1ST NIPN GLOBAL GATHERING - JULY 2018 - NIPN - National Information Platforms for Nutrition

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1ST NIPN GLOBAL GATHERING - JULY 2018

1ST NIPN GLOBAL GATHERING - NIPN GLOBAL SUPPORT FACILITY - PARIS, JULY 3-5, 2018

Presentations:

The core purpose of the NIPN initiative, by Marti Van Liere, NIPN Global Support Facility – Presentation
NIPN experience from Niger, by Issiak Balarabé Mahamane, Institut National des Statistiques du Niger – Presentation
NIPN experience from Guatemala, by Juan Carlos Carias Estrada, SESAN; Otto Velásquez, SESAN; Laura Figueroa, Ministerio de Salud; Eduardo Say Chavez, CATIE – Presentation
Discussing a NIPN theory of change, by Alta Folscher, MOKORO – NIPN evaluation team – Presentation
Process to formulate a nutrition policy question, by Perrine Geniez, NIPN Global Support Facility – Presentation
Strengths and boundaries of NIPN to answer a nutrition policy question, by Jef Leroy, IFPRI – Presentation – Video
Tracking progress in nutrition outcomes: the AARR indicator, by Julien Chalimbaud, NIPN Global Support Facility – Presentation – Video
Tracking progress in financial nutrition investments, by William Knechtel, SUN Movement Secretariat – Presentation – Video
Sub-national nutrition profiles: the example of POSHAN, by Jef Leroy, IFPRI – Presentation – Video
Modeling impact of interventions on stunting: the LiST “Lives-saved tool”, by Jillian Waid, HKI Bangladesh – Presentation – Video
Aggregating data from multiple sources: the GSF “data aggregator tool”, by Milko Skofic, NIPN Global Support Facility – Presentation – Video
Knowledge management & learning across countries, by Marti Van Liere, NIPN Global Support Facility – Presentation
Country roadmaps
Bangladesh: Poster – Video
Burkina Faso: Poster – Video
Côte d’Ivoire: Poster – Video
Ethiopia: Poster – Video
Guatemala: Poster – Video
Kenya: Poster – Video
Laos: Poster – Video
Niger: Poster – Video
Uganda: Poster – Video
Zambia: Poster – Video
Meeting evaluation by participants – Presentation

Data analysis plan

1. Why a data analysis plan?
“A data analysis plan helps you think through the data you will collect, what you will use it for, and how you will analyse it. Analysis planning can be an invaluable investment of time” (Center for Disease Control and Prevention, 2013)
The method for creating a data analysis plan in the context of a NIPN is not much different from the method used in a research context.
In the context of NIPN, the process should be simpler because:

A data analysis framework is already produced (step 3 of question formulation process) and forms the basis for the more detailed data analysis plan (after step 4 of question formulation process).
Section 3.4, pages 7 to 9 describes data analysis methodologies.
NIPN is about the use of existing data, it is not about designing a protocol for new data to be collected.

The next section describes briefly the content of a data analysis plan focusing on what is a bit specific to the NIPN.

As general recommendations:

Don’t panic!
Use the advice and experiences from colleagues and experts
Quickly contact an expert when necessary

Recommended sources to read:
Center for Disease Control and Prevention (2013) Creating an analysis plan. Atlanta.
Simpson, S.H. Creating a data analysis plan: what to consider when choosing statistics for a study (2015).

2. What is a data analysis plan?
Main sections of a data analysis plan (based on CDC module):

Main question and sub-questions
Dataset(s) to be used
Inclusion/exclusion criteria
Variables to be used in the main analysis
Statistical methods and software to be used
Table shells
=> Estimation of time and resources needed

3. Main question and sub-questions
At this stage, the policy relevant question (and, in some cases, its sub-questions) is already well defined (section 3.4, page 11).
Answering all the sub-questions will provide a full answer to the main question.

4. Dataset(s) to be used
The dataset(s) needed is (are) listed. In the context of the NIPN, particular attention may be needed on data management: as the dataset(s) may come from different sources and/or may not have been designed for the main question, there could be quite some work to be done to harmonise / append / clean the raw dataset(s).

Are the datasets comparable?
Are the indicators harmonised?
Is there a need to transform the data for the analysis?
To answer these question, access to the datasets in question is required.

5. Inclusion/exclusion criteria
In this section population subgroups, geographic scope, timeframe… are very precisely defined.
The definition of the data quality level is also required for the analysis.
Indeed, depending on the analysis, a more or less strict data quality level could be required.
This point is detailed in the Data Quality training module (section 3.3).

6. Variables to be used in the main analysis
In this section the exact variables/indicators to be used in the analysis must be defined.
For example, to analyse “obesity”, it needs to be defined whether the indicator is Body Mass Index (BMI) and if different categories of BMI will be used or the mean BMI or both.
In the context of NIPN, the harmonisation of the definition of indicators across datasets will be important.

