IMPROVING CHILD AND MATERNAL NUTRITION IN THE 1000 DAYS AND BEYOND

Transcription

1 The Centre for Counselling, Nutrition and Health Care CARE IS OUR DUTY IMPROVING CHILD AND MATERNAL NUTRITION IN THE 1000 DAYS AND BEYOND ANNUAL REPORT 2012

2 TABLE OF CONTENTS LIST OF ACRONYMS AND ABBREVIATIONS... III ACKNOWLEDGEMENT... V I. EXECUTIVE SUMMARY... 1 II. ABOUT COUNSENUTH... 3 III. ORGANISATIONAL OBJECTIVES... 4 VISION STATEMENT... 4 MISSION STATEMENT... 4 STRATEGIC OBJECTIVES... 4 OUR TARGET GROUPS... 5 IV. PROGRESS MADE IN OBJECTIVE 1: MOBILIZING RESOURCES FOR GOOD GOVERNANCE ACTIVITIES IN NUTRITION DECISION MAKING AND IMPLEMENTATION AND MONITORING OF PROGRAMS... 6 OBJECTIVE 2: HIGH IMPACT NUTRITION INTERVENTIONS INTRODUCED IN SELECTED COMMUNITIES TO IMPROVE CHILD AND MATERNAL NUTRITION... 6 OBJECTIVE 3: CAPACITY OF COUNSENUTH AND OTHER CSOS IN SCALING UP OF NUTRITION BEGINS TO BE ENHANCED OBJECTIVE 4: COUNSENUTH INNOVATIVE PROJECTS TO IMPROVE INFANT NUTRITION, REDUCE NON-COMMUNICABLE DISEASES AND ENHANCING YOUTH LIFE SKILLS STRENGTHENED 41 OBJECTIVE 5: BEST PRACTICES FROM IMPLEMENTATION OF PROGRAM RECORDED, REPORTED AND WIDELY DISSEMINATE TO INFORM PLANNING V. CHALLENGES VI. FINANCIAL PROFILE AND STATEMENT VII. COUNSENUTHE BOARD AND STAFF IN VIII. NEWS AND EVENTS ii

3 LIST OF ACRONYMS AND ABBREVIATIONS AIDS ANC BFHI DC DNuO CBO CHW COUNSENUTH CSOs CTC DEO DMO DRCHCO ECD FANTA FBO FtF GIZ GMP GoT HBC HF HIV HKI IFA IPT ITN IR LGA LLITN M&E MAFC MAM MBNP MCH MKUKUTA MoCDGC MoEVT MoHSW MoU MUAC MVC NACS NACG Acquired Immune Deficiency Syndrome Antenatal Care Baby Friendly Hospital Initiative District Commissioner District Nutrition Officer Community Based Organization Community Health Worker Centre for Counselling, Nutrition and Health Care Civil Society Organizations Care and Treatment Clinic District Education Officer District Medical Officer District Reproductive and Child Health Coordinator Early Childhood Development Food and Nutrition Technical Assistance Faith based Organization Feed the Future Germany Agency for International Cooperation Growth Monitoring and Promotion Government of Tanzania Home Based Care Health Facility Human Immunodeficiency Virus Hellen Keller International Iron and Folic Acid Intermittent Presumptive Treatment Insecticide-treated bed nets Intermediate Result Local Government Authorities Long Lasting Insecticide Treated Net Monitoring and Evaluation Ministry of Agriculture, Food Security and Cooperatives Management of Acute Malnutrition Mwanzo Bora Nutrition Program Maternal and Child Health Mkakati wa Kukuza Uchumi na Kupunguza Umasikini Tanzania Ministry of Community Development, Gender & Children Ministry of Education & Vocational Training Ministry of Health and Social Welfare Memorandum of Understanding Middle Upper Arm Circumference Most Vulnerable Children Nutrition Assessment, Counseling and Support National Anemia Consultative Group iii

4 NCD NCGIYCF N-GLEE NGO NHIF NNS ORCI PLHIV PMO PMTCT PMORALG PMTCT RAO RAS RCH RCHS RRCHCO SAM SBCC SUA TAFSIP TAHEA TAPP TDA TDHS TFNC TUBOCHA UNICEF USAID UWAWAKUDA VAS WASH WDC WFP WHO USAID ZRCHCO Non Communicable Diseases National Consultative Group for Infant and Young Child Feeding Agriculture and Nutrition Global Learning and Evidence Exchange Non Government Organization National Health Insurance Funds National Nutrition Strategy Ocean Road Cancer Institute People Living with HIV and AIDS Prime Minister s Office Prevention of Mother-To-Child Transmission Prime Minister Office-Regional Administration and Local Government Prevention of Mother To Child Transmission Regional Administrative Officer Regional Administrative Secretary Reproductive and child health Reproductive and Child Health Services Regional Reproductive and Child Health Coordinator Severe Acute Malnutrition Social and Behavior Change Communication Sokoine University of Agriculture Tanzania Agriculture and Food Security Investment Plan Tanzania Home Economic Association Tanzania Agriculture Productivity Program Tanzania Diabetes Association Tanzania Demographic and Health Survey Tanzania Food and Nutrition Center Tuboreshe Chakula United Nations Children Emergency Fund United States Agency for International Development Umoja wa Wanawake Wakulima Dakawa Vitamin A Supplementation Water Sanitation and Hygiene Ward Development Committee World Food Programme World Health Organization United States Agency for International Development Zonal Reproductive and Child Health Coordinator iv

5 ACKNOWLEDGEMENT The Centre for Counselling, Nutrition and Health Care (COUNSENUTH) would like to thank the Tanzanian Government, its agencies, national and international organizations for their collaboration and support in the year The Centre recognizes the Government Ministries, particularly the Ministry of Health and Social welfare, and Local Government Authorities for their cooperation and excellent working relationship throughout the years. Without their support our achievements would not have been possible. COUNSENUTH acknowledges the financial support from USAID through the Mwanzo Bora Nutrition Program and EngenderHealth. The Centre also recognizes the financial contribution of the Irish Aid, Global Fund Round 6, The Germany Agency for International Cooperation (GIZ) the national Health Insurance Fund (NHIF) and the Tanzania Diabetic Association (TDA). A sincere note of appreciation also goes to the other organizations and institutions for their continued support and good working relationship; these include Tanzania Food and Nutrition Centre (TFNC), Ocean Road Cancer Institute (ORCI), Zanzibar AIDS Control Program (ZACP), World Health Organization (WHO) and Sokoine University of Agriculture The Centre is indebted to the community it served for its cooperation and trust on our services; also the care providers at different level, volunteers, Community Based Organizations (CBOs), Faith Based Organizations (FBOs), community groups for their contributions, active participation and commitment which contributed to the success of different activities. Last but not the least COUNSENUTH would like to extend its sincere thanks and appreciation to all individuals and organization that in one way or another contributed to the accomplishment of the Centre s Objectives in year We look forward to continued collaboration and support in these efforts towards achieving our goals for improving nutrition of our people, particularly the most vulnerable groups in our society. CARE IS OUR DUTY v

6 I. EXECUTIVE SUMMARY This annual report provides an overview of COUNSENUTH s work for the period of 1st January to 31st December 2012, which is the first year of implementation of COUNSENUTH 5 Year Strategy and Action Plan (summarized in Figure 1 below). COUNSENUTH s strategic plan has four (4) Strategic Focus Areas and six (6) strategic objectives that will lead the organization in the next 5 years. The overall goal of the strategic plan contributes to the MKUKUTA objectives of reducing poverty, malnutrition and reduces child and maternal mortality through improved nutrition for vulnerable groups. Figure 1: Summary Strategic Plan Vision Mission Strategic Focus Areas Strategic Objectives To have a Tanzania where all people have physical and economic access to sufficient, safe and nutritious food at all times to achieve a healthy and quality life. Counsenuth works towards improvement of the quality of life of vulnerable groups through provision of affordable interventions that are evidence based and locally appropriate; advocacy for better governance for nutrition; active engagement of citizens at all levels and multi-sectoral collaboration. Raise awareness in the area of nutrition sector governance and accountability Implementation of evidence-based and scalable interventions at community level Institutional strengthening and stakeholder engagement at all levels 1. Awareness of governance and accountability in nutrition sector relative to baseline is improved 2. Scale up a minimum package of high impact intervention for nutrition in Songea Rural and Tunduru districts of Ruvuma region in line wit the National nutrition framework 3. Contribute to the implementation of the nutrition component of the Feed the Future programme in three regions Dodoma, Manyara and Morogoro 4. Enhance capacity of COUNSENUTH and other CSOs in Scaling Up of Nutrition and nutrition sector governance 5. COUNSENUTH s Innovative projects are strengthened Contribute to knowledge and evidence base in nutrition programming 6. Best practices are documented and utilised for improved planning and resource allocation In 2012 COUNSENUTH activities continued to focus on contributing towards improving the quality of life of vulnerable groups through provision of preventive health education, counseling and nutritional services, with a focus to community involvement. A number of accomplishments have been achieved over the past year; and these include: 1

