Analysing and using information from multiple sources
There are many different sources of data relevant for nutrition in Zimbabwe.
George Kembo, Director, National Food and Nutrition Council and SUN Government Focal Point
describes how the information is analysed and used…
“Government has made commitments to… a national integrated food and nutrition security information system that provides timely, reliable information on the food and nutrition security situation, effectiveness of programmes and informs decision-making…”
Comrade R.G. Mugabe, His Excellency the President of the Republic of Zimbabwe
In response to persistent hunger and under-nutrition, particularly among the poor, the Government of Zimbabwe launched a Food and Nutrition Security Policy in May 2013. The policy marks the start of a concerted effort to promote economic development by addressing food security and nutrition challenges in a robust, coordinated, and multi-sectoral manner. The Food and Nutrition Council (FNC) is the national agency mandated to lead the coordinated, multi-sectoral response. The FNC engages multiple ministries and other stakeholders including United Nations agencies, non-governmental organizations (NGOs) and the business community.
The government sets out seven commitments in the Food and Nutrition Security Policy including a commitment to a national integrated food and nutrition security information system. Key aspects of the information system are:
- reporting on inequity Î harmonization, integration and synthesis of information from multiple sources
- basing the system on standardized, agreed and comparable indicators
- decentralized ownership of information systemsinclusion of routine data
- ensuring a strong linkage between information, decision-making and action including for emergency responses
- building a central information repository Î inclusion of both qualitative and quantitative tools and approaches
- linking with regional and global nutrition information systems; and
- distinguishing between chronic and acute situations.
The system combines a number of different assessment and monitoring tools that together provide a comprehensive understanding of the food and nutrition security situation.
Systems and sources of information
The integrated food and nutrition security information system seeks to collect, analyse and utilize information on impact– progress toward the six World Health Assembly (WHA) targets – and determinants of malnutrition. There are multiple systems and sources of information.
The Zimbabwe Demographic and Health Survey is conducted every five years. With the exception of anaemia in women of reproductive age, data related to all WHA targets are collected. These data are disaggregated according to geography, wealth, gender, livelihood and age group.
The National Nutrition Surveillance System was set up to collect information on an annual basis during the peak hunger season (the time just before harvest). Recently, due to resource constraints, data collection has been on an ad hoc basis. In 2013, data were collected in 10 livelihood zones considered to be most food insecure by means of a rapid assessment. In 2014, data are being collected through mini nutrition surveys targeting 10 food insecure districts in four provinces5. Data are collected on five of the WHA targets, the exception being again anaemia in women of reproductive age. Disaggregation of data is by geography, gender and age group. Members of Multi-sectoral Food and Nutrition Security Committees at provincial, district and ward level are being trained on food and nutrition security surveillance. This includes training on how to collect and analyse data and the production of reports at district level. A total of 98 people from national, provincial and district level have been trained recently including staff from the health sector (nutrition, environmental health, and community nursing), social services, United Nations and civil society.
Routine data collection is carried out by NGOs, usually as baseline and endline at the start and end of a programme, and on a monthly or quarterly basis throughout the life of the project. The information is usually disaggregated by geography, gender, livelihood and age group. The indicators collected vary according to the scope of the programme. Some information has a focus on food security and markets, some on water, sanitation and health and a few collect information on community infant and young child feeding programmes.
The Zimbabwe Vulnerability Assessment Committee (ZIMVAC) carries out an annual rural livelihoods assessment (ARLA) using random sample surveys. The 2013 ARLA was carried out in May and collected data through community and household questionnaires on education, food and income sources, income levels, expenditure patterns, crop production, livestock production, water and sanitation, crop post-harvest management. Data were also collected on wasting in children under five years of age. The ZIMVAC collects and analyses comprehensive data on the determinants of wasting including information on dietary intake, food security, illness (recent diarrhoea, fever or cough in children under the age of five), and water and sanitation. Limited data are collected on access to health services and on the care of the mother and child. The data are disaggregated according to gender, age and geography.
The Agriculture and Food Security Monitoring System collects data in 57 out of 60 districts once every quarter. The system is adapted to conduct a household food consumption survey every year in October at the start of the hungry season. All the data collected under this system are from rural areas. Further disaggregation is carried out according to livelihood zone.
The Crop and Livestock Assessment is carried out twice a year with analysis of data disaggregated down to ward level.
The Health Information System (HIS) collects monthly reports on most diseases and health conditions including wasting, underweight and pellagra (due to niacin or vitamin B3 deficiency disease). The HIS also has a weekly disease surveillance system that monitors outbreaks of diseases of public health importance such as cholera, malaria and measles.