7. Statistical methods and software to be used
Ensure coherence with section 4 of the guidance notes on data analysis.
Also, to provide only indisputable analysis (principle 3 section 3.4, page 4), make sure that the statistical method used is coherent with the datasets available and the data quality of these datasets. The choice of the statistical method is key to avoid over-interpretation of the data that could lead to misleading conclusions.
Does the NIPN team has the technical capacity to handle the statistical method and the software identified?

8. Table shells
Nothing specific to NIPN.

9. Estimation of time and resources
At this stage, a precise estimation of the time and resources needed to conduct the analysis should be made.
If this estimation lead to more time than the initial estimation made during the data analysis framework, you may adjust the question/s to be addressed first.

Main characteristics of existing routine data systems

HMIS

Definition: An information system specially designed to assist in the management and planning of health programmes, as opposed to delivery of care (WHO 1993)
Advantages: Once it has been set up, it is costs less and allows monitoring of health outcomes and indicators
Disadvantages: Only captures information for users of the health system and not representative for entire population, denominator need to be estimated for indicator calculation

IDSR

Definition: Integrated Disease Surveillance programme ensures the availability of guidelines for integrated disease surveillance and response. It provides necessary technical support for strengthening national communicable disease surveillance systems through the implementation of the Regional Strategy for Integrated Disease Surveillance and the International Health Regulations.
Advantages: useful and relevant in monitoring communicable diseases, it has the advantage to alert about sudden increases of MAM/SAM cases and deaths thus providing alerts in case of context deterioration
Disadvantages: Not nutrition relevant

Sentinel Surveillance

Definition: Limited case ascertainment area, traditionally includes largest hospitals in geographic area; Should do pre-evaluation to select appropriate sentinel sites
Advantages: Can easily collect individual patient-related data; Less costly and burdensome on resources; Flexible system design; Useful for documenting trends; Allows for routine monitoring of antibiotic non-susceptibility
Disadvantages: Although less costly than population-based surveillance, sentinel system may still require significant financial investments in personnel and resources; Data may provide biased or skewed findings; Data are not generalisable to geographic population; This method does not collect incidence data

Sectors data systems

Definition: Data routinely collected by sectors based on a set indicators defined to track activities
Advantages: Source of variety of information (Weather, Climate change, Pollution, Water, sanitation, Education, Food chain, Agriculture data, Budget/finance data, etc.)
Disadvantages: Aren’t usually well organised and harmonized ones with others in terms of representativeness

*****

Sources:

WHO, Developing Health Management Information System
Measure Evaluation – Health Information System Facilitator Guide of training of trainers
CDC, Sentinel Surveillance method

Interview with the NIPN Niger team about the data landscape exercise

November 15th, 2018

Issiak Balarabé Mahamane, Assistant to the General Secretary, INS
Guillaume Poirel, Head of Mission for NIPN Technical Assistance, SOFRECO

Recap
The NIPN team in Niger conducted a data mapping study between November 2017 and May 2018, during the start-up phase of the project, using an external consultant. The aim of the study was to carry out “an inventory and analysis of the information and data systems for nutrition in Niger”. The study was carried out by the INS (National Statistical Office), under the strategic direction of the High Commissioner to the 3N “Nigeriens Nourish Nigeriens” initiative. This interview highlights:

How the Niger team has used the results to develop a capacity building plan for sectors
How the Niger team dealt with the lack of official definition of key indicators for nutrition
Methodological recommendations for collecting the information

How did the study go? What were the main challenges encountered?
The structures to investigate were identified based on the institutions named as “responsible” or “collaborative” in the eight commitments of the National Policy for Nutrition Security (PNSN).
Questionnaires were given to the sectors, resulting in a significant loss of time. The best method is to meet with the institutions directly and carry out this mapping work with them. The necessary information was obtained after just two or three visits to each institution and only the institutions at the central level were investigated. This was a limiting factor because certain information, notably on the data quality monitoring mechanism, is available at sub-national level.
Due to the sheer volume of information collected, there was an enormous amount of simplifying and restructuring work to be done by the NIPN team. The ‘sector sheets’ were systematically created, consolidating the various elements.
This led again to considerable delays: instead of being finalised by the end of December 2017, the study was finalised in May 2018 and pushed forward until February 2019.

How did you use the results of the study?
Firstly, the study provided objective information about the available data from multiple sectors.
The results allowed us to draw up an initial list of indicators available in each sector in an Excel file.
The study also produced ‘Sector Sheets’ which outline:

The institutional framework;
The organisational framework;
The collection mechanism;
The mechanism for the validation and quality assurance of data;
The data management mechanism;
The output;
The dissemination and exploitation of information;
The indicators and data available;
The nutrition-sensitive indicators;
The indicators selected for the NIPN.

