement survey every 5 years and an annual Core welfare Indicator Questionnaire.  He applies this to the 25 year MDG period, 1990-2015.
He gets cost estimates for each, based on published data.
He applies this to 138 countries for the 8 MDGs (18 targets and 60 indicators).
The grand total is $27 billion, which works out to just over $1 billion per year over the 1990-2015 period.  He suggests this is an underestimate because data collection capacity costs are not included.
He then notes that the 17 SDGs have 169 targets (we don’t know how many indicators) and therefore the SDGs will cost (169/18) x $27 billion or $256 billion.
He then compares this to official development assistance (ODA) and says it is nearly twice a large.
He also says it is really hard to get a sense of the returns to improved data and says the benefit-cost ratio is likely to be less than one.

There are a few problems with this. 
First, it is highly unlikely that the SDGs will have nearly 10 times as many targets and indicators as the MDGs.  That would be nearly 600 SDG indicators.  Simply not going to happen.  My guess would be fewer than 100 targets and less than 200 indicators, but it may well be a lot less than that.  So let’s increase the $27 billion by a factor of 5.  To about $100 bn.

Second, $100 bn is still a lot of money.  But this has to be divided by 15 years.  Per year this is about $7 billion.  Increase this to $10 billion, because the number of countries is increasing from 138 MDG countries to 193 SDG countries (i.e. all of them). 

Third, so $10 billion per year.  This is a lot of money but less than 10% of ODA. But the comparison with ODA is spurious, because most of the costs will be covered from domestic resources for all but the poorest countries.  I would imagine only about one fifth of the cost of indicator collection will come from ODA.  If so, that is $2bn a year, which is just under 2% of ODA.  Still a lot, but that is the lower bound ratio most organisations factor into their project costs for M&E.

The better arguments for caution, I think, lie on the benefits side.  Jerven rightly points out that data that guides action is most valuable.  He makes the argument that the most valuable of this type of data is collected frequently at a rather granular level and that most of the SDG indicators will not be like this, therefore they will be less valuable.   I’m less pessimistic.  First, we can try to get more of these intermediate indicators into the SDGs—things like spending, coverage and staffing.  Second, the impact indicators on nutrition status, say, are useful for civil society to put pressure on governments to act, and for governments to calibrate their actions.  These data are also essential for research and analysis to guide action.

So my conclusion is that this is a very partial paper.  Data collection costs are certainly not prohibitive.  And the benefits can be maximized by asking when is the absence of data a barrier to action that we know is effective.

The data revolution is just that—a call for better data, but also a different way of thinking about data in terms of costs and benefits and also in terms of effective actions supported and bad actions suspended due to better data.  

Don’t kill off the data revolution before it has even had a chance to turn things around.   

09 December 2014

Global Nutrition Report in a New York Minute: Launch summary

Groucho Marx once said "Practically everybody in New York has half a mind to write a book, and does." 

 Last night, at UNICEF HQ, we discussed the whole of the Global Nutrition Report.   It was organized by UNICEF, Columbia University and IFPRI.

It was a great line up.  Here are some of my takeaways from their presentations.

Kathy Spahn, CEO of HKI International

* we in the nutrition community have spent decades talking to each other--its good to see us having conversations outside the bubble
* civil society has to become more accountable and one way of doing that is to measure the impacts of your programmes
* 3 big areas for increase the focus on: (a) gender (dynamics), (b) WASH and (c) capacity building

Jeff Sachs (by video), Director of the Earth Institute

* nutrition community must engage with the other big 2 development conferences of 2015: on Development Finance (Addis, July) and Climate (Paris, December).  In general, engage with the wider development community
* nutrition might not be mentioned explicitly much in the SDGs but there are plenty of openings for nutrition indicators to be embedded

Glenn Denning, Director of the US branch of the Sustainable Development Solutions Network

* nutrition needs to break with incrementalism, just like HIV/AIDS did in in 2000
* how can we scale up financing for nutrition? why not think about a SUN Fund?  Donors pooling more funds for lower transactions costs and greater coordination. Can we learn from Global Fund and from GAFS?

Leith Greenslade, UN Special Envoy for Financing the Health Millennium development Goals.

* The Report firmly establishes nutrition as a post 2015 21st century global issue
* the nutrition community should try to insert nutrition into the Global Financing Facility
* build political power by setting more ambitious targets, demonstrating the power of coordination and integration, engaging with the private sector, financing, paying more attention to gender, especially focusing on the nutrition status of adolescent girls

Silke Pietzsch, Technical Director, Action Against Hunger

* there are many supply barriers to coverage--need to analyse them: lack of knowledge of intervention, distance and time to intervention, previous rejection by service providers, conflict that makes physical access difficult
* coverage is often low not because of supply, but demand.  But governments can increase demand through (a) information outreach, (b) focusing on the last mile -- what is the quality of service received and (c) incentivizing participation (e.g. payment)

Richard Decklebaum, Director, Institute of Human Nutrition, Columbia University

* the report is clearly written, now what do we do with it?
* need to grow the "nutrition community"
* need to train nutritionists to be boundary crossers--to reach to other disciplines, but also to other sectors

