Strengthening national nutrition information systems
(EC-NIS project)

“Supporting countries to strengthen their national nutrition information systems”

UNICEF and WHO, with financial support from the European Commission (EC), are implementing a project titled “Strengthening national nutrition information systems” in five countries in Africa and Asia: Cote d’Ivoire, Ethiopia, Laos, Uganda and Zambia for a period of four years (April 2020 - March 2024).

Timely and quality data with an adequate level of disaggregation are essential to guide country choices to allocate resources and to monitor progress in nutrition. Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) or national nutrition surveys are the major sources of nutrition data for many countries, but they are complex and expensive undertakings that cannot be implemented with the required frequency. It is, therefore, critical to strengthen or establish integrated nutrition information systems (NIS) of countries to enhance availability and use of routine nutrition data to better support policy development, programme design and monitoring.

UNICEF and WHO’s role to support countries in defining monitoring standards and respond to their demand for technical assistance on nutrition monitoring to address the nutrition data gaps that exist in many countries. This initiative will increase the uptake of nutrition information and provide improved knowledge for policy and programme development and implementation by increasing country capacity in monitoring programmes and national/global nutrition targets

All country-level project activities are implemented and managed by a technical team in the Ministry of Health (MOH) of concerned country in collaboration with WHO and UNICEF country offices.

The objective of this project is improved NIS and country capacity in monitoring programmes and national/international nutrition targets.

The expected outputs in the countries benefiting from this project are:

• Revised National Nutrition Monitoring Frameworks filling in major nutrition data gaps;
• Refined/new data collection systems for existing HMIS including a nutrition module (based on routine health centre data and sentinel sites) using updated data collection tools and digital data collection systems;
• Enhanced human resource capacity for the collection, analysis, interpretation, communication and quality control of nutrition data and for the management of NIS;
• Improved IT supported data management systems in line with the District Health Information System 2 (DHIS2) Nutrition Module and generating information for programmes and policies;
• Availability of quality and timely data from routine data collections in health centres and from surveys; and
• Improved dissemination of NIS information.

After revulsed years 2020 and 2021 due to COVID-19 pandemic, 2022 was a year of accelerating activities. In 2023 nutrition data started to be generated through the DHIS2 platform in the five countries, thus main activities focused on reviewing the data to assess their quality while trying to strengthen their completeness, timeliness, validity and consistency using the WHO DQA toolkit. In parallel, training to MOH health workers continued to address gaps identified and technical work around the HMIS/DHIS2 platform focused on improving data visualization through dashboards aiming facilitating data dissemination and use for policy action by stakeholders.

The annual gathering was organized in Lao PDR on 26th October 2023 preceded by a field visit of the Project Steering Committee to Luang Prabang health facilities. Countries presented their main achievements:

• in Cote d’Ivoire, the Ministry of Health with support from WHO and UNICEF country teams and partners, finalized the development of training material to build capacities of MOH data managers on the revised HMIS/DHIS2 tools and on the DHIS2 platform itself. Using this material, the capacities of data managers of all health regions in the country started being built and a workshop for consolidation and validation of nutrition data produced through the DHIS2 platform was organized. 
• In Ethiopia, several trainings were organized to improve MOH health staff skills on monitoring &evaluation to implement the DQA methodology to assess nutrition data quality. A SOP validation workshop on the use of the nutrition data within DHIS2 was organized. Supportive joint supervisions were also implemented at national level to assess consistency, completeness and timeliness of data generated. The project finally supported the scale-up of the multisectoral UNISE nutrition platform.
• The project in Laos in 2023 supported the roll-out of the Nutrition Information System which is currently covering 17 out of 18 provinces, and the training of MOH health staff on the new data collection tools and on the DHIS2 nutrition module. The DHIS2 Standard Operating Procedures document developed in 2022 including procedures to inform 20 nutrition indicators was officially endorsed by the Vice-Minister of Health and the National Nutrition Committee Secretariat. Nutrition scorecards were also developed to assess data quality for key nutrition indicators. They provide information on indicators completeness, correctness, consistency, and timeliness at province level. Supportive supervision to provinces was implemented as part of the process of quality assurance and data improvement providing on-site refresher training to health workers on the new DHIS2 reporting tools. Finally, an IMAM tracker module for DHIS2 was developed allowing systematic tracking and management of children with severe acute malnutrition and its implementation is planned in 6 targeted provinces. 
• The main highlight in Uganda in 2023 relates to the supportive supervisions carried out to respond to the need for continuous capacity building. To address this, on-site mentorship sessions were organized for 50 health facilities in selected regions. The EC-NIS team also supported the Ministry of Health on data quality assessments using the DQA methodology that and regional nutrition performance reviews were held. The project supported MOH in the development and dissemination of several nutrition information products based on data gathered through the DHIS2 platform.
• In Zambia, nutrition indicators in DHIS2 were reviewed and refined and corresponding HMIS tools were realigned in 2023. Several capacity building activities took place like the training of key personnel in M&E and nutrition, and the implementation of quarterly mentorship sessions in provinces. Senior information officers at MOH were trained on revised HMIS tools in all provinces. Dashboards were also further customized to respond to specific country's needs.

The workshop report highlighting main achievements and challenges is presented below.

On 18th November 2021, UNICEF and WHO convened an annual gathering, with the aim to review the European Commission funded NIS project implementation to date, exchange lessons learnt and good practices, share knowledge and start planning the activities for Year 3. The main objectives of the annual gathering were to review key achievements and areas of improvement, document lessons learned and best practices for each country, strengthen collaboration between all stakeholders at country, regional and global level and to review country workplans for Year 3 (2022).

The annual gathering was preceded by five national review workshops, organized under the leadership of the respective Country Steering Committee (CSC), with participation from the Project Steering Committees (PSC) and country Technical Working Groups (TWG).  Overall, the implementation of the activities planned for year 2 of the project are on track in all countries. In Lao People’s Democratic Republic, one of the key achievements reported the leveraging of the existing DHIS2 platform to reflect nutrition within the broader national information system of the country. Côte d’Ivoire developed a manual for nutrition data management, while Ethiopia completed the review of the existing NIS and Unified Nutrition Information System (UNISE) – a multi-sectoral nutrition data management tool that captures nutrition specific data through the DHIS2 as well as nutrition sensitive data from the other sectors through the DHIS2. Uganda reviewed their NIS and customized the country national nutrition M&E framework into the DHIS2 and Zambia the revised nutrition data elements in HMIS.

The European Commission (EC), United Nations Children’s Fund (UNICEF), and World Health Organization (WHO) and governments convened for the launch of the joint NIS project, aimed at improving national Nutrition Information Systems (NIS) in five countries: Côte d’Ivoire, Ethiopia, the Lao People’s Democratic Republic, Uganda, and Zambia. The meeting in October 2020 provided an opportunity for all stakeholders to develop workplans to meet the project objectives.