Decision-making in nutrition: areas of opportunity to support greater use of economic evidence - Survey results of the multi-sectoral nutrition ...
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Decision-making in nutrition: areas of opportunity to support greater use of economic evidence Survey results of the multi-sectoral nutrition community Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition)
How evidence on costs and benefits are used in decision- making for nutrition
Respondents represent a variety of decision-makers: people who
fund, plan, advocate for, or set policy/guidelines for nutrition
Which of the following decisions do you help make in your current role? Decisions could be
internal within your organization/institution or external (n=112)
Decision to plan implementation
81 (72%)
of nutrition interventions
Decision to advocate
81 (72%)
for nutrition interventions
Decision to fund nutrition
64 (57%)
interventions (piloting or scale up)
Decision to set policy or guidelines
57 (51%)
for nutrition interventions
Other 13 (12%)
0 10 20 30 40 50 60 70 80 90
3
Note: Disaggregated numbers do not sum to the total sample size because respondents could select multiple decision typesWe received responses from a variety of institutions
that work across nutrition-sensitive sectors
Type of institution (n=112) Nutrition-sensitive sector (n=112)
32 Health
I/NGO 21 11 55%
(29%)
Government/public sector 15 9 24 (21%)
Agriculture, livestock, fisheries 54%
21
University or research institute 12 9
(19%) WASH 26%
10
Bilateral or multilateral donor 3 7
(9%)
7
Social protection 20%
United Nations institution 4 3
(6%)
5 Education 13%
Private donor 2 3
(4%)
13 Other 24%
Other 5 8
(12%)
0 10 20 30 40 0 10 20 30 40 50 60 70
Country focus (one or multiple countries)
Global/regional focus (could include some country work)
4Criteria by which decisions are evaluated: 75% of
respondents use information on return on investment
When making decisions to fund, plan, recommend/advocate, or set policy/guidelines, how often
do you evaluate nutrition interventions based on the following criteria? (n= 112)
110%
100% 1% 2% 1% 100%
8%
3% 3% 4% 6% 4% 2% 7%
1% 7% 4% 3% 5%
90% 13% 12% 9%
13% 19% 17% 19%
80% 19%
29%
70% 29% 29% 36%
28% 23%
60% 28% 29% 35%
50%
40% 30%
30% 61% 54% 54% 52% 49%
20% 44% 44% 42%
10% 22%
0%
Resources Resources Benefits and Socio-cultural Feasibility to Long-term Equity Political will/ Return on
available required (cost) harm (impact) acceptability implement sustainability acceptability investment
(budget)
Always Often Sometimes Rarely Never
5Respondents reported using different types of economic
evaluation evidence
What types of economic evaluation data do you From what source do you get this data/
support and or use in your current role? (n=104) evidence? (n=104)
Primary data
Cost-effectiveness 68 (65%) 61 (59%)
collection of impact
Published
Cost-benefit* 53 (51%) 57 (55%)
academic literature
Primary data
Cost-efficiency 38 (37%) 43 (41%)
collection of costs
Published M&E
Cost or cost minimalization 32 (31%) 41 (39%)
reports from programs
Advocacy
Cost-utility 19 (18%) 33 (32%)
materials/policy briefs
I don’t know 2 (2%) World Bank reports 32 (31%)
None, I do not None, I do not
15 (14%) 8 (8%)
typically use cost data typically use these data
Other 11 (11%) Other 13 (13%)
Secondary source
0 10 20 30 40 50 60 70 Primary source 0 10 20 30 40 50 60 70
6
*analysis of return on investment (ROI) Note: Disaggregated numbers do not sum to the total sample size because respondents could select multiple decision typesRespondents also reported using several nutrition
modeling tools to support decision-making
Do you use any of the following nutrition modeling tools or their outputs for decision-making?
(n=104)
Cost of the Diet (CotD) 30 (29%)
Lives Saved Tool (LiST) 23 (22%)
PROFILES 17 (16%)
Optima Nutrition 16 (15%)
Outcome Modeling for Nutrition Impact (OMNI) Tool 12 (12%)
Cost of the Double Burden 11 (11%)
Tool does not use data on cost, CEA or CBA
Optifood 6 (6%) Tool uses data on cost, CEA or CBA
MINIMOD 4 (4%)
Intake Modeling and Prediction Program (IMAPP) 3 (3%)
Other 13 (13%)
None 20 (19%)
0 5 10 15 20 25 30 7Applications of existing evidence: challenges and the way forward
Respondents gave qualitative feedback on how economic
evaluation evidence has been used in practice and challenges
Q: What evidence, knowledge and/or practices are missing that would improve the decision-
making process to invest in, plan implementation, recommend and/or set policy or guidelines for
nutrition interventions?
Please consider evidence on the costs and benefits of nutrition programming including cost analysis, cost-effectiveness, cost-
utility (i.e. cost per DALY or cost per QALY), benefit-cost analysis, or other economic and financial analyses (please indicate).
Responses were summarized into these three categories:
1 2 3
Availability and Applications of the Applications of the
quality evidence to evidence to policy
of evidence programs and advocacy
91
Availability and quality of evidence
What we heard: Key questions:
Evidence on economic evaluations for • What kind of economic
evidence do you find most
nutrition is limited and what is present is
useful when making decisions?
either insufficient or hard to access What level of detail is
▪ Eg, What is the combined impact of multiple important?
interventions?
▪ Eg, Does one intervention have multiple benefits? • What are the cases where
having information on
Concerns were raised on the quality of combined impact is useful?
existing evidence: not enough or the right • What are the aspects of poor-
data to draw conclusions quality data you struggle with
the most?
“Consistent methodology is critical for • What would help you deal with
reliable evidence” data quality limitations?
102
Application of the evidence to program design
What we heard: Key questions:
Using evidence that is based on a few studies restricts • Do you make these types
decision-making because it’s difficult to make
of comparisons? Others?
appropriate comparisons for both cost and impact:
▪ Comparing the same intervention across different delivery • Is there evidence to make
platforms and contexts those comparisons? What
▪ Comparing multiple interventions in the same context
▪ Making country comparisons
are the challenges you face
when doing so?
Concern on whether CEA for nutrition-sensitive • What are the ways you fill
interventions is appropriate: the information gaps
“Assessing cost-effectiveness of a direct intervention that has a
direct pathway to impact is not comparable to cost-effectiveness
without that evidence?
of a nutrition-sensitive ag intervention, which (1) is several steps
removed from a single identifiable impact, and (2) has a wide
• Is the concern in the quote
array of additional potential impacts” on the left shared?
113
Applications of the evidence to policy and advocacy
What we heard: Key questions:
It can be difficult for policy makers to • What are the key
understand very technical analyses benefits/outcomes decision-
makers in the sectors you’re
It’s important to think about the needs of working in care most about?
each sector to garner interest in new • What are the key economic
program investments – “Need to speak their evaluation metrics that are
language” likely to influence the
decision-makers you’re trying
“Data use is not always a priority” for policy to reach?
makers, underscoring the need to fit • How is the communication
evidence into a broader narrative that strategy different across
“speaks” to the right audience sectors?
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