Scaling Up Nutrition – Tanzania Hits The Road…

By Steve Godfrey, Chief Investment Officer, Global Alliance for Improved Nutrition (GAIN)

This week, Tanzania launched its five-year strategy to tackle malnutrition, and reviewed progress – the National Multisectoral Nutrition Action Plan (NMNAP). Political leadership was in abundance. But equally encouraging is the size and quality of efforts to build the machinery to deliver it.  Some real positives.

First, leadership. Some feared that the exceptional personal commitment of former President Kikwete on nutrition would be a hard act to follow. PM Kasim Majaliwa, as well as the Finance and Health Ministers spent two hours at the session. Three weeks ago, Vice President (VP) Mama Suluhu brought a team of five ministers to the national summit on strengthening food fortification.  The passion is evident – but backed by specific budget, performance and staffing commitments (more below).  It’s unusual to hear a Minister of Finance speak 15 minutes on malnutrition – its damage to the economy and harshest impact on the poorest. He is appointing a focal point in the Ministry to handle nutrition, maybe a first.

Second, budget commitment and spending.  This year government will double spending to Tz11bn shillings ($6M) for local government actions for nutrition support to Maternal Infant and Young Child and Adolescent Nutrition (MIYCAN) – now adding adolescents to mothers, infants and young children. In the past budgets have been underspent (52% in 2016/17), so the VP is bringing regional commissioners together next month to sign performance contracts to deliver this. The Expenditure Tracking Unit in Finance has set up a new national nutrition budget code. The President’s Office will soon have 10 nutrition advisers to drive implementation (the Deputy Ministers in the Prime Minister and President’s office also attended and spoke). Overall, the number of local nutrition workers will rise from 120 to over 600 next year.

Third, while not perfect (what is?) one real quality of the strategy is its breadth – as UNICEF’s Maniza Zaman said, this is not just a measurement framework on results, but also on resource flows and accountability. The systems put in place need development partners to up their game in reporting, but a good set of tracking and reporting scorecards are in place.

Finally, there is growing capacity and commitment at community and local government level – presentations on local in-clinic alternative models for Ready-to-use Therapeutic Food (RUTF), using traditional leaders to manage Severe Acute Malnutrition (SAM), new ways to identify and screen children, and using local foods better. The 100 local nutrition officers, civil society and academe present were passionate.

Malnutrition and food systems are complex problem, and there are always multiple challenges. From an outside – and imperfect – perspective here are a few which may be worth reflection –

First, while public sector investments in nutrition sensitive areas (ag, health, education etc) are being measured (and not doing badly, and they make up 70% of the total strategy investment), a wider social effort to involve opinion leaders across community, faith, media and is needed to make the issue a bigger priority. Leadership needs to be extended to all walks of life. Government can only do so much.

Second, while the overall strategy is comprehensive, it is focused on nutrition specific actions and needs more on building healthier food system. Only 3 of the 29 indicators are linked to food systems (two on fortification, one on dietary diversity)

There are worrying dietary trends causing ill health (globally, and in Tanzania – one presentation estimated that type-2 diabetes will rise to 7.9% by 2025). Grappling with the food system means building partnerships with business to boost the consumption of healthy and affordable diets, and curb elevated consumption of harmful foods. World Food Programme (WFP) reported that 59% of households cannot afford a nutritious diet. A start has been made in fortifying staples, and launching the Tanzania SUN Business Network, which has 90 members, but this is the least elaborated part of the strategy and  there were no businesses among the 200+ participants. The strategy calls for 10% of the investment from business, a pioneering effort – but there are few roadmaps globally to draw on.

Third, Tanzania is increasing its domestic investment in nutrition, and it would be great to see more coinvestments from donor partners.  At present about 43% of spending is from international partners. A core of donors have some engagement (USAID, DFID, Irish Aid, CIFF, World Bank, Power of Nutrition, Canada, EU) but the allocation of aid budgets to nutrition is small.  As the Heads of the World Bank and AFDB have said, nutrition is a top candidate for development impact. The Netherlands recently joined the effort and made a grant through GAIN for work on fortification and for SBN. UNICEF and WFP are doing great work. But Tanzania has many donors, more is needed for nutrition!

Tanzania has fifty million people and as the Minister of Health reminded, a third of its children are stunted and anemia is widespread. It will need to sustain the energy in the room (ululation, sirens accompanying the signing ceremony, a buzz which clearly impressed the PM) by building of public awareness and institutional investment. But overall, it feels like SUN is going to see some success in Tanzania. All development roads are bumpy, but Tanzania on the way to building a nutrition 4×4.

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Published 8 September 2017