ADVANCING NUTRITION GOALS IN TANZANIA

ANNUAL REPORT

2015

The CenTre for Counselling, nuTriTion and healTh Care (CounsenuTh)

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The Centre for Counselling, Nutrition and Health Care (COUNSENUTH)

ADVANCING NUTRITION GOALS IN TANZANIA

ANNUAL REPORT 2015

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ACRONymS AND AbbREVIATIONS

AIDS AcquiredImmuneDeficiencySyndromeANC Anti – Natal CareARV Anti-RetroViralBCC BehaviourChangeCommunicationBFHI BabyFriendlyHealthInitiativeCBO CommunityBasedOrganizationCBOs CommunityBasedOrganizationsCHW CommunityHealthWorkerCHWs CommunityHealthWorkersCMT CouncilManagementTeamCOUNSENUTH TheCentreforCounselling,NutritionandHealthCareCSOs CivilSocietyOrganizationsCTC Care and Treatment ClinicDC DistrictCouncilDED DistrictExecutiveDirectorDNMSC DistrictNutritionMultisectoralSteeringCommitteeDNTFs DistrictNutritionTechnicalFacilitatorsDNuOs DistrictNutritionOfficersFBO FaithBasedOrganizationFTF Feed the FutureGOT GovernmentofTanzaniaHFs HealthFacilitiesHFW HealthFacilityWorkersHIV HumanImmunodeficiencyVirusIBFAN InternationalBabyFoodActionNetworkIEC Information,EducationandCommunicationIFA IronFolicAcidIGA IncomeGeneratingActivityLGAs LocalGovernmentAuthoritiesMBNP MwanzoBoraNutritionProgrammeMPs MembersofParliamentsNCD Non-CommunicableDiseaseNGO Non-GovernmentalOrganizationORCI OceanRoadCancerInstituteOVC Orphan and Vulnerable ChildrenPLHAs PeopleLivingwithHIVandAIDSPSGs PeerSupportGroupsRAS RegionalAdministrativeSecretarySAM SevereAcuteMalnutritionSBCC SocialandBehaviorChangeCommunicationSILC SmallandInternalLendingCommunitygroupsSUN ScalingUpNutritionTDHs TanzaniaDemographicHealthSurveysTFNC TanzaniaFoodandNutritionCentreUNICEF UnitedNationsChildren’sFundUSAID UnitedStatesAgencyforInternationalDevelopmentVF Virtual Facilitated VHNDs VillageHealthandNutritionDaysWBW WorldBreastfeedingWeekWHO WorldHealthOrganization

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TAbLE OF CONTENTS

Acronyms and Abbreviations .................................................................................... 2

1.0 Introduction ....................................................................................................... 4

2.0 COUNSENUTH’s Vision, Mission, Strategic Themes and Strategic Objective ........................................................................................... 5

2.1 Programsunderstrategicobjectives .......................................................... 6

2.2 COUNSENUTH’sPrinciples ........................................................................... 6

2.3 CoreValuesofCOUNSENUTH ................................................................. 7

2.4 OurMandates .................................................................................................... 7

2.5 Strategies ............................................................................................................. 7

2.6 Resources ............................................................................................................ 9

3.0 Accomplishment for 2015 ............................................................................... 10

4.0 Detailed Activities ............................................................................................ 11

4.1 StrategicObject1:AwarenessofGovernanceandAccountabilityin NutritionSectorRelativetoBaselineisimproved ....................................... 11

4.2 StrategicObjective2:Improvednutritionofwomenandchildrenunder 5throughscaleupaminimumpackageofhighimpact interventionfornutrition. ................................................................................ 12

4.2.1 Lishe Ruvuma Programme ............................................................................. 12

4.2.2 Mwanzo Bora Nutrition Programme (MBNP) ............................................ 24

4.2.3 COUNSENUTH Innovative Projects are strengthened ............................ 34

4.3 StrategicObject6:DocumentationofSuccessStoriesand LessonLearnt ..................................................................................................... 38

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1.0 INTRODUCTION

During 2015, COUNSENUTH continued to keep its commitment to improve thequalityof lifeforvulnerablegroupsbystrengtheningevidencebased,costeffectiveand locallygrown innovativenutrition interventions.Numerousopportunities andinitiativesenabledtheCentertoprogressinkeepingwithitscommitment.

TheInstitutionhasafiveyearstrategicplanwithfivestrategicobjectiveswhichalignwithcurrentnationalplaninnutrition.Theseinclude:

i. Increased involvementofCSOs innutritiondecisionmaking, implementationandmonitoringofgovernanceandaccountabilityinthenutritionsector

ii. Improvednutritionofwomenof reproductiveage (15-49years) and childrenunder 5 years of age through high impact nutrition interventions at thecommunitylevel

iii. Improved provider performance and internal capacity of COUNSENUTHand other CSOs to expand access to quality nutrition services to vulnerablepopulations

iv. Improved capacity for prevention, management and control of non-communicable, diet related diseases (NCDs) and enhanced youth life skillsthroughCOUNSENUTHinnovativeprojects

v. Enhanced evidence-based decision-making through research, documentationofbestpracticesfromimplementationofprogramsandwidedisseminationoffindings

ThisreporthighlightstheCentre’sworkfortheyear2015toimprovethequalityoflifeforvulnerablegroupsinTanzania.Despitesomefinancialchallenges,theCentrewasabletosuccessfullycompleteover90%ofitstargetsin2015.Thestrategicplan2012-2016gavedirectiontotheachievementsmadeandcontinuedtoguidetheactivitiesoftheorganization.

TheCentre’sprioritieshavebeenthatofbuildingawarenessandinspirationalactionsto improvenutritionathousehold level.Theyearmarkedamajor increase in suchactivitiesthroughmulti-facetedevidence-basedapproacheswhichincludeSocialandBehavior Change Communication (SBCC) and strategic grants to implement high-impactnutritioninterventionsthroughregionalanddistrictauthoritiesandlocalCivilSocietyOrganizations(CSOs).TheCSOshaveundergoneinstitutionalcapacitybuildingandsupporttoleadprogramimplementationatthegrassrootslevelespeciallyunderMwanzo Bora Nutrition programme. All programmes’ nutrition interventions areaimedatpromotingtheadoptionofpositivebehaviorsathouseholdandcommunitylevel;strategicpartnershipsinordertoleverageresources;andtraining/institutionalstrengtheningtoimprovethequalityoffacility-basednutritionservicesandnutritionprogrammingatnationalanddistrict/councillevelsandhomemadesolutionsatthecommunityandhouseholdlevel.

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2.0 COUNSENUTH’S VISION, mISSION, STRATEGIC THEmES AND STRATEGIC ObjECTIVE

Figure 1 shows COUNSENUTH’s vision, mission, strategic themes and strategicobjectivesinwhichtheCentre’simplementationoftheworkplanfortheyear2015isbased.ThisyearTheCentrehasassuredfundingforObjective1,2,3,somepartsof4and 5.

Figure1:SummaryStrategicPlan2012-2016

Overall,in2015COUNSENUTHresourcesandactivitiesfocusedonthefollowingmainprojectareas:

a) Lishe Wajibu: It is an integrated program to enhance capacity of CSOs toaccelerate nutrition actions and improve governance and accountability inachievingnutritiongoalsandreducechildhoodstuntinginCoast,MtwaraandKageraRegions

b) LisheRuvuma:ItisanintegratednutritionprogramtoreducechildhoodstuntingbyscalingupaminimumpackageofhighimpactinterventionsinTunduruandSongeaDCinRuvumaregion,afiveyearprogram.

c) Mwanzo Bora Nutrition Program: A program under the Feed the FutureInitiative to reduce maternal anaemia and childhood stunting in Morogoro,Iringa,ManyaraandDodomaregions

d) TechnicalAssistanceToPartners&CSOs:Providetechnicalassistancetootherdevelopmentpartnersandgovernment(asperdemand)

e) EnhancingtheCapacityofProvidersandInternalCOUNSENUTH’sCapacity

• Institutionalandorganizationalstrengthening

• Building of care provider and CSOs’ capacity in nutrition programminginMorogoro,Manyara andDodoma regions and LisheRuvumaprogramin Tunduru and Songea districts; and in monitoring of governance andaccountabilityinCoast,MtwaraandKageraregions

To have a Tanzania where all people have

physical and economic access to

sufficient, safe and nutritious

food at all times to achieve a healthy and quality life.

Implementation of evidence-based and

scalable interventions at community level

Strategic Focus Areas Strategic Objectives Vision Mission

Raise awareness in the area of nutrition sector

governance and accountability

Contribute to knowledge and evidence base in nutrition programming

Counsenuth works towards

improvement of the quality of life of

vulnerable groups through provision of

affordable interventions that

are evidence–based and locally

appropriate; advocacy for better

governance for nutrition; active engagement of

citizens at all levels and multi-sectoral

collaboration.

1. Awareness of governance and accountability in nutrition sector relative to baseline is improved

6. Best practices are documented and utilised for improved planning and resource allocation

Institutional strengthening and stakeholder

engagement at all levels

2. Scale up a minimum package of high impact intervention for nutrition in Songea Rural and Tunduru districts of Ruvuma region in line wit the National nutrition framework

3. Contribute to the implementation of the nutrition component of the Feed the Future programme in three regions –Dodoma, Manyara and Morogoro

4. Enhance capacity of COUNSENUTH and other CSOs in Scaling Up of Nutrition and nutrition sector governance

5. COUNSENUTH’s Innovative projects are strengthened

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f) Counselling&InnovativeCounsenuthServices

· Nutritioncentrebasedcounselingandworkplacewellnessservices · Nutritioncounselingfordietarymanagementofcancer forcancerpatients

andfamiliesatOceanRoadCancerInstitute · Youthlifeskillsdevelopmenttopromotehealthylifestyles · WasichanaLeadershipprogram · VolunteersandInternsprogram · Consultancies

g) EnhancingEvidenceBasedDecisionMakingThroughResearch,DocumentationOfBestPractices

· Strengtheningmonitoring and evaluation systemswithinCOUNSENUTHprogrammesandaligningwithnationalsystems.

· DocumentationofLessonsandBestPracticesandtheirwidedisseminationthroughvariousmediahouses,stakeholdermeetingsandpublications.

· Needbasedresearchtoinformpolicyandplanning.

2.2 COUNSENUTH’s Principles

Inimplementingthestrategicplan,COUNSENUTHobservesthefollowingprinciples:

· ThereisonecomprehensiveNationalNutritionStrategyandPlanofAction,andCOUNSENUTHwillworkwithinthismulti-sectoralcoordinatedframework.

