Concept Note for the Second Tanzania Joint Multi-Sectoral Nutrition Review (JMNR-2)
1. Proposed Dates: 03-04 September 2015
2. Venue: Serena Hotel, Dar Es Salaam
3. Participants
About 140 participants drawn from national level relevant ministries who are members of the HLSCN, nutrition relevant institutions (e.g. TASAF), the Research and Academic institutions (SUA, MUACS, Ifakara Health Institute), Development Partners, NGOs and relevant private sector entities. Regional and district representatives to include RMOs, DMOs and selected Regional and District Nutrition Officers from both Mainland and Zanzibar. Media to be invited to ensure key messages from the meeting are covered for public information and accountability
4. Strategic context of the JMNR-2
The First Tanzania Joint Multi-Sectoral Nutrition Review (JMNR-1) )[1] organized by the High Level Steering Committee on Nutrition (HLSCN)[2] at the Julius Nyerere Convention centre in August 19-21, 2014 reviewed progress, and challenges in scaling up nutrition in Tanzania based on the eight strategic objectives of the 2011/12-2015/16 National Nutrition Strategy (NNS)[3]. The review identified progress, successes, gaps, challenges and opportunities to accelerate achievement of the strategic objectives of the 2011/12-2015/16 NNS and made 25 recommendetations with identified responsibilities and timeframes (see annex-1) divided into three categories as follows: 10 Key overall recommendations (see table 1 of annex-1), 7 priority action areas (see table 2 of annex -1) and 8 consolidated key successes, issues/challenges and proposed actions and way forward (see table 3 of annex-1). The JMNR-1 was conducted as part of a process to develop a long term nutrition vision requested by the President’s Office (Nutrition Vision 2025)[4] that was supported by UN-REACH and was used an input into the review of the 1992 Food and Nutrition Policy and its implementation srategy.
A key recommendation from the JMNR-1 was to convene annual joint multi-sectoral nutrition reviews as a way to monitor progress in addressing the nutrition challenge, keep nutrition on the agenda of key stakeholders and adjust course as appropriate. Thus, JMNR-2 is an important implementation of this recommendation.
A brief review of key progress since JMNR-1 shows several important developments among which are:-
(i) The conduction of a National Nutrition Survey[5] in September – October 2014 to provide a baseline for measuring progress;
(ii) The review of the Food and Nutrition Policy[6] with its draft 10-year (2015/2016 – 2025/2026) implementation strategy. Both the Policy and its implementation strategy considered some of the recommendations from JMNR-1 and Nutrition Vision 2025 on eliminating malnutrition in Tanzania.
(iii) The development of several sector specific strategies or plans which have strong nutrition components. Theses include the Health Sector Strategic Plan IV (HSSP-IV) and the new World Bank funding PforR; the Agriculture Sector Development Programme-II (ASDP-2) and the new One Plan on Maternal and Child Health (MCH). Moroever, there is also the development of a Nutrition Score Card underway.
The National Food and Nutrition Policy Implementation Strategy guides coordinated actions for operationalizing the National Food and Nutrition Policy and provides strategic direction for interventions to address 19 key priority national food and nutrition policy issues within a timeframe of 10 years (2015/16 - 2025/26)[7]. The key priority policy issues include: household food and nutrition security; access to quality nutrition services along the life course; adolescents and maternal nutrition; Infants and young child nutrition; nutrition for most vulnerable groups; and prevention and management of DRNCDs. The others are nutritional care and support during emergencies and disasters; national capacity to improve nutrition; multisectoral coordination of nutrition services and interventions; private sector contribution to nutrition; availability of reliable, timely and sustainable nutrition data; nutrition knowledge, behaviours, attitudes and practices; and regional and international collaboration for improvement of nutrition.
The National Nutrition Survey done in September to November 2014 using the SMART methodology shows both improvements and challenges:
The key progress on nutrition indicators were as follows:
ü The prevalence of stunting decreased from 42.0% in 2010 to 34.7% in 2014. This represents a reduction of 18% since 2010 (Annual Reduction Rate - ARR of 1.46%) and 30% since 1992 (Annual Reduction Rate of 1.02%). However, the situation is still above the cutt-off point of 30% for severe stunting, categorizing Tanzania as still having a severe problem of stunting and above Africa’s average of 30%. If the trend of the ARR of 1.46% between 2010 and 2014 continues, it means Tanzania will achieve a stunting rate of about 20% by 2025, five points below the 2025 MKUKUTA objective of 15%. To achieve the MKUKUTA objective, an ARR of 1.97% will be required, an objective that is possible if the effective nutrition interventions are scaled up and sustained.
