‘Ingredients for success’ in Tanzania: Reaping the rewards of a decade of nutrition collaboration

‘Ingredients for success’ in Tanzania: Reaping the rewards of a decade of nutrition collaboration

In 2020, ‘good news’ often gets lost. But in Tanzania, there is plenty to dwell on. According to the mid-term report for the National Multisectoral Nutrition Action Plan (NMNAP), published at the halfway point in September 2019, Tanzania is ‘generally’ on track to meet its goals, with 80 percent of impact indicators meeting mid-term targets. Figures for under-five wasting and under-five overweight were among these.[1] Stunting is also being reduced incrementally, from 34 percent to 32 percent, on target for 2018/19.[2] 

Photo1-Tanzania-ABC

Other indicators have surpassed expectations. Anaemia among women aged 15 to 49 decreased from 44 percent in 2016 to 29 percent in 2018, surpassing both mid-term goals (40 percent) and final NMNAP targets (33 percent).[2] This typically requires a multi-pronged approach, and in Tanzania’s case, the success was attributed to increased interactions within the healthcare system that resulted in better coverage and higher compliance for iron supplementation. In addition, counseling women about the consumption of iron-rich foods and the treatment and prevention of infectious diseases, such as malaria and intestinal parasitic (soil-transmitted helminths, STH) infections played a role.[3]

Despite these gains, 20 percent of the country’s nutrition interventions are not on track. Overweight and obesity among women are increasing, with approximately one-third of females ages 15 to 49 falling into those categories.[3] A related effect is that the prevalence of diabetes has almost tripled from 11 percent in 1991 to 28 percent in 2016, placing additional stress on already constrained health systems.[1]

A Promising Start

Tanzania joined the Scaling Up Nutrition (SUN) Movement in 2011, being one for the first countries to do so. UNN-REACH, a partnership founded in 2008 to accelerate progress on addressing child undernutrition and hunger, sent staff members to the country in 2011 to collect and map data, build capacity among staff and start to form a coalition, which led to the country’s first comprehensive nutrition plan, the NMNAP 2016–2021.

Photo 2 - Tanzania, UNICEF

The NMNAP charts a path forward that takes into account global, regional and national strategies and plans, the Sustainable Development Goals (SDGs), World Health Assembly targets, the country’s SUN Movement, the African Union Strategy on Nutrition (2015–2025), the Tanzania Vision 2025 and the National Five-Year Development Plan (2016–2021). Its interventions are evidence-based, with targets set at both national and sub-national levels. The NMNAP strives for one impact, seven outcomes and twenty-six measurable outputs.[2]

Joyce Ngegba is currently a Nutrition Specialist at the United Nations Children’s Fund (UNICEF), who previously served as the UNN-REACH Facilitator in Tanzania. “In 2012, we set priorities and started to prepare joint work plans linked to the United Nations Development Assistance Framework (UNDAF). I joined in 2014 and worked as a facilitator until 2016. [The way we worked with UNN-REACH] is still the way we work today. It helped to cement [our approach].”

What they’ve got right

In 2019, Tanzania and scored ten out of ten on the UN Network (UNN) functionality index.[4] When asked to account for this success, Fatoumata Lankoande, Chief of Nutrition at UNICEF, pointed to government ownership. “[Government officials] are more and more empowered, accountable and in the driving seat. [The UNDAF] is a national agenda, not just the agent for developing partners. The contribution to the budget for district-level nutrition was 52 percent from domestic resources.

Photo 3 - Tanzania UNICEF

Juliana Muiruri, Head of Nutrition for the World Food Programme (WFP), held a similar opinion. “Inclusivity. [Government officials] include the development partners in decisions so that we are part and parcel of the process. Government holds the chair and the co-chair is a development partner. We are not taken for granted. [This approach] infuses capacities.”

In an appropriate metaphor for nutrition, Juliana and Fatoumata unpacked some of the ‘top ingredients’ for Tanzania’s successful coordination mechanisms. In their words:

  1. We have a reference point: The National Multisectoral Nutrition Action Plan (MNAP I & II). Everyone working in nutrition refers to this document. REACH, as part of the UN Network, helped to draft these documents in 2016.
  2. There is a strong coordination structure from district to national level. At national level, we have a high-level steering committee which includes the Ministries of Education, Livestock, Agriculture, Industries, Health and Social Protection, among others. Moving down, we have regional steering committees led by regional officers in 26 regions. At district level, we have council steering committees, who hold quarterly meetings. Ward leaders also are accountable for their areas within districts. Specifically, they are expected to budget for and ensure [the] integration of nutrition priorities in their annual plan as well as to oversee the implementation of planned activities. 
  3. We have working groups that focus on themes such as micronutrients, maternal, infant, young child and adolescent nutrition, integrated management of acute malnutrition, diet-related noncommunicable diseases and governance. The Prime Minister’s office coordinates these technical groups, along with a development partner who acts as co-chair.
  4. The government provides approximately half of the funding which allows these interventions to be mainstreamed.