7 Initiation of startup activities in scaling up a minimum package of high impact interventions in Ruvuma region Initiation of key interventions to reduce maternal anaemia and childhood stunting in Morogoro, Manyara and Dodoma Provision of technical assistance to other development partners and government Strengthening of innovative projects to improve infant nutrition, reduce noncommunicable diseases and enhancing youth life skills During the reported period COUNSENUTH also faced many challenges. The main challenge continued to be dependency on donor funding to implement nutrition activities; as a result the Centre s activities focused on donor interest rather than COUNSENUTH vision and mission The Centre was not able to secure funds for implementing the whole strategic plan by January 2012 and therefore, the overall objective for year one of the strategy was to mobilize more resources so that all planned objectives could be achieved, and began to implement start up activities under the funded objectives or sub-objectives. In addition, the lack of funding made it increasingly difficult to recruit needed staff and adequately fund nutrition interventions. 2

8 II. ABOUT COUNSENUTH The Centre for Counseling, Nutrition and Health Care (COUNSENUTH) is an indigenous non-governmental, non-profit organization in Tanzania established in 1998 (under registration number SO. 9495) and is located at 44 Galu Street Ada Estate in Dar es Salaam. COUNSENUTH is the only major local Non-Governmental Organisation (NGO) that focuses on nutrition- improving the quality of life of vulnerable groups through provision of preventive health education, counseling and nutrition services, by focusing on community involvement. For the past 14 years COUNSENUTH has been actively making tangible progress and significant difference in the nutritional wellbeing of the people of Tanzania, especially the most vulnerable groups by implementing community based nutrition programs COUNSENUTH s leadership includes the Board of Directors, Management Committee, and NGO Executive Committee. The Board of Directors consist of 6 Members, who come from different backgrounds including nutrition, medicine, academics, financial and political as well sociology. COUNSENUTH also has a number of qualified and skilled staff with nutrition, public health and other expertise and with local, national and international exposure and have had experience of over 15 years of both research and nutrition programming (see section 7). The Centre have experience of working with and have good relationship with the Government, nutrition partners and other CSOs at various levels and have implemented community based nutrition programs in over 22 districts from The Centre is currently a technical partner to a huge Feed the Future s Mwanzo Bora Nutrition Program being implemented in 3 regions, Manyara, Morogoro and Dodoma, and we are gaining further experience in social behaviour change communication and benefiting from organizational capacity building. Donors that have supported our organisation include Irish Aid, USAID, National AIDS Control Programme (NACP), Ministry of Health, Rapid Funding Envelope (RFE) for HIV/AIDS, Global Fund, International Baby Food Action Network (IBFAN) Africa and others. 3

9 III. ORGANISATIONAL OBJECTIVES VISION STATEMENT A Tanzania where all people have physical and economic access to sufficient, safe and nutritious food, at all times to achieve a healthy and quality life. MISSION STATEMENT COUNSENUTH works towards improvement of the quality of life of vulnerable groups through cost effective interventions that are evidence based, proven and locally appropriate; and advocacy for better governance for nutrition through active engagement of citizens and multi-sectoral collaboration at all levels. STRATEGIC OBJECTIVES 1. Mobilizing resources for good governance activities in nutrition decision making and implementation and monitoring of programs 2. High impact nutrition interventions introduced in selected communities to improve child and maternal nutrition 3. Capacity of COUNSENUTH and other CSOs in scaling up of nutrition begins to be enhanced 4. COUNSENUTH innovative projects to improve infant nutrition, reduce noncommunicable diseases and enhancing youth life skills strengthened 5. Best practices from implementation of program recorded, reported and widely disseminate to inform planning To achieve its goals, COUNSENUTH employs a number of strategies including the following: 1. Capacity building on nutrition including that of a critical mass of implementers at all levels (i.e. regional, district, health facility and community level) as a way of increasing access to knowledge and information on nutrition care and support for vulnerable groups. Vulnerable groups that COUNSENUTH supports including People Living with HIV and AIDS (PLHAs), Orphans and Most Vulnerable Children (MVCs), NGOs, Community Based Organizations (CBOs), Faith-Based Organisation (FBOs), women, the youth, and children; 2. Nutrition Advisory and Technical Assistance services to government and implementing partners in program design and implementation; support of policy, planning and related areas; capacity building and mentorship; feasibility studies, other nutrition surveys and assessments; operational research; project evaluation and propagation of local methods and technologies; 4

10 3. Designing, development and dissemination of user friendly and up to date education and advocacy materials and tools; 4. Advocacy to place nutrition high on national development agenda and for proper government control of national resources for nutrition, food standards, safety, hygiene and sanitation. This includes holding producers, distributors and other food handlers on food safety standards, hygiene and sanitation accountable; 5. Working with CBOs/FBOs to implement community based health and nutrition related programs and counseling services for women, children and other vulnerable groups, with emphasis on infants, young children and maternal nutrition; youth and adolescent health; non communicable diseases and lifestyles; and nutrition care support for PLHAs; and 6. Networking within the country and abroad for cross fertilization of ideas to increase effectiveness of the organization and its work. OUR TARGET GROUPS Women, Children, Youths, Adolescents and Families. Most Vulnerable Children and Orphans Social/health service providers and other extension workers 5

11 IV. PROGRESS MADE IN 2012 Year 2012 was the first year of implementation of the COUNSENUTH s new Five- Year Strategy and Action Plan The strategy has four Strategic Focus Areas and six strategic objectives that will drive the strategy of the organization in the next 5 years. Our objectives for 2012 included: 1. Mobilizing resources for good governance activities in nutrition decision making and implementation and monitoring of programs 2. High impact nutrition interventions introduced in selected communities to improve child and maternal nutrition 3. Capacity of COUNSENUTH and other CSOs in scaling up of nutrition begins to be enhanced 4. COUNSENUTH innovative projects to improve infant nutrition, reduce noncommunicable diseases and enhancing youth life skills strengthened 5. Best practices from implementation of program recorded, reported and widely disseminate to inform planning In year 2012, despite the funding challenges faced by the Centre, the centre was able to accomplish majority of the planned activities. Planned activities under objective 1(Mobilizing resources for good governance activities in nutrition decision making and implementation and monitoring of programs) could not be funded despite efforts to mobilize the funding. The following is the summary of major achievements for 2012 under each strategic objective. Objective 1: Mobilizing resources for good governance activities in nutrition decision making and implementation and monitoring of programs Activities under this objective are aimed at advocating for appropriate government leadership and equitable use of national resources for nutrition among CSOs and the general public. Activities have not been funded this year. Efforts to mobilize funding are still going on. Objective 2: High impact nutrition interventions introduced in selected communities to improve child and maternal nutrition 2.1 Initiate start up activities in scaling up a minimum package of high impact interventions in Ruvuma region The Centre was awarded small grant by Irish Aid to implement a number of activities which were part of the process of putting together a five-year proposal for improving 6

12 The Centre for Counselling, Nutrition and Health Care (COUNSENUTH) maternal and child nutrition as part of Scaling Up Nutrition initiative in Tanzania. The strart-up districts are Songea Rural and Tunduru. Activities that have been carried out so far included: COUNSENUTH team and a TFNC representative visited Ruvuma in early December and held discussions with the regional and district authorities. The aim of the meetings was to acquire information on the regional needs and priorities in matters related to nutrition as well as creating ownership. The regional and district authorities promised to accord COUNSENUTH all needed support and information to facilitate the preparation of the proposal.in addition, they were enthusiastic and ready to cooperate in the implementation of the proposed program and grateful to be considered as they are often left out in such endeavor. The authorities showed their readiness to be involved in the finalization of the proposal to ensure that the priorities of the region as well as the aspect of ownership and sustainability of the program are well covered. COUNSENUTH team with Ruvuma regional authorities 7