· CivilSocietyhasakeyroletoplayincontributingtobetternutritioninTanzania,and COUNSUNUTH will strive to increase CSOs and its participation inimprovingthenutritionofitspeople.

· Communitymembersarethekeyplayersinassessingtheirproblems,analysingthecausesandrespondingeffectivelytofindsolutionsfornutritionchallenges.COUNSENUTHwillbethecatalystandassisttofacilitatethisprocess.

· Thegovernmentanditspeoplearethedriveroftheirdevelopment.TheroleofCOUNSENUTHwillbetosupportthisprocessinthebestwaypossible.

· Allworkinnutritionistobeguidedbythenationalgovernmentandgloballyacceptable laws, policies, and guidelines. COUNSENUTH will work withintheseparameters.GenderandhumanrightsconcernswillformthebasisofallCOUNSENUTH’swork.

2.3 Core Values of COUNSENUTH

· Integrity –COUNSENUTHstrivesforstrictworkethics.ItprotectstherightsofwomenandchildreninallitsProgrammes,statements,andadvocacywork.ItisattheforefrontinmonitoringcomplianceoffoodindustriestowardsinternationalandnationalFoodLawsandRegulation.AsaNon-GovernmentOrganization(NGO),COUNSENUTHstrives toworkwithin thegovernment’s regulationsguidingcivilsocietyoperations,anditalsoappliesdemocraticelectiontochooseitsexecutiveleadership.

· Accountability – COUNSENUTH has its own internal rules and it is alsoaccountabletoitsBoardofDirectors,organization’smembersandbeneficiaries(i.e. vulnerable groups,CSOs, government and others requiring its services).COUNSENUTHpracticesahighleveloftransparencyinallitsundertakings.

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· Quality of Service – COUNSENUTH is very particular about the quality ofservices it delivers. It ensures that its services arewithin theWHOnutritionrecommendations and the national nutrition policies and guidelines. Ourtechnical assistance to our partners often exceeds their expectations. Ourinformationandcommunicationmaterialsareamongthebestandareinhighdemandsincetheyarerelevant,targettheneedsofthepeopleandalwaysuptodate.

2.4 Our Mandates

COUNSENUTHcontributestopovertyreductionandachievementoftheMillenniumDevelopment Goals, established by global leaders in 2000 and endorsed by HisExcellency,thePresidentandotherworldleaders;aswellasotherglobalandnationalcommitmentsonnutrition.

ThemandatesofCOUNSENUTHincludebutarenotlimitedto:

1. Monitoringnutritionsectorgovernanceandinfluencingpoliciesanddecisionstoimprovenutritionalwell-beingofTanzanians.

2. Promotingoptimalchildandmaternalnutritionandnutritionofothervulnerablegroups.

3. Improvingknowledgeandskillsofcivilsocietygroupsandcommunitybasedserviceprovidersonpreventivehealth,nutritionandcounsellingskills.

4. Contributing to knowledge and evidence base by working with communitygroupsto implementcommunity–basedhealthandnutritionprogrammesforvulnerablegroups,withemphasisonhomegrownsolutionssuchaspromotionofbreastfeeding,useoflocaltechnologiessuchasfermentationandgerminationanduseofindigenousfoodstoimprovefoodsecurityanddietaryquality.

5. Promoting awareness to food consumers on food quality, safety standards,hygiene and sanitation, nutrient value and healthy lifestyles through publiceducationandinformation.

6. Creating awareness on human rights, gender issues and gender sensitivenutritionplanning

7. Promoting innovative interventions to improve nutritional wellbeing of allpeople.

8. Organizational and institutional development for COUNSENUTH and otherCSOs.

9. Advocacy and lobby to achieve sound policies, guidelines for nutrition andbetterlivesforwomenandthepoor.

2.5 Strategies

Toachieveitsmandates,COUNSENUTHemployedanumberofstrategiesincludingthefollowing:

1. Capacitybuildingonnutritionincludingthatofacriticalmassofimplementersat all levels (i.e. regional, district, health facility and community level) as away of increasing access to knowledge and information on nutrition care

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andsupport forvulnerablegroups.Vulnerablegroups thatCOUNSENUTHsupports includePeopleLivingwithHIVandAIDS(PLHAs),OrphansandMostVulnerableChildren(MVCs),NGOs,CommunityBasedOrganizations(CBOs),Faith-BasedOrganization(FBOs),women,youthandchildren.

2. Nutrition Advisory and Technical Assistance services to government andimplementing partners in programme design and implementation; policydevelopment, planning and related areas; capacity building andmentorship;conductingbaseline, formativeandfeasibilitystudies,othernutritionsurveysand assessments; operational research; project evaluation andpropagation oflocalmethodsandtechnologiesthatenhancenutritionofpeople.

3. Designing, development and dissemination of user friendly and up to datesocialbehaviourchangecommunicationeducationandadvocacymaterialsandtools.

4. Advocacytoplacenutritionhighonnationaldevelopmentagendaandforpropergovernmentcontrolofnationalresourcesfornutrition,foodstandards,safety,hygieneandsanitation.Thisincludesholdingproducers,distributorsandotherfoodhandlersonfoodsafetystandards,hygieneandsanitationaccountable.

5. WorkingwithCBOs/FBOstoimplementcommunity–basedhealthandnutritionrelated programmes and counselling services forwomen, children and othervulnerable groups, with emphasis on infants, young children and pregnantandlactatingwomen,youthandadolescents;noncommunicablediseasesandlifestyles;andnutritioncaresupportforPLHAs.

6. Networkingandlobbywithinthecountryandabroadforcrossfertilizationofideastoincreaseeffectivenessoftheorganizationanditswork.

COUNSENUTHmeasures successby the improvement it observes inpro-nutritionbehaviour and increase in the number of women and childrenwho are free frommalnutritionandhavebetterqualityoflife.

Womenofreproductiveage

· Childrenunder5yearsold

· YouthandAdolescents

· MostVulnerableChildren,OrphansandFamilies

· Menaspartners

· TheselectedCSOsfromthetargetregions

· The Local GovernmentAuthority (RAS, DED,Heads of Department,MPs,Councilors, and the Council nutrition multi-sectoral committees, staff ofcouncilsespeciallythenewlydeployedregionalanddistrictnutritionofficersandfocalpersonsfromthenutritionspecificandsensitiveministries

· Extensionworkers,Communityleaders,HealthFacilityWorkers,VillageHealthWorkers,andothercommunitygroups

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2.6 Resources

OurPeople

COUNSENUTHmaintainsaminimumnumberofstaffandemploysothersdependingonfundedprojects.Currently,COUNSENUTHemploys23wellqualifiedstaffatourHeadQuarters inDaresSalaamandfour (4) in thefield.COUNSENUTHalsohasanumberofvolunteersandanetworkofmembers, trainersandconsultantsat thenationallevelandinthedistricts.COUNSENUTHisalsoaffiliatedtoabout25CBOsin25districts.Ourcommunities,ourleaders,ourhealthserviceprovidersandallthoseCOUNSENUTHservesandassociateswithareourresources.

Information and Communication Resource Centre

TheCOUNSENUTHInformationandCommunicationResourceCentredevelopsanddisseminatessocialbehaviourchangecommunicationresourcematerialsfornutrition,counselling, trainingandadvocacy.TheCentrehasbeenagreatsourceofnutritioneducationespeciallyforcommunitybasedimplementers.

Nutrition Technical Services

Thisfunctionfocusesonmajorareasincludingdesignandimplementationofformativeresearch,feasibilitystudiesandsurveys;capacitybuilding,trainingandmentorship;programme design, implementation, monitoring and evaluation; and curriculumdevelopment.

Counseling Services

COUNSENUTHhasestablishedacounsellingcentreopentothepublic,whichnowprovidesnutritionandhealthcounsellingtopromotehealthyeatingandlifestyles.

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3.0 ACCOMPLiSHMENT fOR 2015

A Summary

During the year, COUNSENUTH, through Mwanzo Bora NutritionProgramme,managedtocover89(75.4%)ofthe118newplannedhealthfacilitiesprovidingRCHservicestocommunitiesinthezoneofinfluence(ZOI)inthreecouncils(Mafinga,Kilolo&IringaMunicipal)ofIringaRegion.Also,theprogramcovered293(99.7%)ofthe294wardsand1,557(99.9%)ofthe1,558villagestargetedintheZOIinMorogoro,Dodoma,ManyaraandIringaregionsinthisfinancialyear(Table1).

InLisheRuvumaproject,theCentremanagedtocovermorethan100%ofthetargetsinyear2015.Briefly,10(100%)divisions,19(126.7%)wards,92(100%)villages,353(110.3%)Hamlets/Streets,80(140.4%)healthfacilitiesand31(310%)primaryschoolsinTunduru,SongeaandMadaba(Table1).

Table 1: Summary Coverage of MBNP and Lishe Ruvuma in 2015 year

Project Coverage in 2015 year

Category Target Achievement %

MBNP

healthfacilities 118 89 75.4Wards 294 293 99.7Villages 1,558 1,557 99.9

Lishe Ruvuma

Divisions 10 10 100Wards 15 19 126.7Villages 92 92 100Hamlets/Streets 320 353 110.3Healthfacilities 57 80 140.4

Primaryschools 10 31 310

InLisheWajibuprogramCOUNSENUTHaimedtostrengthenthecapacityofNGO’stobeabletomonitoraccountabilityinnutritioninterventions.In2015,COUNSENUTHwith financial support from the Foundation for Civil Society (FSC), conductedassessmentinnutritionknowledgeandgovernanceandcapacityofCSOsinhandlingnutritioninterventionsinthethreedistrictsofBagamoyo,MulebaandMasasi.LisheWajibuisaprojectthatisaimedatenhancingthecapacityofCivilSocietyOrganizations(CSOs)toacceleratenutritionactionsthroughimprovedgovernanceinordertoreducechildhoodstuntingby2percentfrombaselinein3years.PoorGovernancecultivatespovertyandinequity”andpovertyisanunderlyingcauseofpoordietaryintakeandinfectiousdiseasesthetwomajorcausesstunting.

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4.0 DETAiLED ACTiViTiES

4.1 Strategic Object 1: Awareness of Governance and Accountability in Nutrition Sector Relative to Baseline is improved

During 2015, COUNSENUTH incollaborationwithLGAs,DNTFs,andPrimeMinister’s Office conducted a number ofcapacitybuildingactivitieswhichincreasedinvolvement of CSOs in nutrition decisionmaking, implementation and monitoringof governance and accountability in thenutrition sector in the regions ofDodoma,MorogoroandManyaraaswellasTunduru,Songea and Madaba districts in RuvumaRegion.CivilsocietieshavehelpedtoshapetheScalingUpofNutrition(SUN)Movementatgloballevelandhelptodeliverimprovednutritionatcountrylevel.

