Investing in nutrition for national growth and prosperity in Tanzania UNICEF Tanzania/2009/Pudlowski
Development Partners Group on Nutrition February 2010 Suggested citation:
DPG Nutrition (2010). Investing in nutrition for national growth and prosperity in Tanzania. Development Partners Group
on Nutrition, Dar es Salaam, Tanzania.
For further information contact:
Harriet Torlesse, Chair DPG Nutrition, [email protected]
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Why nutrition is critical to economic growth Malnutrition is slowing Tanzania’s progress towards economic growth and poverty reduction. It does this by threatening
the lives, health, growth and development of children, lowering school performance, and reducing work productivity in
adulthood.
This is a critical time for nutrition. With the global economic crisis, climate change, volatile food prices and HIV pandemic,
urgent actions are needed now – more than ever before – to protect the nutritional status. Cost-effective interventions are
available and feasible. Food fortification alone could save the country over TZS 150 billion each year by averting the
productivity losses due to vitamin and mineral deficiencies. Failure to take action to improve nutrition will thwart
Tanzania’s good intentions to promote growth, equity and poverty reduction.
This document has been prepared by the Development Partners Group on Nutrition, a coalition of development partners
and non-governmental organizations committed to advancing nutrition in Tanzania. It explains why nutrition must be
firmly anchored within the next MKUKUTA, and how this can be done.
Malnutrition is one of the most serious threats to
economic growth. It diminishes the ability of children to
grow, learn and earn income as adults, and thus
contribute to the economy.
Malnutrition retards cognitive development and
lowers school performance. It deprives the body of
essential nutrients for healthy brain development, even
amongst those with invisible deficiencies of iron and
iodine. Iron deficiency makes children tired and slow
while children from communities that are iodine deficient
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can lose an average of 13.5 IQ points . Evidence from
Kagera shows that improving child nutrition reduces the
delay in school enrolment by one year.2
Box 1: MKUKUTA I and nutrition The UN Standing Committee on Nutrition evaluated the
commitment of 36 countries with high burdens of malnutrition
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to accelerate nutrition action . Commitment was determined
using a number of methods, including an assessment of the
degree to which poverty reduction strategies deal with nutrition
in terms of recognizing undernutrition as a development
problem, use of nutrition information for poverty analysis, and
support for appropriate nutrition policies, strategies, and
programmes. The 2005-10 MKUKUTA was classified as ‘weak’
in terms of its nutrition content, scoring only 17.5 out of a
possible 58 points.
Malnutrition reduces work productivity and earning
potential. Short and weak adults cannot work as hard,
making it very difficult for poor households to escape
from poverty. Iron deficiency in adults decreases
productivity by up to 17 percent3. Malnutrition is
particularly damaging for the majority of the workforce
that depends on small-scale farming, a labour intensive
livelihood.
When these impacts are aggregated, the burden at the
national level is considerable. Recent cost benefit
analysis determined that vitamin and mineral
deficiencies alone cost Tanzania TZS 650 billion in lost
revenue each year, equivalent to 2.65 percent of its
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Gross Domestic Product . Most of these losses are
within the agriculture sector (almost TZS 400 billion),
where physical stature and body strength are critical to
productivity.
Malnutrition kills children and women. In Tanzania
130 children die every day from diseases they would
have survived if they had been well-nourished. It
weakens the immune system making illnesses more
dangerous. Anaemia saps the strength of women during
childbirth, and reduces their ability to survive serious
blood loss.
Despite these documented impacts, nutrition continues
to be marginalized within Tanzania’s national plans and
strategies. A recent global analysis of national poverty
reduction strategy papers (Box 1) rated the nutrition
content of Tanzania’s current MKUKUTA as weak.
Malnutrition reduces the impact of investments in all
key basic services. Resources spent on education,
health, and in the treatment of HIV and AIDS will have
less impact unless malnutrition is prevented and treated. UNICEF Tanzania/2008/Pirozzi
We cannot wait for economic growth to solve the
malnutrition problem because trickle-down effect is too
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slow, long and indirect . Good nutrition is fundamental
for a productive nation and is a powerful driver of
economic growth. It enhances productivity by improving
cognitive development, educational achievement,
physical stature and body strength. It also helps make
investments in other sectors more effective.
Tanzania can no longer afford to overlook the human
welfare and economic consequences of malnutrition.
Nutrition-related problems are likely to become larger,
not smaller, especially in light of ongoing financial and
economic crisis, rising food prices, repeated droughts
and other extreme climatic events, and the HIV
pandemic. Nutrition must be more firmly anchored in the
next MKUKUTA.