13 A rapid in-depth needs assessment of nutritional situation in Songea Rural and Tunduru districts of Ruvuma region was carried out, to gather insight into current nutrition situation, political, economic and social-cultural aspects of the region which can contribute positively or negatively to nutritional well-being of the population and especially women and children under five years of age. Preliminary findings showed that many people are faced with household food insecurity despite of the region being one of the national strategic food reserves. Sub-optimal caring practices for women and children as well as infant feeding practices were observed. The information obtained from the above activities formed a basis of a comprehensive five year budgeted proposal which is currently being developed and will be sent to Irish Aid in February 2013 for possible funding. The aim of the proposed five-year program is to reduce childhood stunting in Ruvuma region by 10%. 2.2 Initiate key interventions to reduce maternal anaemia and childhood stunting in Morogoro, Manyara and Dodoma The Mwanzo Bora Nutrition Program (MBNP) is implemented by a consortium of four organizations where Africare is the lead, working in partnership with COUNSENUTH, Deloitte and The Manoff Group. Other partners include the Government of Tanzania (GoT), The Tanzania Food and Nutrition Centre (TFNC), national institutions of higher learning, and nongovernmental organizations (NGO). The program implementation responds to the need for supporting the Tanzanian Government in implementing its 5 years National Nutrition Strategy as well as the challenges on maternal anaemia and childhood stunting. Implementation of the program effectively started in October, 2011 mainly in 3 regions of mainland Tanzania namely Morogoro, Dodoma and Manyara as well as Zanzibar. The overall goal of the program is to improve the nutritional status of children, pregnant and lactating women in Tanzania in order to decrease maternal anemia and childhood stunting by 20% in targeted regions. Towards this goal, the project will strengthen the capacity of Tanzanian systems at all levels and across sectors to provide critical nutrition services and education. The program s main objectives are to: 1. Strengthen the capacity of government and indigenous NGOs to deliver quality nutrition education and communication 8

14 2. Strengthen the delivery of integrated community-based nutrition services and social behavior-changing education, resulting in a model that can quickly be scaled-up to reduce childhood stunting and maternal anemia. The program implements its activities at various levels. At national level, the program is expected also to assist the Government to develop a National Strategy for Nutrition Social and Behavior Change Communication (SBCC) that will address the aforementioned challenges. At district level, activities implemented focus on building the capacity of key actors to play pivotal roles in interpreting government policies and guidelines, development of council plans and monitoring and evaluation of the implementation of nutrition activities in the councils. Furthermore, key players are expected to play an important role in making the program sustainable. The above intermediate results will be achieved through various strategies including engagement of government and civil society in the development of a vibrant national platform for nutrition, placing an emphasis on the first 1,000 days of life; providing targeted assistance to further strengthen the technical, administrative and financial capacity of the key players notably Tanzania Food and Nutrition Centre (TFNC), the Centre for Counseling for Nutrition and Health Care (COUNSENUTH), an indigenous CSO and consortium member. Social Behavior Change Communication (SBCC) is the major approach of the program at changing people s behavior and social norms. Strong coordination between various programs will be attained by working with various stakeholders including Feed the Future partners in order to leverage resources, and link with facility based activities; other livelihoods, food security, agriculture, and health and nutrition programmes at the wards, community and household. Under Mwanzo Bora Nutrition Program, COUNSENUTH is responsible for the technical aspects of the nutrition component and therefore contributing its expertise into capacity building for SBCC; and implementation of evidence based interventions for reduction of maternal anaemia and childhood stunting. The following is progress made at national, district, facility and at community levels during the reported period. Orientation seminar for district multisectoral nutrition committee in the 10 districts MBNP conducted a 3 day orientation seminar to district nutrition multisectoral teams on the prevention of maternal anaemia and childhood stunting. The regional and district nutrition officers, the district pharmacists, reproductive and child health coordinators and other technical staff from key CSOs in the council also participated. 9

15 This activity covered ten selected districts of Morogoro Region (Morogoro Municipal, Mvomero, Ulanga and Kilombero), Dodoma Region (Dodoma Municipal, Kongwa and Kondoa) and Manyara Region (Babati Town Council, Babati DC and Kiteto). A total of 211 people (87 males and 124 females) were oriented on prevention of maternal anaemia and childhood stunting. During the orientation, it was observed that most plans shared by the districts lacked/had very few nutrition activities especially on maternal and young child nutrition. This indicates a likelihood of less budget allocation to nutrition related activities in the districts. Development of Community Leaders Advocacy package Community materials on nutrition assessment counseling and support (NACS) which were developed by COUNSENUTH under FANTA 2 project were adapted and used for orientation of community leaders in 4 selected districts under MBNP (Mvomero, Ulanga, Kongwa and Babati DC) on their role in supporting maternal and child nutrition. The issues addressed in the advocacy package included the roles of community leaders in promoting optimal nutrition, importance of optimal maternal and child nutrition, and the consequences of maternal anemia and childhood stunting to mothers, children, families and society. The national nutrition problems were discussed and finally, few doable actions were identified to prevent or improve the situation in their communities, and the roles of community leaders were clarified in supporting these interventions at the community level. The advocacy package was necessary to guide service providers and the leaders on key actions to improve maternal and child nutrition particularly prevention of maternal anemia and childhood stunting. It also provided possible strategies for engagement of leaders in their development and nutrition issues. Sensitization of community leaders at ward levels A total number of 84 community leaders (70 males & 14 females) from four selected wards of Morogoro (Ulanga and Mvomero), Manyara (Babati DC) and Dodoma (Kongwa) regions were sensitized for one day on matters pertaining to the prevention of maternal anemia and childhood stunting. The participants list comprised of ward Community Development Officers (1 male and 1 female), community leaders from Ward Development Committee (WDC) that included influential members who were: Counselors, Ward Executive Officers, Education Officers, Agriculture and Livestock Officers, Health Officers, Ward Community Development Officers and Village Chairpersons. 10

16 Orientation of Health Facility Staff in 10 selected districts Health facilities play a critical role in addressing maternal anemia and childhood stunting as they serve as key points of contact for pregnant women and young children, through antenatal care and RCH services MBNP conducted a three-day orientation of 128 health workers (15 males and 113 females) from 70 selected health facilities on prevention of maternal anemia and childhood stunting. The topics covered were on, maternal anemia and childhood stunting addressing causes symptoms, consequences and prevention. The detailed frameworks for maternal anemia and childhood stunting were discussed in detail to update their knowledge and impart skills. Major observations from these orientations, were lack of knowledge of issues of maternal anemia and childhood stunting, no information/access to the guidelines and lack of appropriate communication skills especially counseling skills. From this orientation it is expected that health workers are in a better position to provider better services to pregnant women, lactating mothers and children under 2 years. Health facility assessment An assessment of health facilities ability to implement all essential actions for maternal anemia and childhood stunting was conducted to 70 selected health facilities in all the 18 MBNP priority districts. The tools used during the assessment were adapted from Landscape Analysis Tools jointly developed by WHO/TFNC/COUNSENUTH in The facilities assessed included 14 hospitals,11 health centers and 45 dispensaries from Morogoro, Manyara and Dodoma regions. The assessment found out that: The capacity of health facilities to implement all nutrition actions is limited due to lack of resources. There was a limited knowledge, attitude and practice of nutrition standards among health workers Shortage of priority equipment, supplies and nutrition IEC materials in the health facilities The findings have provided critical information on gaps and identified entry points to allow for design of effective interventions that would build on available resources to reduce maternal anemia and childhood stunting at health facility level in the 3 regions. 11

