Measures taken to tackle malnutrition in Tanzania

01Aug 2016
Gerald Kitabu
The Guardian
Measures taken to tackle malnutrition in Tanzania

In part one of this special report on the status of malnutrition in Tanzania, The Guardian brought to you the state of malnutrition, obesity, overweight,

A businesswoman at Shekilango Market in Dar es Salaam Teddy Boazi arranging her vegetables and fruits ready for the customers

economic costs of under nutrition and the national perspective on the magnitude of poor nutrition. In this second part of the report, this paper sheds light on the consequences of poor nutrition and measures being taken by the government and other stakeholders.

Consequence of poor nutrition
According Geoffrey Chiduo, the Acting Director, Policy and Planning of Tanzania Food and Nutrition Centre (TFNC), it is estimated that in the year 2025, a total of 580,687 children will die if stunting levels would remain at 42 per cent (status quo scenario) in 2010.

On the other hand, 120, 633 lives would be saved over the time period if the nutrition situation improves and the targeted reductions for each nutrition problem is reached (improved scenario).

He said that based on PROFILES estimates, it is also estimated that in the year 2025, a total of 209,638 children will die due to Vitamin A deficiency if no action is taken (status quo scenario). On the other hand, 101,859 lives would be saved over the time period if the nutrition situation improves and the targeted reductions for each nutrition problem is reached (improved scenario).

He explained that another scenario is on the number of children with permanent disabilities that would result if the current nutrition situation regarding maternal iodine deficiency during pregnancy continued (status quo scenario).

And the number of children who would be prevented from having permanent disabilities over the time period if the maternal iodine situation improves and the targeted reduction is reached (improved scenario).

PROFILES estimates revealed that 1,730,000 children will be suffering with permanent disabilities in 2025 if the current nutrition situation regarding maternal iodine deficiency during pregnancy continued (status quo scenario).

A total of 869,800 children would be prevented from having permanent disabilities over that time period if the maternal iodine situation improves and the targeted reduction will be reached (improved scenario).

“Economic productivity losses and gains was another issue examined through PROFILES estimates. It was revealed that on the productivity losses related to stunting would have been 28.796trn/-, anaemia 2.285trn/- and iodine deficiency 1.521trn/-; if the current nutrition situation continues (status quo scenario),” he said.

The productivity gains (or, put another way, economic productivity losses averted) that could be made over the time period would be stunting 6.237trn/-, anaemia 611bn/- and iodine deficiency 767bn/-; if situation improves and the targeted reductions are reached (improved scenario).

According to Chiduo, profiles consist of a set of computer-based models that calculate estimates of the benefits of improved nutrition on health and development outcomes and the consequences if malnutrition does not improve.
He said that to calculate estimates, PROFILES requires current country-specific nutrition data that are identified and agreed upon in collaboration with other stakeholders in the country.

In Tanzania, estimates (using the most recent DHS and other relevant sources) were calculated in terms of child and maternal mortality, economic productivity, disabilities, and human capital for the period 2014 –2025.

Issues in terms of nutrition response in Tanzania
According to Chiduo, good nutrition was long recognised as an important factor for the health and well being of people even before independence. However, efforts taken during the colonial period prioritised increase in labour productivity by targeting employees in plantations.

It was after independence that the Government took more concrete efforts to promote good nutrition for all Tanzanians when it declared “Poverty, disease and ignorance” as the three biggest enemies of the nation. Other Government initiatives included national political declarations such as “Kilimo cha Kufa na Kupona”, “Siasa ni Kilimo, Kilimo ni Uhai” and “Mtu ni Afya”.

These provided guidelines for actions to support nutrition improvement. The ideology of “self-reliance” also recognised the potential of the country to sustain itself with adequate food for the population. In 1973, TFNC was established to spearhead nutrition activities and in 1992 Food and Nutrition Policy was developed and endorsed to strengthen coordinated efforts.

Chiduo explains that currently, Tanzania stands out among countries with high-level political commitment geared towards eliminating the threats of malnutrition.

Citing examples he said that Tanzania was one of the first 19 countries to join the scaling up nutrition (SUN) movement in 2011. As mentioned earlier, the causes of malnutrition are nested in multiple sectors include health, agriculture, livestock, water, sanitation and hygiene (WASH), community development and social welfare.

SUN is a country-led movement, which puts countries at the heart of global efforts to improve nutrition. It unites people from governments, civil society, the United Nations, donors, businesses and researchers in a collective effort to improve nutrition.

He said that national leaders are prioritising efforts to address malnutrition by putting the right policies in place, collaborating with partners to implement programmes and mobilising resources to effectively scale up nutrition with a core focus on empowering women.