Through MBNP, Lishe Wajibu and LisheRuvuma projects, COUNSENUTH aims toimprove the lives of pregnantwomen andchildren from conception to 24months bymeans of supporting the GOT and localTanzanian CSOs to improve nutritionalawareness, governance, accountability andoutcomesintargetedregionsofthecountry,withastrongfocusonscalingupcommunitylevelinterventions.

In 2015, COUNSENUTH continued tointroduceanintegratednutritionpackagetoenhancecapacityofCSOstoacceleratenutritionactionsandimprovegovernanceinnutritionprogramstoreducematernalanaemiaandchildhoodstuntinginMorogoro,Dodoma,Manyara andRuvumaRegions.These regionswerepurposively selectedfromamongtheregionsthatcontributetohighprevalenceofmalnutritioninchildrenandwomenofreproductiveagebasedonTDHS2010.

During2015,fundingfromUSAID,IrishAIDandFoundationforCivilSocietyenabledCOUNSENUTHtosupportthefollowingnutritioninterventionsthroughMBNPandLisheRuvumaprojects:

- Conducted Needs Assessment to 15 CSOs (working with MBNP) foroptimization of the capacity in supervising program implementation atcommunity level. Lishe Wajibu in particular, assessed CSOs operating inMuleba, Bagamoyo andMasasiDistrict Councils in terms of awareness onnutrition issues, good governance and accountability in implementation ofnutritionprogrammes.Theaimwastofindoutanyareaforimprovementinparticularorganizations.ThisisacomprehensiveapproachadoptedtosupportLocal Civil SocietyOrganizations on evidence-based activities in achievingorganizationalchange,learninganddevelopment.

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- Conducted training, coaching and mentorship to 64 (50 from Morogoro,Dodoma&Manyararegionsand14fromTundurudistrict)CSOsstafftoaddressidentified capacity gaps as appropriate where MBNP and Lishe Ruvumaprojectsareoperating.ThemainobjectiveofthetrainingwastoenhancethecapacityofCSOsonkeypriorityinterventionsforreducingmaternalanemiaandchildhoodstunting.

- Conductedquarterlysupportivesupervisionto15CSOsonimplementationofnutritionSBCCactivitiesintheregionsofMorogoro,ManyaraandDodoma.Thisconstitutes100%of the totalnumberofCSOs targeted thisyearunderMBNP.

4.2 Strategic Objective 2: improved nutrition of women and children under 5 through scale up a minimum package of high impact intervention for nutrition.

Malnutritionisoneofthemostserioushealthproblemsaffectinginfants,childrenandwomenofreproductiveageinTanzania.Despiteprogressmade,millionsofchildrenandwomeninTanzaniacontinuetosufferfromoneormoreformsofundernutrition,including low birth weight, stunting, underweight, wasting, anaemia, iodine andvitaminAdeficiency.

Improvementofnutritionofwomenofreproductiveage(15–49)andchildrenunderfiveyearsofagehasbeenrealizedthroughhighimpactevidencebasedinterventionsatthecommunitylevel.

4.2.1 Lishe Ruvuma Programme

Lishe Ruvuma programme goal is to reduce childhood stunting by 10 % throughscalingupofaminimumpackageofhighimpactEssentialNutritionActionsfocusingon thefirst 1000days (fromconception to 24months). In 2015,COUNSENUTH incollaboration with DNuOs, LGAs, CHWs and Community Leaders managed todeliver nutrition services and messages to big numbers of program beneficiariesthroughVillageHealthandNutritionDays(VHND),healthfacilities,IECmaterials,campaignsandeventslikeWorldBreastfeedingWeekandNaneNanecelebrationsinTunduruandSongeaDCs(Table2)

Table 2: Summary distribution of beneficiaries reached in Tunduru and Songea districts

Project Program Beneficiaries Reached Through various programs

Type of Beneficiary Target # Achieved %

Lishe Ru-vuma

Pregnantwomen 6,300 11,540 183.2

ChildrenU5whoreceivednutritionservicesunderIrishsupportedpro-grams

17,700 36,018 203.5

Lactatingwomen 4,800 9,197 191.6

Womenofchildbearingage 55,794 64,328 115.3

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COUNSENUTHhascontributedtothisthrough2leadprograms:

Buildingonthesolidmomentumaboutpositivenutritionbehaviours,COUNSENUTHworksoncapacitybuildingforLGAs;improvementofperformanceofhealthfacilityand community level providers ; capacitating households to produce and accessnutrient – dense foods improved through increased linkages to agriculture andlivestock sectors; strengthening community ownership and investment in nutritionfocused andnutrition sensitive interventions; improvedpractices anddemand forhealthandnutritionservices forpregnantand lactatingwomen, infantsandyoungchildren;influencingpositivegenderrelationsandequalityandthesituationofwomenandgirls;andempoweringDistrictCouncilstoestablishdistrictnutritionsurveillanceandknowledgemanagement.During2015theprogramwasabletodeliveronvariousoutcomesasfollows:

i. Enhanced Capacity of LGAs on gender sensitive planning and implementation of nutrition policies and programs

Inorder toenhanceprioritizationofnutritionandthecapacityofLGAsforgendersensitive planning and implementation of nutrition policies and programs withmeaningful linkages between nutrition, health services, agriculture and other keysectorstoimprovelivelihoodsandnutrition,COUNSENUTH,throughLisheRuvumafacilitatedthefollowingactivities:

- Established one (1) District Multi-sectorial Nutrition Steering Committee and discussed their Terms of Reference and Sector Representatives in Songea DC. TheestablishmentoftheDistrictNutritionMulti-sectoralCommitteesisthedirectiveofthegovernment.TheCommitteewasorientedontheNationalNutrition Strategy and its key areas, themalnutrition situation, its causes,consequencesandtheneedforpreventionofmaternalanemiaandchildhoodstunting.Theneedtoplanandbudgetfornutritionactivitiesintheirrespectivesectors was emphasized and the national guidelines for district nutritionplanning were shared with all heads of Departments. The members wereremindedtoconductquarterlyreviewmeetingsfortheirplans.TheobjectiveofthemeetingwastoringabellabouttheobjectivesoftheProgrammeandtherolesoftheDMNCinachievingthenationalgoalsfornutrition.

- Facilitated Quarterly & Monthly Meetings for Planning and Progress Review in Songea and Tunduru Councils. ThroughCOUNSENUTH’sadvocacy,theLGAswere able to conduct six quarterlymeetings (4meetings in Tundurudistrictand2inSongea).TheTundurudistrictinparticularwasabletobudgetfortwomeetings.Thiswasadvancementfromthefirstyearwhentheycouldonlypartiallysupportonemeeting.

The aim of District Multi-sectoral Nutrition Committee (DMNC) is tostrengthen LGA capacity to increase investment in nutrition and improvequality of district nutrition services, report on progressmade and enhancecoordinationofnutritionactivities.

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ii. Improved performance of health facility and community level providers in delivering quality care and integrated nutrition services for pregnant, lactating women, infants and young children through a number of activities in all targeted regions

Duringthisyear,COUNSENUTHnutritioninterventionsalsofocusedontheimprovementofperformanceofhealthfacilityandcommunitylevelproviderstodeliverqualitycareandintegratednutritionservicesforpregnant,lactatingwomen,andinfantsandyoungchildren.

Intotal294(190CHWs&104HFWs)workersweretrainedinTunduruandSongeacouncils.

A total of 36 (18males and 18) CommunityHealthWorkers (CHWs)wereoriented.TheCHWsweredrawn from8wardsnamelyMbesa,Muhuwesi,Nakapanya,Mchoteka,Matemanga,Majengo,NamasakataandMtina.

COUNSENUTHSBCCexpertshowingparticipantshowtousearadiowithvirtualfacilitatedsessionstobeusedintheorientationofhealthandcommunityworkers

Intotal294 (190CHWs&104HFWs)workers

weretrainedin Tunduru andSongeacouncils.

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A training of district nutrition technical team was conducted

TheDistrictNutritionTechnicalFacilitators(DNTFs)are teams selected and trained byCOUNSENUTHto serve as facilitators on key program nutritioninterventions and facilitation skills. They weredrawn from the key sectors (Agriculture, Health,Community Development, Social Welfare andEducationtohaveamixofexpertise).Thepurposeoftheteamsistocreateacriticalmassoffacilitatorsin Songea andTunduru councils,who canprovidebackupsupporttotheDistrictNutritionOfficersinimplementingnutritionprogrammesinthedistricts.

Atotalof30(18malesand12)DNTFswereorientedinthedistrictsofTunduruandSongea(Table4)

To provide support to LGA’s, COUNSENUTH incollaborationwithDNuOsfromSongeaandTundurufacilitatedintrainingof154(75males&79females)Community Health Workers (CHWs) on severalsessionsaimingat:

- Introducing a minimum package ofinterventions with key messages to pass onto pregnantwomen andmothers of childrenundertwoyears;

- Orienting them about formation of peersupport groups and preparing them toconducthomevisitscommunicateandprovidecounselingservicestothetargetgroups;

- Orienting them on following up the growthanddevelopmentofchildrenusingtheRCH4cards,pregnancyusingRCH1cardandprovidefeedbacktomothers/parents/caregiversandmakereferralstohealthcareworkers.

- Orienting them on how to conduct Villagehealth and Nutrition Days: Participantsdiscussed in detail the steps to follow inorganizing village health and nutrition days,therangeofservicestobeofferedduringthesedaysandthenecessaryequipmenttobeused.Referral procedures between household andhealth facility were also streamlined usingspeciallydesignedforms.

- StrengtheningtheirskillsonIYCFcounseling,enriched complementary foods, homegardensestablishment,aswellaspromotionofWASHandECD

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- Strengthening monitoring and evaluation. This included how to conductmonitoringbycorrectfillingoftheformsforthegivenindicators

The objective of training CHWs wasto get them committed to form andsupervise community support groupsto provide nutrition messages to thetarget households. The gained skillsare expected to improve their skills inconducting nutrition days and follow-up of children with and/or at risk ofmalnutrition that are identified duringVHND; improve the quality of datacollected at the community level andreports made to the monthly wardmeetings and improve the qualityof nutrition support provided at thecommunitylevelonthewhole.