Following the data mapping, it became apparent that there was an urgent need to put together a referential database of NIPN indicators. In fact, in Niger there is no existing framework providing an official list of the multi-sectoral indicators for nutrition. We are working to adopt nutrition-sensitive indicators in each sector. These indicators will serve as a basis for the NIPN platform.

Taking into account the institutions’ capacities, we decided to recruit a few ‘Sectoral Study Officers’ for four months.

The Sectoral Support Officers have access to clearly identified indicators and will have to ensure that the values for each indicator are collected (15 October 2018 – 15 February 2019), which is a necessary prerequisite for organising the data and building the ‘Nutrition Info’ module. The work of the Sectoral Support Officers will enable us to:

Consolidate the database of nutrition indicators. As a result, for example, we have determined that in the health sector 27 nutrition indicators were missing in the initial mapping. To date, there are several stages to the consolidation: 1. Verifying the comprehensiveness of the indicators, 2) Sorting the indicators according to their link with or ‘sensitivity’ to nutrition, 3) Completing the 23 fields for each indicator (definition, frequency, method of calculation, etc.) and 4. Validating the set of fields for the indicators selected for the NIPN. Also, 239 indicators have been selected for the 3 sectors currently covered (123 indicators for health, 23 indicators for education, 93 indicators for farming and agriculture);
Analyse the nutritional statistics situation in the beneficiary sectors;
Create and validate data sheets for each indicator;
Collect information and documents;
Update the contact list.

The ‘Sectoral Study Officers’ also make it possible to strengthen capacities in each sector and build relationships that will facilitate access to multi-sectoral data at a later stage.

Two options to overcome challenge n°1

Option 1: Limit the exercise to the level of the datasets (exclude the indicator matrix)

The exercise is still vast and the scope of the exercise can be further reduced by considering the following:
1) The range of datasets to investigate
For example, Côte d’Ivoire decided to investigate the datasets managed by key sectors involved in nutrition (health, education, gender, social affairs, agriculture, animal resources, water, economy, finance & planning) and other agencies known for managing databases (National Agency for Rural Development, National Water Offices, etc.)
“Key sectors” are those involved in the Multi-sectoral Plan of Action for Nutrition. In some countries this list can be much more vast, including more than ten ministries. For the sake of the data landscape exercise, it is recommended to reduce the list of data providers to investigate to keep the exercise feasible. Other sectors could be investigated in a second stage using the experience of the first exercise.

2) The level of detail of information to collect for each dataset
NIPN teams can decide the level of detail necessary to collect for each dataset. One option is to request a detailed description of datasets only for some prioritised sectors.

Option 2: Include datasets and indicator matrix in the data landscape exercise

The scope of the data landscape exercise can be reduced by looking at:
1) The number and range of indicators to investigate
There are several ways to decide the number and range of indicators to include in the matrix:

Select key data providers instead of selecting indicators. For example, the Côte d’Ivoire NIPN country team decided to investigate all the data available in key ministries (health, education, gender, social affairs, agriculture, animal resources, water, economy, finance & planning) and other agencies known for managing databases (National Agency for Rural Development, National Water Offices, etc.)
Refer to the M&E plan and list of multi-sectoral indicators that are attached to a national multi-sectoral plan of action for nutrition. If this list is still too long, key indicators can be identified and selected. For example, the Guatemala NIPN country team selected 70 key indicators from the M&E plan. This would mean that the indicators matrix is limited to those 70 indicators but the description of the datasets would need to have a wider scope.
Adapt the SUN MEAL system which includes a list of multisectoral indicators (about 300) and a sub-selection of key indicators (about 70) for nutrition.

2) The level of detail of information to collect for each indicator
There are several options to consider when deciding the level of detail for each indicator, which include:

Complete a full indicator matrix. The indicator matrix available here is an example of an in-depth assessment for each selected indicator.
Compile only basic information for each indicator. For example, the NIPN in Burkina Faso listed all the indicators available in the datasets and their definition only.
Complete the indicator matrix in full for key sectors only (Health, Agriculture, Education, etc.) and collate less detailed information for the sectors that are of lower priority. For example, the NIPN in Ethiopia decided to focus on nutrition & WASH in the first phase. This means that a detailed indicator matrix can be completed for these two domains with less detailed information for the other domains.

Example of question reformulation from the NIPN capacity building workshop in Lao PDR

Topic 1: budget allocation to nutrition interventions for the education sector of the NPAN

ORIGINAL BROAD QUESTION: Is the budget allocation enough for each education intervention?

REFORMULATED BROAD QUESTION: Is the budget allocated to education sector as part of the National Nutrition Strategy equal to what is costed (planned), for each of the planned intervention and how do the provinces prioritize nutrition?

SUB-QUESTIONS:

How do they prioritize nutrition interventions?
How many interventions have been implemented with the allocated budget?

REFORMULATION OF SUB-QUESTION 1:

How does the allocated budget compared to the planned one? What is the gap? What are the trends, by year and by intervention?
How budget expenditures compare the allocations? By year and intervention of the NPAN? at national and provincial level?

