18 February 2017

Can Tanzania emulate Ghana's nutrition achievements? Don't bet against it

Small businesses need support to lower the price of nutritious foods
I was in Tanzania this week to work with our Country Representative, Enock Musinguzi and the rest of the terrific GAIN Team.  We spent a few days talking to the government and its development partners on the country’s nutrition needs and how GAIN’s next generation of projects could help advance agreed priorities. 

It has been about 18 months since I was last in Tanzania and in that time the country’s road map to improved nutrition, the National Multisectoral Nutrition Action Plan (NMNAP—which I can’t find on the net) has been published (October 2016).  

It is an impressive document: compelling in making the case for nutrition, clear about where it wants to get (yes the targets are smart—e.g. 28% stunting by 2021), comprehensive in how it is going to get there, who is going to pay for what, and all evidence based. 

But it is more than a document--all the development partners I met talked about how important a framing it was for their own action.  So it really feels like it is a roadmap for all stakeholders.  My main worry is about priorities—when there is so much to do, where to start?  And there is no study that helps to explain which determinants of undernutrition have, say, driven down stunting rates in the past 6-7 years.  At a pragmatic level we have to act and go where the political energy and the capacity to deliver are, although it would be good to have the confidence of knowing that we were helping to relax a truly binding constraint to improved nutrition. 

Other reflections:

Large scale fortification fatigue has set in, but the fatigue must be shrugged off.  I don’t think one of the development partners we spoke to (with the exception of MI and HKI) were enthusiastic about this.  I found this amazing in a context where effective coverage rates are much lower than anticipated (see the 2015 FACT survey, for example even universal salt iodisation is only at 69% effective coverage levels) and where children and women’s anemia is actually increasing.

Diet related non-communicable disease is being talked about.  Adult overweight and obesity together stand at about 26% and the numbers are rising.  The risk is that treatment for the related diseases such as type 2 diabetes, hypertension and heart disease will divert health system resources away from efforts to reduce undernutrition.  The government has featured NCD reduction in its nutrition plan and clearly some donors are beginning to wonder what they can do to make a contribution (answer: make safe and nutritious foods more affordable, keep promoting exclusive breastfeeding, and work to influence the diet and nutrition choices of adolescents, wherever they are found). They must keep working on this. 

There is an increasing recognition of what businesses can contribute to the national nutrition plan.  Mr. Obey Assery, the key driver of nutrition in the Prime Minister’s Office, has stressed this and the NMNAP counts on businesses for 10% of its budget.  But nutrition development partners are only now beginning to look for ways to engage with businesses.  After brainstorming with each of them for 30 minutes or so, together we can usually identify opportunities within value chains, or in workplace policies, or in behaviour change/demand creation for healthy foods, or in building the capacity of small and medium enterprises to comply with food and nutrition legislation.

Multistakeholder working is strong.  One example was the monthly meeting of development partners for nutrition, to which I was invited to. I was enthused by the energy and commitment of those who support the government in its nutrition plans. It is great for knowledge sharing and action coordination. Moving forward, it would be good to draw in more business knowledge and action through the SUN Business Network to complete the multisectoral loop that the NMNAP champions.

Tanzania clearly wants to be the “next Ghana” a country that halved stunting rates to 19% within a 10 year period. 

After having witnessed the leadership, energy and determination within the country right now, I wouldn’t bet against it happening.

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