All participants received copiesof breastfeeding, complementaryfeeding, and maternal nutritionbrochuresandpostersonhealthyeating.

COUNSENUTH supported theDistrict nutritionists in Tunduruto conduct fourdays trainingonnutrition to 33 (6 males and 27females) health facility workersdrawnfromRCH,maternityandpediatricsectionsfrom3hospitals,5healthcentersand10selecteddispensaries.Table3givesasummaryofalltrainedin2015

Table 3: Number of people trained on various programs in Tunduru and Songea DC in 2015 under Lishe Ruvuma

No Capacity building activityTunduru Songea DC

Grand Total Males Females Total Males Females Total

1 Orientation of CHWs onSBCConnutrition 18 18 36 0 0 0 36

2Training CSOs, carpentersand communities on FoodSecurityandFoodProcessing

16 9 25 0 0 0 25

3Training of health careproviders in basic nutritionandcounselingskills

6 27 33 33

4

Training of district nutritiontechnical facilitators onnutrition interventions andfacilitationskills

8 4 12 10 8 18 30

5

TrainingofDistrictfacilitatorson community mobilizationand conducting nutritioncampaigns

10 13 23 23

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No Capacity building activityTunduru Songea DC

Grand Total Males Females Total Males Females Total

6

Trainingofcommunityhealthworkers insupervision,datacollection andworkingwithcommunities

23 27 50 52 52 104 154

7

Orientationonhandholdingof health facility staff onprovision of skilled supportto pregnant and lactatingmothers(BFHI)

14 32 46 7 18 25 71

8Sensitization of communityleaders in their roles ascommunitymobilizes

206 57 263 169 67 236 499

9

OrientationofselectedCSOson their roles in supervisingcommunity activities andfinancialmanagement

11 3 14 14

Total 312 190 502 238 145 383 885

Ms. Mary Kibona, from TFNC providing support to a mother in the post-natal ward

.in one of the hospitals

As one of Centres interventions, in 2015, COUNSENUTH through Lishe Ruvumaprogramme improving skilled support for breastfeeding mothers in the course oforientationsinallhealthfacilitiesinSongeaandTunduruDCs.Tokickoffthisprocess4hospitals,namelyTunduruDistricthospital,MbesaandKiumahospitalsinTunduruandPeramihoHospital inSongeaDCwereassessedonthequalityofservicestheyprovide to pregnant and lactating mothersbased on the 10 Steps to SuccessfulBreastfeeding recommended by the WHOand UNICEF.

Observationsweremadeinthecriticalareassuch as the maternity wards, postnatalwards,pediatricwards,deliveryareas,CareandTreatmentCentersforHIV(CTCs)andtheantenatalclinicsamongothers.

Findings:Outofthe10stepsassessed,onlythreestepswerewellimplementedandmeettheglobalBFHIcriteria:Step6-Donotgivefoodordrink to thebaby;Step7:Promoteroomingin;andStep9:Noartificialfeedsordummies–arewelldone.Thehospitalsdidbadlyonalltheothersteps.

A feedback meeting was conductedwith hospital management team in eachhealth facility to discuss the results of theassessment. The discussion majored onfillinginthegaps,sharingexperiencesandgiving suggestions for improvement ofpracticalproceduresrelatedtobreastfeedingandothercarepracticesforpregnantwomenandchildren0-23monthsincludinginfantfeedinginthecontextofHIV/AIDS.

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In 2015, various socialbehaviour changecommunicationmaterialsandjobaidsonmaternalandchildnutritionweredevelopedanddistributed tobringvisibilityand awareness to “LisheRuvuma” and as workingtools(Table4).

Table 4: Summary distribution of IEC materials in Ruvuma Region

No. Type of IEC material Intended userNo of copies

1Wallcalendar2015onstrategiesforreductionofstunting

LGAandCommunityleaders,healthworkersandfamilies

1,000

2Newsletter briefs on results ofTunduruandSongeaDCsurveys

Leaders,careproviders,stakeholdersandthegeneralpublic

300

3

Reminder tool for pregnantwomen to take iron tablets(calendar to remind mothers athouseholdlevel)

Pregnantwomenandfamilymembers 1,000

4T-shirts with Lishe Ruvumabranding

Community health workers and districttechnical facilitation team as a means ofcommunicating messages to the communitytheyserve.Theyalsoservesasanincentiveandassistinbeingrecognisedasserviceproviders

460

5BagswithLisheRuvumabrand-ing

185

6Wall charts with child growthcard

Village health workers, village leaders,community and other stakeholders as a tooltohelp initiatediscussiononnutrition statusofchildrenineachvillage.Thewallchartsareused to plot nutritional status of each childinavillageanddisplayedatvillageofficeforreference.

430

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iii. Improve capacity of households to produce and access nutrient – dense foods.

Increasing capacity of households to produce and access nutrient dense foods is one of the most effective ways to sustainably prevent hidden hunger at households. Any programme that increases the production and consumption of micronutrient-rich foods is likely to have a beneficial effect on the micronutrient status of a population. Empowering people, agricultural diversification, public health interventions, and household practices to maximize micronutrient intake are just some of the ways COUNSENUTH uses in addressing under-nutrition at the community level in Tunduru and Songea districts.

There are about 3 - 4 months of short term foodscarcityinTunduruandSongeaDC.Thisisduetothedependencyonrainfedagriculture,lackofalternateincome,lackofknowledgeonhowtoestimateannualgrainandpulseneedsandofappropriatestorageandhomeprocessing.Alsotraditionalceremoniessuchas“Jando andUnyago”which start immediately afterharvesthaveresultedintoroughuseoffoods.

In 2015, COUNSENUTH is made efforts towardsreducing food and nutrition insecurity in RuvumaRegion.

Three strategies were used to improve householdfoodsecurity:Thesewere:

- Developing skills in estimation of annualhouseholdfoodneedsusingastandardTFNCHousehold Food Security Card. Participantswere introduced to basic nutrition andimportanceofhouseholdfoodsecurity.Theywere then introduced to factors affectinghousehold food security and how to assessfood security status at household level, thefoodsecuritysignsandstrategiestoimprovehouseholdfoodsecurity.

- Theyfinally tried touse the foodestimationcard.

- Promotedbackyardsackgardensandsmallanimalskeepingthroughouttheyear.

- Improvingfoodprocessingandstoragetoenhancefoodavailabilityduringleanseason.

Community training on solar drying

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A total of 13 carpenters andmasonswere trained on proper construction of solardriersand18districtextensionstaffandCBOsonhowtousesolardriersindryingofvegetables,fruitsandmeatandtheirproperpackagingandstorage.

Presently, a total of 494 households and48 community groups now have homegardens, while 34 households and 10communitygroupshave startedkeepingsmall animals in 34 villages of Tundurudistrict.Threeschoolshavealso initiatedhomegardens.

The types of vegetables grown includeamaranth,Chinesecabbagesandcarrots.Theanimalskeptincludechicken,rabbitsandfish.

CSOs have sensitized resource poorhouseholds to initiate home gardens inform of sack gardens and small animalkeeping for households’ consumptionandincomegeneration.

Theideaofsackgardensratherthanplotscameaboutafter reports thatgoatswereletloosetodestroyproduce.Sackgardensarealso seenas easy tomanage, as theyneedlittlewaterandcanbelocatednearhomes.

Demonstration of preparation ofnutritiousfoodsforchildrenusinglocallyavailable foods is one of the strategiesused in teachingthecommunityonhowto improve complementary feeding ofchildren.

Over one year 120demonstrations wereconducted duringVillage Health andNutritionDays

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iv. Strengthening community ownership and capacity to invest in nutrition focused and nutrition sensitive interventions. This is one of the strategies used by COUNSENUTH in 2015 to improve behaviors, practices and demand for health and nutrition services for pregnant and lactating women, infants and young children.

Theaimofthisactivitywastoenhancecommunityownershipofinterventionsimplementedinthecommunitytoenhancechildandmaternalhealth.Someofthecommunitymobilisationeffortsundertakentoenlistpublicownershipoftheprogrammearehereunderlined:

Ø Conducted “Siku Elfu 1000” Campaign to transform communities into 1000

Days advocates

COUNSENUTH in collaboration withTunduru district authorities and TCDCconductedadistrictwideopenawarenesscampaignfocusingonnutritioninthefirst1000 days in order to create awarenessof nutrition district-wide. A mid-mediacampaign approach was used to targetthe public. This included using roadshows, cultural shows, community-widecampaign launches, training, distributionofbrochuresandposterswithkeymessagesto bring visibility to the campaign andeducate the public.

Campaign messages, which were simpleand easy to remember, selected for thepromotionalmaterials, including posters;pullupbanners,stickersandt-shirtswereused.The“Siku1000”wasthecampaign’sslogan and the pictures in the campaignlogodepictedthestagesinthe1000days,whichwereapregnancy,infancyanduptotoddlerage.

The campaign was organised alongseveral steps: Preparation and design ofthe campaign. A reference guide called“How-ToGuide”;DistrictLevelCampaignlaunch; Ward-Level Campaign Launchesand Wall paintings was also used. Over7,000peoplewerereacheddirectlybythecampaign.

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Ø Supported communities to conduct village health and Nutrition days & child growth

During 2015, quarterlyVillageHealth andNutritionDays (VHNDs)were initiatedin40targetedvillagesinTunduruwherescreeningof19,621childrenundertheageof5yearswasdoneusingweightforageevery3monthsandheightforageevery6months.Thesedatawillcontinuouslybeanalyzedtoshowtrendsinnutritionstatus.

Theconceptofvillagehealthandnutritiondays(VHNDs)waspracticedinTanzaniainthe1980’stofacilitatetheapplicationoftripleA(Assess,AnalyzeandAct)possibleso thatcommunitiescan takeaction to improve theirnutritionsituationand ithadpositive impact inreducingmalnutrition in theunderfives.Thismethod isalsoanattempttoincreaseaccesstonutritioninformationandservicestowholecommunitiesratherthanjustthetargetgroups.Itprovidesanopportunityforcommunitiesandtheirleaderstotakeownershipoftheirproblemsandappreciatetheprojectsandthereforethisisexpectedtoenhancesustainability.

Ø Promoted an increase of mother-CHW contact time to enhance impact of nutrition interventions for mother and child

Inthereportingperiodatotalof97communitysupportgroupswereformedinthe40startervillagesinTunduru.

There is evidence that increased contact timebetweenmother/caregiver or serviceproviderincreasestheimpactofinterventions.Thiswasshownthroughcommunitysupport for breastfeeding by the WHO in several countries where mothers whoreceivedmorethanfourvisitsfromacommunitysupportgroupincreasedexclusivebreastfeedingbyover50%(WHO2004).