Topic 2: understanding the cultivation of crops of high nutritional value

ORIGINAL BROAD QUESTION: Why does the production of ’nutritious crops’ not increasing?

REFORMULATED BROAD QUESTION: What factors can explain that the production of ’nutritious crops’ are not increasing?

SUB-QUESTION:

Does the production of ’nutritious crops’ suit with the local conditions?

REFORMULATION OF SUB-QUESTION:

What proportion of the inputs (seeds, seedling, training to farmers) planned for increasing ‘nutritious crop’ production are reaching the targeted provinces / targeted farmers since the beginning of the strategy?
What is the proportion of targeted farmers that received the inputs (seeds, seedling, training) did use it to produce ‘nutrition crops’
What proportion of these farmers producing ‘nutritious crops’ consumed it and what proportion sold it?
etc.

Topic 3: understanding how vitamin A supplementation achieve its objectives

ORIGINAL BROAD QUESTION: How can we improve the VAS coverage (national baseline being 38%)?

SUB-QUESTIONS:

What are the differences in VAS among the provinces?
What is the trends in VAS? Country ? Provinces?

REFORMULATION OF SUB-QUESTION:

What is the coverage of VAS provided to children 6-59 months delivered through health centers services compared to delivered through campaign, comparing the results in the different provinces?
What are the trends of VAS for children 6-59 months during the past 10 years comparing each province?
How are those in relation to the target: how is the annual rate of reduction in each province?
how are the trends for other selected inputs and activities indicators, comparing a province with high annual rate and low annual rate? (further analysis will need to identify the relevant indicators)

Capacity development Ethiopia case study

The Ethiopia NIPN country team is adopting a dual approach to building capacity by addressing immediate needs for NIPN specific capacity while developing a long term and systematic capacity strengthening strategy which supports the overall monitoring, evaluation and research agenda of the national nutrition program.

NIPN capacity needs assessment

To develop Ethiopia’s long-term capacity to manage and maintain a NIPN, it is important to identify existing capacities as well as any additional capacities needed to sustain the NIPN approach in the country. A Capacity Needs Assessment (CNA) was launched in 2018 to explore capacity gaps related to evidence based policy making and the monitoring, evaluation and research agenda of the National Nutrition Program (NNP).
This process was initiated by a workshop, facilitated by the International Food Policy Research Institute (IFPRI), which brought together 36 nutrition monitoring and research experts from various sectors and institutions in October 2018. Most of the workshop participants play a role in the National Nutrition Monitoring, Evaluation and Research Steering Committee, which also has an advisory role for NIPN. The aims of the workshop were:

To define a framework for the capacity needs assessment and subsequent strategy related to strengthening the national nutrition monitoring, evaluation, and research agenda, and within it specific needs related to NIPN
To agree on the current architecture for nutrition related policy processes, monitoring and evaluation and research i.e. assess the capacity of this aspect of the nutrition system in Ethiopia and how NIPN could strengthen it.

Workshop participants developed a framework, which included the ‘demand capacity’ for evidence by the policy makers as well as the ‘supply capacity’ of existing evidence, across three related levels (individual, organizational and systemic). As a result of this workshop an approach paper was developed, which guides the subsequent steps of this multisectoral process.
The next step is the actual assessment of the existing capacities and capacity needs, which was launched in the first trimester of 2019 through an elaborate multi-sectoral and multi-stakeholders participatory process. It included questionnaires, interviews and follow-up consultations with key stakeholders from different ministries, national institutions and universities responsible for collecting and monitoring data for nutrition, and for nutrition-related evaluation and research. Information was sought from over 20 national institutions, in addition to key informant interviews with multisectoral users of these data, including programmatic and policy decision makers.

NIPN capacity development strategy

The findings of the capacity need assessment will be used to develop a capacity strengthening strategy, which will be finalized in the second trimester of 2019. In the meantime, action is already underway to address immediate capacity needs within NIPN.

Short-term capacity development

A number of activities were undertaken during the first year of NIPN implementation to address the immediate capacity needs at the individual, organizational and systemic level .These needs were identified through the experiences with the “Learning-by- Doing” demonstration project (see later), rapid capacity needs assessments by direct NIPN stakeholders and were initiated in advance of the NIPN capacity assessment workshop.

Individual level

Different approaches have been used, including short training courses, ‘learning by doing’ and peer learning. Details of individual capacity development activities undertaken by Ethiopia in 2018 and 2019 are summarized in the table below.

Organisational level

Within EPHI a small, dedicated, team has been assigned to NIPN which collaborates with additional nutrition researchers from EPHI’s Food Science and Nutrition Directorate and other relevant directorates. Their capacity has been strengthened in project management, creating a common understanding of the NIPN approach, analytical and communication capacities and finally creating a better understanding of the different elements of a data repository.

