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 types
We 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)
                                                                                                                                                                                4
Criteria 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
                                                                                                                                                    5
Respondents 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 types
Respondents 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      7
Applications 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

                                                                                                                                    9
1
    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?
                                                                                                   10
2
     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?

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3
    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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