Strength in Numbers

By Saul Guerrero

Saul Guerrero is the Director of Operations at Action Against Hunger UK. He has been working in acute malnutrition policy and practice since 2003. Prior to joining Action Against Hunger, he worked for Valid International in the research and development of CMAM, supporting the pilot and roll out in over 15 countries in Africa and Asia. He is a co-founder of the Coverage Monitoring Network (CMN) and currently oversees the implementation of multiple information and knowledge management initiatives in nutrition and the wider humanitarian sector.

What is the real burden of acute malnutrition worldwide? How much funding currently goes to acute malnutrition? How much would it cost to treat acute malnutrition at scale? How many children die from acute malnutrition every year? Which countries have made the greatest progress in providing treatment to children suffering from acute malnutrition in the last decade?

These questions are essential to launch, coordinate and monitor any large-scale effort to tackle acute malnutrition. Yet, these questions are difficult or impossible to answer at present.

There are many questions about acute malnutrition and not enough answers.

Our efforts to scale-up nutrition and to influence global debates require that we are able to address these questions with confidence. But it also requires that we are in a position to address new and emerging strategic and tactical questions about how we tackle the problem of acute malnutrition at scale.

At present, some of the answers can be found in the myriad of initiatives that exist; UNICEF, WFP, GAIN and the Global Nutrition Report have all contributed a wealth of data and information on acute malnutrition. Their initiatives and those of others are providing crucial insights and analysis that take us far beyond where we were a mere decade ago.

Global nutrition information initiatives dealing with acute malnutrition are not taking us far enough.

However, current initiatives are not taking us far enough because they provide answers but do not empower us to ask our own questions. Without access to the data behind these reports and initiatives, gaps remain unclear and we are unable to aggregate data to deliver the kind of comparative analysis (let alone the data mining) that we can and should be doing. There are three commonly cited, but often misunderstood reasons.

The first is ownership. Who owns nutrition information? National Governments? United Nations (UN) agencies?  The agencies that generate the data? Many international donors explicitly state that data generated with tax-payers money belongs to the public. And yet it is not, in part because we – the people – do not demand that data are released. Today it is virtually impossible to access the existing datasets that stipulate the burden of acute malnutrition or the performance of services treating it at national level without entering into (often complicated) agreements about its use. These agreements act as a barrier to critical and participatory analysis and there is little empirical evidence to suggest that they are needed. We have a lot more power to decide how data are used than we realise and we need to exercise that power.

The second is risk aversion. How can the misuse of nutrition information be avoided? Acute malnutrition is a political issue and data tells its own story about the success of public health policy and practice. National governments and other nutrition stakeholders are understandably concerned about the risks involved in full data disclosure. But are we working with them to adopt a more open and transparent stance, driven by constructive efforts to improve programming? Our own experience in collecting and sharing national level data (including the coverage data from Mali used in our latest article published in issue 49 of Field Exchange¹) shows that national authorities may be more open to sharing (potentially sensitive) data than we are supporting them to be.

The third is leadership. Who should lead global efforts to aggregate and facilitate access to information on acute malnutrition? The UN agencies (UNICEF, WHO, WFP, UNHCR) have a delegated responsibility. But are we - the partners, advisors and donors - supporting and encouraging them to do so? The emphasis on mandates and responsibilities has not been used to empower them, but instead has, more often than not, been used to justify inaction on the part of those of us who can play a more defining role. We can all do a lot more to lead this process than we have done to date.

All of these elements have shaped access to information on acute malnutrition in the past, but they should not define how this information is managed and used in the future.

Over the past few years, Action Against Hunger has collaborated with a wide range of nutrition stakeholders worldwide to implement nutrition information initiatives that have openly but responsibly shared data on acute malnutrition. Our experience has demonstrated that nutrition stakeholders – from governments, to UN agencies to non-governmental organisations (NGOs) – are ready to share and work in a collaborative manner. The inter-agency collaboration to estimate the burden of kwashiorkor (Putting Kwashiorkor on the Map²) has shown that this kind of collaboration and data-sharing can be achieved across multiple agencies if the objective is clearly defined and shared. Similarly, the collaboration between Action Against Hunger, UNICEF, Ministry of Health (MoH), Children’s Investment Fund Foundation (CIFF) and other partners in Nigeria (described in this issue) proves that greater openness, far from proving detrimental, has actually catalysed discussions (and increased funding) for a new generation of nutrition initiatives designed to improve performance and scale-up efforts.  

The time has come to set acute malnutrition data free.

Freeing data on acute malnutrition requires a series of changes, but above all, it requires a space that frees what is already there. We need an inter-agency initiative to aggregate acute malnutrition data on a scale never before seen; an openly available, non-proprietary space where information on acute malnutrition can be accessed and used by all. A platform founded on fundamental commitments to improve:

1. Our understanding of the magnitude and scale of the problem of acute malnutrition;
2. The quality and standardisation of information on acute malnutrition, and;
3. Access and utilisation of information on acute malnutrition.

We need to deliver something that carefully complements existing initiatives and platforms rather than undermine them. We can turn this ambitious vision into a reality, right here, right now. But to do so we need to recognise that our strength will be in numbers, that our success will depend on our ability to join³ with others and rally the nutrition community to this cause. We are willing to take a first step and transfer all acute malnutrition information currently managed by Action Against Hunger UK to this initiative effective immediately.

Who’s next?

If you are interested, email Saul Guerrero