ü The prevalence of Global Acute Malnutrition (GAM) remains at below 5%, a level consistent with WHO’s 2025 objective.
ü The prevalence of Underweight was at 13.4% in 2014 which is very close to 2015 target (12.5%) for indicator 1.8 of Millenium Development Goal one (MDG1). This represent 46% reduction since 1992. Thus, Tanzania is “on track” to reach the target indicator 1.8 of MDG1 (50% in 2015)”.
ü The coverage of Vitamin A Supplementation among children 6-59 months increased from 61% in 2010 to 72% in 2014. A high coverage of vitamin A supplementation was noted in Arusha, Kagera and Unguja North (>90%) and the lowest in Mwanza, Singida, Manyara and Town West with less than 50%.
ü The coverage of deworming among children 12-59 months increased from 50% in 2010 to 71% in 2014 implying an improvement in the anaemia situation.
ü Chronic Energy Deficiency among women (BMI below 18.5) improved in both Mainland and Zanzibar.
The challenges include:
Ø More than 2,700,000 children under five years of age are stunted in Tanzania in 2015 and 58% of stunted children live in 10 regions. Most of these regions are not benefiting from key nutrition interventions.
Ø Over 435,000 children under five years of age suffer from acute malnutrition including more than 105,000 who are severely acutely malnourished. These children have the highest risk of dying if they do not receive appropriate and timely treatment.
Ø Indicators of of feeding practices for infants and young children have not improved between 2010 and 2014. This was linked to low coverage of SBCC activities at community level.
Ø Obesity among women increased from 6% in 2010 to 10% in 2014. High levels of obesity were found in Kilimanjaro (22.2%), Dar-Es-Salaam (20.9%), Town West (25.2%) and Unguja South (24.8). It is paradoxical that both undernutrition and overnutrition in women increased.
Ø The coverage of Iron and Folic Acid Supplementation during pregnancy improved more than twofold from 3.5% in 2010 to 8.3% in 2010, but the level is still very low. The regions with lowest level of Iron Folic Acid supplementation are Singida (0%), Mwanza (0.5%), Tabora (1.9%), Katavi (2.4%), Geita (3.2%), Simiyu (3.8%) and Mara (4.5%).
Ø The use of Iodized Salt at Household level decreased from 82% in 2010 to 64% in 2014, despite provision of potassium iodate to Tanzania Salt Producers Association (TASPA) in 2013. Of great concern is that even the level of iodization is very low in regions like Lindi (6%), Mtwara (13%), Tabora (20%), Rukwa (22.5%), Simiyu (23%), Geita (23%), Ruvuma (25%), Singida (33%) and Shinyanga (30%).
The results of the nutrition survey helped to report on the Tanzanian progress towards MDG-1, and also prepare for the next United Nations Development Action Plan (UNDAP) for Tanzania. Moreover, it provided a good baseline for the 10 year (2015/2016 – 2025/2026) National Food and Nutrition Policy Implementation Strategy. Because, it is hard to measure progress towards nutrition targets without more frequent data, it is also planned this national nutrition survey will be repeated in 2016 and 2018, between the Tanzania Demographic and Health Surveys (TDHS) of 2015 and 2020. This will provide more frequent data within the context of the nutrition common results and accountability framework as recommended by Nutrition Vision 2025 for Tanzania.
5. Objectives and expected outcomes
Overall Objective
The primary objective is to review, analyze, and document progress, challenges, and lessons learned from the implementation of the recommendations of the First Tanzania Joint Multi-Sectoral Nutrition Review (JMNR-1) and agree on a long-term way forward. Recommendations from JMNR-2 will suggest improvements to the final period of the 2011/12-2015/16 NNS implementation and inform the finalization of the National Nutrition Action Plan for the next 10 year period 2015/2016-2025/2026) within the framework of Nutrition Vision 2025 as guided by the Food and Nutrition Policy and its implementation strategy.
Specific Objectives
1. To update on the nutrition situation in Tanzania since the JMNR-1 (Progress, challenges, lessons).
2. To review the implementation of the recommendations of the (JMNR-1). (See annex 1 for list of recommendations) and share implementation experiences (successes, challenges, opportunities).
3. To review the status of implementation of the 2011/12 – 2015/16 National Nutrition Strategy as of August 2015 and identify causative factors for improving and deteriorating trends.
4. To share experiences especially at the district/regional level of the opportunities and challenges in implementing the 20111/12 – 2015/16 National Nutrition Strategy
5. To discuss key policy and strategy issues and multi-sectoral plans with a view to understanding the policy and strategy basic framework for nutrition relevant work for the next 10 years.
6. To review a proposal for a road map towards the development of an implementation plan for the Food and Nutrition Policy and its Strategy.