Systemic level

Research-Policy seminars
EPHI has started organizing regular NIPN Nutrition Research and Policy Seminars. These seminars bring together researchers, program implementers and policy decision makers to discuss and disseminate existing policy-relevant research findings. Participants come from research institutes, universities, non-government organisations and development partners.

Multi-sectoral involvement
Selected staff of key ministries involved in the National Nutrition Program (NNP) and research institutions that are key for NIPN have been able to access the training opportunities provided under NIPN thus strengthening the long-term capacity of the broader Ethiopian nutrition system and forging partnerships. Members of the Nutrition Monitoring, Evaluation and Research Steering Committee as well as of the Food Based Dietary Guidelines Technical Committee and various universities participated actively in the analytical training.

Long-term capacity development

In parallel to addressing short-term needs, the NIPN aims to address long term capacity requirements to manage and maintain a NIPN. Besides the research policy seminars and the multisectoral engagements, they also include:

PhD training

Long term capacities are being strengthened by involving PhD students from local universities in the formal NIPN training courses. In addition, EPHI has a capacity building budget for staff linked to the NIPN analysis unit or the NIPN advisory committee to attend training (online or formal) in Ethiopia or overseas, which will lead to a certificate, diploma or master’s degree at an overseas university. EPHI can also hire local training institutes and subcontract local universities. There is also a small grant scheme to encourage and support the enrolment of about six staff involved in the NIPN to pursue a PhD programme to sustain capacities beyond the project timeframe. Two researchers have been identified and started their PhD programmes at Addis Ababa University in September 2018.

Mentoring

The Senior Technical and Policy Advisor and the National Research Officer at IFPRI are assigned to support the NIPN full time and they provide continuous support and on the job training for staff and organisations involved in NIPN. In addition, IFPRI provides needs based technical support, which covers a wide set of NIPN skills, including writing, communication and analytical skills. In 2019, a report writing mentor was assigned to provide temporary support to the team. In 2019, IFPRI also assigned a researcher to guide a specific analytical process for further analysis of existing data.

Guidance notes

A set of guidance notes on different aspects of the NIPN approach have been prepared by the NIPN GSF. This guidance aims to facilitate a coherent approach to implementing the NIPN operational cycle. NIPN team members from EPHI as well as from other key partner’s institutions from the national nutrition Monitoring, Evaluation and Research Steering Committee participated in webinars as well as in an on-site country workshop on the content of the guidance notes. The NIPN team in Ethiopia will adapt the guidelines to the local context. The NIPN Global Support Facility (GSF) based in Europe also provides direct technical support to NIPN country teams.

Challenges and opportunities

While embarking into developing the capacity development strategy, the Ethiopia country case shows the importance of focusing on the bigger nutrition governance structure, national policies and programs in order to prevent overlap and ensure a sustainable system which supports the long-term objectives of NIPN:

Importance to set aside sufficient time which allows for a participatory process. The capacity needs assessment should involve all those who will ultimately be involved in NIPN
Assess earlier experiences and the existence of capacity needs assessment potentially conducted by partners’ institutions or sectors. Often, sectors or partners have conducted their own assessment already. Thus, it is useful to avoid duplication and focus on the yet ‘uncovered’ or ‘un-addressed’ elements of capacity need assessment.
In developing the evaluation tools for the actual capacity needs assessment, be mindful about what the objective is and how to formulate the demand on capacity needs. The questionnaire design is an important element of the capacity need assessment as it influences the final output and its scope. Thus, the questionnaire and evaluation tools have to be designed to explore and capture the capacities to be developed as a matter of priority and that will help to unlock potential bottlenecks and bring solutions to the key sectors and partners involved in the national monitoring, evaluation and research agenda in nutrition.
Be mindful of the selection of the respondents for the capacity need assessment and make sure to involve those linked to the national nutrition program. Where NIPN is supporting a national policy or program, it is important to link this capacity assessment and strategy on the actors involved in monitoring, evaluation, research or policy relevant of this national program.

Setting up a Multisectoral Advisory Committee: an Ethiopia case study

Context

Ethiopia is implementing the second phase of its National Nutrition Programme Phase II (NNP-II) 2016-2020. NNP-II is co-signed by 13 Ministries. It is governed by a multisectoral national coordination structure, consisting of the National Coordination Body at high political and decision-making level, and of the National Nutrition Technical Committee at technical and planning level.
NIPN in Ethiopia is established under the umbrella of the national multisectoral nutrition program and its governance system. It aims to generate knowledge and lessons learned to guide the implementation of NNP-II and support its contributing sectors.
NIPN is hosted by the Ethiopia Public Health Institute (EPHI) who is also the chair of the Monitoring, Evaluation and Research Steering Committee (M&E&R SC), one of the three high level thematic committees of the national multisectoral coordination structure. In addition, due to its multiple responsibilities, EPHI is closely linked to the National Nutrition Technical Committee and the National Nutrition Coordination Body.