Madana Arabi, Executive Director, Sackler Institute for Nutrition science at the NY Academy of Sciences

* Welcomed the focus on implementation science in the Report
* the recommendation on the need for more country focused research resonated with her
* there is a big gap between data and knowledge--capacity is the bridge

Followed by a great discussion on , as yet, unanswered questions:

* SUN Fund or Global Finance Facility or no pooled fund?
* Who actually is going to be the advocate for nutrition in the SDG finalization? (no-one apparently)
* How will these new 2030 targets be set (UN organisations are committed to a consultation)
* What should FAO be doing (telling us what a dashboard set of indicators looks like for a healthy and sustainable food system)
* how many countries have set their own WHA targets? (no idea)
* which WHA targets are most in need of greater ambition? (my take: stunting and EBF)

Big thanks to Jessica Fanzo who shaped the meeting and pulled it together!

02 December 2014

Do We Really Need a Nutrition Data Revolution? Um, Yes.

The just released Global Nutrition Report makes the case for a “Nutrition Data Revolution”.  

Data collection, storage and analysis costs money – so why do we need to invest in it?  Consider a few facts from the Report:

  1. 49% of 193 countries lack the data to be able to track if they are on or off course for even 4 of 6 World Health Assembly (WHA) indicator targets.  And these targets were set nearly 3 years ago.
  2. 40% of the most recent child growth surveys (anthropometry) are over 5 years old.  Economic policymakers could not run their economies on data that were over 5 years old—why would nutrition policymakers think they could?
  3. For the WHA indicator that shows least progress--anaemia in women of reproductive age—we have the weakest data. How can we reduce anemia if we do not have a good sense of who is most affected and when and where progress is greatest.
  4. There is no Global Database on Food Consumption.  For hunger data we rely on food supply data, heroically adjusted by FAO, but still with severe limitations.   We cannot even measure individual trends in the most immediate manifestation of malnutrition: hunger.
  5. Data on nutrition intervention coverage is very sparse. For example, only 37 countries have data on all five of the nutrition interventions and practices with the most extensive coverage data.  We know that increased coverage will reduce stunting and yet little attention is paid to monitoring that coverage.
  6. We know how important the first 1000 days post conception is for nutrition status throughout the lifecourse and yet data on weight at birth is so poor, the Global Nutrition Report could not even report trends in low birth weight.

What to do?  Invest in data collection and in building the demand for data collection.  And while they interact, the first is easier than the second.  Globally the data priorities are reflected in the points above: food consumption, anaemia, low birth weight, and nutrition programme coverage.  Nationally, the priorities will need to be set by national stakeholders.   

How can we convince funders to invest in data? A 2012 independent evaluation of the ESRC’s UK Data Service estimated that the return on investment to the research community alone range from 2.5: 1 to 10:1.  If we believe that research has wider benefits then the return on investment to wider society will be very large indeed. 

How to stimulate the demand for data?  We must promote accountability.  The more accountable public officials are for programme coverage, spending money wisely, and reducing malnutrition the more they will demand data and evidence.  Accountability can be strengthened by civil society working with the media, researchers and champions within public agencies to identify, track, assess and publicise commitments made (or not made).

So more data needs to be demanded and supplied, but do we really need a revolution?  Absolutely.  We need a marked change in our attitude to data.  The data systems we have designed are stuck in the 20th century and don’t respond to the information demands of the mobile technology age nor take advantage of its possibilities.

Information is power and power shapes information.  Until nutrition data collection and availability are revolutionised, nutrition data cannot be democratised.  And without democratisation of nutrition data it remains too easy to ignore malnutrition--unless you happen to be one of the 2-3 billion people suffering from it.  
(Note: This blog first appeared on the blog site of the British Medical Journal)

01 December 2014

Who's On Course to Meet their N4G Commitments? And Who is Not?

The 2014 Global Nutrition Report sticks it's neck out and makes assessments of whether the 100 or so Nutrition for Growth 2013 signatories are meeting their publicly stated commitments to nutrition (financial and non financial).

The Tables from the report are pasted in below.

You can find them in Chapter 8 of the Report. If you want to see the actual commitments made and the progress reported against the commitments, see the detailed tracking tables here.  You may use them to disagree with the assessment we made.

The good news is that of the 168 commitments made by the 100 or so organisations, 43% are on course with only 9% off course.

The less good news is that in 37% of the cases it was not possible to determine if the responses were on or off course either because the commitments were vague or the responses were (or both).

Only 11% of the commitments were not reported on.

The assessments were made independently by 2 of the writing team, and then reviewed jointly, and then reviewed jointly again.

The assessment threw up some key points:

* some organisations had made heroic commitments and fallen just short which others had made weak commitments and exceeded them.  The former got an off course while the latter an on course. This does not feel satisfactory.

* a substantial minority of commitments were made by someone  in the organisation who is not longer in that role and with the subsequent institutional knowledge about the commitment being vague and unclear.

* given the small numbers of organisations in each group, the on course/off course proportions are broadly similar across groups.

We are going to try to make the whole process more streamlined and automated next time around.

We also figure that the organisations will understand the stakes a little better for 2015 which will lead to some of them requiring a little less nagging!


Civil Society Organizations

UN Agencies


Other Organisations