17 Orientation of Home Based Care providers on maternal anemia and childhood stunting A 2 day seminar on maternal anaemia and childhood stunting was conducted in 4 districts of Morogoro (Mvomero, Ulanga), Dodoma (Kongwa) and Manyara (Babati DC). The seminars aimed at providing Home Based Care (HBC) providers with basic practical knowledge about nutrition care and support for people living with HIV & AIDS (PLHIV). The orientation seminar also sought to sharpen the care providers communication and counseling skills to enable them provide appropriate guidance on appropriate food choices, utilization of local technologies to improve food quality and dietary management of health conditions associated with HIV infection. The critical role of iron rich foods and supplementation with iron for PLHIV was also emphasized. A total of 93 HBC providers (34 males and 59 females) were oriented on nutrition and HIV and AIDS. The care providers were from HIV support groups in the catchment areas of the health facilities that are carrying out in-depth nutrition interventions. Four district HBC Coordinators (2 males and 2 females) also participated in the orientation seminar. This is expected to enhance the quality of services and efficiency of the service providers in the delivery of services, and in the long run expected to increase utilization of nutrition and HIV and AIDS services and improving people s health. Orientation of Village Health Workers (CHWs) on Maternal anaemia and childhood stunting As part of making sure that the MBNP interventions are well implemented at the community level, a three day orientation of village health workers (VHW) was conducted to sensitize them on the importance of reduction of maternal anemia and childhood stunting. Participants were drawn from 2 districts in Morogoro (Mvomero and Ulanga), one in Dodoma Region (Kongwa) and one in Manyara region (Babati DC), making a total of 4 districts involving 68 villages. Participants were selected from the trained health facilities catchment areas. A total of 114 (57 males and 57 females) VHWs were oriented. In addition there were 15 other participants who included 5 district 12 MBNP Nutritionists explaining on how to form support groups at Towero dispensary, Mlimani ward in Morogoro region

18 community health workers coordinators, 5 ward community development officers and 5 focal persons from the multisectoral nutrition committees. The Ward Community Development Officers were involved in these orientations because their work involves dealing with all the community development issues. Their inclusion was necessary for them to support MBNP community activities. During the orientation, the VHWs were introduced to the program, their potential roles and draft tools that they will use in the future were discussed, to get their inputs before being finalized. They also practiced the use of communication guide (Cue card) and counseling cards which was developed by COUNSENUTH. Initiation of Community Nutrition Activities and Scale up in 10 districts through the Siku 1000 Community Nutrition Initiative Mwanzo Bora Nutrition Program started forming community groups of pregnant and lactating women as a preparation for introduction of care support group model for implementation of maternal and child nutrition through Siku Elfu community nutrition initiative. In Morogoro, the activity started in Mlimani ward where five groups of pregnant women and 5 nursing mothers with children below 6 months and other 5 with children aged 6 months to 1 year were sensitized on nutrition Demonstration plot at Towero (Morogoro) education, and encouraged on the use of IFA supplements, exclusive breastfeeding, and adequate complementation. These women groups are also responsible in taking care of the vegetable garden demonstration plot established at Towero dispensary and have been encouraged to establish home gardens and small animal keeping. The members of these groups will later be used as trainers of peer mothers at their nearby households. 13

19 Furthermore, the District Nutrition Officer together with MBNP staff in Morogoro municipality held an advocacy and sensitization meeting with Mlimani ward leaders and wards health committee on the prevention of maternal anaemia and childhood stunting. The focus was on what role they can play to reduce the problem in their ward. Twelve ward leaders of whom 5 were males and 7 were females attended the meeting. In Dodoma municipal community sensitization meetings were initiated on essential nutrition actions through the use of village agriculture meetings. The Municipal Agriculture Officer sensitizing villagers on ENA during agriculture meeting at Mkoyo village focus was on early booking to ANC clinics for pregnant women; use of IFA and how to overcome the side effects; exclusive breast feeding; complementary feeding and the importance of diversed diet. A total of 432 people were sensitized, of which there were 109 villagers at Hombolo Makulu, 148 people at Mkoyo and 174 at Zepisa village. The meetings were conducted in collaboration with the council s focal persons in agriculture, livestock, fisheries, community development, and nutrition sectors. Cultural groups were used during the sensitization to communicate message to the audience. The villages sensitized were within a dispensary catchment area. Vegetable gardening in Hala village managed by Mkombozi group 14

20 Zepisa Cultural group giving nutrition about importance of using IFA during village meeting at Zepisa village (Dodoma) Improvement of skills and attitudes of Health Workers in the provision of maternal and child nutrition services MBNP made a significant progress in its process of finalizing a number of nutrition education materials which will support different target groups, improve their skills and attitudes in the provision of maternal and child nutrition services or practices. The following is a list of the materials: a. Orientation Guides for Health Care Workers; community leaders; extension workers; community workers on reduction of maternal anemia and childhood stunting; b. Job Aids and Handouts such as (i) Health talks on male involvement, exclusive breastfeeding, Consumption of iron rich foods, growth monitoring and promotion (GMP), early ANC booking, prevention of malaria, deworming, care of a sick child, IFA supplementation, WASH, myths and beliefs-for health facility workers; (ii) Hospital visit checklist for District Nutrition Technical Facilitators (DNTF) and (iii) Self Appraisal Questionnaire for health facilities. c. Cards: (i) Cue Cards/ Counseling 15

21 Checklist for health facility workers; (ii) IFA reminder tool-for pregnant women; (iii) Male invitation card for spouses (pregnant women). d. Poster on: (i) 10 steps to successful breast feeding for health facilities; (ii) Flip chart on infant and young child feeding for health facility and community care providers; (iii) IFA Poster. All these materials will now be utilized in the training and orientation of the different groups as a way of pre-testing and later be revised based on the pretests and be finalized ready for final printing. All this was necessary to achieve quality standards in implementation in all districts. Integration of nutrition into agricultural programs within MANR, Zanzibar MBNP carried out several consultative meetings with Ministry of Agriculture and Natural Resources of Zanzibar (MANR) to identify and agree on nutrition interventions to be implemented in Zanzibar with support from MBNP. A total of 12 government officials from different sectors in both Unguja and Pemba Islands participated in the consultative meetings. Three regions namely Unguja North, Pemba North and Pemba South were identified as targeted areas for MBNP supported interventions due to their high prevalence of maternal anemia and childhood stunting. These plans are being finalized for inclusion into Year 2 work plan. Partnerships with Other FtF Implementing Partners i. Collaboration with Tuboreshe Chakula MBNP and Tuboreshe Chakula have held various discussions to come up with ways to collaborate among them. Among the results of the discussion is a Memorandum of Understanding (MoU) between the two implementing partners which will act as a guiding tool for this collaboration. Among key achievements to date are: The two organizations have shared their plans around activities relating to the 4th component of the Tuboreshe Chakula program namely Demand Creation/Nutrition and agreed they would work together on this aspect They have achieved a common understanding on the evidence concerning micronutrient powders and agreed that these would be a key component of MBNP interventions in the health facilities and communities for all children aged 6 to 24 months. MBNP team has supported Tuboreshe Chakula to revise its promotional materials for the Micronutrient powder sachets so that they adhere to the National Regulations 16

22 and the International Code of Marketing of Breast Milk Substitutes and Designated products. MBNP and Tuboreshe Chakula have worked together conducting orientation of community leaders, home based care providers and village health workers. The collaboration significantly contributes to the FtF Intermediate results (IR) 6: Improved nutrition related behaviors; and IR5 Increased dietary diversity. ii. Partners meeting During this reporting period, MBNP attended Feed the Future implementing partners Meeting which took place on 18th of December The MBNP- Morogoro team attended an FtF implementing partners meeting held at NAFAKA project Morogoro Regional Office. This was the follow up meeting from a successful workshop on Nutrition held at Mwanzo Bora office in Dar es Salaam on 5th and 6th December The aim of the meeting was to discuss and plan activities to be jointly implemented that will ensure nutrition is integrated in the FtF partners programs. Also to review past year activities, where partners have not been communicating and collaborating on activities that integrate nutrition in the value chain. About 11 participants from MBNP, Tuboreshe Chakula, TAPP and NAFAKA projects attended the meeting. The meeting led to the identification of joint activities in the areas of Mvomero, Morogoro Municipality and Kilombero districts where the following villages (Table 2) were selected as starting points in Mvomero district: Table 1: List of villages where FtF IPs will have joint nutrition activities in Mvomero district DISTRICT VILLAGE IMPLEMENTORS MVOMERO DAKAWA HEMBETI KIGUGU LUKENGE MBNP, Tuboreshe Chakula, TAPP, NAFAKA MBNP, Tuboreshe Chakula, NAFAKA MBNP, TAPP, NAFAKA MBNP, TAPP, NAFAKA The following were the activities agreed as the appropriate start-ups to the integration: a. TAPP with the help of NAFAKA, to follow-up on UWAWAKUDA/KIPEPEO, with a view to reviving the failed project. TAPP to report findings to the team in January b. All the implementing partners to link the field officers, in order to get acquainted with the various farmer groups. 17