Multisectoral coordination structure of the National Nutrition Programme (NNP) Phase II (2016-2020)

Creation of the Multisectoral Advisory Committee

During the NIPN design phase, the M&E&R SC was identified as the best placed committee to take up the role of the Multisectoral Advisory Committee to NIPN, because its objectives are so closely aligned with the NIPN objectives. The committee aims to provide technical support and direction, to generate evidence and monitor progress, and to timely inform decision-making for successful implementation of the NNP-II. The members of the M&E&R SC represent all NNP-II signatory government ministries, as well as donors, civil society and research organisations. The SC has most of the MAC attributes: it has included many of the functions for NIPN into its TOR and will play the validation and the communication and dissemination functions; it is ideally placed to be the official relay between the NIPN and the national decision making level. It also presents the advantage of meeting most of the MAC core principles: being part of the existing multisectoral coordination structure overseeing the NNP-II implementation progress; ensuring regular participation of the government representatives of the NNP-II and having the ability to mobilise additional expertise through donors, civil society and research organisations’ participation.

Despite all these advantage, the steering committee has many members. While this steering committee has integrated NIPN advisory roles in its terms of reference, the NIPN also anticipates to create a dedicated NIPN MAC, which will be composed of a small group of selected advisors with high level decision making leverage and with close linkages with ministers. This dedicated MAC will be created in 2019 and it is expected to take up a selected set of NIPN specific activities.

Composition and working modalities at national level

Thus, the MAC follows a dual approach in Ethiopia as it relies on an existing committee, the M&E&R SC and a dedicated NIPN Advisory Committee.

Existing Terms of Reference defined the M&E&R SC membership and operational modalities prior to the NIPN. In addition to those, the M&E&R SC will take up the following MAC tasks:

Support, advise and coordinate efforts on the development and utilization of a nutrition database under NIPN
Support the identification of key priority areas for nutrition policy research to better understand the evolution of the national nutrition program and the need for re-direction
Help to identify key policy questions in line with high level decision makers demand
Relay and support findings dissemination to high level decision makers, through the national multisectoral coordination (NNCB and NNTC)
When applicable, actively contribute to the NIPN Capacity Needs Assessment process and be involved in the capacity strengthening efforts launched by NIPN

In the NIPN inception period, the M&E&R Steering Committee has requested the NIPN team to explore further which activities should be carried out to further enhance stunting reduction. As a result, the team has started working on a NIPN demonstration project on WASH and nutrition.

EPHI is the chair of the M&E&R SC, with the Ethiopian Institute of Agricultural Research (EIAR) as co-chair.

Strengths and challenges

The main advantage of embedding some of the functions of the MAC within this existing M&E&R SC lies in the fact that it is already a functioning and credible structure. The Committee’s Terms of Reference are formalized and all committee members have been officially assigned by their respective ministries and are well sensitized with respect to the current nutrition issues in the country and within their respective institutions. The SC is meeting on a regular basis, and many members have direct links to high-level decision makers. It is expected that the multisectoral character of the committee will facilitate data access across sectors, as members have a vested interested in responding to the policy questions taken up by NIPN.
Through its role as chair of the M&E&R SC and its role in the NNCT and the NNCB, EPHI is engaging on a continuous basis with a wide set of multisectoral nutrition stakeholders. It reports on NIPN to the highest nutrition governance structures, allowing for high-level political and decision-making leverage.
Finally, this set-up further promotes the multisectoral implementation of the NNP and facilitates the capacity building approach of NIPN, with motivated members of the M&E&R SC both contributing to the capacity need assessment process, as well as benefiting from the capacity building investments.
However, as the NIPN MAC will be functional only in 2019, it remains to be seen whether it will have the ability to create efficient working relationships with the M&E&R SC to work in complementarity and whether it will acquire the respectability to influence the higher decision making level.

Setting up a Multisectoral Advisory Committee: a Guatemala case study

Context

Guatemala has strengthened and institutionalised its approach to food and nutrition security through a series of legal and policy frameworks for food security and nutrition. This process began in 2005 when a law was enacted that saw the establishment of the multisectoral coordination system, the National System for Food and Nutrition Security (SINASAN).
SESAN (Secretariat for Food and Nutrition Security) is the core structure of the multisectoral nutrition coordination system in the country, operating under the Guatemala Presidency, which also hosts a committee of all ministers as its decision-making body. SESAN is also in charge of overseeing and coordinating the implementation of the National Food and Nutrition Security Policy 2016-2020.

Organisational structure of the Guatemala National System for Food and Nutrition Security (SINASAN)

When NIPN was set up in 2017 it was positioned as a key vehicle to support SESAN in tracking and generating evidence on the implementation of Guatemala’s National Strategy to Prevent Chronic Malnutrition 2016-2020. The Strategy is aligned with the National Food and Nutrition Security Policy but it offers a more in-depth focus on stunting reduction. As such, NIPN strengthens the existing centralised information system, managed by SESAN, which relies on data from the information systems of different key ministries.