Annual mapping exercises are conducted by the Nutrition Technical Coordination Group to produce a Nutrition Atlas. The mapping captures which stakeholder groups are doing what and where they are active. The mapping covers government activities as well as those of NGOs. The Agricultural Working Group does a similar mapping exercise on a yearly basis for the food security sector. The information for the mapping exercise is collected through self-administered questionnaires which are sent to key people at the different agencies and sectors.
Analysis and use of information
There is high level commitment from government to collect, analyse and use data. There is good capacity for collection at national and district level but currently the capacity for analysis is largely confined to the national level. Provincial and district level staff are currently being trained to analyse their own data and produce reports as part of a broader data management training.
Programme design and targeting of geographical areas by partners is usually based on the nutrition information that is available. Organisations frequently carry out baseline and end line assessments to determine the effectiveness of programme implementation at district or ward level depending on the scope of their programmes. At national level, there is a need for operational research to determine the overall impact of the different programmes on the nutrition situation in the country.
Dissemination of information
The FNC is currently establishing a website to create a forum where the public can have access to food and nutrition security data and can also provide feedback. Information is presented in the form of maps, graphs, tables and dashboards.
Coordination, alignment and dissemination across different sectors is expected to improve with the strengthening and continued revival of multi-sectoral FNSCs in which NGOs participate together with key food security and nutrition sectors including agriculture, health, social welfare, education, gender, youth and local government.
Integrating information on food and nutrition security for flood response
Agriculture extension workers from the Ministry of Agriculture surveillance system monitored the effects of the rain and flooding on crop production in each of the affected areas. They found that extensive damage had been incurred to maize, sorghum and pearl millet crops.
A malnutrition screening exercise was carried out in the areas affected by the floods through the Ministry of Health. The screening was done in coordination with the expanded programme for immunisation in three wards. Mid-upper arm circumference was measured in order to assess acute malnutrition (wasting) in affected areas. A total of 156 children between the ages of 6 and 59 months were screened and referred to treatment programmes to prevent further deterioration. In addition, members of the DFNSC took part in a SMART6 nutrition survey in March 2014. The survey measured mortality, child nutritional status, and food security.
The DFNSC met to discuss the information collected in affected areas. The committee agreed that advocacy for programmes – such as school feeding – was needed to protect children from malnutrition. In addition, the DFNSC highlighted the need for training to strengthen the quality of data produced through community based growth monitoring in the district. This would allow the nutrition situation to be monitored over time as part of the early warning system especially in the affected areas. A total of 160 village health workers were trained on growth monitoring in March 2014, specifically on the use of new child growth curves7 so that data collected are as accurate as possible.
DFNSC members took part in data management training to establish guidelines for an integrated information system on food and nutrition security and vulnerability. The result is that the DFNSC can now collect and analyse their own food and nutrition security information. Surveillance systems under different ministries (e.g. Ministry of Health and Ministry of Agriculture) are combined to produce a comprehensive picture of food and nutrition situation in the district. This integrated information sharing system will act as an early
warning mechanism for pending food and nutrition insecurity and to monitor the situation in flood affected communities. It also allows the DFNSC to prioritisate programmes to be implemented in the district.
Challenges and opportunities
While efforts are being made to generate reliable nutrition information that can be used for nutrition programming and planning, disaster preparedness and response, there remains a need to increase the capacity for response. Furthermore, though it is recognized that multi-sectoral response is the most effective way to address nutrition, it can be delayed due to competing priorities within the different individual sectors themselves. The high attrition rate of staff within government is also a challenge resulting in trained and experienced staff departing for ‘greener pastures’, leaving untrained and inexperienced staff with low motivation. Resources for response are currently limited and strong efforts to mobilize them are required.
There are opportunities, however. The five year costed National Nutrition Strategy for Zimbabwe which is now being finalized includes ‘quality nutrition information systems and advocacy’ as one of its six key result areas and hence resources will be mobilized specifically around improving nutrition information systems in Zimbabwe. There is a high level of recognition of the role of nutrition in development. As the multi-sectoral collaborative platforms continue to strengthen, this will have a ripple effect on the effectiveness and advocacy towards improved nutrition information systems. In Zimbabwe these multisectoral coordination and governance structures are being strengthened at national, provincial and district level and are being established at ward level.
- The quality of advocacy improves as nutrition information systems are strengthened and local evidence is documented.
- Communities can play a vital role in contributing to nutrition information systems through building the capacity of community based volunteers participating in disaster preparedness and response activities and also providing specific follow up to vulnerable households and/or individuals in wards.
- Feedback to communities is a vital part of nutrition information systems enabling them to prioritise their own problems and areas for response.
- Participatory monitoring and evaluation results in participatory response and increased sustainability of nutrition information systems.