23 c. Mwanzo Bora to coordinate with the field officers for identification of the focal persons. Currently working with government community health workers who could also be members of the farmer groups but to ensure that the persons are acceptable in the community/ farmer groups. The focal persons to be trained on nutrition. d. NAFAKA to share seasonal calendar to enable planning of the intended activities. During planting and harvesting, it s usually difficult to mobilize farmers for capacity building and training. e. All implementing partners to share training schedules for the current year 2012/13 MBNP team in a meeting with Tuboreshe Chakula in one of the collaborative sessions in Manyara f. NAFAKA to identify women groups to be linked to TAPP for training and capacity building on high nutrient vegetables. g. TAPP to schedule capacity building activities for various groups, targeting VBAA s, Lead Farmers and other key persons that will help disseminate knowledge and information. h. Mwanzo Bora to coordinate a BCC experts meeting to deliberate on message integration. MBNP Manyara also attended a meeting which was held by officials from Tuboreshe Chakula Program who were visiting Manyara from Morogoro and Dodoma on 25th October The visit aimed at introducing their program to the district councils and targeted health facilities. The teams had an opportunity to share and discuss the two program objectives and activities, the coverage areas and explored the possible opportunities of working together as FtF partners. It was agreed that Tuboreshe Chakula should work with the health facilities where MBNP is being implemented. In year 2 MBNP will concentrate its activities in particular areas where other FtF implementing partners are operating. 18

24 The Centre for Counselling, Nutrition and Health Care (COUNSENUTH) iii. Consultative workshop with district level FtF and agriculture programs A five days district partner s capacity building and consultative workshop was convened in Morogoro region. The aim of the workshop was to sensitize the implementers on the National Nutrition Strategy and MBNP goals and priorities; and work together to identify areas of collaboration for significant integration of nutrition interventions into all FtF districts and community level activities in the three regions for better reduction of maternal anemia and childhood stunting. As a result of this workshop:a) A total of 32 (10 males and 22 females) technical staff from LGA, FtF, MBNP have been introduced to the basic principles of programming in nutrition based on the national nutrition strategy, and for the 3 regions, special attention paid to integrating identified evidence based priorities including social behavior change and communication to support behavior change in prevention of maternal anemia and childhood stunting; b) Plans and activities to be implemented by the Tuboreshe Chakula and Nafaka programs and their roles were identified; and c) The FtF partners were properly linked to the MBNP nutrition technical team from the 3 regions and districts, hence forming a strong basis for continued collaboration in year two, where MBNP will work with selected Tuboreshe Chakula and Nafaka farmer groups. iv. Working with Nafaka (UWAWAKUDA) MBNP conducted an orientation session on maternal anemia to the UWAWAKUDA Women s Farmer Group in Dakawa Kilombero, Morogoro. A total of 28 women group leaders and other members of the association were sensitized. During the session, the facilitators raised awareness on maternal anemia including causes, consequences, prevention and a need for daily use of IFA tablets by pregnant women. The session also provided an opportunity for the program to pre-test a draft Reminder Tool that was being developed for pregnant women on taking IFA tablets. This was later distributed to the group so that they can further distribute them in their neighborhoods. This will enhance the understanding of families on maternal anaemia and is expected to increase demand for iron and folic acid supplements from pregnant women, which eventually will Group members reviewing the draft reminder tool 19

25 prevent maternal anaemia and improve pregnancy outcomes. This initiative will create synergies between MBNP and NAFAKA, thus leveraging the resources for better outcomes in the communities where FtF interventions take place. Literature review on household and health facility -level behavioral influences on maternal anemia, IFA supplementation and diet for pregnant women in Tanzania MBNP conducted a selective literature review to quickly understand what is known within and outside of Tanzania about factors that contribute to the success of iron deficiency control programs and generally anemia control programs. The literature review based on the knowledge about the behaviors and social norms relevant to pregnancy, maternal diet, IFA adherence, and early care-seeking for ANC as priority areas of the program. The review was done by a technical consultant in collaboration with SBCC experts. The findings revealed that there are various factors that influence compliance and adherence to the recommended intake of iron-folate tablets during pregnancy. These factors mainly are related to a woman s willingness and ability to take iron-folate during pregnancy including late ANC attendance, poor quality of ANC services, stock outs of essential medicines including IFA, negative attitudes among health provider, and inadequate support from partners. The findings of the assessment will be used in the designing of SBCC interventions in the second year of the MBNP. Identification of local media and cultural resources inventory for nutrition and SBCC MBNP has documented various cultural media resources that could be used to communicate a variety of messages for reducing maternal anemia and childhood stunting in the community as they were identified by the district officials and the mapping exercise recently conducted. These cultural resources were those relevant for behavior change communication with pregnant women and mothers of children under 2 years of age, fathers of children under 2 years of age & husbands/ partners of pregnant women and mothers in law. In addition, information on the available local media and FM radio stations as well as its accessibility was gathered. These have formed the basis for Year 2 nutrition and SBCC activities. 20

26 SBCC Materials Development i. Development and Reprinting of User friendly reminder tools on nutrition MBNP nutrition and SBCC team developed and piloted in 6 district hospitals, user a friendly reminder tool on IFA supplementation for pregnant women and an invitation card (to ANC) for men so as to encourage men participation in maternal and child health services in the three targeted regions. Three brochures on maternal and child nutrition i.e. maternal nutrition, breast feeding and complementary feeding, were also reprinted and distributed in 70 selected health facilities in the three regions for reference. These are expected to improve provider performance on quality of services, thereby improve demand. ii. Multi- media SBCC Materials Development COUNSENUTH through Senior Program Officer SBCC participated in the development of sample multi-media SBCC materials and further development of two theoretical frameworks to support the linkage between agriculture and nutrition programming. The creative brief and a behavior-centered process was followed when developing these multi-media SBCC materials. The sample SBCC materials and the two frameworks were shared with Partners attending the FtF Partners Meeting in Dar es Salaam. The two frameworks will contribute to the design of SBCC strategies for maternal anemia and childhood stunting. Below is the list of the sample multi-media SBCC materials and theoretical frameworks: a. Ag-Health-Nutrition Critical Pathways for Maternal Anemia b. Poster with 5 Household Action Clusters for Diet Diversity c. Demonstration complementary food cooking video for cell phone d. Sample voice message for cell phone e. Sample virtual facilitator segment for audio-cassette or CD ROM f. Two sample creative scripts for virtually facilitated group meetings (provider-client relationships, and diet diversity) World Breastfeeding Week Commemoration MBNP joined the rest of the world to commemorate the World Breastfeeding week in a special way. This year s theme was TUTAMBUE TULIPOTOKA NA TUPANGE 21

27 TUNAPOKWENDA (Understanding the past and planning for the future). Various communication channels, including TV, radio and SMS were used to sensitize and educate communities on the importance of breastfeeding. COUNSENUTH provided technical inputs into the development of both the text messages and radio spots which also promoted the short code and key word for which was used by individuals to subscribe to receive the breastfeeding SMS text messages. The SMS text messages campaign marked Tanzania government s first national effort to use SMS text messaging to support social and behavior change communication for nutrition. In addition, MBNP in collaboration with Mvomero District Council in Morogoro region also created awareness to 192 lactating women on breastfeeding from August 1st to 7th, 2012 to commemorate these celebrations. The peak of the WBW Commemoration in Mvomero was celebrated at Mlali Health Centre on 04/08/2012. Development of the inventory of nutrition materials MBNP is a member of the task force for the harmonization of nutrition training materials in Tanzania which is tasked to coordinate the harmonization process. An inventory spreadsheet was developed in collaboration with TFNC and sent to various partners and stakeholders to fill in the type of materials they have developed. TFNC is expected to compile the list of the training materials from various stakeholders. With the support of the task force, TFNC has developed a draft proposal for carrying out the actual harmonization activity. The draft proposal is to be shared with MBNP and other stakeholders, so that TFNC can get more support including SBCC technical support to do the harmonization. Mapping of nutrition partners and inventory of local media and cultural resources for communication MBNP conducted an assessment (using a modified LGA mapping tool) in the 18 districts of Morogoro, Dodoma and Manyara regions to map out the available nutrition partners including CSOs that are strategic for the goals of the program. A total of 83 organizations were identified and visited. These were NGOs (45), CSOs (10), FBOs (12), Women's groups (3), CBOs (12), and one academic institution. About half of the organizations were from Dodoma region (42). There were no organizations identified for 3 districts in Morogoro (Ulanga and Morogoro Rural) and Manyara (Babati Rural); 22

