"You can't study if you're hungry..."

29 Nov 2013

MPs visit nutrition programmes in Tanzania

[caption id="attachment_14142" align="alignleft" width="200"]Checking for undernutrition at a health post in Chanika community Checking for undernutrition at a health post in Chanika community[/caption]

Two British MPs recently visited Tanzania  with staff from RESULTS UK, on a delegation which aimed to assess possibilities for improved early childhood development. The delegation visited education and nutrition programmes and spoke to MPs, ministers, DFID, civil society, teachers, parents and pupils. Tanzania is one of the poorest countries in Africa, and this is notable in a country that has not suffered civil war or internal strife. The MPs were interested in what could be done to improve the lives of 2.7 million children who are undernourished, and the even greater number who are leaving school without being able to read or write well.

Our delegation was shocked to learn that 42% of under-five children are stunted (too short for their age). This is caused by chronic undernutrition which can be due to food insecurity, poor sanitation  or poor dietary diversity.  Stunting is one reason why school performance in Tanzania is so poor (see last weeks blog on education in the country) but it also means that at a national level economic growth is held back. Undernourished children on average enrol in school at a later age, complete fewer years of school and are  less likely to pass school exams, get or  create good jobs, or  contribute sufficiently to the national economy. According to officials we met, little progress has been made on undernutrition in the last decade.

In spite of these statistics we were able to observe some more optimistic findings. Firstly we visited some projects where community volunteers had been trained to screen children in their local area- using a simple technique to measure a child’s upper arm circumference for severe acute malnutrition. Weighing babies and children is another simple method to monitor progress. In Zanzibar we visited an early childhood development programme run by the Aga Khan Foundation, where school feeding combines with child-focussed madrassa teaching to give a very high quality kindergarten service. Mark Williams MP, an ex-teacher himself, said:

“I felt privileged to meet so many young people, who despite their circumstances were totally committed to getting an education.  We were concerned about the effect of malnutrition on children, and felt that more importance should be attached to the first 1000 days of the children life”.

We learnt that in most parts of the country the “under-fives” education system non-existent or extremely weak, with the exception of private pre-schools. In the state system most children don’t even start primary school till age 7, or even 8. So even in the relatively unusual case that the child goes to ‘pre-school’ this is not until around age 6. As one NGO staff member told us, “there is a big gap between about ages 1 and 6, when children are not being reached by any consistent government service… there is no mechanism, apart from a few NGO projects, to deliver supplementary food or early education”.

[caption id="attachment_14143" align="alignright" width="300"]Cathy Jamieson MP & Mark Williams MP at the Bakresa flour mill Cathy Jamieson MP & Mark Williams MP at the Bakresa flour mill[/caption]

Secondly  the delegation did visit one very impressive nutrition intervention that seems to be a model for other countries in East Africa.  Two-fifths of women in Tanzania of reproductive age  and over half of children under five are anaemic (usually caused by iron deficiency). Anaemia can lead to reduced cognitive capacities,  in young children and potential birth complications for pregnant women. In order to address anaemia and other micronutrient deficiencies the government signed a new law in May of this year mandating that all wheat flour sold in Tanzania much be enriched with  micronutrients including iron, zinc, folic acid and B12. To see how the wheat is fortified we  visited a flour factory run by the Bakresa group, one of the largest companies in Tanzania. From a combined initiative of DFID, government and private sector Bakresa and 7 other millers are now fortifying flour with 4 micro-nutrients. The fortified flour should reduce anaemia and increase micronutritient intakes for almost half the population. Cathy Jamieson MP said “I was impressed to see that the private sector wanted to be part of the solution on nutrition, and is playing a  key part in food fortification programme”. We did realise however that shop-bought bread is more likely to have benefits among the urban dwellers than the rural poor.

As well as visiting projects the MPs also met the deputy Health Minister, the Permanent Secretary from the Prime Ministers office and the  Parliamentary Group on nutrition. We had some interesting debates with the MPs and officials. One issue that seems counter-intuitive is that even MPs from some of the most food secure regions of Tanzania told us they still have very high levels of undernutrition in their constituencies. They explained to us that children are given enough food (meaning calories) to eat, but the food lacks variety and is mainly maize porridge. This does not provide essential vitamins and minerals necessary for optimal growth. . Therefore in these regions community level projects and public education is necessary for parents, yet the funds are lacking for this sort of programme.

[caption id="attachment_14146" align="alignleft" width="300"]Meeting with MPs group on nutrition, in parliament All photos credit Steve Lewis Meeting with MPs group on nutrition, in parliament
All photos credit Steve Lewis[/caption]

Another interesting debate was around the role of the private sector. The UK Aid programme has recently announced an increase in aid directly for four private companies. The idea is that economic growth will “lift people out of poverty”. However we heard that there is little correlation between economic growth and reduction in undernutrition. Tanzania already has 7% economic growth p.a. but the benefits are most felt in industries such as natural gas, extractives, and in the better off suburbs of the main cities. Poverty levels in rural areas are unaffected.

Research by organizations such as the International Food Policy Research Institute demonstrated that the current growth in Tanzania is not pro-poor and even the current high levels of economic growth are unlikely to lift the poorest fifth  of society out of poverty. Evidence shows that economic growth alone is insufficient to tackle undernutrition in the time frame needed. . There is evidence that directly investing in nutrition interventions such as Vitamin A supplementation  campaigns, promotion of exclusive breastfeeding  or community based nutrition promotion can give a rapid reduction in malnutrition. Findings published in The Lancet medical journal in June this year  have shown clearly that targeted investment in nutrition programmes has a definite benefit in levels of undernutrition and can have an immediate effect in the poorest rural areas.

The delegation left Tanzania with the following recommendations:

  • Encourage the DFID country office to begin to support at least one specific nutrition programme, preferably long-term (5 years).
  • Encourage civil society to increase education programmes which enhance rates of exclusive breastfeeding, but at the same time be clear on the role and definition of volunteers.
  • Encourage government to step up funding and support for Community Based Nutrition Programmes especially in rural areas.
  • Encourage all stakeholders to invest in monitoring and evaluation systems to ensure that nutritional progress   can measured and lessons learnt. .
  • At the global level, for the international community to ensure that nutrition is incorporated as a specific component of the post-2015 Global Development Goals.

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