“Through SUN collaborative action are being undertaken targeting the “1000 days” window of opportunity where consequences of stunting, wasting, and underweight could still be reversible. In total, there are 57 countries worldwide that have joined the SUN movement” he said.

Putting the right policies in place
The country has made commitments at regional and global level for improvement of nutrition in the country. They include Agenda 2030 on Sustainable Development Goals (SDGs) and the six world health assembly (WHA) Global Nutrition Targets for 2025.

Other commitments include the nine global voluntary non-communicable diseases (NCD) targets for 2025, the East Africa Food and Nutrition Security Policy, Nutrition for Growth commitments made under the G-8 Summit (June, 2013), the African Regional Nutrition Strategy (2013-2018) and other relevant national and global policies, programmers, strategies and action plans.

Apart from regional and global targets mentioned above, nutrition priorities also consider attainment on national objectives as outlined in the Second National Five Year Development Plan (20161/17-2020/21), the Long Term Perspective Plan (LTPP), the Health Sector Strategic Plans IV (2015-2020) and other national wide strategies and plans in other sectors essential for efforts to improve the nutrition situation in the country.

According to Chiduo, among the first key steps the Government has undertaken this year in line with nutrition commitment is exemption of vitamins and food supplements (micronutrient compound), water treatment chemicals in the list of exempted items which have been approved by the Minister responsible for Health.

The decisions complement efforts initiated by the retired President Jakaya Kikwete in 2013 when he launched a food fortification programme aimed at adding value to food.

Currently, 21 industries in Tanzania are implementing food fortification through salt, cooking oil and flour. Improving child nutrition through micronutrient supplementation has been recognised among the high impact nutrition interventions.
Collaborating with partners to implement programmes

In line with SUM movement initiatives, the High Level Steering Committee in Nutrition (HLSCN) was established in 2011. This is the multi-sectoral, multidisplinary and multi-dimensional body to ensure collective efforts are made to scale up nutrition.

The HLSCN is chaired by the Permanent Secretary in the Prime Minister’s Office (PMO). The HLSCN members include representatives from six key sectoral ministries, development partners, non-governmental organisations, faith-based organisations, the private sector and higher learning institutions.

According to Chiduo, similar committee has also been established at region and council levels. All technical issues are normally addresses through the national technical working group in nutrition (NTWGN) meetings chaired by TFNC and Ministry for Agriculture, Livestock and Fisheries.

“Our main agenda is built in the spirit of cooperation because we are optimistic that improved nutrition can be achieved through enhancing partnerships amongst nutrition stakeholders so that available resources are used optimally to deliver evidence – based and cost-effective nutrition interventions” he explained.

To strengthen coordination, councils and regions are continuously recruiting or appointing nutrition officers to serve as nutrition coordinators, he added.

Mobilising resources for nutrition
In 2011 the national nutrition strategy was developed and launched by the former Prime Minister, Mizengo Pinda. In order to facilitate its implementation, the Government and stakeholders needed up to date information on the resources available, allocated and spent on the nutrition.

To address this, the Ministry of Finance in Tanzania, with the technical and financial support of UNICEF and the World Bank, conducted a public expenditure review (PER) for nutrition.

The purpose of the PER was to provide baseline information on allocations and expenditures on nutrition in the 2012/13 – 14 financial year.

The findings revealed that although there is an increase of expenditure in nutrition, the actual investment has not gone beyond 1 percent of government expenditure or Councils Budget allocation for the three financial years.

“Nutrition is still not prioritise and hence underfunded, but prospects are encouraging,” said Chiduo, citing an International Conference on Nutrition (ICN2) recommendation that the UN General Assembly endorse the Rome Declaration and Framework for Action and consider declaring a Decade of Action on Nutrition for 2016 -2025.

The conference was held in 2014 whereby among the proposed commitments which countries are required to fulfill are increasing investments on nutrition, raising the profile of nutrition and strengthening and facilitate, contributions and action by all stakeholders.

The study conducted involving the World Bank (WB), Results for Development Institute (R4D), and 1,000 Days Initiative, in partnership with the Bill & Melinda Gates Foundation and the Children’s, Investment Fund Foundation (CIFF) it is estimated that it will cost approximately an additional $8.50 per child per year to meet the global stunting target by 2030.

This cost covers the scale up of high-impact, proven interventions focused in the 1,000 days of a child namely, improving maternal nutrition, improving infant and young child feed practices, which include exclusive breastfeeding for the first six months of life and improving child nutrition through micronutrient supplementation and complementary foods.

For Tanzania, and in line with these findings, district councils have been directed to allocate a minimum of 500/- per child aged under five years; beginning 2016/17 financial year. This amount will be aggregated annually to reach 18, 000/= per child per year by 2030.