One of my
favourite book reviews (as long as it never applies to me) is: “This book fills
a much needed gap” (think about it).
Those who advocate for more nutrition data need to ask themselves the
same thing: do these data simply fill a much needed gap? In other words, do we really need to fill any
given data gap?
Yesterday I
participated in a brainstorming meeting at WHO on data gaps that matter for
scaling up nutrition interventions. Data
are needed at the subnational, national and global levels to guide action, to
assess progress, to help advocacy and to strengthen accountability.
We spent the
whole day (a) identifying gaps that need filling, (b) mapping ways forward on
data gaps that can be filled relatively straightforwardly and (c) brainstorming
on the more difficult or “gnarly” data gap issues.
Some
reflections:
The
participants work mostly at the “global” level—and it showed. It was important to keep in
mind the constraints faced by people working with data in the domestic nutrition
system. There was a tension between
framing things as “what do we need to do to get more domestic data into the
international system?” and “what do countries want/need to move their nutrition
agendas forward?” Another tension was
around framing that said “what additional data would be useful to countries?”
and “what do countries need to make existing data more useful?” All of the framings are valid, it seems to
me, it is about listening to countries while also meeting global accountability
and advocacy needs. But how to “listen
to countries” without burdening countries, while doing it in a demand driven
way that is not patronising? And then
how to aggregate up? Perhaps via country
typologies in terms of the nutrition problems they face and the capacity they
have to collect and use data.
The parlous
state of food consumption data. This was mentioned
by nearly everyone as a problem. Food
intake is vital to address undernutrition, but also other forms of malnutrition
driven by unbalanced diets. How can
countries formulate a strategy to address undernutrition in a balanced way if
they do not know what their population eats? There are a number of initiatives
in process to strengthen food intake data, but there was a general sense that
data collection in this area needs to step up a gear.
Coverage data. As the GNR 2014 pointed
out, of 10 Lancet nutrition specific interventions, only 4 have internationally
comparable data on coverage for more than a handful of data (vitamin A
supplementation of under 5’s, iodized salt intake, zinc treatment of under 5’s
with diarrhea and iron folate capsule intake during pregnancy).
But what to do
about nutrition specific intervention coverage?
Why is it not more routinely embedded in on going data collection activities such as DHS/MICS/SMART surveys? One reason is that we do not have a set of
agreed on and easily implemented coverage indicators that can be embedded in
surveys or, indeed, in facility-based data collection.
We need such a set.
And what to do
about nutrition sensitive programmes? How do we know if they are nutrition
sensitive and how do we figure out who they reach? No answers I’m afraid, just prioritizing
unknowns.
Cost data for
nutrition interventions. If we want to know how much reducing
malnutrition costs—and try to make action more cost effective--cost information is
essential. What can we do to make sure
these are always collected? And how can
these data be curated and made available to a wider audience?
So more
questions than answers, but a list of follow up actions was drawn up, and
different people committed to deliver on these actions. Many were process actions, but that is OK it
seems to me. The costs of data
collection are high and the costs of collecting the wrong data are even higher. Doing data things in a deliberate and coordinated
way is important.
Surprises? There were 2-3 strong
advocates for better micronutrient surveys but not as many arguing for it as I
would have thought given the large numbers of people affectedly them, the lack of
specificity about who they are and the lack of progress in addressing the
burdens. We did not talk much about
indicators for capacity (beyond the number of front line health workers)
although this is an important issue.
We talked about the need for better data on preventing severe acute malnutrition
and on the coverage of treatment, but not as much as the issue perhaps
deserves. As usual, the issues raised
depend on who is in the room, no matter how objective they are trying to be.
In the context
of the broader dialogue, the group is aiming to write a more considered piece
for public consumption to contribute to the wider discussion about which data
to invest in. And why that investment would
fill a gap that is not much needed.
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