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Trends, disparities and causes of malnutrition Trends and disparities
illiteracy, social norms and behaviours.
Tanzania has made progress in reducing malnutrition
since 1990 (Figure 1), but the country is still not on track
to achieve the MDG 1 target to reduce underweight by
one-half by the year 20157.
Almost all children in Tanzania suffer from one or more
forms of malnutrition at some point in their young lives.
According to the 2005 Tanzania Demographic and
Health Survey (TDHS), four out of every ten children
aged less than five years are chronically undernourished
(stunted) and two out of ten are underweight. A
staggering nine out of ten infants are anaemic as they
approach their first birthday. And over one-half of
households do not have access to adequately iodized
salt, increasing the risks that young children will suffer
intellectual impairment.
Figure 1. Trends and targets for under‐five nutrition Stunting
MKUKUTA stunting target
Percentage (%)
50
43
43
29
31
44
38
40
30
Underweight
MDG underweight target
29
22
20
20
15
10
0
1992
1996
1999
2004-5
2010
2015
The nutrition situation of women in Tanzania is also
alarming. Almost of half of women are anaemic, and one
in ten are undernourished (TDHS 2004-5). Malnourished
women are more likely to give birth to low birth weight
infants, thus transferring malnutrition from one
generation to the next.
Inequities in nutritional status continue to persist in
Tanzania, with most malnourished children and women
living in rural areas. In fact, rural children are 1.6 times
more likely to be chronically malnourished than their
urban counterparts.
Causes of malnutrition There are many causes of malnutrition, not just a lack of
food. Children become malnourished if they suffer
diseases that cause malnutrition or if they are unable to
eat sufficient nutritious food. These two causes –
diseases and inadequate dietary intake and – often
occur together and are caused by multiple underlying
factors including inadequate access to food and health
services, an unhealthy environment and inadequate
caring practices. More basic causes include poverty,
Inadequate access to food: Households need access
to sufficient, nutritious food throughout the year, and this
food must be fairly shared amongst family members.
Tanzania’s national vision for self-sufficiency of five
strategic crops (maize, beans, wheat, rice and cassava)
is admirable, but it must not be at the expense of the
production of foods that are rich in nutrients as well as
energy. With the exception of beans, these crops
provide energy but little in the way of vitamins, minerals
and protein. Food fortification has huge potential to
address vitamin and mineral deficiencies in Tanzania in
a sustainable manner, but progress has been
disappointingly slow. Stunting, poor educational
achievement and low productivity in adulthood will
persist if little attention is paid to the quality as well as
the quantity of foods produced in the country.
Inadequate caring practices: Caring practices are
critical. For the first six months of life, breastmilk is the
only food that infants need yet data from the 2005 DHS
show that 86% of children are given other foods and
drinks by the age of 4-5 months. These foods and drinks
are often nutritionally inferior to breastmilk and may be
contaminated with germs. Complementary foods given
to children are often lack sufficient protein, minerals and
vitamins. For women, poor nutritional health is also
aggravated by their intense burden of responsibility in
agricultural production. Their day-to-day workload
typically denies them the time and energy to engage in
other activities to safeguard the welfare of themselves,
their children and other family members. It will be
important for the vision of the MKUKUTA II to ensure
preferential access to nutrition and agricultural support
services for women, as this will have dividends for their
welfare and for the overall economic growth of the
country.
Inadequate access to health services: The coverage
of essential nutrition interventions within the health
system is far from universal. The capacity of health
managers and service providers to adequately plan and
implement nutrition interventions is weak. Some
interventions such as twice-yearly vitamin A
supplementation has achieved good coverage, but there
are gaps in many other nutrition services. The Tanzania
Service Provision Assessment Survey (2006) revealed
that little attention is being given to infant feeding
counselling. Only 6% of sick child consultations included
advice to continue feeding the child. A mere one in ten
women took iron supplements for at least three months
during pregnancy and only one-fifth were reached with a
vitamin A capsule after delivery. Unsafe water,
inadequate sanitation and poor hygiene increase the risk
of diarrhoea and other illnesses that deplete children of
vital nutrients.
Interventions that drive nutrition improvements and economic growth The good news is that there is clear evidence on interventions that are effective in reducing malnutrition and have high
economic returns. Eight sets of interventions, described below, will help the nation achieve the vision and results
articulated in the next MKUKUTA II when delivered at scale and with high coverage. . › Fortify foods with vitamins and mineral
Prevent and treat diseases
Recent cost benefit analysis has shown that food
fortification can save Tanzania over TZS 150 billion
each year by averting the productivity losses due to
vitamin and mineral deficiencies. Food fortification
involves adding small amounts of vitamins and minerals
to food staples such as maize flour, wheat flour, salt and
vegetable oil. It is a sustainable and highly cost-effective
intervention that can make vitamins and minerals
available to large segments of the population.
