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UNICEF NYHQNational Nutrition Information SystemsOctober 2013

BackgroundWhy are experiences of national nutrition information systems important for community-based SAM treatment?• Programming trends

• to expand SAM management in-country • to integrate SAM management into national/govt systems• to link SAM management to preventative action (& stunting agenda)

• Programme trends mirrored in information• So we need to:

1. Understand how SAM data from a wide range of sources comes together at national level

2. See SAM information within broader efforts around nutrition information collection /analysis/usage

GAM/SAMSurveillanceIYCF status

Micronutrient(National / Sub-National Level)

Situation & Early Warning

Surveys (MICS, SMART, etc.)

FEWS-NET; VAM

Routine information e.g.:- SAM Admissions- IYCF counselling- MN distribution

(National & Sub-National Level)

Delivery

Geographical Coverage(National & Sub-National Level)

Performance

Annual Budgets for Nutrition interventions

(National Level)

Nutrition Information Needs

Method

Source

SAM performance indicators

IYCF + MN KAP trends

(National & Sub-National Level)

Routine data; coverage surveys; KAP studies

UNICEF Country Reports

Intervention Coverage

(National & Sub-National Level)

MoH Surveys (National)

NGO Surveys (Sub-National)

Coverage Monitoring Network

UNICEF Country Reports

Supply Availability(Sub-National Level)

NGO Reports

Food securityHealth situation

Sanitation and hygiene(National & Sub-National

Level)

Routine data etc.

Elements of national nutrition information system

Country profile (pop. data; risks; DRR etc.)

MoH

Generic example: nutrition information / reporting system

Situational / Impact

Vertical programme

Programme delivery

HMIS

CMAM programme

- Survey- Survey- Survey

Vertical programme

Vertical programme

- Surveillance

- Coverage surveys

- KAP studies/ surveys

Programme performance

District / Province / National

District / Province / National

District / Province / National

District / Province / National

HMISGovt/UN/

NGOs

Govt/UN/

NGOs

Country SAM reporting systems

As of 2012, 51 COs (of 62 reporting) have CMAM/SAM reporting system*

• Information comes together at national level differently across countries• Govt + UNICEF play a significant role in bringing together SAM info at national level

* UNICEF Global SAM Management Update 2012

Govt run UNICEF run (Pakistan) UNICEF/Govt run0

5

10

15

20

25

30

3534

1

16

Manager of system

District health office

Health Facilities Implementing partners

Regional health office

02468

1012141618

1715

8

11

Report source

1. Pakistan: how CMAM output data(+) comes together at national level

2. Viet Nam: challenges of bringing together nutrition information reporting streams

Country examples

Pakistan: Nutrition programming context

• UNICEF continues to be a major supporter of nutrition programming, particularly for CMAM.

• Main programme interventions:• CMAM (MUAC screening; OTPs; SFPs), • Micronutrient supplementation• IYCF messaging

• Changing programming landscape in Pakistan:• Increased government ownership of nutrition programming (inc. CMAM)• Increased non-UNICEF supported NGO activity (e.g. NGO consortia in Sindh) • Increased programming focus shift from emergency to development (from

CMAM to IYCF/MN.

Pakistan national nutrition information system

Component What WhoSituational / EWS

• National and localized nutrition surveys (MICS; FANS (2010/2011); NNS (2011)

• DEWS

• Nutrition / health situation indicators

• Disease/health info

• Govt• WHO

Delivery • DHIS• National Programme

Reporting• NIS database• MRP• WFP supply system

• MNCH / NP indicators• SAM/MAM

admissions by site • IYCF counseling; • MN distribution; • Supply

• Govt• UNICEF• ECHO• WFP

Performance • National Programme Reporting

• NIS database• MRP• WFP supply system

• IYCF/MN/MNCH• SAM/MAM PIs; LoS +

AWG• Stocks

• Govt• UNICEF;• ECHO• WFP

NIS information flow (KP/FATA)

UNICEF

Reporting flow (KP/FATA)

NIS system

NIS key findings: challenges

Macro level• Standardization issues (2 provinces use; MRP)• Utilization and reporting flow issues (analysis; usage) • Sustainability issues (resource heavy)

Technical• Content gaps• Quality issues• IT technical issues

Viet Nam: Nutrition programming context

• Government-led nutrition programming• Development focus on stunting:

• National Targeted Programmes – (Nutrition [PEMC] and Maternal & Child Health (IYCF; MN)

• NGO programmes (IYCF ‘franchise’)• Introduction of IMAM pilot

• (Government-led / UNICEF-supported)

Current Nutrition Data Flow

Village

District HC/Hospital

VHW collects individual data and compiles monthly summary

Commune Monthly meeting at commune: Commune Nutrition Focal Point (or commune head) compiles

data monthly in hard copy (inc IMAM)

Monthly meeting: District planning FP collects general and specific programme

reports

25th each month

Monthly meeting: District Nutrition FP collects specific programme reports

30th each month

PEMC (IYCF & Vit A); MCHmonthly

IMAM; & general reportmonthly

PEMC (IYCF & Vit A); MCH;monthly

Current Nutrition Data Flow (cont.)

District HC/Hospital

Province

District planning FP compiles general report (& IMAM) monthly; sends either

monthly / quarterly summary to province via letter & email

Reproductive Health Centre (Nutrition FP) receives data and

compiles

5th of month

District Nutrition FP compiles programme reports monthly; sends

either monthly / quarterly summary to province via letter & email

Health Service Department/Planning

receives data and compiles

Preventive Health Centre receives; data and compiles

General reportsMonthly/quarterly

PEMC (Vit A)quarterly

PEMC (IYCF); Quarterly MCH: Monthly IMAM

Provincial Hospital

Curative data

IMAM (inpatient)

IMAM (inpatient)

Curative & IMAM data

IMAM (inpatient)

Complexity of reporting lines

Current Nutrition Data Flow (cont.)

Province RHC Nut FP compiles and sends

via email & letter

National

HSD/Planning compiles and sends via

email & letter

NIN (PEMC) MCHRegional

institutionObstetrics

hospital south

PHC compiles and sends via email &

letter

MoH (Cabinet Office)

PEMC (IYCF ); QuarterlyMCH: Monthly

PEMC (Vit A)quarterly

General reportsMonthly/quarterly

NIN (NSS)

Annual Nutrition survey

data

MoH

Complexity of reporting lines continues

Other experiences of national systems

• Data generation• Advances in coherence, quality, standardization & technology• But: Quality / credibility; politics; timeliness (surveys & routine systems)• Coherence (different reporting lines / staff / frequencies / indicators etc.)• Resources & capacity (technology; info collection)

• Data analysis• Sudan Darfur Update; Pakistan Cluster Update; • FSNAU; WCARO DevInfo & monthly report• But: Need for clarity of roles for analysis; capacity; breadth of analysis

• Data utilization• For advocacy and fundraising (Ethiopia & Sudan); programme adaptation

(Kenya MYRs adjusted targets, strategy, funding needs etc.)• But: Translation to programme adaptation; politics; level of info needed for

programme staff

Implications / Next steps

A. For bringing CMAM reporting together at country level: 1. Advocate for government ownership at national level & build capacity 2. Standardization of indicators/ & forms; develop tools & technology; clarify

reporting lines3. Strengthen analysis & utilization of data

B. For linking CMAM with other nutrition/multi-sector reporting:4. Advocate for Government buy-in & ownership5. Map, assess and harmonize / streamline6. Strengthen integrated data analysis7. Data utilization

Thank you

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