1. The Hidden Emergency Child Malnutrition in Tanzania Save the Children Tanzania

2. Overview of presentation Lessons from Save the Children’s research in Lindi District – cost of diet and study on extreme poverty Lessons from Save the Children’s research in Lindi District – cost of diet and study on extreme poverty What is the impact of malnutrition and under- nutrition on children in Tanzania? What is the impact of malnutrition and under- nutrition on children in Tanzania? Policy implications Policy implications

3. The study objectives: To determine what it would take to ensure all households are able to afford a quality diet, particularly for children under two, in Lindi Rural District To determine what it would take to ensure all households are able to afford a quality diet, particularly for children under two, in Lindi Rural District To develop an increased understanding of extreme poverty To develop an increased understanding of extreme poverty The aims were to feed into two broader related debates; increasing a sense of urgency around the reduction of chronic malnutrition – delivery MDG 1 - and the design of social welfare systems and social protection within them

4. Some facts about Lindi Population – 214,885 (2002 census) Population – 214,885 (2002 census) Chronic malnutrition rate – 54.4% (38% national average) – the highest in the country Chronic malnutrition rate – 54.4% (38% national average) – the highest in the country GDP per capita – 150,000 (among the poorest districts in Tanzania) GDP per capita – 150,000 (among the poorest districts in Tanzania) U1 mortality – 152/1000 U1 mortality – 152/1000 Pregnant women mortality – 166.5/10,000 Pregnant women mortality – 166.5/10,000

7. Table 8 Combined cash income and food production of household profiles Cash income Value of food Income and food Income and food per person Older headed, 2 children 65,00050,000115,00038,300 Female headed, 3 children 105,00075,000180,00045,000 Active couple, 3 children 145,000120,000265,00053,000

8. Table 10

9. Figure 8 Annual household income and income sources

12. Study Findings Children’s diet is influenced primarily by 3 factors: 1. 1. Seasonality - post-harvest vs pre-harvest. 74% of children were fed frequently enough in July compared to 48% in March. Frequency is not the same as quality. 2. 2. Wealth - At post-harvest time only 65% of children in poorer households were fed frequently enough, compared to 100% in middle/better-off households 3. 3. Age – The frequency of feeding decreases with age. Reports from school children indicated that they only ate once a day, usually at night (During this age children should be fed at least 4 times a day). The 12 to 23 months age group is of particular concern - only 23% were fed frequently enough pre-harvest and 56% post-harvest. (During this age children should be fed at least 4 times a day).

15. Price (Tsh)QuantityCost (Tsh) Food Basket Maize / Sorghum300229 kg68,650 Cassava100482 kg48,200 Pulses275135 kg37,200 Fish100104 piles10,400 Vegetables 2,600 Coconut40120 nuts4,800 Non-food basket Salt2008 packets1,600 Clothes 10,000 Soap10072 bars7,200 Kerosene40208 units8,320 Matches30208 boxes6,240 Body oil5052 tubs2,600 Utensils 2,000 Bed sheet15002 sheets3,000 Hand hoe5002 hoes1,000 Social contribution 2,000 Health 3,000 Education 10,000 Annual basket per household ~229,000 Annual basket per person ~57,000 Table 10 Minimum food and non-food basket

17. Globally, child under-nutrition is responsible for half of all child deaths Source: Black RE, Morris SS, Bryce J (2003) Where and why are 10 million children dying every year? Lancet; 361: 2226- 34

18. What MDG 1 says Eradicate extreme poverty and hunger Eradicate extreme poverty and hunger Target 1 Target 1 Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day. Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day. Target 2 Target 2 Halve, between 1990 and 2015, the proportion of people who suffer from hunger (measured by underweight) Halve, between 1990 and 2015, the proportion of people who suffer from hunger (measured by underweight)

19. Infant undernutrition is irreversible - It happens early and its costs persist throughout life and are transferred to next generation % Age (months) source: TDHS 1999

20. Stunting at Age 2 - Tanzania Moderate28% Severe23% Normal49%

21. Consequence of Stunting Reduces Physical Capacity & Productivity 1% decrease in height  1.4% decrease in productivity Source: Haddad & Bouis, 1990 UNICEF/91-029 J Schytte

22. 1,262 323 Mental Impairment Stunting Anaemia Total: 2,822 Billion TShs 1,237 Total Economic Loss from Stunting & Iron/Iodine Deficiency, Tanzania 2000-2010

23. Tackling child malnutrition is Everybody’s business, nobody’s responsibility

24. Conclusions of Study Findings in Lindi District 1. 1. Diet quality/diversity needs improving, either through maximising the existing food available, increasing people’s access with a cash transfer, and/or through a system of supplementation. 2. 2. Feeding frequency/quantity could be improved by a cash transfer scheme. Feeding frequency is constrained by women’s workload, particularly in poor households. Any scheme must take into account other essential needs (not just the cost of diet). 3. 3. Measures to improve children’s diet are particularly essential in the pre-harvest to prevent the seasonal decline. 4. 4. The relevance of cash transfers, supplementation or a combination of both needs further debate to determine what is structurally feasible, sustainable and efficient.

25. Recommendations Government and DPG establish nutrition group with high level of ownership and leadership from Presidential level, review / strengthen a nutrition policy and strategy with implementation plan and resources. This will need to include a strategy for high level advocacy for national,regional and district level decision makers. GOT/DPG to prioritise social protection programmes within effective national social welfare systems linked to national planning processes. The Social Protection Framework under development needs to be approved, resourced and implemented as a matter of priority. These systems must provide direct financial and other benefits; particularly to families who are extremely poor in the form of cash transfers - pensions, child benefit, disability allowance, benefit for the chronically sick and nutrition programmes appropriate for different age groups. GOT and DPG to include civil society at national, district and sub district levels to pilot and test social welfare and protection initiatives as above within national and district planning and budgeting frameworks. This has to include funding

26. Recommendations Government and DPG to review and evaluate whether their indirect investments really do tackle malnutrition, reform them accordingly, and ensure they have human resources to do that Start reporting against the internationally agreed indicator on nutrition and use nutrition indicators to report progress in food security, safety nets and social protection, governance, water and sanitation and health Districts to include nutrition and other social protection interventions into Council Plans and Budgets