28 a) Information on human resources for nutrition revealed that in 16 districts, District Nutrition Officers/ District Nutrition Focal Persons were in place, except in Kondoa and Bahi; b) In 17 districts except for Bahi, the district multisectoral nutrition steering committees has been established; c) Forty six out of 83 organizations surveyed reported to support PLHIV and MVC. ; and d) Information on the accessibility and availability of local FM radio stations was obtained. Consultative meeting on supply chain assessment for Iron and Folic Acid MBNP commissioned a consultant to assess the supply chain of IFA and other essential medicines in selected districts of Dodoma, Morogoro and Manyara regions. This activity aimed at identifying ordering and delivery bottlenecks in the national supply chain system for essential maternal nutrition and child health commodities specifically IFA; identify factors that affect the availability and use of IFA by pregnant women at facility level; and make recommendations on concrete short and long term actions/solutions that MBNP may take to address the bottlenecks in the supply chain of IFA. The review revealed that key challenges in the supply chain are on the quantification and forecasting of the needs, inadequate financial resources to procure the needed supplements, human capacity in terms of the number and technical knowhow; and clients not understanding the benefits of taking IFA and side effects of the supplements. Initiation of model evidence based minimum package of interventions in the reduction of maternal anemia and childhood stunting. MBNP identified a minimum integrated package of interventions/services which will strengthen the nutrition component in the RCH section, CTC, Pediatric ward and PMTCT clinic in 6 selected district hospitals in Morogoro (Mahenge and Turiani), Dodoma (Kongwa and Makole) and Manyara (Dareda and Babati) regions were involved in in-depth nutrition interventions, with the aim of introducing quality assurance measures on these. The goal was to establish model hospitals out of the selected 6 health facilities, one in each district, where health workers can be sent in the future to learn about best practice in providing maternal and child health services. 23

29 Key interventions were on informing mothers on the importance of good nutrition during pregnancy, provision of adequate IFA tablets to pregnant mothers up to the next visit, importance of IFA intake and management of the side effects; correct estimation and delivery of IFA in facilities. Others were immunization and provision of de-worming tablets, IPT, and ITNs as per guidelines, support mothers to initiate breastfeeding within one hour and messages on how to breastfeed successfully. As a result of this intervention, a total number of 98 (33 males and 65 females) health workers were mentored, and 700 maternal anemia reminder tools distributed to pregnant mothers and 700 male invitation cards were introduced to 6 hospitals to encourage best practices in IFA use and male involvement in reproductive and child health services. Following the initiation of the intensive interventions on reduction of anaemia and childhood stunting the regional and district nutritionists were charged to mentor health care providers to provide quality services in these areas. The trained teams succeeded to improve providers performance through coaching, mentorship and supportive supervision. As a result many pregnant and lactating mothers were reached, counseled; provided with IFA tablets and handed information materials from the program. In Dodoma region the MBNP team was particularly successful. They collaborated with the District Nutrition Officers, the Health Sector Nutritionists and actively coached and mentored health facility personnel on early ANC attendance and improving infant feeding practices in Kondoa and Kongwa district hospitals. They worked in maternity, labor and pediatric wards where 24 women with babies and 47 pregnant women who were waiting to deliver at the district hospital were counseled on correct breastfeeding skills and given take-home materials for further reference. Following the visit an action plan was developed for Kondoa focusing on the following issues:- a. Improve male participation in RCH clinics through faith leaders, b. Work with the representatives from the mosque to discuss on issues of childhood stunting and how they have affected development in the Kondoa district. c. Use of HBC providers to talk with males and share the importance of accompanying their spouses to the clinic The Morogoro team conducted supportive supervision and mentorship to 27 health workers in MBNP targeted health facilities that were reached in year one in the districts of Ulanga, 24 A mother being supported to breastfeed by a health care provider.

30 Mvomero, Morogoro Municipality and Kilombero. The aim of this activity was to make follow up of nutrition related activities done by health facilities on implementing MBNP activities with the aim of reducing maternal anemia and childhood stunting. Also coaching and strengthening knowledge of health facility workers on providing services related to maternal and child nutrition, challenges faced and suggestions in order to improve maternal and child nutrition services. During the field visit the team observed the following maternal and child nutrition interventions in all visited Health facilities: a. The RCH clinics, Maternity wards, CTC and pediatric wards clients are given health education on the importance of good nutrition during pregnancy (ANC- RCH), health and nutrition education (CTC), role of animal sources in diet (GMP/ANC RCH), hygiene, breastfeeding benefits (GMP RCH), skin to skin contact (Labor ward), attachment and positioning (maternity ward). Brochures are being given to clients after health education (RCH and CTC). b. Growth monitoring to under-five children is being done every month and their weight being recorded in the growth monitoring cards. c. Adequate IFA tablets are provided to pregnant mothers up to the next visit and discuss with pregnant women on how to manage side effect of IFA supplements. d. Immunization, deworming, IPT, and ITN is provided as per guidelines and feedback is given to mothers as a result of weight monitoring exercises. e. Support is provided to mothers to initiate breastfeeding within one hour of birth. f. Infant and young child feeding support is provided to HIV positive mothers based on their choices. They are both encouraged to exclusively breastfeed when the child is 0 6 months of age, and start complementation when the child is 6 months while continuing to breastfeed up to two years and beyond. g. Ulanga and Mvomero district hospitals formed a breastfeeding committee and formulated a hospital breastfeeding policy. h. Male invitation cards and reminder tools are being distributed and male s attendance to RCH clinic has improved (and the success of men invitation cards will be documented in the next quarter). In Manyara region, MBNP team conducted supportive supervision to three district hospitals i.e. Babati TC, Dareda and Kiteto and other six dispensaries of Kiongozi, Kiru, Mwada, Sangaiwe, Dosidosi and Kiperesa. During the supportive supervision emphasis was on improving breastfeeding practices, IFA supplementation, and follow up on specific maternal, infant and young child nutrition interventions including BFHI in the RCH, Maternity and Paediatric wards, and at the CTC clinics. 25

31 The National Anemia Consultative Group MBNP in collaboration with Tanzania Food and Nutrition Centre (TFNC) organized a meeting as an effort to revive the National Anemia Consultative Group (NACG). The meeting aimed at discussing progress made since the last meeting convened in May 2011 and to introduce the MBNP activities aiming at the prevention of maternal anemia in Morogoro, Dodoma and Manyara regions. In addition findings from a literature review on household and health facility influences on maternal anemia, IFA supplementation and maternal diet in Tanzania from a literature review were shared. The resolutions made in the meeting were that the NACG meeting should be on quarterly basis and MBNP committed to provide financial and technical support for the for one year; a task force to review Terms of Reference (ToR) for the consultative group was established and TFNC to take an active role in supporting the guidelines for promotion of fortified foods including micronutrient powders; mapping out institutions or partners implementing programs addressing maternal anemia; and finalize the national guidelines on micronutrient supplementation. The need to involve SBCC expert in harmonization of materials was emphasized. National Consultative Group on Infant and Young Child Feeding (NCGIYCF) In the reporting year, MBNP technically supports the activities of The National Consultative Group on Infant and Young Child Feeding (NCGIYCF). MBNP nutrition team participated in finalization of the national guidelines on infant and young child feeding and in the drafting of training manual for training community health workers. Consultative Groups are like Task Forces to the Multisectoral Technical Working Group at the TFNC, and these are instrumental in following up day to day activities in various national programs. In the past they were very successful in documenting progress of programs on quarterly basis, and this provided momentum for speeding up implementation of key nutrition projects. The IYCF consultative group was initiated in 1987; it has had many achievements to date. If these can be strengthened, the coordination of key sub-components of the National Nutrition Strategy can be improved. However, currently they lack leadership and motivation due to lack of funding to implement many components of the NNS. Multi-Sectoral SBCC Consultative Group Meeting COUNSENUTH participated in organizing and facilitating the first Multi-sectoral SBCC Consultative Group meeting this was held at Peacock Hotel, Dar es Salaam from 13 14th December A total of 23 individuals attended of whom 12 were males while 11 were females. The group has the major role of overseeing and coordinating the 26