Creation and institutionalisation of the Multisectoral Advisory Committee

As the NIPN positioning was clarified, different options for the creation of the Multisectoral Advisory Committee (MAC) were considered during the six-month design phase of NIPN in 2017. The options were based on a thorough review of the national multisectoral coordination structures led by CATIE (Centro Agronómico Tropical de Investigación y Enseñanza), the implementing partner of the NIPN, which included a review of legal documents and interviews with key government and non-government counterparts. Considering the Guatemala specificities, stakeholders agreed that the MAC should support the existing system and thus be part of the existing food and nutrition security coordination structures.
The final decision was to link the MAC to the existing Inter-sectoral Technical Committee (or CTI). The CTI is a technical committee in which all ministries playing a role in food and nutrition security are represented. Though only formed by government representatives, its regulation allows calling upon ad hoc participation of development partners and civil society.
The choice for this option aligns with the core principles of the MAC: it is embedded into multisectoral coordination structures, the structure is formalised to ensure members’ continued participation, and it has the flexibility to invite ad hoc participation of experts outside the government.
In the legal statutes of the existing committee, CTI is allowed to “create any permanent and temporary committees that it deems necessary to fulfil its functions”. When committees are permanent or integrated “their nature, purpose and organisation must be specified, and the financial resources necessary for its operation shall be indicated”. The MAC is registered as a “Working Committee” under the CTI by law, thus ensuring its institutionalisation and sustainability.

Role of the MAC

The Multisectoral Advisory Committee’s main role is to “support, orient and provide technical inputs to any of the NIPN work streams aiming at strengthening the Centralised Information System for Food and Nutrition Security to fulfil its mandate of tracking progresses of implementation of the National Strategy to Prevent Chronic Malnutrition and understanding the evolution of chronic malnutrition in a coordinated and comprehension approach.”

Specific roles of the committee include:

Identifying and formulating policy needs and questions in relation to the progress made in the implementation of the National Strategy to Prevent Chronic Malnutrition;
Identifying information and data gaps and overcoming bottlenecks in relation to the above, and in particular to problems related to data quality and consistency;
Supporting the analysis and generation of information to answer the above-mentioned policy needs and questions;
Mobilising expertise and technical support as required for the implementation of the NIPN operational cycle;
Supporting the interpretation of existing data and information on nutrition to improve understanding of the determinants of the nutrition situation, both nationally and at sub-national level, with a particular focus on supporting the pilot department and municipalities;
Formulating key messages and recommendations in order to communicate the findings of the analyses to policy makers;
Contributing to tracking the progress of stunting prevention at the national, departmental and municipal levels;
Contributing to the strengthening of national capacity and enhancing the accountability of government and donors to the CTI.

Composition and working modalities at national level

The Committee is multisectoral and multi-stakeholder by nature: it is composed of representatives from the governmental institutions and all ministries who are part of the Food and Nutrition Security System, typically programme officers in charge of planning, monitoring and evaluation. The full Committee is chaired by the Head of the Planning, Monitoring and Evaluation Division of SESAN.
To operate with maximum efficiency, a core group has been constituted from representatives of the four key ministries and institutions responsible for the implementation of the National Strategy to Prevent Chronic Malnutrition: the Ministry of Public Health and Social Assistance; the Ministry of Agriculture, Livestock and Food; the Ministry of Social Development; and the agency in charge of supplying potable water.
The Committee will seek the active contribution and participation of representatives from civil society, the private sector and international development partners, since the law permits civil society and partners’ representation in and contribution to CTI committees.
The CTI not only provides oversight to the MAC but will also present its findings and recommendations to the decision-making committees of all ministers involved in food and nutrition security. Intermediary outputs and findings of the MAC will be shared with other technical coordination fora, such as the SUN platform, and civil society and donors coordination fora.

Strengths and challenges

As all stakeholders in Guatemala felt it was crucial to formally embed the MAC in the existing food and nutrition security coordination structures, the first six months of the NIPN implementation phase focused on the institutionalisation process (October 2017 to March 2018). This elaborate process offered the MAC the legitimacy and authority to function effectively. The MAC will use the existing formal communication mechanisms between the technical and decision-making levels to create a data-driven policy dialogue. Though it is too early to have evidence, this set-up maximises the probability of influencing policy decisions and sustaining the policy dialogue beyond the duration of the project.
The current set-up does not come without challenges. The CTI structure is required to comply with government procedures to call upon meetings and thus may lack the flexibility and reactivity to respond in a timely manner to the NIPN’s needs. Mobilising the full committee, with its large number of government representatives, has proven to be challenging up to now. However, the constitution of the core group – with officially appointed representatives from the four key ministries – offers the flexibility to function in an agile and efficient manner. Since December 2018 the core group has met in specific instances including a first workshop to initiate the process of formulating policy questions.

