Disseminating evidence for informed action in Ethiopia
(MSc), Ethiopian Public Health Institute, Gelelle Abrbegnoch Street, Addis Ababa, Ethiopia
(PhD), Federal Ministry of Health Ethiopia, Addis Ababa, Ethiopia
(MSc), Ethiopian Public Health Institute, Gelelle AbrbegnochStreet, Addis Ababa, Ethiopia
(PhD), Ethiopian Public Health Institute, Gelelle Abrbegnoch Street, Addis Ababa, Ethiopia
Knowledge gained through research can improve policies, programs and practices within a nutrition service delivery system. This will contribute towards significant improvements in the nutritional status and nutrition equity of a country and beyond.
The coordinating mechanism
The National Nutrition Coordination Body (NNCB) is the primary mechanism for leadership, policy decisions and the coordination of Ethiopia’s National Nutrition Program (NNP). The implementation of this program began in 2008, using a multi-sectoral and life cycle approach. The NNP’s five-year plan was revised in line with the Millennium Development Goals (MDGs) for the years 2013-2015. The MDGs were also used for the development of the country’s second five-year plan (NNP 2016-2020).
The NNCB includes government sectors, partners, civil society organisations, academia and the private sector. Under this body is the National Nutrition Technical Committee (NNTC) composed of senior nutrition experts from the same sectors. This committee is divided into three sub-committees:
- Nutrition Program Coordination Sub-Committee chaired by the Federal Ministry of Health
- Nutrition Research, Monitoring and Evaluation Sub-Committee chaired by the Ethiopian Public Health Institute (EPHI)
- Food Fortification Program Sub-Committee chaired by the Federal Ministry of Industry.
While these committees function at a national level, there are other similar multi-sectoral nutrition coordination program implementation arrangements in place at regional, district (woreda and kebele) levels, using the decentralisation structure. The terms of reference, membership, frequency of meetings and roles and responsibilities of sectors are detailed to ensure transparency in conduct.
The Nutrition Research, Monitoring and Evaluation Sub-Committee is led and coordinated by EPHI. Members of the Sub-Committee access the research agenda of EPHI, and generate, translate and deliver evidence to decision-makers to answer their questions.
For example, Ethiopia is currently planning a national food fortification program, which will begin within the next five years. To ensure appropriate fortification, decision-makers assessed the existing evidence summarised by EPHI and invested in context-specific research. This entailed a National Food Consumption Survey and the National Micronutrient Survey, which collected data on Ethiopian food intake and micronutrient status, respectively. EPHI is also reviewing existing data, including recently published systematic reviews, to produce policy briefs on the relevance of zinc fortification to Ethiopia. EPHI also conducted the National Nutrition Survey in 2015. The results of this survey were reported to the Federal Ministry of Health to help set targets for the NNP of 2016-2020.
While nutrition academics from EPHI are mandated to inform nutrition actions, various other academic institutions have also linked with the Department of Food Science and the Nutrition Research Directorate, specifically to provide evidence-based answers to questions on nutrition programs from decision-makers. Evidence produced by these institutional capacities is shared across academia through annual conferences and is subsequently compiled and presented to appropriate government ministers to aid program reform. A website is also used to disseminate research outputs.
Barriers to overcome
Despite the ongoing efforts to use evidence in making decisions about nutrition programs, there are still a number of gaps and barriers to the process of decision-making in Ethiopia. These include:
- Poor use, and integration of research outputs in program and policy change
- Insufficient personnel trained to work on producing systematic reviews to inform policy
- Poor use of health economic evaluation papers
- High attrition rate of trained nutritionists into government sectors
- Difficulties in finding synergies between the agendas of different partners in development
- Poor linkages at the regional level.
Some of these gaps can be addressed through:
- Short- and long-term training of personnel in performing systematic reviews and full health technology assessments
- Developing methodological tools and processes on identifying and setting priorities in nutrition, with decision-makers
- Establishing a national nutrition database of previous and ongoing research and programs performed within Ethiopia by the different entities (NGOs, donors, universities, EPHI, etc.)
- Evaluating the systematic process of decision-making, from priority-setting to the implementation of evidence-informed policy briefs.
Collaborating with global initiatives
These activities will be facilitated by a number of well-established and sustainable institutions that are already carrying out priority-setting and evidence synthesis. Ethiopia’s experiences with the SURE collaboration1 (Supporting the Use of Research Evidence) and its readiness to accept evidence for better implementation of programs to improve the nutrition outcomes of the country are also vital assets.
Thus far, Ethiopia has mapped the stakeholders involved in evidence-informed decision-making in nutrition, identified priority research topics by talking to these decision-makers and various other key stakeholders, and built the capacity of some researchers in nutrition academia on evidence synthesis. The government has also acknowledged and recognised the importance of evidence in policy-making. Many of these actions have taken place due to Ethiopia joining the EVIDENT Network2. The network is facilitating Ethiopia in bridging the gap between science and policy and has therefore become an integral part of EPHI’s nutrition research agenda and the next five-year (2016-2020) National Nutrition Plan (NNP).
- It is helpful to have a good governance structure in the country as this will make it easier to facilitate the acceptance of evidence-based policies, and accept the concept of evidence-informed decision-making and what it entails.
- A readiness by policy-makers to accept evidence to inform their decision-making is key forbetter implementation of nutrition programs.
- Strengthening institutional collaborations and experience sharing within Ethiopia institutions, between African and global partners for useable and reliable evidence generation is essential.
- Developing systems to translate knowledge and evidence into policies and programs and establish clear decision making process in the country.