Malnutrition is both a cause and consequence of illhealth. Effective control of diseases can help in breaking
the vicious cycle between ill-health and malnutrition.
Tanzania has made important progress in expanding the
coverage and use of insecticide treated bednets for the
prevention of malaria over the past few years, and this
program has likely been pivotal in reducing under five
mortality across the country. Expansion of the
Integrated Management of Childhood Illness (IMCI)
program in Tanzania, focusing on improving the quality
of service delivery, will help to reduce the burden of
malnutrition as well as common childhood illnesses..
› Supplement children and women with vitamins
and minerals
Children and pregnant women are at high risk of vitamin
and mineral deficiencies during periods of rapid growth,
particularly the period between conception and the first
two years of life. This is also the critical window of
opportunity to prevent malnutrition. If action is not taken
during this period, the adverse effects of malnutrition
can be permanent.
These deficiencies are best addressed by
supplementing these high risk groups with vitamins and
minerals. During pregnancy, women should take daily
micronutrient tablets to prevent anaemia. After delivery,
they should be given a vitamin A supplement. Children
also need supplements to prevent anaemia and vitamin
A deficiency. Vitamin A supplementation can reduce
child deaths by up to 23 percent8, and should be given
to children aged 6 months to 5 years every six months.
Zinc supplements should be used in the treatment of
every episode of diarrhea in children under the age of
five.
› Support and promote infant and young child
feeding
Recent global analysis indicates that about one-fifth of
child lives can be saved if there is universal coverage of
optimal breastfeeding and complementary feeding
practices9. Encouraging Tanzanian mothers to
exclusively breastfeed for the first six months is a basic,
but critical intervention. For children beyond six months
of age, it is imperative that they are given frequent
nutritious meals containing a good balance of pulses,
fruits, vegetables and animal products, in addition to
breastmilk, in order to grow well and stay healthy.
› Treat acute malnutrition
When mechanisms to prevent malnutrition fail, there
needs to be a system in place to treat acute malnutrition.
Severe acute malnutrition can kill up to half of children
who do not receive appropriate treatment. The
management of acute malnutrition should be routine
component of health and nutrition services throughout
the country.
› Nutrition-friendly agriculture and livestock
policies
The agriculture sector in Tanzania has a critical role in
improving the access of households to affordable
nutritious foods throughout the year. There is currently a
vibrant debate on ‘Kilimo Kwanza’ and the best ways to
increase agricultural production to both feed the growing
population and stimulate economic growth. But we
cannot assume that increasing agriculture production
will benefit the poor or reduce malnutrition.
Agricultural policies must be designed to increase the
availability and affordability of nutritious foods, not
simply staple foods that predominantly contain
carbohydrate. Foods rich in protein, vitamins and
minerals are needed to safeguard every Tanzanian from
stunted growth, poor health, and low productivity in
adulthood. These foods include pulses, animal products,
fruits and vegetables. Agricultural policies must also be
specially designed to increase the incomes of the
poorest sections of society and directly address the
difficulties they face in accessing land, inputs, labour
and markets. They must also take specific account of
the fact that women carry the greatest burden of
responsibility for agriculture, many of whom balance
child care responsibilities with farming.
› Safety nets and social cash transfers
Safety nets and social cash transfers are very important
for helping poor families afford a nutritious diet for their
children. These transfers should reach vulnerable
pregnant women and children under the age of two so
that resources reach children at critical points for the
promotion of good nutrition.
› Early warning and response
Timely data on emerging nutrition problems is needed to
predict when nutrition crises will occur and trigger
appropriate responses. Such information systems can
provide the basis for longer-term planning (design of
safety nets and emergency preparedness) as well as
emergency response
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Strategies for scaling up interventions to improve nutrition Nutrition interventions must be delivered at scale and with high coverage if they are to have impact on prevalence of
malnutrition at the population level. The following strategies are needed to make this happen.
› Political leadership:
Malnutrition in Tanzania has not attracted sufficient
political attention and action and does not feature high
on the development agenda. The government of
Tanzania must reposition nutrition as central to
promoting economic growth and prosperity. Top political
leaders should be assigned to oversee coordinated
efforts across line ministries. The Ministry of Health and
Social Welfare should demonstrate leadership and
accountability for the provision of nutrition services for
children and women. › Policy and strategy formulation:
All government development policies must adequately
incorporate nutrition as a priority area of achieving
economic growth, stability and prosperity. The multisectoral nature of nutrition requires advocacy for its
inclusion in national and sector policies and plans.
