We sat down with members of the Nutrition team at the Bill & Melinda Gates Foundation: Rahul Rawat, Senior Program Officer responsible for the DataDENT grant, and Ellen Piwoz, Lead of the Data Analytics and Evidence initiative. Rebecca Heidkamp, a faculty member at Johns Hopkins Bloomberg School of Public Health (JHSPH) who serves as the Principal Investigator for DataDENT, also joined the conversation. We discussed the nutrition data landscape, and their visions for how Data-DENT can make a difference in the quality, availability, and use of data across the value chain.
Q: How did you personally get interested in working at the intersection between data and nutrition policy?
Ellen: I have always worked at the intersection between data, evidence and policy. During my time at JHSPH I did a lot of epidemiology and biostatistics work largely because of how important it is to understand the numbers that go behind the science and link it to the policy process. I like to sit in that translation space taking new innovations and knowledge and figuring out how to get it adapted for policy. Previously, I made these policy connections for nutrition and child survival and nutrition and HIV while working to advise the Africa Bureau at USAID. At the Gates Foundation I have had the opportunity to do this more comprehensively and globally, across many issues.
Rahul: I am fascinated by data and how it can be used and also cautious of how it can also be used in incorrect ways. I have mixed background with my master’s from JHSPH and my PhD from Cornell University. I started my professional career at International Food Policy Research Institute (IFPRI), which was great because it was very applied in nature. The work is rigorous but with an angle around how it will be used to inform policy and program decisions. At the foundation, I work on the Data Analytics and Evidence team where we are thinking about how to help transform what a data revolution in nutrition means. We’ve put a lot of thought about different elements along what we call the data value chain.
Rebecca: My story has echoes of Rahul’s and Ellen’s. I started out my career working with an international NGO on implementation of U.S. Government-funded maternal child health and HIV programs across multiple countries. During graduate school I worked with a local government-affiliated institution in Haiti and then the UNICEF country office where I began to appreciate the essential role of government in policy and program planning. When I came to JHSPH I joined IIP – a group focused on improving large-scale measurement for maternal, newborn, child health and nutrition (MNCH&N) that is committed to working with government partners. I have come to fully appreciate that many governments are making decisions in a data vacuum. This has felt like an interesting space where the global community can really come together in a positive way.
Q: Rahul, please talk to us about the data value chain (DVC) concept. Could you explain what you mean and what do you see as the gaps within that value chain?
Rahul: The first Global Nutrition Report released in 2014 delivered a strong message that the nutrition needed a ‘data revolution’ because the world lacked sufficient data to track progress against global targets and monitor key deficiencies that hinder development. The conversation was focused on collecting new data primarily. At the foundation and with several partners,
we felt that we needed to think more holistically and transformative about the way we think about data. It’s not just about collecting more data more often. There are instances where we have a lot of data, but it is not being used because of quality, because of the way the data is presented, or because of the applicability to program and policy decision makers. We took this concept of a value chain and thought about how we could position data across it.
The value chain considers data prioritization, how data is collected and curated, how data is analyzed and visualized, and then ultimately, how that data is interpreted and used. When we analyzed the problem against the value chain, we realized that the nutrition data ecosystem — like other aspects of the nutrition sector — is quite fragmented. With our Nutrition strategy here at the foundation, we are making investments along each of the steps in that value chain with the ultimate goal of improving the quality, availability, and use of data for progress tracking and decision-making.
Q: Along this general theme, what do you see as the main barriers in working in data and measurement within nutrition?
Rebecca: One of the big barriers is that systems are built in fragmented ways – often in response to a very particular need. They become the systems that we need to build on and it can be really difficult for the people already entrenched in the systems to step back and to think about how they can be holistically improved. Another struggle is that we lack technical guidance. We often do not have a lot of evidence underlying recommendations about what to measure and how to measure it. Measurement can be really costly. In a resource limited context, it’s hard to justify investing in M&E if we do not have confidence that we are measuring the right things in the right way. There is also a vacuum of technical resources in terms of having the people with the statistical, data-collection, and quantitative skillsets to implement.
Q: What do you see as the role of development partners in addressing some of these gaps along this continuum of data along the value chain?
