Are data available for tracking progress on nutrition policies, programs, and outcomes in Bhutan?

Abstract

The World Health Organization (WHO) and other global nutrition and health agencies recommend nutrition actions throughout the life-course in order to address malnutrition in all its forms. In this report, we examined how Bhutan’s nutrition policies and programs addressed recommended nutrition actions, determinants, and outcomes. We reviewed population-based surveys to assess the availability of data on nutrition actions, nutrition outcomes, and the determinants of these outcomes; we also assessed the data availability in administrative data systems for selected nutrition actions and outcomes. Our policy review identified a total of 53 recommended nutrition actions; of which, 48 were applicable in Bhutan; of those, Bhutan’s nutrition policies addressed 46 and programs addressed 41. Nutrition actions that were not included in current policies and programs were: iron and folic acid (IFA) supplementation and deworming during preconception, food supplementation for malnourished lactating women, and IFA supplementation during early childhood. Policies addressed four actions for which there were no programs to implement it: daily IFA supplementation and deworming during preconception, advice about weight gain after weighing during pregnancy, outpatient management of severe acute malnutrition (SAM) and management of moderate acute malnutrition (MAM) during early childhood. National strategies and plans recognized and aimed to address all key determinants of nutrition except coverage under social protection schemes. National strategies and plans showed an intention to track progress of all other nutrition outcome indicators except underweight among non-pregnant women 15 to 49 years, overweight among school children and adolescents five to 19 years, and hypertension among adults. Of 41 actions that Bhutan’s policies and programs addressed, our data review found that population-based surveys contained data on only 17 actions; similarly, out of 15 actions we reviewed in the administrative data systems, data was available on seven actions. Data was not available from population-based surveys on a number of indicators, including those related to IFA supplementation, deworming, and food supplementation during adolescence; calcium supplementation, deworming, weight monitoring, and counseling during pregnancy; newborn care during delivery and the postnatal period; and infant and young child feeding (IYCF), growth monitoring, immunization, identification and management of SAM and MAM during early childhood. Population-based surveys contained data on 18 of 20 indicators on immediate and underlying determinants. Data on dietary diversity among pregnant women and on coverage of households under social protection schemes were not available in either the administrative data systems or the population-based surveys. The population-based surveys contained data on all nutrition outcomes except overweight among adolescents. In conclusion, Bhutan’s policy landscape for nutrition is robust. The gaps in availability of data for tracking progress on nutrition are large, however, and much greater than are the gap in policies and programs for addressing recommended actions. Future population-based surveys and modifications of other data systems should aim to fill the identified data gaps for nutrition action and outcome indicators.