Identifying Imperatives for an Effective Nutrition Surveillance Policy Framework for Maternal and Child Health in Lesotho

Background: Surveillance of nutrition indicators is critical for informing nutrition policies and programs. The failure by many sub-Saharan countries to maintain functional surveillance systems for maternal and child health (MCH) hampers their capacity to achieve the 2030 Sustainable Development Goals relevant for MCH. The nutrition surveillance system (NSS) for MCH in the southern African country of Lesotho is no exception to this problem despite the country having some of the highest maternal and child mortality ratios globally. Objective: The study reviewed Lesotho's quantitative nutrition surveillance data and qualitatively analyzed the structure and functionality of Lesotho's NSS to identify imperatives for an effective nutrition surveillance policy framework for MCH in the country. Methods: Descriptive quantitative analyses were based on NSS data and nationally representative Lesotho Demographic and Health Survey (LDHS) data while qualitative analysis on data obtained through interviews with purposefully selected key informants working in the NSS of Lesotho was based on grounded theory. Results: Nutrition surveillance system data were inconsistently compiled across Lesotho's 10 districts, while LDHS data suggested that stunting, maternal anemia, child overweight, and low birth weight remain high. Challenges with the NSS were linked to poor coordination of the NSS due to an indistinct organogram of nutrition offices and poor cooperation among stakeholders in the NSS. Conclusions: To improve the NSS in Lesotho, the most critical imperative is to capacitate the Food & Nutrition Coordinating Office which in turn should create distinct nutrition offices yet with adequate cooperation and clear benchmarks for monitoring and evaluation of the NSS.