Nutrition Programs in Tanzania

Presentation by Amanda Pitts, Adriane Siebert, Yara Koreisi, Anne Marie

Dembel, Kate Dupont and Tina Lloren

Historical Context

Independence in 1961 Mwalimu Julius Nyerere elected

president Arusha Declaration contained policy of

ujamaa

Socialist policies dominated through the early-1980s.

Resisted pressure from IMF to implement SAPs

Accepted IMF/WB recommendations for SAP in 1982

“We cannot protect the excellence of education for the few by neglecting the education for the majority; in Tanzania, it is a sin to do so.”

~Mwalimu Julius Nyerere

Education’s role in nutrition Co-involvement of Nutrition programs

and Education began in 1920’s Initially directed at women, with less

emphasis on men and children TFNC attempts to include the general

population

Primary Schools in Tanzania “Every person has the right to education.”

Constitution of United Republic of Tanzania (1984)

Primary school network is widespread in Tanzania – more so than health service delivery points At least 1 school in every village Total 10,000 schools in Tanzania

Government provided support

Trend in rate of illiteracy in Tanzania, 1967-1986

Year Illiteracy Rate in %

1967 69

1975 39

1977 27

1981 21

1983 15

1986 10

Source: Ministry of Education, Tanzania, 1989

IEC and use of the mass media

Newspapers Radio Tanzania “Facts of Life” booklet distributed

by TFNC and MOH Posters and films

Iringa Nutrition Programme

Part of Joint WHO/UNICEF Nutrition Support Programme (JNSP)

Funds from gov’t of Italy

5-years In 168 villages in

Iringa District

Objectives

Development of community based improvements in nutrition and health

Fundamental change in process

Design

First large scale application of the UNICEF conceptual framework “Triple-A Cycle” implemented at all levels

of administrative and social hierarchy (HH to village to central gov.)

Each level assessed, analyzed and took action on the problems that could be addressed at their level, using the resources available at that level

Coverage and Activities Coverage: 168 villages in seven divisions ~46,000 children Program started with 14 different programs with 42

sub-projects But decreased to 8 programs with 31 projects

Systems development and support Maternal and child health Water and environmental sanitation, Household food security Child care and development Income generating actions Research Management and staff

Management & ImplementationMethods/materials developed

from scratchUtilized already-established local

government and political systems

Research was instrumental

Quarterly meetings of the steering committee held in villages

Management and implementation transferred to the district level from regional level

Village health committees were strengthened

Management Information Systems

Community growth monitoring by quarterly weighing

Parents given info on feeding practices, food security, and referrals

**Info about child nutritional status given to all levels and used in decision making

Program Impact and Outcomes Indicated mainly by quarterly growth monitoring

systems Considered a success:

Severe malnutrition decreased by 71.4% and total underweight by 32% in a period of 5 years

Impact attributed to program b/c rates of malnutrition in non-program areas remained high

Increase in immunization rates from 35% in 1984 to 93% in 1988

**Improvements in the nutritional situation occurred before health services and water facilities had been improved Initial success attributed to increased

feeding frequency, est. of child feeding posts, and improved health care

Improved information and use of info systems was important factor in success

Costs and Affordability

$19/child/year

Seems expensive, but benefits of health services, food security and income generating activities extended to the families and communities

Costs were drastically reduced in the expansion of the program

Iringa JNSP 168 villages

↓CSD program

600 villages in Iringa +villages in 9 other regions

and Zanizibar

The Child Survival and Development Program (CSD) 1989

Phase I Implementation committees (regional and

district level) formed and visits are made to the regions

Villages voted on participation Advocacy and mobilization approaches

used to elicit community involvement

Phase II CSD

Three trials established: Safe Motherhood Initiative Community financing for primary health

care Control of critical common disease factors

Trends in prevalence of underweight in CSD areas through 1991

0

10

20

30

40

50

60

1984 1985 1986 1987 1988 1989 1990 1991

Iringa

Kagera

Kilimanjaro

Mara

Morogoro

Mtwara

Ruvuma

Shinyanga

Singida

Source: TFNC and UNICEF nutrition databases, 1992

Limitations of nutrition programsLow capacity in service deliveryPoor food productionEconomic declinePopulationHIV/AIDS

Asante sana