Thegroupsare formedby communityhealthworkers fromamong familieswith achildofbelow2yearsorafamilywithapregnantwoman.ThesearegiveninformationduringpeermeetingsusingvirtualfacilitationanddiscussionmethodswithCHW.

Thesemeetingsaredesignedtostimulatediscussionaroundchild feedingandcarepracticescommonincommunitiesandcomparingthemwithpro-nutritionbehavioursandhouseholdactionssupportingthereductionofmaternalanaemiaandchildhoodstuntingwhilepromotingpositiverolemodelsthroughstories,dialogue,testimonies

Mothers attending a VHND in Tunduru

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andsharedexperienceandfosteringgroupcohesionandcommunitysupportaroundpro-nutritiongroupnorms.

Among interventions promoted include WASH activities to enhance hygiene and sanitation in the districts of Ruvuma. There are:

Ø Tippy tap technology to increase the practice of hand washing with soap

ThebaselinesurveyresultsforTunduruindicatedthatonly8%ofhouseholdsmanagetheirhouseholdrefuseandonly42%washedhandsafter toiletusewhileonly55%of toilets have covers. Lack of environmental hygiene has been reported to havesignificantimpactonstunting.WASHisthereforeoneoftheidentifiedinterventionstoreducechildhoodstuntingintheLisheRuvumaprogramme.COUNSENUTHhasconducted advocacy and public campaigns for improved hygiene and sanitationpractices in thecommunities inTunduru throughpromotingadoptionof tippy taptechnology.Atotalof800householdsand22schools in21villagesweresupportedwithjerrycansforconstructingtippytaps;therestofthematerials(sticks,wood,ropesandsand/grits)weresuppliedbybeneficiaryhouseholds.Villageandwardleaders,communityhealthworkers,schoolsandsupportgroupswereencouragedtoadoptthetechnologyaroundtheirhomesandserviceareastoserveasrolemodels.

Ø Improved Toilets

Lishe Ruvuma conducted advocacy forimproved pit latrines popularly knownas “choo cha sungura” and their properuse. In collaboration with the districtauthorities Lishe Ruvuma trainedcarpenters, provided villageswith initialbasicmaterialsfortoiletsasasample.Thecarpenters made toilet rims and coversandeachhouseholdpurchasedthemfromthem and the money earned was usedtobuymorebasicmaterials.To date 322 households in 15 villages have improved toilets with covers.

Ø Safe, clean play spaces for young children

There is evidence that play aids in cognitive, physical and social development;and has a nutrition benefit amongyoung children. Creating clean, safeenvironmentforachildtoplayservesthepurpose of psychological and physicaldevelopmentbutalsopreventsdiseases.Junglegyms,swings,andtireswerebuiltin3villagesasamodel.Thecommunitieswereencouragedtoprovidesafecornersforchildren toplaynearorwithin theirhouseholds for younger children, sincetheplaygroundsseemedtobetakenoverbyolderchildren.

Local carpenters making toilet cover

Children in Tunduru playing at a clean playground

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v. Enhanced gender relations and the situation of women and girls

“Several studies link positive health outcomes to women’s economic, social, and educational status. Studies also show that women are much more likely than men to spend additional income on food and healthcare, so increasing women’s income is likely to have a proportionally greater impact on children’s health and nutrition than comparable increases in men’s income. However, few address the tradeoff in nutritional outcomes for a woman and her children as they pursue certain time-consuming agricultural activities”.

In Ruvumawomenareforcedtoleavetheirinfantsbehindathomewhilewomengotothefieldswhicharefarawayfromhomeassoonasthechildreaches40daysoldafterbirth.Theveryyounginfantsareintroducedtopoornonnutritiousfoodsuchas thinhighlypolished cassavaormaizeporridge fromavery early age (day 3 inTunduruandfrom3monthsinSongeaDC).Giventhesignificanttimeconstraintsonwomen,interventionsthataffectwomen’stimeallocationcanhelpimprovetheirownnutritionaswellasthatoftheirchildren.

AnotherdisparityfactorinTunduruisaboutthegirlchild.About25%ofgirls12-19becomepregnantbeforetheyfinishprimaryschool.AnutritionsurveyhasindicatedthatChildhoodpregnanciesareahighrisktomalnutritionanddeathformotherandbaby.Under-nourishedgirlsaremorelikelytoperpetuatethecycleofunder-nutrition,givingbirthtounder-weightbabies.

In 2015 COUNSENUTH increased the number of adolescents who have life skillsand earning power to improve their nutrition and that of their children throughinitiationofincomegeneratingactivitiesforoutofschoolsgirlsandyoungmothers.Todatea totalof169out-of-schoolgirlsandyoungmothers in thefirst40villageshavebeenequippedwithlifeskillsandincomegeneratingactivities.TheCSOswillcontinuevisitingthemtoassesstheirsituation.ThoseeligiblewillbelinkedtoexistinglivelihoodsandfundingsourcessuchasTASAF,SACCOS,smallandinternallendingcommunitygroups(SILC).

4.2.2 Mwanzo Bora Nutrition Programme (MBNP)

MwanzoBoraNutritionProgramme(MBNP)isfundedbyUSAIDthroughtheFeedthe Future initiative. Since it started in 2011, this program has reachedmore than2,000villagesandsupportedover2millionwomenofreproductiveagewithvariousnutrition tools and information, such as gardening,micronutrient supplementationandhealtheducation.

In2015,MwanzoBoraNutritionProgrammeperformanceonhigher levelFeed theFutureindicators(throughUSG-SupportedPrograms)issummarizedasfollows:

i. Number of People Trained in Child Health and Nutrition

The program through a cascade method and working closely with thedistrictteamsandTFNCinthisfinancialyeartrainedatotalof7,104peoplefromdifferentgroups.Thisconstitutes87%ofthetotalnumberofpeopleofvariouscadrestargetedfortraininginfourthyear(Table5).

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Table 5: Summary number of people trained under MBNP in Fourth Year

Groups of People to be trained Target# of people trained

% achievedMales Females Total

CommunityHealthWorkers 2,592 1,258 1,386 2,644 102

CommunityleadersandExtensionWork-erstrainedon1000daysparentkit 3,245 2,864 682 3,546 109.4

CommunityExtensionWorkerstrainedonfarmer’skit 2,045 378 234 612 30

CouncilExtensionWorkerstrainedonba-sicskillsonnutritionSBCCforimprovedhouseholddiet

60 22 18 40 66.7

HealthFacilityWorkers 206 44 190 234 113.6

DistrictNutritionTechnicalFacilitators 29 11 17 28 97

Grand Total 8,177 4,577 2,527 7,104 87

ii. Number of Children Under Five Reached

A total of 938,117 of the 964,921children under five years old targeted thisyearwere reachedwithnutritionservices,which includedbehaviorchangecommunication activities, home or community gardens, micronutrientsupplementation, anemia reduction packages, growth monitoring andpromotionandmanagementofacutemalnutrition.Thisconstitutes97%ofthetotalnumberofchildrentargetedthisyear.

iii. Number of Children Under Five Who Received Vitamin A

Throughthehealthworkerstrainedbytheprograminadditiontosupportingthe district teams during the bi-annual vitaminA campaign, the programreached a total of 1,059,087 out of 964,921 childrenunderfive years of agetargeted.Thisconstitutes110%of thetotalnumberofchildrentargetedthisyear.

iv. Number of Women of Reproductive Age Reached

The number of women between15 - 49 years of age who receivedservicesintheformofmicro-nutrientfortification and supplementation,anaemia - reduction packages,and other nutrition services fromhealth facilities and who havebeen reached by behaviour changecommunications from USG -supportedprogramswere 1,302,940(118%) of the 1,099,625 pregnantwomentargetedthisyear.

Since 2012 underMBNP,COUNSENUTHhas improved performance ofhealthfacilitiesandcommunitylevelprovidersthroughimprovingdeliveryof quality care and integrated nutrition services for pregnant, lactatingwomen,andinfantsandyoungchildren.AnumberofstrategicapproacheshavebeenusedinMorogoro,Dodoma,ManyaraandIringaregions.

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Priority Focus Areas for Interventions about: (a) Addressing maternal anemia included advocacy for early ante natal booking; optimal intake iron and folic acidsupplementation;consumptionofironrichfoodsanddietarydiversification;optimizeuseofthesafemotherhoodpackage(de-worming,malariapreventionandtreatment).(b) Addressing childhood stunting included optimal complementary feeding;exclusivebreastfeeding for thefirst 6months; consumptionof animal source foodsanddietarydiversification;careofasickchild;preventionofchildhoodillnessesandimprovedmaternalnutrition.

ImprovementofnutritionrelatedbehavioursoftheprogrambeneficiarieshasbeenrealizedthroughpromotionofprioritynutritionSBCCinterventionsonastrongfoundationofhealth,care,diseasecontrolandWASH

KeycollaboratorswereTFNC,thePrimeMinister’sOffice,MinistryofAgriculture,andMinistryofHealth.

PeopleTrainedinChildHealthandNutrition 7,104ChildrenUnderFiveReachedfornutritionservices 938,117ChildrenUnderFiveWhoReceivedVitaminA 1,059,087WomenofReproductiveAgeReached 1,302,940

Atthecommunityandhouseholdlevel,improvedknowledgeoncaringpracticesforinfants,youngchildrenandwomenofchild–bearingageisanecessarycomponentofsustainableeffortstoreducemalnutritioninTanzania.Thiswillbeattainedthroughenhancementofbehaviours,customsandtraditionsofmen,women,caregivers,familyand community members, and those who influence them positively on nutrition.MBNPusesasunflowerfigureofspeechtoenhancetraditionsthatsupportimprovednutritionasfrompregnancytotwoyearsafterdelivery.

Distribution of nutrition SBCC tools: Fortheongoingeffortsofimprovingnutritionbehavioursneedtobestrengthenedandsustainedtheprogramdistributed1,557nutritionSBCCkitstonewvillage(Table6)

Table 6: Summary number of SBCC kit sets added and distributed in fourth year.

Activity Target Achievement in fourth year % achieved

AdditionalsetsofNutritionSBCCkitstargeted(IR6.1.1.1) 1,000sets 1,000additionalsetsofNutrition

SBCCkitsproduced 100

SetsofNutritionSBCCkitstobedistributed(IR6.1.1.4) 1,150sets 1,557ofsetsofNutritionSBCC

kitsdistributed 135.4

Conducted community (ward) meetings to create awareness on Nutrition SBCC Siku 1000 and to provide community support in preparation of PSGs

To reinforce positive nutrition relatedbehaviors, in this financial year, MBNPconducted sensitization of communitymembers on essential nutrition actionsthrough60outof251meetingsconductedat the village level. This constitutes 24%of the total number of the communitysensitizationmeetingstargetedthisyear.