Expected Outcomes
1. Better understanding about the nutrition situation and the priority areas to focus action.
2. Gaps in the implementation of the recommendations of JMNR-1 are identified and agreement reached on how to address those gaps.
3. The participants understand the policy and strategic framework for the implementation of nutrition activities for the next 10 years.
4. Key recommendations that will propel Tanzania towards eliminating malnutrition by 2030 focusing on nutrition vision 2025.
5. A meeting report which will be discussed by the HLSCN focusing on implementation of the recommendations and monitoring progress
6. Methodology
The review process
In order to achieve the planned objectives and outcomes, the review process is planned in three phases: -
Phase one will be the pre-workshop period (July 28th – 2nd September 2015) with intensive preparations to ensure smooth facilitation and engaged participation in the workshop. An organizing committee under the chair of TFNC will lead this.
Phase two will be the period of the workshop itself (3 & 4th September 2015) will be led by the Lead Facilitator and Moderator who will steer the meeting towards expected objectives and outcomes. TFNC will provide 3 note takers to support the facilitator.
Phase three will be post-workshop to produce the workshop report and its submission to the High Level Steering Committee on Nutrition. The lead facilitator will be responsible for writing the report and TFNC responsible for submission to the HLSCN.
Faciltation methodology
1. The meeting will start with an opening session where the review will be introduced and key stakeholders in Government and Development partners make opening remarks or statements. This will be followed by technical presentations and discussions and will end with a closing session where key stakeholders will again make closing remarks.
2. The key activities for the first day (3rd September 2015) will include:
a. A presentation by TFNC on progress on the nutrition situation in Tanzania (using information from National Nutrition Survey, 2014), analyzing the reasons for improvement or otherwise and the new nutrition funding initiatives (DFID, CIFF, WB).
b. Review of the status of implementation of the recommendations of the 2014 JMNR-1 followed by a presentation on the Review of Implementation of the National Nutrition Strategy by LGAs and MDAs, for the period FY 2011/12 – 2014/15. Both presentations will be done by TFNC. JMNR-1 had 10 overall key recommendations (see table 1 of annex-1), 7 priority action areas each with proposed way forward and responsibilities (see table 2 of annex -1) and identification of gaps and way forward based on the 8 strategic objectives of the NNS (see table 3 of annex-1).
c. To better understand the challenges of the implementation of the 2011/12-2015/16 NNS at community level, two more presentations will be done by the District Councils one from a low performing district (Bahi district) and the second from a high performing district (Muheza district) looking at the challenges and lessons learnt.
d. The last part of day-1 will be be group work with the objective of identifying the key challenges for planning, budgeting and implementing nutrition activities and formulation of recommendations. TFNC will develop a template for the reporting on the group work. Participants will be divided into five groups all with the same terms of reference. The groups will have one hour for deliberations followed by 30 minutes plenary group presentations of 6 minutes each and 30 minutes for discussion. Since groups will have the same TOR, the first group to present will be given a little bit more time with subsequent groups only adding aspects not covered by previous groups.
3. Day 2 (4th September 2015) will address progress and challenges in scaling up nutrition through critical nutrition relevant sectors and multi-sectoral approaches.
a. Scaling up nutrition through social protection measures will be presented by TASAF (Tanzania Social Action Fund) sharing their experience in addressing the nutrition challenge through conditional cash transfers (CCT), where nutrition is one of the three key conditions; the others being education and health.
b. Scaling up nutrition through the health sector to be presented by MOHSW will look at the Health Sector Strategic Plan-4 (HSSP-IV) and the new WB funding PforR as an opportunity for scaling up nutrition. This will be followed by a Panel discussion led by IHI/TNCD Alliance on other health initiatives.
c. Scaling Up Nutrition through the Agriculture Sector will provide a brief overview of nutrition partners in Agriculture Sector by the MAFSC followed by brief presentations by USAID and SAGCOT.
d. To provide an understanding of the global and national policy and strategy framework for nutrition in the next 10 years, the PMO will present the key Global and National Food and Nutrition Policy and Strategy issues for nutrition in the next decade (include the Sustainable Development Goals –SDGs, National Food and Nutrition Policy) followed by a presentation on a Roadmap for National Multisectoral Nutrition Action Plan (NMNAP 2016/17 – 2020/21). The presentations will be followed by group work. The same five groups of day-1 will deliberate and formulate recommendations on how to ensure that the new NMNAP 2016 / 17 – 2020/21 is adequately designed to address the challenges of implementing multi-sectoral nutrition interventions in Tanzania. Group work will take one hour followed by 30 minutes of plenary group presentations and discussion.