The way forward for strengthening the sub-national level

The NIPN platform in Guatemala aims for replication at the sub-national level. SESAN has selected one department to study the cost-efficiency of setting up an NIPN platform at the decentralised level, including a departmental MAC.

1ST NIPN GLOBAL GATHERING - JULY 2018

1ST NIPN GLOBAL GATHERING - NIPN GLOBAL SUPPORT FACILITY - PARIS, JULY 3-5, 2018

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Example 1: Trend analysis of stunting to track progress

GLOBAL AVERAGE ANNUAL REDUCTION RATE FOR STUNTING

NIPN dissemination events Guatemala

Press release NIPN Lao PDR

NIPN newsletter Ethiopia

NIPN branding in Niger

How to do a stakeholder analysis?

MAP STAKEHOLDERS ACCORDING TO LEVEL OF INTEREST AND INFLUENCE

NIPN visibility campaign in Guatemala

Difference between communication and visibility

Comparison of parameters used for generating AARR by main international initiatives

Short history of the evolution of the parameters used to calculate AARR

UNICEF Technical Note n°185 (2007): How to calculate Average Annual Rate of Reduction (AARR) of Underweight Prevalence

Nutrition Landscape Information System (WHO NLiS) country profiles

EXAMPLE

Countdown 2030 maternal, new-born and child survival national profiles

EXAMPLE

The Global Nutrition Report national dashboards

EXAMPLE

The POSHAN District dashboards (India)

EXAMPLE

The SUN MEAL national and sub-national dashboards

EXAMPLE

What do we mean by “Sub-National” divisions in NIPN countries?

SUB-NATIONAL DIVISIONS IN NIPN COUNTRIES

Question 4: How much impact can we achieve with nutrition-specific interventions on stunting?

Question 3: Have investments (input) in WASH interventions (activity) led to better access to WASH facilities (output), resulted in a reduction in % of children suffering from diarrhoea (outcome) and reduced child undernutrition and mortality (impact)?

Question 2: What are the determinants of stunting by region?

Question 1: What is the spatial distribution of obesity and overweight in Bangladesh? Who are the most affected groups?

Example: Why having a control group is essential for establishing a causal relationship

Confounding

Example 6: Equity analysis of child feeding practices

CHILD FEEDING PRACTICES BY WEALTH QUINTILES IN ONE AFRICAN COUNTRY

Example 5: Descriptive analysis of coverage of health interventions in India

COVERAGE OF INTERVENTIONS

Example 4: Descriptive analysis to improve the targeting of hygiene interventions

OPEN DEFECATION AND STUNTING RATES BY REGION

Example 3: Descriptive analysis to improve the targeting of a social assistance programme in Mexico

BENEFIT INCIDENCE OF FOOD ORIENTED SOCIAL ASSISTANCE, BY INCOME DECILE, 1994–2000

Example 2: Venn diagrams to visualise the coexistence of multiple forms of malnutrition

COEXISTENCE OF MULTIPLE FORMS OF MALNUTRITION IN ONE AFRICAN COUNTRY

Data analysis plan

The types of data that can be used by a NIPN

ix) Quality of population data

viii) External comparison of HMIS with survey values

vii) Internal consistency between related indicators

vi) Consistency over time – increasing trend for the indicator

v) Consistency over time – constant trend for the indicator

iv) Identifying outliers

iii) Completeness of reporting

ii) Metrics or dimensions not in WHO DQR

i) WHO DQR Data quality domains & metrics or dimension

Main strengthes and weaknesses of existing data quality assessment tools

Main characteristics of existing routine data systems

HMIS

IDSR

Sentinel Surveillance

Sectors data systems

Example 2: National versus sub-national analyses

Example 1: Using routine data to identify trends

Interview with the NIPN Niger team about the data landscape exercise

Two options to overcome challenge n°1

Option 1: Limit the exercise to the level of the datasets (exclude the indicator matrix)

Option 2: Include datasets and indicator matrix in the data landscape exercise

Information system, dataset, indicator

Map the data available along the impact pathway and in time

Example of question reformulation from the NIPN capacity building workshop in Lao PDR

Topic 1: budget allocation to nutrition interventions for the education sector of the NPAN

Topic 2: understanding the cultivation of crops of high nutritional value

Topic 3: understanding how vitamin A supplementation achieve its objectives

EXAMPLE 3: Formulating questions related to a social protection pathway for impact on nutrition

EXAMPLE 2: Identify the different elements of a specific policy question against the impact pathway and break them down into sub-questions

EXAMPLE 1: Type of questions which can be articulated at each level of of the impact pathway

EXERCISE 5: Identify and know the key ‘decision makers’ at the various administrative levels

EXERCISE 4: Identify which policies, programmes or investment decisions are more likely to be influenced and decide which administrative level to influence

EXERCISE 3: Create a timeline for the multisectoral policies and plans

EXERCISE 2: Map out key multisectoral policies and plans of action in relation to the undernutrition trend