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Throughthesesensitizationmeetings,MBNPreinforcedtheneedforearlybookingforAntenatalCare (ANC)forpregnantwomen,useof IronFolicAcid(IFA) tabletsfor theprevention of anemia, homegardening andkeeping of small livestock andtheimportanceofexclusivebreastfeedingforchildrenundersixmonthsofageandcomplementaryfeedingforchildrenabovesixmonthsofage.

Supported street theatre groups to conduct community awareness on maternal and child nutrition - during demo days

Lending voice to social campaignsthrough Street theatre groups isone of the instruments used bythe program in heartening SocialBehavioral Change Communicationin communities. A total of 174 ofthe 495 theatre groups were usedin creating community awarenessabout program activities in theregions of Morogoro, Dodoma andManyara. This constitutes 35.2%of the total number of the theatregroupstargetedthisyear.

Capacity Building

The promotion of positive nutrition behaviours and healthy eating and lifestylesisbecomingapriority inTanzania’shealthandnutritionpolicy. Inorder toensurenationwide implementation of nutrition education on a sustainable basis, capacitybuildingonnutritioneducationneedstogainofficialrecognition indifferent levelsandgroupsofpeople.

In2015,theCOUNSENUTHthroughthenamedMBNPstrategicapproach

• Mentored CSOs in planning, implementation, coordination, monitoring andevaluationofnutritioninterventionsatthecommunitylevel

• Supported CHWs to form Peer Support Groups (PSGs) in order to ensureeffective intervention on social behavior, attitude and gender norms change

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aboutmaternalandchildnutrition,formationofPSGsisinevitable

• Trainedcommunityandhealthfacilityworkersonmaternalandchildhoodnutrition

• Sensitizedcommunityleadersandextensionworkersonmaternalandchildhoodnutrition

Healthfacilityworkerstrainedonmaternalandchildhoodnutrition

234

CSOtrainedonmaternalandchildhoodnutrition 15Communityleadersandextensionworkerssensitizedonmaternalandchildhoodnutrition

3,546

PeerSupportGroups(PSGs)formed 6,496Communityhealthworkerstrainedonmaternalandchildhoodnutrition

2,644

Improvement of Quality of Maternal and Child Nutrition Services at the HealthFacility andCommunity through demonstration days, communitymeetings, focusgroupdiscussions,growthmonitoringthroughmeasurementofheightagainstage.

v. Other planned activities that have accomplished in 2015 which have played great role on improvement of Quality of Maternal and Child Nutrition Services at the Health Facility and Community are summarized below:

Ø Supported DMNSCs and DNuOs to conduct quarterly review and planning meetings on implementation of nutrition SBCC interventions: Duringthisfinancial year,MBNP regional teams attended and supported 14 of the 60plannedDMNSCsreviewmeetingsin14councilsintheregionsofDodoma,ManyaraandMorogoro.Thisconstitutes23.3%ofthetotalnumberofmeetingstargetedthisyear.TheaimwastosupportDMNSCstoplanandmonitortheimplementationofnutritionactivitiesatthecouncilleveldepartment.

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Ø Advocated for increased availability of IFA, de-worming tablets, anti-malaria drugs (SP), vitamin A tablets and haemocue at health facilities: AdvocatingforincreasedavailabilityofIFA,de-wormingtablets,anti-malariadrugs(SP),vitaminAtabletsandHemocuemachinesathealthfacilitieshasbeenhighlightedasoneof theareaof focus to intervenematernalanaemia.Duringthisyear,theprogrammanagedtoadvocateincreasedavailabilityofthe IFA,de-worming tablets, anti-malaria drugs (SP), vitaminA tablets andhaemocuetoCouncilHealthManagementteam(CHMT)intheregion.Intotal10ofthe40CHMTsmeetingswereconductedin10councilsnamelyChemba,Kondoa, Kongwa, Bahi, Chamwino, and Dodoma Municipal Councils(DodomaRegion) andMorogoroDC,MorogoroMunicipal, Kilombero andUlangacouncils(MorgoroRegion).Thisconstitutes25%ofthetotalnumberofmeetingstargetedthisyear.

Thisadvocacyisimpliedtohaveincreasedavailabilityofthesuppliesinclinicsandthe uptake of the same. For example, theMBNPmid-term evaluation report (June2014)indicatedanincreaseinuptakeby47%ofiron-folatetabletsfor90ormoredaysfrom4%ofthe2010TDHSReportto51%in2014MBNPMid-Termevaluationreport.

Ø Supported CHWs and HBCs to conduct regular supportive supervision to Peer Support Groups (PSGs)

DistributionofpropermaternalandchildnutritionmessagesandfacilitationofPSGsdiscussionisattainedthroughcapacitatingCHWs.Duringthisyear,CSOs in collaboration with MBNP regional offices, DNuOs and DNTFsconducted supportive supervision to 1,962 of the 2,492CHWs inDodoma,ManyaraandMorogororegions.Thisconstitutes78.7%ofthetotalnumberofCHWstargetedthisyear.

Ø Conducted monthly and quarterly review meetings with CHWs and HBCs:Forstrengtheningcommunityhealthworkersandadequatenutritioninformationflow to the community,MBNP regional offices in collaborationwith15CSOsconducted32ofthe60quarterlyreviewmeetingswithCHWs.This constitutes 53.3% of the total number of meetings targeted this year.The focus of the meetings was about reviewing MBNP activities, sharinginformation,experiences,andchallengesamongvolunteers

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Ø Supported DMNSCs and DNuOs to organize commemoration of the World Breastfeeding Week (WBW):WorldBreastfeedingWeekiscerebratedeveryyearworldwideatfirstweekofAugust(1st-7th).TheWorldBreastfeedingWeekcalledforconcertedglobalactiontosupportwomentocombinebreastfeedingandwork.TheWBW2015themeonworkingwomenandbreastfeedingrevisitsthe1993WBWcampaignontheMother-FriendlyWorkplaceInitiative.MBNPthrough itsCSOsmanaged tosupportDMNSCsandDNuOs in20councilstoorganizecommemorationoftheWorldBreastfeedingWeek(WBW)ineachdistrictintheregionsofManyara,DodomaandMorogoro.

Duringthewholeweekofcommemoration,atotalof4,818participantswerereached, among them 1,081 were males and 3,737 females who receivednutritionaleducationconcerningbreastfeeding,importanceofbreastfeedingtomotherandbabyanddemonstrationofproperpositioningandattachmentofthebabytothebreastandtheyheardbreastfeedingtestimoniesfromdifferentwomen.

Also,COUNSENUTH,throughMBNPmanagedtosend10SMStextmessagesto 1,572HFWs trained underMBNP in the regions ofMorogoro, Dodoma&ManyaraandZanzibar,oneSMStextmessagetoeachHFWdaily,asfromAugust1st2015toAugust7th2015,usingFrontlineSMSsoftware.SMStextmessagesmainlyfocusedonsensitizationofcommunityprogrambeneficiarieson early initiation of breastfeeding, exclusive breastfeeding and dietarydiversificationduringcomplementationviahealthfacilityworkers.

vi. Improvement of access to diverse and quality food through increasing capacity of households to produce and access nutrient – dense foods

AlackofavailablefoodstoconstituteadiversifieddietisacrucialfactorinmostcommunitiesinTanzania.Thisisparticularlythecaseinthedevelopingworldwheredietsoftenconsistofstarchystapleswithnotenoughnutrient-richsourcesoffood,suchasanimalsourcefoods,fruits,vegetables,beansandpulses.

Under-nutritionandmicronutrientmalnutritionremainproblemsofsignificantmagnitudeinlargepartsofthedevelopingworld.Improvednutritionrequiresnotonlybetteraccesstofoodforpoorpopulationsegments,butalsohigherdietaryqualityanddiversity.Becausemanyofthepoorandundernourishedpeoplearesmall-holderfarmers,diversifyingproductiononthesesmallholderfarmsiswidelyperceivedasausefulapproachtoimprovedietarydiversity.

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In 2015, COUNSENUTH under MBNP used a number of strategies to promoteproductionofqualitydiversityanddietarydiversityinsmallholderfarmhouseholds:

Ø Participation in NaneNane exhibition at 3 zone centers of Morogoro (for Morogoro Region), Dodoma (for Dodoma Region) and Arusha (for Manyara region)

MBNP and other FtF projects (MBNP, TAPP and Nafaka) participated indisplaying activities during the Nanenane exhibitions at regional levels(Manyara,MorogoroandDodoma).ThegeneralobjectivewastodemonstratetothepublichowFtFprojectsworkinsupportingsmallholderfarmersandthecommunityingeneralinreducinghunger,povertyandundernutritioninTanzania.Morethan2,000peoplevisitedMBNPboothsinthethreeregions.Duringthefestival,MBNPteamhadanopportunitytoexplaintothefarmers,parentsandthegeneralpublicabouttheSBCCKitsMaterialsandtheworkthatMBNPisdoinginthe5priorityregionsonTanzaniamainlandinadditiontoZanzibaraswellasrespondingtodifferentquestionsaskedbythosewhovisitedthebooth.

Ø Supported collaboration between Council extension workers and CSOs in following-up and backstopping adoption of home gardens, small livestock keeping, food preservation and processing including basic skills on Nutrition SBCC for improved household diet

MBNP in collaborationwithTFNCandRNuOandDNuOs conductedToTtrainingonnutritionSBCCDDkitwhichtookplaceinIringa,ManyaraandMorogororegions.Atotalof75 (39malesand36 females)of the60councilextensionworkerstargetedattendedthetraining.Thisconstitutes125%ofthetotalnumberofcouncilextensionworkerstargetedthisyear.

TheTraininghadthegoalofimprovingparticipant’sknowledgeonnutrientsuppliesanddietdiversificationusingDDkitsotheycanbeabletorollouttrainingofVillageExtensionWorkersandWardExtensionWorkersontheuseofnutritionSBCCdietdiversitykit.

