2. Nutrition Programs in Tanzania Presentation by Amanda Pitts, Adriane Siebert, Yara Koreisi, Anne Marie Dembel, Kate Dupont and Tina Lloren

3. Historical Context Independence in 1961 Mwalimu Julius Nyerere elected president Arusha Declaration contained policy of ujamaa

4. Socialist policies dominated through the early-1980s. Resisted pressure from IMF to implement SAPs Accepted IMF/WB recommendations for SAP in 1982

5. “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

6. 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

7. 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

8. Trend in rate of illiteracy in Tanzania, 1967-1986 YearIlliteracy Rate in % 196769 197539 197727 198121 198315 198610 Source: Ministry of Education, Tanzania, 1989

9. IEC and use of the mass media Newspapers Radio Tanzania “Facts of Life” booklet distributed by TFNC and MOH Posters and films

10. 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

11. Objectives Development of community based improvements in nutrition and health Fundamental change in process

12. 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

13. 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

14. Management & Implementation Methods/materials developed from scratch Utilized already-established local government and political systems Research was instrumental

15. 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

16. 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

17. 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

18. **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

19. 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

20. Iringa JNSP 168 villages ↓ CSD program 600 villages in Iringa + villages in 9 other regions and Zanizibar

21. 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

22. Phase II CSD Three trials established: Safe Motherhood Initiative Community financing for primary health care Control of critical common disease factors

23. Trends in prevalence of underweight in CSD areas through 1991 Source: TFNC and UNICEF nutrition databases, 1992

24. Limitations of nutrition programs Low capacity in service delivery Poor food production Economic decline Population HIV/AIDS

25. Asante sana