Monitoring and evaluation of guideline implementation

A plan for monitoring and evaluation with appropriate indicators, including equity-oriented indicators, is encouraged at all stages (57). The impact of this guideline can be evaluated within countries (i.e. monitoring and evaluation of the programmes implemented at national or regional scale) and across countries (i.e. the adoption and adaptation of the guideline globally).

WHO is committed to supporting countries to reduce anaemia and has recently developed a comprehensive framework for action to prevent, diagnose and manage anaemia through a multisectoral approach (60). The framework sets forth ways to address the direct causes, risk factors, and broad social inequities that are fundamental drivers for anaemia. It describes the necessarily comprehensive approach that brings together multiple sectors and actors and identifies key action areas to improve the diagnosis, prevention, and management of anaemia, driving progress towards national and global targets. This guideline is key for supporting countries in the initial, and monitoring, phases of anaemia prevention and control programmes. WHO and UNICEF have also established an Anaemia Action Alliance (61), bringing partners across sectors together to support implementation of this guideline and the framework at the country level. A dedicated section of the WHO Global Health Observatory contains up-to-date global, regional, and country data on anaemia for the areas of maternal, newborn, child, and adolescent health and ageing (62). Since 1991, WHO has hosted the Micronutrients Database as part of the Vitamin and Mineral Nutrition Information System (VMNIS) (63). Part of WHO’s mandate is to assess the micronutrient status of populations, monitor and evaluate the impact of strategies for the prevention and control of micronutrient malnutrition, and track related trends over time. The Department of Nutrition and Food Safety manages the VMNIS Micronutrient Database through a network of regional and country offices, and in close collaboration with national health authorities.

For evaluation at the global level, the WHO Department of Nutrition for Health and Development has developed a web-based Global targets tracking tool (64) that allows users to explore scenarios to achieve the rates of progress required to meet the WHO Global nutrition targets 2025, including target 2 of a 50% reduction of anaemia in women of reproductive age (7). The tool also serves as a central platform for sharing information on nutrition actions in public health practice implemented around the world (64). By sharing programmatic details, specific country adaptations and lessons learned, this platform will provide examples of how guidelines are being translated into actions. The Global database on the Implementation of Nutrition Actions (GINA) (65) provides valuable information on the implementation of numerous nutrition policies and interventions.

An efficient system for the routine collection of relevant data, including relevant determinants of health, therapeutic adherence, and measures of programme performance, is critical to ensure programmes are effective and sustained and drivers to the achievement of the right to health for all population groups. Monitoring differences across groups in terms of the accessibility, availability, acceptability, and quality of the interventions contributes to the design of better public health programmes. Creation of indicators for monitoring can be informed by social determinants of health approaches, so that inequities can be identified and tackled. It is particularly important to design sound implementation strategies to serve as the basis for scaling-up efforts. Appropriate monitoring requires suitable data, so attempts towards collecting and organizing information on the implementation are also fundamental.