Further efforts are needed so that nutrition is firmly part
of policies and strategies in the health, agriculture,
education, community development and industry
sectors.
social policy experts and health service providers who
can orient their work towards improved nutrition.
The institutions and human resources that are identified
to transform agriculture and strengthen health service
delivery will also need to have clearly defined and
stronger capacities in nutrition, so that the synergy
between actions to promote agriculture, health and
nutrition can be better realized. As LGAs are now
responsible for implementation of nutrition services, it is
essential that there be district level nutrition focal points
who are accountable for the delivery of quality nutrition
services, and supportive structures at the regional and
national level to provide technical backstopping,
guidance and supportive supervision.
› Partnerships:
Strategic partnerships should be forged with the private
sector, civil society and other development agencies to
advance nutrition. The availability of iodized of salt
throughout Tanzania shows that it is possible to
collaborate successfully with the private sector. Other
opportunities for public-private partnerships exist, for
example, the production of other fortified foods and
social marketing of nutritious foods.
› Multi-sectoral coordination:
Malnutrition is caused by multiple factors and requires
solutions that involve many sectors, including health,
food and agriculture, industry, water supply and
sanitation, education and others. Coordination
mechanisms are necessary at all levels – national,
regional, and district - to create and sustain coordination
and synergy both within and across sectors. Ministries
require clear roles and responsibilities, and sectors must
be linked. Similar clarity and well-coordinated support is
also required from the international community.
› Financial resources
UNICEF Tanzania/2008/Pirozzi
› Human resource development:
There is a scarcity of people who understand the threats
to good nutrition and have the skills to design and run
effective strategies. It is not just nutritionists that are
needed but also agriculture specialists, social workers,
The Copenhagen consensus 200810 listed nutrition
interventions amongst the most cost-effective actions to
tackle some of the world’s most pressing challenges.
With such favourable returns on investments, there is a
strong economic rational to increase the allocation of
financial resources to improve nutrition in Tanzania. In
addition to appropriate funding at the national level, local
government authorities must also ensure that nutrition
priorities are included in plans and budgets.
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Recommendations on integrating nutrition into MUKUKUTA II The scale of malnutrition in Tanzania is having a profound effect on economic development, growth and prosperity. It is
imperative that malnutrition is recognized as a key constraint to poverty reduction, and addressed accordingly in the next
MKUKUTA. Key ways in which nutrition should be firmly anchored into MKUKUTA II are as follows:
1. Recognize undernutrition as central to development
problems in Tanzania.
Address nutrition in the poverty analysis including
the impact of malnutrition on human capital,
productivity and economic growth.
Ensure nutrition is higher on the policy agenda of
the MoHSW, and reposition nutrition at the centre of
health sector policies, plans and budgets.
2. Emphasize the need for actions across several
sectors to improve nutrition, including health and
social welfare, agriculture, education and industry.
3. Give greatest attention to nutrition actions during the
most vulnerable period of a child’s life, beginning in
pregnancy up to two years of age.
4. Prioritize and scale-up these evidence-based
nutrition interventions:
› Fortification of foods with vitamins and minerals
› Vitamin and mineral supplementation
› Protection, support and promotion of infant and
young child feeding practices, including
breastfeeding and complementary feeding.
› Treatment of acute malnutrition
› Prevention and treatment of diseases that
cause malnutrition
› Nutrition-friendly agriculture and livestock
policies
› Safety nets and social cash transfers
› Early warning and response
5. Link priority interventions with clear plans for
› Political leadership
› Policy and strategy formulation
› Human resource development
› Partnerships
› Multi-sectoral coordination
› Financial resources
6. Allocate adequate budgets for nutrition interventions
7. Include nutrition targets and indicators to monitor
progress of MKUKUTA II, including both indicators
of macronutrient and micronutrient deficiencies.
Suggested targets and indicators and are given
below.
UNICEF Tanzania/2009/Pudlowski
Suggested indicators and targets for monitoring progress
Indicators
Baseline
(2004-5)*
Target
(2015)
Prevalence of underweight in children 0-59 months
22%
15%
Prevalence of stunting in children 0-59 months
38%
25%
Prevalence of exclusive breastfeeding in children <6 months
41%
60%
Prevalence of anaemia in pregnant women 15-49 years
58%
40%
Not available
50%
Proportion of women 15-49 years with urinary iodine excretion <100 µg/L
* Source: Tanzania Demographic and Health Survey 2004-5
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10
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