I just returned from a week in Tanzania, exploring options for evaluating the impact of m-nutrition initiatives on nutrition behaviours and status. More on that as it develops.
During the trip I found out about a recently released 2014 SMART national nutrition survey that shows under 5 stunting rates at 34.7% in 2014, down from 42% in 2010. That is 7.3 percentage points in 4 years. Good news. This is an annual average rate of reduction of nearly 5% -- well above the nearly 4% required to meet the World Health Assembly targets. If this can be maintained then this is even better news. But there seems to be no consensus as to what is driving the decline.
I don't know of a study that looks into this for Tanzania (my IFPRI colleague Derek Headey has done these kinds of studies in Ethiopia, Bangladesh and Nepal), so I went to the Global Nutrition Report's Tanzania Nutrition Country Profile. The profile shows that the rates of food security, improved water and improved sanitation are all increasing, but very slowly. Unimproved sanitation + open defecation rates remain very high (79% in 2012). Economic growth is steady but not spectacular. The big change seems to be $1.25 a day poverty rates which have almost halved in 12 years: 85% in 2000 to 43% in 2012.
As you can see from the link to the 2014 survey results, infant and young child feeding has not improved and for exclusive breastfeeding rates have actually decreased. Iron Folate supplementation rates have increased, Vitamin A supplementation rates for under 5's have increased and women's thinness has declined: but none of these positive changes are huge.
The Government of Tanzania's health expenditure has increased substantially between 2008 ($383 million) and 2014 ($622 million). The 2014 Nutrition Public Expenditure Review is even more revealing. As the picture below shows, the total budget for the nutrition sector has increased rapidly. Equally important the share of the government in that expenditure, although quite low at about 30%, has held steady, so real GoT expenditure on nutrition is also increasing rapidly.
This is the really good news story--an increasing government commitment to nutrition, not only in words, but also in cold hard cash that has multiple alternative uses. Of course, money is not the only important resource, and it has to be spent on things that can improve nutrition, but scale up of programmes is impossible without it.
So, while we need a proper study to confirm it, maybe, just maybe, it is the declining poverty rate combined with increased nutrition spending by government and external partners, that is responsible for the decline in stunting in Tanzania. And more good news: there is plenty of room for improvement in water, sanitation and infant and young child feeding programme coverage rates.
Can Tanzania meet its WHA targets? If these trends are maintained the situation seems very positive.