Ellen: The development partners include a diverse group, ranging from civil society organizations (CSOs) to the technical support organizations, to the UN, as examples. Each type of partner has a role to play. For example, civil society should be demanding data for accountability. Technical partners and academia should be generating global public goods that can help countries design, deliver, and monitor policies and programs. UN agencies, such as WHO and UNICEF, have normative roles and responsibilities, including providing guidance, not only on what interventions are effective, but also how to measure delivery readiness, coverage, and quality. Data often falls through the cracks. People are not out there advocating for costed data plans to make sure countries have both technical capacity and financial resources to measure what needs to be measured across a spectrum of issues.
There is not that voice for data. We see DataDENT helping to sort through this space, not so much by filling the gaps, but by helping shape the dialogue – being a voice for nutrition data and these priorities.
Q: As we move on to the role of DataDENT, where you see the biggest need and the biggest value-add that DataDENT can provide in a coordinating function?
Rahul: The goal of this investment was to help advance our global intervention coverage measurement agenda. We believe that nutrition has lagged behind some of the other sectors and we have relied on proxies for intervention coverage, such as status and behavior data which is not as useful for immediate decision making. DataDENT plays a role in helping to link and coordinate the coverage measurement area. By nature of the consortium partners involved in DataDENT, they are a part of expert groups supporting WHO and UNICEF in countries discussing monitoring frameworks for accountability tracking. DataDENT can help play a critical role to ensure the right data is used for these monitoring frameworks and address the specifics of the indicators used by countries to report against these frameworks. The last piece is around thinking about new metrics that need to be developed based on programmatic work.
Q: Let’s talk about the consortium aspect of DataDENTs work. Any thoughts on the partnership from the perspective of the foundation?
Rahul: I think it was clear to us that no single institution would likely be able to deliver against the ambitions of the project when we developed the request for proposals. The three institutions that came together to win this grant each brought unique perspectives and experience. I had not worked with R4D in the past, although Ellen has, and I have been impressed with the way they think about data visualization tools and scorecards. JHSPH has very rigorous methodological and research strengths. IFRPI has on the ground presence and strong links with policy makers and researchers. In India they are working closely with the newly formed National Nutrition Mission, the POSHAN Abhiyaaan. We are already seeing how the different organizations offer a new perspective to our work and how they can provide expert advice as well as play a coordinating function.
Rebecca: It’s been really wonderful. With IIP, we have been able to pull in faculty with deep experience with MNCH&N coverage measurement. IFPRI has very rich country experience applying metrics for evaluation. R4D is helping our more technical institutions to rethink how we are interfacing with policy makers and new audiences. They bring a new perspective and set of skills including communications expertise that has worked really well. There is a close partnership with the foundation team. It has been a fruitful and enjoyable collaboration with some early outputs that none of our individual institutions would have been able to deliver on our own.
Q: What are the main priorities right now for DataDENT?
Rebecca: DataDENT is a technically-rooted advocacy project that is working at a couple different levels to strengthen nutrition data systems. One level is by filling data gaps. Advocacy is all about striking while the iron is hot and responding where there is an opportune moment. One of these moments is the upcoming process to revise the Demographic Health Survey (DHS) Core Questionnaire which is used in many countries as the major data source. We decided to make one of our first priorities to help inform the nutrition community’s input to the DHS revision by pulling together knowledge and best practices in household and facility coverage measurement. We conducted an online survey of more than 230 nutrition data stakeholders to get a sense of the data demand and organized a 2-day consultation with technical experts, country and survey program representatives as well as development partners to review questionnaires. Another arena is the R4D-led work about data visualization tools. There has been a proliferation of these tools at global and country level, but we want to be able to have a clear reason why to invest in building more. So far R4D has looked across a set of global data visualization tools to identify whether there was a clear theory of change behind them and how they are being received by users. They will continue this work in a couple of our DataDENT countries and produce some recommendations for the broader nutrition community.
Q: What is your vision for DataDENT?
Rahul: DataDENT can play a role in strengthening the data system for nutrition through better coordination. Ultimately, we want to ensure the improved availability, quality and use of nutrition data for decision-making.
Ellen: In all the work that we do, it’s not really data for data sake but data for better policies, programs and outcomes. We see DataDENT helping the nutrition community keep focused on data alignment and results.
Rebecca: We have a wide mandate, but we want to take the lead from the nutrition community and in particular countries about where to focus. We do not want to start from zero. Rather we are walking into real situations, trying to identify some gaps and produce things that are responsive to the realities on the ground.