32 design, development, implementation, monitoring and evaluation of SBCC strategy for nutrition interventions. During the meeting, members of the SBCC Consultative Group managed to review, discuss and provide inputs to the draft Outline for the National Nutrition SBCC Framework and Strategy. It was observed that the Group Members had high morale; showed strong ownership on the Outline presented, and were fully engaged in the process and tasks at hand. Vitamin A supplementation campaign MBNP teams in Morogoro, Dodoma and Manyara regions participated in the December Vitamin A campaign in all the districts. The program supported the campaign in community sensitization in order to maximize its coverage. The program managed to sensitize the community through radio advertisement, posters and advertisement cars in all MBNP districts. A total of 50,171 underfive children received Vitamin A supplementation from the USG supported programs. Table 2: Number of underfive children who received vitamin A in MBNP Regions Region District Total No. of <5 who received Vit. A supplementation Babati DC 3,812 Manyara Babati TC 1,001 Kiteto DC 1,004 Ulanga DC 1,707 Morogoro Kilombero DC 596 Mvomero DC 2,068 Morogoro Municipal 2,721 Dodoma Municipal 18,692 Dodoma Kondoa DC 7,852 Kongwa Dc 10,718 Total 50,171 In Manyara region, MBNP in particular participated in a three day meeting which was organized by HKI and TFNC aiming at orienting participants to various nutrition problems, the National Nutrition Strategy and provided an opportunity of planning and budgeting for nutrition activities that address nutrition problems in specific areas of Manyara and Singida region. Vitamin A supplementation and de-worming were also discussed. 27

33 In this regard, MBNP team conducted a number of vitamin A supplementation meetings in the program areas including Kiru ward, Kiru six, Kimara, Kiru ndogo and Kiru diki villages while in Mwada ward, Kisangaji, Mwada, Sangaiwe and Shaurimoyo villages were also involved in the campaign. MBNP team campaigning for Vitamin A supplementation at Kisangaji Village, in Mwada ward The MBNP team campaigned for vitamin A supplementation through village council and school committee in Kisangaji village and through village assembly meeting in Kiongozi village. 1. Strengthening of institutional capacity of TFNC, COUNSENUTH, PMO, Districts Multisectoral Steering Committees and CSOs As part of the institutional capacity strengthening, COUNSENUTH participated into a number of activities geared towards building its capacity. COUNSENUTH held discussions with Deloitte to iron out key capacity building milestones from year 2 up to year 5, and the initial draft of the milestones prepared by Delloite was revised and finalized. Delloite also conducted skills audit for COUNSENUTH and findings have been presented to the management, and the management has provided its feedback. The report also proposed remedial plan on areas that needed improvements i.e. skills development plan. Some training will be provided to staff on various skills immediately year two funds are approved by USAID. Deloitte also assessed COUNSENUTH staff workload and results have already been shared with COUNSENUTH. It was observed that Technical staff is overworked while at the administration and management level, the level of effort is adequate. This however, underscores the fact that Technical staff at the national level play the roles of procurement, IT and administration offers because of lack of staff in these positions. The regional nutritionist is also overwhelmed and this will worsen as activities move to the community level. Deloitte is coming up with a recommendation to ease the situation, and finalizing the report. 28

34 Collaboration with other partners i. Strategic Partnership with MoHSW/m- Health partnership to implement the National Campaign on Safe Motherhood MBNP established a strategic partnership with MoHSW/m-Health partnership spearheading implementation of a National Campaign on Safe Motherhood, dubbed Wazazi Nipendeni (Parents love me), aimed at promoting positive health behaviours and outcomes for pregnant and lactating women. MBNP participated in reviewing and finalizing the nutrition text messages for inclusion in this campaign. The nutrition messages were designed to promote adherence to iron folic tablets during pregnancy, consumption of additional food and nutritious foods during pregnancy and optimal feeding of the newborns including initiating breastfeeding within 1 hour, breastfeeding on demand and exclusive breastfeeding for 6 months. These messages were pre-tested in the MBNP districts before recommended for use in the campaign. ii. Stakeholders participation in project activities As part of the MBNP work, COUNSENUTH worked with participants from FHI360 (NACS) and TFNC on the orientation and training materials, job aids and guides which will be used in the implementation of year 2 activities. COUNSENUTH also actively consulted a number of other international NGOs like JHPIEGO, PACT and HKI as well as the Health Education Unit of the MoHSW, and Reproductive and Child Health Unit during the development of education materials and guides. MBNP had also been involved in various activities such as Wazazi Nipendeni Partners Health Facility Mapping such as PSI, Plan International, Tunajali, CRS, CARE, CCBRT, MAISHA, EGPAF, and THPS. COUNSENUTH was also requested by TAHEA to provide technical assistance in their three days workshop in November The workshop was organized by TAHEA, an NGO working on nutrition work, to help develop tools for food and nutrition analysis study for Pamoja Tuwalee project. This project is funded by USAID and implemented by TAHEA and AFRICARE. The outcome was three questionnaires and checklists were developed for assessing the food and nutrition situation of households, including assessing nutrition for children underfive and school Children. iii. Mainstreaming Appropriate Nutrition Messages and Actions in the Work of Stakeholders The MBNP Manyara region participated in meeting organized with CSO s and NGO s aimed at identifying nutrition and/or nutrition related activities and the general scope of 29

35 work of these organizations; their target groups/population and partners/stakeholders. Table 1 summarizes the organizations which attended meeting. Table 3: List of the organizations and the summary of their activities as influenced by MBNP nutrition team Sno Name of NGO Activities Location 1. Friends in Development Agriculture, Nutrition, economic Babati (FIDE) empowerment 2. MVIWATA Agriculture economic empowerment Babati 3. MUVI Value chain of sunflower animal products Babati 4. Support for International Change HIV/AIDS prevention including Home Based Care 5. Maasai Women Development Women education and economic empowerment Economic and provision of Kiteto Organization (MWEDO) 6. Community Research and Development Services (CORDS) health services Provision of health services, women education and economic empowerment 7. KINNAPA Support gender awareness, livestock and agriculture development, water supply, environment protection and access to education Kiteto Kiteto The MBNP Manyara also participated in the meeting organized by Multi-sectoral Nutrition Committees in Simanjiro, Mbulu and Hanang districts aiming to introduce MBNP and sensitizing members from each sector to plan and budget for nutrition activities in the year 2013/14. Develop and Rollout Program Data Collecting Tools from the Community and Health Facilities MBNP developed program monitoring tools and also collected a number of nutrition data and revised MBNP mapping by districts, ward, village, health facility and program. The community data collections tools will facilitate implementation of the care group model at the community level so as to meet the targets and indicators of the project. COUNSENUTH monitoring and evaluation staff spearheaded the development of these tools guided by the MBNP expert. MBNP Manyara region in particular participated in collection of M-nutrition contact list and Vitamin A and IFA stock outs from DMO s Office and Health Facilities Management activities and meeting / workshops attended 30

36 COUNSENUTH participated in a number of meetings and workshops, many of which involved other FtF implementing partners: MBNP participated in regional food security meeting organized by WFP Dodoma hotel to discuss interventions, locations, challenges and how to overcome the challenges in regarding to food security. The meeting, which took place on 5 th October 2012 was organized by WFP and chaired by the regional commissioner. Participants who attended the meeting included Government Officials, Representatives of NGO, CBOs, and FBOs. Main challenges observed include challenges with data collection by different partners, It was expressed that sometimes the data collected were not genuine hence interventions planned may not have been needed by the community e.g. food aid. Dodoma is still regarded as food insecure, but feeds other people around Tanzania. Main resolutions after the meeting were as follows:- a. District council plan should develop nutrition interventions as directed by the Prime Minister s Office e.g. to improve the availability of IFA, Vitamin A etc. b. Districts partners to reduce childhood stunting focusing pregnant women and the period up to two years c. Regional partners to encourage exclusive breastfeeding for six months. d. Regional partners to work on changing community cultural and beliefs that do not favour food production and utilization so as to improve food security. e. It was requested that each partner who is working in Dodoma to provide quarterly report to the regional office (RAS) who is the coordinator of all the activities in the region COUNSENUTH on behalf of MBNP also participated in a 3 days zonal workshop on planning and budgeting for district councils which was organized by Helen Keller International in collaboration with Tanzania Food and Nutrition Centre. The workshop was held at Edema hotel in Morogoro from 31st October - 2nd November The workshop involved participants from Morogoro and Dodoma regions. These included District Nutrition Offifers, District Nutrition Focal Persons, DPLOs; PLOs, DIVO; RAO for Dodoma Region; Acting Regional Nutrition Officer for Morogoro region, Cold chain coordinators, DRCHCOs, RRCHCOs from Morogoro and Dodoma and Eastern Zone, Reproductive and Child Health Coordinator (ZORCHCO) from Dar es Salaam Region, as well as MBNP Staff -Regional Coordinators for Morogoro and Dodoma regions, and SPOs-Nutrition for Morogoro region. 31

