3

Framework for Discussion

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The Committee on International Nutrition (CIN) reviewed the reports of the five nutrition survey-surveillance activities provided by the U.S. Agency for International Development (USAID) from the perspective of how the survey findings could be utilized by USAID in decision making. The committee did this with regard to nutrition monitoring and programming in the Newly Independent States (NIS).

The CIN made three assumptions concerning the timeliness with which information from surveys was needed, USAID's role in NIS institution building, and causes of future changes in the food and nutrition situation. These are described below and guided the comments and suggestions that follow. These assumptions were necessary for several reasons. First, it was not always evident from the documents available to the committee why the information was being collected or for what purpose it would be used. Information verbally provided to the committee by the USAID representatives attending the first day of the meeting sometimes conflicted with the written instructions to the CIN in the memoranda in Appendix A—for example, with respect to the proposed time frame of USAID's involvement in the NIS. Second, the studies evaluated were diverse in purpose and populations studied; this fact, plus the inconsistent quality of methods across studies, made interpretation of the overall findings difficult. The committee wishes to note in this context, however, that many of the studies examined were in a pilot, preanalysis, or draft phase, and thus had not yet generated the types of data that would have been helpful to the committee. Third, it was not possible to provide the committee with all the background information needed to make a detailed assessment of the nutrition situation in the NIS or to



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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities 3 Framework for Discussion ◆ ◆ ◆ ◆ ◆ The Committee on International Nutrition (CIN) reviewed the reports of the five nutrition survey-surveillance activities provided by the U.S. Agency for International Development (USAID) from the perspective of how the survey findings could be utilized by USAID in decision making. The committee did this with regard to nutrition monitoring and programming in the Newly Independent States (NIS). The CIN made three assumptions concerning the timeliness with which information from surveys was needed, USAID's role in NIS institution building, and causes of future changes in the food and nutrition situation. These are described below and guided the comments and suggestions that follow. These assumptions were necessary for several reasons. First, it was not always evident from the documents available to the committee why the information was being collected or for what purpose it would be used. Information verbally provided to the committee by the USAID representatives attending the first day of the meeting sometimes conflicted with the written instructions to the CIN in the memoranda in Appendix A—for example, with respect to the proposed time frame of USAID's involvement in the NIS. Second, the studies evaluated were diverse in purpose and populations studied; this fact, plus the inconsistent quality of methods across studies, made interpretation of the overall findings difficult. The committee wishes to note in this context, however, that many of the studies examined were in a pilot, preanalysis, or draft phase, and thus had not yet generated the types of data that would have been helpful to the committee. Third, it was not possible to provide the committee with all the background information needed to make a detailed assessment of the nutrition situation in the NIS or to

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities conduct an in-depth review of individual programs and projects. This task was complicated by the enormous geographic, ethnic, sociocultural, economic, and political diversity of the NIS and the difficulties in generalizing findings and recommendations for programmatic change on the basis of a few geographically limited studies. Fourth, the documents provided on the nutrition situation in Russia described the situation as of, or prior to, 1992 (except for the Cooperative for American Relief Everywhere [CARE] survey on children under 2 years of age in Russia, conducted in 1993); no data were available on which to base an assessment of the current situation. As a result of these limitations, the CIN was not able to answer the three questions posed to it by USAID to the degree of specificity that it would have liked. TIME FRAME DEFINITION There are three time frames within which food and nutrition information might be needed in a situation where there is the potential for food or nutrition problems: An intervention might be needed immediately, due to short-term food or nutrition emergencies caused by the dislocations resulting from liberalization of the market of the former Soviet Union and the development of the NIS. In this case, a short-term single survey is required to provide an alert and from which necessary information must be available within a few months. The CARE Pensioner Surveys provide such an example of a rapid turnaround approach. The information required should, however, be linked to potential programmatic solutions, and the committee could not discern the extent to which this was done in the CARE surveys. If there is a longer-term concern, wherein decisions have to be made within approximately 6–12 months, then surveillance should be instituted. In this report, the word “surveillance” is used only when monitoring activities are linked to the decision-making process.5 This internationally recognized convention was not followed systematically in the documents given to the committee. Although this surveillance can be done by external agencies, it is best achieved by setting up an indigenous system that makes repeated short-term surveys. If the period of concern is at least 1–2 years, then indigenous longer-term surveillance activities such as the Russian Longitudinal Monitoring Survey (RLMS) are appropriate. Again, links to decision making are essential. The CIN believes that a longitudinal survey such as the RLMS should also be able to produce timely information that could be useful for assessing the acute impact of the current situation on the nutritional status of populations in Russia and the NIS. In order for a survey to be useful as an alert to emergencies, as well as 5   J. B. Mason, J-P. Habicht, H. Tabatabai, and V. Valverde. 1984. Nutritional Surveillance. World Health Organization, Geneva, Switzerland.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities It was not clear to the committee which of the above time frames is most important to USAID or to those who will use the information. The committee believes that collecting information during all three time frames is important but assumed in its review that the USAID requires this information from the NIS primarily as an alert to food and nutrition emergencies. Chronic, preexisting problems with the quality or quantity of food or with micronutrient deficiencies create a different level of concern and require different actions. Nevertheless, these problems are also noted in this report. INSTITUTION BUILDING AS A PRIORITY The committee was informed verbally that USAID is not currently planning to provide major support for institution building in the NIS, and it assumed this viewpoint in its review. It should be noted, however, that a letter to the committee from the Chief of Health Programs at USAID indicates that their Office of Democratic Initiatives and Health and Humanitarian Resources (DIHHR) is responsible for longer-term health programs that focus on institutional development (see Klement memo, Appendix A). A major objective of the RLMS appears originally to have been to train and empower Russian institutions to monitor their own food, nutrition, health, and economic situation. CAUSES FOR FUTURE CHANGES Changes observed in the health and nutrition situation in Russia and the other NIS could be explained by several causes that differ in their implications for interventions and changes in policy. These include: changes in the food system (food availability); diminished consumer purchasing power, which denies households access to food despite availability in the market place; failure of social networks and government safety nets; and lack of medicines and nutrient supplements. Working within the framework of these assumptions, the CIN reviewed the information provided, with the aim not only of summarizing what was known about the food and nutrition situation in Russia in 1992–1993 (see USAID's Question 1 to CIN), but also of evaluating the methodologies that have been used and suggesting approaches for future surveillance activities.

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