Ø Trained Village Extension Workers (VEWs) – Agric / Livestock / Village Executive Officers (VEOs) and Ward Extension Workers (WEWs)-agric/livestock on the use of Nutrition SBCC Famers Kit (including skill development of materials in the Kit)

MBNP in collaboration with the DNTFsand DNuOs conducted orientation on theuse of Nutrition SBCC Famers Kit to 612(378malesand234 females)of2,045WardExtensionOfficers fromhealth, agricultureand communitydevelopment sectors. Thisconstitutes 29.9% of the total number ofVillage Extension Workers targeted thisyear.Theactivityaimedat increasing theirnutrition awareness and skills necessaryto provide supervisory and mentorshipsupport to household in adopting optimalpractices about small livestock keepingandhomegardeningintendedforfoodand

Inordertoincreaseconsumptionofnutritiousfoodbywomenandchildreninanattempttoaddressingmalnutritionathouseholdlevel,theprogramworkedwithandthroughAgricultureExtensionWorkers,DNuOs,CSOs,HealthWorkersandCommunityLeaderstofacilitateanumberoftheplannedactivitiesintheZOI,usingFarmersKit.

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dietarydiversificationthatcanresultintoreductionofmaternalanemiaandchildhoodstunting.

Ø Mobilized and facilitated community groups to establish and manage integrated demonstration plots at ward level (one per ward or health facility)

Demonstration plots are the agricultural methods identified to promotepositivenutritionbehaviorinthecommunities.Itisthemosteffectivemethodto show to a target group that a particular recommendation is practicableunder local conditions. Through the demo Plots including small livestockandvegetablegardens, theprogrameducateswomenandmenonpracticaladaptionofvegetablesandsmalllivestockforhomeconsumptioninordertoenhancethenutritionalcontentoftheirdiets.Duringthisfinancialyear,atotalof190outof227demonstrationplotshavebeenestablishedintheregionsofMorogoro,ManyaraandDodoma.Thisconstitutes83.7%ofthetotalnumberofdemonstrationplotstargetedthisyear.

Ø Supported communities to establish and use tippy tap at every demonstration plot site to promote good hygiene and sanitation practices at household level (Done during the development of demonstration sites/ plots

In promoting good hygiene and sanitation practices at community level,MBNP regional team in collaboration with CSOsdemonstrated the establishment of 201 out of 227tippy taps at the new established demonstrationplots. This constitutes 88.6%of the total numberofthetippytapstargetedthisyear.

Duringtheestablishment,PSGswereinsistedtoadoptthe idea around their homes for good hygiene andsanitation practices. Proper sanitation and hygienecan preventmaternal and child under nutrition byaverting development of environmental diseases.Frequentillnesssapsthenutritionalstatusofchildren,lockingthemintoaviciouscycleofrecurringsicknessandfalteringgrowth.

Ø Provided support to communities to conduct field demonstration days at each demonstration plot (one per quarter per Ward)

As part of the program’s efforts to promote goodpractices on preparation of diversified foods foradequate nutrition to both health facility workers,communityhealthworkersandprogrambeneficiaries;and encouraging communities to adopt homegardening, tippy tap technology, keeping of smalllivestock and positive nutrition behaviors practices;MBNP facilitated 371 out 1,552 field demonstrationdaysintheDemoplotsithadestablished.

This constitutes 23.9% of the total number of thedemonstrationdaystargetedthisyear.

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Ø Worked with extension workers to technically support beneficiary households in adopting and out scaling home gardening, small livestock keeping, tippy tap at adopt locally food preservation and processing technologies

In improving households diet and nutrition, the CHWs in collaborationwithMBNPRegional office, PSGs,CSOs and community extension officersemphasizedandsensitized132,271outof100,228beneficiary’sandcommunity’shouseholdinnewwardstoestablishhomegardensandkeepsmalllivestockforhouseholds’consumptionafterlearningfromDemoplots,Demodaysandcommunitysensitizationmeetings.Thisconstitutes132%ofthetotalnumberofthehouseholdstargetedthisyear.

Ø Collaborated with partner programs to provide IGA training and establish Savings and Internal Lending Communities (SILC) groups to MBNP targeted communities

Increased incomes among farmers have the potential to impact positivelyon household diets when the income is channeled towards householdfood consumption. During this reporting year, the programmobilized andtrained177of64communitygroupsonIncomeGeneratingActivities(IGA);establishmentofsavingandcreditscheme(SILC)ofwhichmemberswillbeabletoborrowmoneyforexpandingtheirownbusinesstoimprovehouseholdincomesandfinallyincreasepurchasingpowerofnutritiousfoods;andhowhorticultural production and small animal keeping can became not onlyas sourceof food to theirhouseholdsbutalsoasan incomegenerator.Thisconstitutes276.6%ofthetotalnumberofthecommunitygroupstargetedthisyear.

Ø Distributed Dietary Diversity Kits

Atotalof345DietaryDiversityKitsweresenttoIringaregionpriortocapacitybuilding activities in September 2015. Once the Training of Trainers (ToT)trainingwascompleted in Iringa inSeptember2015,RegionalCoordinatorsfromDodoma,ManyaraandMorogoroRegionsreturnedto theirrespectiveregions to conduct a similar ToT training on the DD Kit to DNTFs and

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CSO in their respective regions. The regional TOTs trainings composedof 39 participants inDodoma, 35 participants inMorogoroRegions and 32participantsinManyara.Thetrainingwasconductedfor4days.

TheDDKithasfivemodules:1)Discuss and Decide Together, 2) Raise and Grow, 3) Earn and Buy, 4) Prepare, Process and Store, and 5) Rest, Share and Eat.ThemodulesaredesignedtoequipMBNPbeneficiarieswithnecessaryskills for rational decisions on how to spend family income on familynutritional needs,what and how to grow and raise best, food preparation,preservationandstorageandhowtoshareavailablefoodintermsofqualityandquantityandgivingenoughtimeforrestingespeciallyforpregnantandlactatingwomen.Annex2providesanoverviewofthekit.

The training of 368 Village ExtensionWorkers and roll out of the DietaryDiversityKittovillageswasconductedinIringa.ThesametrainingwilltakeplaceduringQuarter1ofYear5 (October-December2015) inother regions.ThiswillbedonebyMBNPstaffandthetrainedCouncilsToTs

vii. Community ownership strengthened and capacity to invest in nutrition interventions increased for improved behaviors, practices and demand for health and nutrition services (for pregnant and lactating women, infants and young children)

Ø Conducted “The SikuElfu 1000”Campaign to transform communities into 1000 Days advocates

MBNPincollaborationwith,communityleaders,CSOs,DNuOsandtheBBCmediaactionfacilitatedthecampaignusinganumberoftechniques.Atotalof7,250peoplewerereachedduringcampaigninthetargetwardsintheregionsofManyara,DodomaandMorogoro.

Ø Formation of Community support groups

During this year, a total of 6,496PSGswith 67,728 (23,401males and44,327females)membersofthe4,985targetedgroupswereformedinVillagesin241WardstargetedinthethreeregionsnamelyMorogoro,ManyaraandDodoma.Thisconstitutes100.8%ofthetotalnumberofPSGstargetedthisyear

4.2.3 COUNSENUTH INNOvaTIvE PrOjECTS arE STrENgTHENEd

4.2.3.1 Prevention and management of NCDs

Ø COUNSENUTH is continuing to improve capacity for prevention, management and control of diet related NCDs

There is an increase in incidence of non communicable diseases (NCDs) inTanzania. Healthy lifestyles contribute to the prevention and managementof theNCDs. Serviceswill beoffered to individuals andgroupsonhow topreventormanageNCDs.

COUNSENUTHtookpartatthecancerpreventionandscreeningactivitiesthat

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tookplaceattheOceanRoadCancerInstitute(ORCI)DaresSalaam.Womenwereinvitedforafreecervicalcancerscreening;Inaddition,COUNSENUTHassessed their nutritional status by using BodyMass Index (BMI).Amongthe80womenwhosenutritionalstatuswasassessed,only21%hadnormalBMI;34%wereoverweight,42%obeseand3%wereunderweight.Theclientswerecounseledonweightmanagementandimportanceofobservinghealthylifestyles.

The WHO report provides the baseline for monitoring implementation ofthe ‘globalactionplanfor thepreventionandcontrolofnoncommunicablediseases2013to2020’,whichseekstoreducethenumberofprematuredeathsfromNCDsby25%by2025.Thereportrevealedthatmuchremainstobedoneinallcountries,especiallyindonor-dependentnations,toattainthevoluntaryglobaltargetsby2025.

In2015, theCentreplayedanactiverole incontributing to thereductionofNCDsviasomeofitsinnovativeprojects:

Ø Nutrition Center Based Counseling and work place Services

Studies have indicated benefits ofworkplacewellness.Most employees inthecitiesspendmorethan40hoursaweekatworkplace.Thisreducesthetime theywouldhavedevoted to theirhealthandsocial interactionswhichare importantforpsychologicalandphysicalhealth.Workplacecouldbeanimportant place for healthy lifestyle support programmes. COUNSENUTHis exploring the potential of companies’ workplace wellness programs inTanzania.

In2015,COUNSENUTHhasestablishedacounselingunitwhichwillprovidecenterbasedandworkplacecounselingservicestocreateawarenessofandbuildthecapacityforpreventionofdietrelatednoncommunicablediseasesand promotes better management and mitigation of diet related healthproblems. Companies are supported to come upwith healthy living plansandconductnutritioneducationsessionsonhealthy livingsoas topreventnoncommunicablediseaseswhicharehighlyassociatedwithsedentaryandunhealthylifestyles.

Ø Counseling Services at Ocean Road Cancer Institute

Currently,OceanRoadCancerInstituteservesover3,500newcancerpatientsperyearandattendstoover10,000follow-upcancerpatientsannuallyacrossthe country.While nutrition is not a cure for cancer, it iswell known thatnutritioncancontributeto improvingtheimmunesystem,andgeneralwellbeing of a cancer patient. Good nutrition plays a vital role in preventing,management,efficacyoftreatmentandimprovementofthequalityoflifeofcancerpatientsandsurvivors.

In 2015, COUNSENUTH continued to provide nutrition counseling andsupportattheOceanRoadCancerInstitute.Mainactivitiesconductedwere:

· Counseling cancer patients already admitted and those attendingdaily.

· Providing nutrition education and counseling to those coming forscreeningandpeoplewithdifferentnutritionalrelatedproblems.

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Intotal5,087cancerpatientsweresupportedwithcounselingservicesatOceanRoadCancerinstitute(Table7).Themaingoalofthisinitiativefoundedin2011istohelpcancerpatientsimprovetheirhealthwhiledealingwithtreatmentofcancer.Theothergoalistoinformfamiliesoftheaffected,onpreventivemeasuresandcontrolofthedisease.