Collaboration with other SUN networks

Four additional SUN networks ‒ Business, Civil Society, Donor and Parliamentarian ‒ are active in Tanzania. They collaborate with partners, including the United Nations agencies, and government under the aegis of the Development Partners Group for nutrition. The networks run activities individually as well and report to each other. On a monthly basis, each SUN network provides an update of their activities, budgets and goals, including the UNN. Sometimes, these meetings result in forming new partnerships for specific activities, according to Juliana. One joint activity is the Kigoma Joint Programme (KJP) that focuses on health, nutrition and agriculture.

Photo 4 - Tanzania, UNICEF

Joint programming and successes

Kigoma is a region in Western Tanzania that is challenged by high stunting levels and maternal mortality, and also host to almost a quarter of a million people living in refugee camps from Burundi and the Democratic Republic of the Congo. The KJP comprises four United Nations agencies (UNFPA, UNHCR, UNICEF and WFP) to provide support in: education; agriculture; health; prevention of violence against women and children; economic empowerment; and energy.[5] While nutrition-specific actions are integrated into the health arm of the programme, other aspects of the programme (e.g. agriculture support) are nutrition-sensitive, helping to maximize impact. These interventions improve the availability, access and utilization of nutritional foods, especially for the most vulnerable communities, alongside social and behaviour change communication (SBCC) strategies to promote healthy diets.

Photo 5 - Tanzania, UNICEF

Another “One of our greatest accomplishments within the UN Network is the launch of an information system the culls from health, education and nutrition sectors country wide... Now we have a live system for data to report, analyze and make decisions,” says Juliana. The data portal ‒ the Multisectoral Nutrition Information System (MNIS) ‒ was recently launched in August 2020 and couples nutritional impact indicators with intervention coverage. While this an aspiration for many countries, it is now a reality for Tanzania. The system uses District Health Information Software, version 2 (DHIS2), an open source, web-based, health management information system platform. Its development was informed by an analysis that was done by UNN-REACH on nutrition information and surveillance systems in 2012, according to Joyce. “It was also inspired by the mappings,[6] carried out by UNN-REACH in collaboration with the government, which generated intervention coverage data aggregated across stakeholders for the first time,” adds Holly D. Sedutto, a long-serving member of the UNN Secretariat.

Similar platforms, used in Nepal and Pakistan, reflect a history of nutrition governance that has seen many iterations and strives to continually improve coordination efforts. “The MNIS platform makes timely, high-quality nutrition data readily available to a wide swathe of stakeholders and integrates seamlessly with other portals. The portal is a testament to the desire to update and share various real-time indicators to inform nutrition policy. The need for a harmonized data platform in Tanzania was discussed as early as 2012. Eight years later, it is operational and utilized by a wide range of stakeholders.[7]

Challenges ahead

When asked about the way forward, all three accomplished nutritionists referred to their collaboration with local government. Fatoumata and her colleagues are currently hammering out the next iteration of the NMNAP. She added, “We are [currently working on] developing the NMNAP II in conjunction with the Prime Minister’s office to ensure that the gains we have made are maintained.” For Juliana, the question of funding remains foremost, especially as the economic landscape of Tanzania shifts. “We are still looking to increase domestic funding. Now that Tanzania is a lower to middle income country, donor funds are decreasing, and we need domestic funding to replace external funding,” she says.

Joyce had another concern: capacity development. “We have to change the way we are working as the UN to support the capacity for [nutrition policy] implementation. We should change our role to technical support to ensure government counterparts have the skillset they need.” This question elicited emotion and her dedication to the country’s progress. “Mentorship, coaching. We have a big role,” she continued. To reach the most vulnerable.

 

Endnotes:

[1] https://globalnutritionreport.org/resources/nutrition-profiles/africa/eastern-africa/united-republic-tanzania/#profile

[2] Mid-term Review of the NMNAP 2016 –2021

[3] Analysis of the drivers of change in nutrition status of children and women in Tanzania, IFPRI, 2019

[4] https://www.unnetworkforsun.org/sites/default/files/country-profiles/UNN%20Country%20Profile-TANZANIA%20%28final%29.pdf

[5] https://www.dfa.ie/irish-embassy/tanzania/news-and-events/latestnews/ireland-supports-healthcare-in-kigoma---the-united-nations-kigoma-joint-programme.html

[6] The final mapping reports are available https://www.unnetworkforsun.org/tools/nutrition-stakeholder-action-mapping.

[7] MNIS Power Point Presentation, September 2020

Photo credits:

Photo 1: ABC Bros Company

Photo 2: UNICEF/Kate Holt

Photo 3: UNICEF/Chiara Frisone

Photo 4: ABC Bros Company

Photo 5: UNICEF/Chiara Frisone