Table 7: Summary distribution of cancer patient people who were counseled in 2015

Month Wards Chemotherapy Radiotherapy Screening Grand Total

June 98 215 300 260 873

July 120 200 282 345 947

August 210 228 270 389 1,097

September 253 234 287 298 1,072

October 263 256 264 315 1,098

Total 944 1,133 1,403 1,607 5,087

4.2.3.2 Enhanced youth life skills

Ø Youth Counselling and Life Skill Development Project

COUNSENUTHpromotes healthy eating and better lifestyles in youth, lifeskills counseling for youth toprepare them for life outside college or for anewenvironmenttoattendhighereducationinthecountryorabroad.Someofthesessionsprovidedincludegeneralnutritionknowledge;selfexploration,awarenessonpersonalstrengthsandweakness,goalsetting,timemanagement,healthyrelationships,managementofpeerpressure,stressmanagementandhealthy eatingand lifestyles.Counselling sessions areprovided throughouttheweek;forindividualsandgroupcounselingservicesarealsoprovidedforyouthandfamiliesonweekends.Nationalcampaignforhealthylifestyleswillalsobeconductedinthefuture.

Ø Nutrition Volunteer and Interns Project

Theprojectwasinitiatedtocontributetotheimprovementofskillsforhumanresource in nutrition and improve nutrition programmemanagement skillsandemployabilityfornewlygraduatingnutritionists.In2015,COUNSENUTHreceived 3 interns and 2 new graduates from Universities (e.g. SokoineAgriculture University, MUHAS, and Jordan University) who work asvolunteers in different projects. Throughout the program, COUNSENUTHcoaches and mentors volunteers on essential tools and methodologiesrequired to run nutrition programmes. Many volunteers have successfullysecured employment after gaining experience from COUNSENUTH, whileCOUNSENUTHgainedaffordablehuman resources to supportprogrammeactivitiesthatdonotneedmajorskills.Volunteersareprovidedwithmonthlyupkeep allowances. Future plans include training of large numbers of newgraduates on employability skills and field attachment to gain hands onprogramexperience.

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4.2.3.3 infant and young child feeding

Ø National WBTi -Assessment on the situation of IYCF practices

InJune2015,COUNSENUTHincollaborationwithTFNCconductedthefirstWorldbreastfeeding Trends Initiative (WBTi) rapid assessment to update the countryon situation of IYCF practices, national policies, strategies and programs that areimplemented in the country. The WBTi is an innovative initiative, developed byIBFANAsia,toassessthestatusandbenchmarktheprogressoftheimplementationoftheGlobalStrategyforInfantandYoungChildFeedingatnationallevel.

Theresultsoftheassessmenthaverevealedthatthecountryisdoingwellinpolicy,information and program design, but lacksactionatthehealthfacilityandcommunitylevel.Amongthegapsidentifiedwhereon:(i)TheBabyFriendly Hospital Initiative, where the countryscoredonly4.5/10becauseoflowGovernment’scommitment to BFHI and other reasons; (ii)MotherSupportCommunityOutreachwherethecountryhadascoreofonly6.0due tovery fewcommunity based initiatives. (iii) Infant feedingin emergencies where the country scored only2.5,duetolackofEmergencyPreparednessPlanforinfantfeeding,and(iv)Lackofenforcement,monitoringandawarenessofCodeofMarketingandNational Regulations despite that Tanzaniahadthelawsince1994.

Ø Capacity building on Code Monitoring and Enforcement

As part of strengthening capacityand information on implementationand monitoring of the InternationalCode and the National Regulations ofMarketing of Foods and DesignatedProductsforInfantsandYoungChildren,The Centre for Counselling, Nutritionand Health Care (COUNSENUTH) incollaboration with Tanzania Food andNutrition Centre (TFNC) organized afivedayworkshopto26representativesfrom government (Ministry of HealthandSocialWelfare(MOHSW),TanzaniaFood and Drug Authority (TFDA),Tanzania Bureau of Standards (TBS), CSOs (Partnership for Nutrition in Tanzania(PANITA)andCOUNSENUTH).

TheaimoftheworkshopwastosensitizepolicymakersathighlevelsontheissuessuchasPublicPrivatePartnership (PPP) innutrition, impartknowledgeand skillsonCodemonitoringtohighlevelimplementersandsensitizelawenforcersontheirresponsibilitiestowardsCodeenforcementandtakingactionsagainstviolators.TheworkshopwasfundedbyIBFANAfricaandUNICEF,andfacilitatedbyIBFANAfrica,IBFAN-ICDC and COUNSENUTH.

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4.2.3.4 Wasichana Leadership Project

TheprogramstartedinJanuary2011withtwogirlsbeingofferedscholarship.ThesejoinedformoneatSt.JosephMillenniumSecondarySchoolinDaresSalaam.In2014othertwogirlsreceivedfinancialsupportandjoinedMwenyeheriAnuariteSecondarySchool in Dar es Salaam Region. Through its effort in mobilizing resources fromsympatheticdonorsandstaffresources,thisyeartheCenterwasabletoidentifyonemoregirlwho joinedformoneatHope&JoySecondarySchool,bringing the totaltofive (5).This year, two of the girls (Jovinatha Julius and Anastazia Shayo) sat for their National Form four Examinations and the younger two, Grace Sanga and Salama Semweza sat for their form two National Examinations.

TheWLP isadministeredbyCOUNSENUTHasa componentof theirOrphanandVulnerableChildren(OVC)program.TheobjectiveoftheWLPistoprovideorphangirls, who have no other means of support, access to quality secondary schooleducation.Theprogramusesaholisticapproach,namelyaconcernfortheemotional,physicalandacademicwell-beingofeachgirl.Theprogrammotto“opportunityforgrowthandexcellence”embodiesthisobjective.

4.3 Strategic Object 6: Documentation of Success Stories and Lesson Learnt

Ø Success Story 1: “Mwanzo Bora Nutrition Program brought happiness in my family”

A story of Mariam Hassan from Digoma village, Mvomero district

“FiveyearsagoIwaspregnant,Ididn’tattendantenatalclinicuntilgavebirthtomybaby.Irememberitwasalongnightwhenmylabourstarted.ThankstomyhusbandwhoimmediatelysentmetohospitalandIgavebirth.However,mybabywasbornwithlowweight,veryweakwithmalariaandlowblood.Iwasgivenbloodandgotbackfullenergy”.

“Lastyear,Igotpregnantthesecondtime.WhileinourhamletonedayIsawPSGmemberswhowerediscussingissuesrelatedtonutrition,Iwasveryglad

andIdecidedtojoinduetopreviouspregnancyproblems. Different issues were discussed, onething was to attend clinic once you observethat you are pregnant and taking FeFo. Theimportance of taking those vitamins wasexplained by community health workers. Forthatreason,IagreedtoattendclinicearlywhenIwas twomonthspregnantwhere Iwasgiventablets to increasemyblood,which Imanagedtotaketodate.IwassurprisedthatIwasgiventhose tabletswithout payment.My communityhealthworkerMr.OmaryZakuseadvisedmeonpropernutritionandIfollowedthat,Ifeelstrongandhealthy”.

“IwouldliketothankMwanzoBoraNutritionProgrammeforteachingusabouthealthbecausenowIamgoingtohaveahealthybaby”.

Mariam Hassan taking FEFO tablets, with Joyce P. Singili (TAWG Nutritionist)

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Ø Success story 2: A Head Nurse at Mchoteka Health Centre feels empowered by “Lishe Ruvuma” Programme

“I Now Can Provide Essential Nutrition Services” says the nurse

ThisiswhattheNurseInchargesaysaboutherserviceafterLisheRuvumaAfter gaining nutrition information from the training organized by LisheRuvumatheHeadNurseatMchotekahealthCentresays“shecannowprovideappropriate nutrition services including nutrition education to mothers onbreastfeeding; how to prepare improved complementary foods; and howtocounselapregnantwomanondietduringpregnancy.OurstaffnowtakeextraefforttoeducatepregnantwomenontheimportanceoftakingIronandFolicAcidsupplements(IFA)andencouragethemtousereminderCalendarsprovidedbyLisheRuvumaprogrammetoremindpregnantwomento taketheirdailytabletofIFA.InmyHealthCentrethereisanincreaseofabout20%inearlyantenatal(ANC)bookingforpregnantwomencomparedtopreviousyearswhichwaszero%andthisincreasecanbeattributedtotheawarenesscreatedforhealthfacilityworkersandfromtheimprovednutritioneducationinthecommunity”.

Thedataunderlinedisatestimonytowhatthenursewasstating.TheTable8showsHospitalAttendanceRecordsatMchotekaHealthCentre.

Mbesa ward Leader’s meeting

Table 8: Early Antenatal booking of pregnant women at Mchoteka Health Centre

Year Total number of women on first visit

Women visiting < 12 weeks of pregnancy

2013 446 0

2014 496 19(3.8%)

2015(Jan-March) 128 25(19.5%)

Ø Success Story 3: Ward leaders meetings now Discuss Nutrition

“In Mbesa Ward about 34 peoplecomprisingofward,villageandreligiousleaders gather for a meeting every 3months to discuss progress of LisheRuvumaandotherprogrammes in theircommunity.Theaimistodiscussresultsofquarterlyvillagehealthandnutritiondays including child healthmonitoring,home/back yard/ sack gardening,WASH, and nutrition and healtheducation.Theyalsodiscussprogrammechallengessuchas lackof transportandwaystofundCHWtocontinuethegoodwork after the programme”, said wardexecutiveofficer.

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Ø Success story 4: communities discussing growth of their children at Village Health and Nutrition Days

“In2015VHNDshasscreenedabout19,621childrenunderfivesandreferredthosewithsevereacutemalnutritiontohealthfacilitiesandfollowsuphomethose withmoderatemalnutrition. Community leaders have also played asignificantroleinTunduruinmotivatingcaregiversandparents.Theleaders’role in the community is tomobilize the community toaccept changesandunderstand the importance of good nutrition for their children’s growth,developmentandschoolperformance”.Thegrowthchartisthebestvehicletostimulatethisdiscussion”saidMr.Mapunda(Ag.DNuO–Tunduru).

IrishAidofficialvisitingVHNDsinAction

For more information contact:The Centre for Counseling, Nutrition and Health Care (COUNSENUTH)

Plot No. 22 Sam Nujoma Road, Mikocheni B, P.O. Box 8218 Dar es Salaam, Tanzania

Tel: +255 22 2775275 Email:info@counsenuth-tz.org

Website: www.counsenuth-tz.org