37 The main objectives of the workshops were to roll out the 2013/14 nutrition planning and budget guidelines for district councils; discussion on vitamin A campaign exercise conducted twice yearly; to discuss on follow up actions expected of participants; and to provide technical support on districts in planning. The following were some of the recommendations needing MBNP attention in year 2: a. Next year, this kind of workshop should be conducted jointly with Mwanzo Bora Nutrition Program as most of the activities are addressed by MBNP. b. A special session should be done with TFNC on what exactly MBNP is able to meet in relation to district and community program implementation. TFNC thinks that MBNP is supposed to provide funding to the LGAs c. Follow up with TFNC and PMOs should be done to ensure clear understanding on scheme of service for DNuOs, provision of official letter for the DNuO, clarification on a situation where foal persons (FP) will be recategorized from other departments to work as DNuO. There are issues as to whether they maintain their salary scales and benefits or they will be starting a new salary scale. d. There is a need to take note of the social mobilization kit (a copy of the kit will be distributed to partners) e. More advocacy with district authorities is needed to ensure that MBNP is well understood and receive maximum support. It is still not clear that MBNP is not going to give funds to the districts, and there is much expectation of the program f. District councils need to involve nutrition technical partners in its steering committee meetings. If possible, MBNP should lobby to participate in such meetings which are key in making decisions reporting and budgeting g. Planning and budgeting for district councils is very challenging. More convincing power is needed h. The DNuOs should be capacitated to stand for nutrition activities and provide appropriate advice to the councils regarding planning and budgeting for prioritized nutrition interventions. i. There should be continuous advocacy with decision makers in each district COUNSENUTH organized a 2 days meeting for the MBNP technical team. The Meeting was held in Dar es Salaam, at MBNP Head office from 19-20Th Nov The Program meeting involved 21 participants including MBNP National 32

38 office (Dar es Salaam) and regional teams (Morogoro, Dodoma and Manyara regions). The main objective of the meeting was to make a common understanding on Year 2 work plan, including the following: 1. Year 2 work plan a. Intermediate result framework (1R 3, 5, 6, 7, 8) b. Community approach Siku 1000 nutrition initiative and care group model c. Program set up and implementation framework : level and key players 2. The role of SBCC across the IRs and the concept of a 1000 Days social change campaign 3. Key indicators and targets, which will then be translated to data to be collected and tools to be used 4. Identify and agree on key milestone for year 2 i.e. on the roles and responsibilities. MBNP attended Agriculture and Nutrition Global Learning and Evidence Exchange (N-GLEE) workshop entitled Strengthened and Sustainable Linkages among Agriculture, Economic Growth and Nutrition in Africa, which was held at The Kampala Serena Hotel, Kampala, Uganda from December 10th 12th, The workshop was organized by The SPRING project under the support of the USAID s Bureau of Food Security through the Feed the Future Program. The main Objective of the workshop was to offer opportunities for knowledge acquisition, sharing of better practices and practical application of evidence in developing country-specific plans for improving nutritional outcomes under the Feed the Future (FtF) investments. Way forward was as follows: (a) Tanzania Country Team will review and update the Landscape Analysis Mission Report, and (b) Knowledge acquired during the workshop will help to improve MBNP planning and implementation especially linking agriculture and nutrition for better outcomes. MBNP attended GAIN workshop held in Dar es Salaam in December 5, 2012 where other FtF partners were available, they included; NAFAKA, TUBOCHA, SERA, M & E Project, and TAPP. The main objective was to integrate agriculture and nutrition considering opportunities and challenges. The way forward requiring MBNP attention include to re-examine the agriculture and nutrition linkage; collaboration and sharing of nutrition materials with other FtF partners; and knowing the location of other FtF partners for quick linkages. 33

39 MBNP also attended a 4 day workshop (3rd to 6th December, 2012) organized by Tuboreshe Chakula (TUBOCHA), which aimed at reviewing a draft training manual for blended flour processors. The workshop was held at Kibaha, and involved participants from SIDO, TFNC, TFDA, TBS, SUA, Ministry of Agriculture and TUBOCHA. MBNP was represented by nutrition technical staff. COUNSENUTH capacity building activities COUNSENUTH applied Learned-by-Doing approach for SBCC capacity enhancement by participating actively in the SBCC/nutrition activities that have been implemented by MBNP which included: a) Pre-testing of the 11 SMS Nutrition Text Messages which was included in the MoHSW/m-Health Campaign titled Parents Love me. The messages were pretested in the 3 MBNP councils namely Dodoma Municipal, Kongwa and Kiteto. b) Development of 7 SMS text messages promoting optimal breastfeeding practices. for SMS Breastfeeding Week Campaign (1st 7th August), targeting pregnant women and lactating women, husbands/partners of pregnant and lactating women as well as parents and guardians of children less than 2 years of age. These messages c) Working with a creative agency to develop 3 radio spots which used an entertainment-education to promote a special short code number and the keyword maziwa for people to use to register for daily educational text messages during the World Breastfeeding Week to promote optimal breastfeeding practices. d) Stared compilation of SBCC Materials Inventory (work in progress) which included cultural resources. Program Management and Staffing All needed staff for implementing Mwanzo Bora nutrition component and program support were recruited, sensitized on the program and provided with job descriptions for the work. These include 3 senior program officers who serve as focal persons for regions, project officers stationed in each of the 3 regions, M&E officer whose role is to understudy the key M&E expert in preparation for the transition of program leadership to COUNSENUTH by year 4; senior SBCC officer who understudies the Manoff expert in preparation for transition by year 4, a senior training coordinator who doubles up as backup for Manyara and finally a senor program manager who leads the nutrition component for COUNSENUTH. Internally 4 senior staff and two accountants provide program technical and financial support respectively. 34

40 2.3 Strengthen technical assistance capacity and provide technical assistance to other development partners and government i. Development of a Modular Curriculum and Training Materials The Germany Agency for International Cooperation (GIZ) and the National Health Insurance Funds (NHIF) partnered to initiate a project which aims at improving the health status of public servants in Tanzania through health promotion, early detection and management of priority chronic lifestyle related diseases at the workplace. Public servants will be sensitized to participate in the workplace health promotion, prevention and screening activities, advocate for change of lifestyle to prevent HIV infection and non communicable diseases (NCD) and seek early treatment for detected health problems. COUNSENUTH was tasked to develop a modular curriculum and training materials (power point presentations) in Kiswahili. The curriculum and training materials are in line with the Maswali na Majibu booklet which was prepared by COUNSENUTH in 2011 as a reference book for health promotion and screening intervention for the public. The materials were used to sensitize public servants in Dar es Salaam, Korogwe and Lindi. ii. Strengthening Nutrition Component in the Reproductive and Child Health Clinics ENGENDERHEALTH engaged COUNSENUTH to strengthen the nutrition component in the reproductive and child health (RCH) clinics in Iringa and Manyara targeting 6 hospitals in each region. The capacity of the care providers will be built to enable them provide quality nutrition services to mothers and children hence improved maternal health and child survival. The components to be strengthened will include infant and young child feeding practices and maternal health and nutrition. To date the following activities have been carried out: a. Assessment of the technical capacity of care providers at RCH clinics on the provision of nutritional care and support to pregnant and lactating women, infants and children. The overall objective was to assess knowledge and practices pertaining to nutrition among RCH staff, community care providers and women attending RCH clinics in Iringa and Manyara regions. Based on the findings nutritional care and support is currently not adequately addressed by the majority of the health facilities visited and community care providers. Regarding breastfeeding practices, the assessment showed that there is a gap between knowledge and practice, as most of the mothers had the basic knowledge on infant feeding such as 35

41 exclusive breastfeeding for six months, but did not practice what they knew. The team also learnt that most of the pregnant women did not know the function of the drugs they were provided when they visited the RCH. As a result they might not adhere to medication schedules especially during occurrence of side effects. Tradition, customs and other cultural believes seemed to interfere with optimal infant feeding in some of the surveyed areas, where prelacteal feeds were given to newborns b. Documentation of local foods found in Iringa and Manyara regions. The aim of the activity was to document local foods and useful local technologies used in food processing, preparation and preservation in Iringa and Manyara regions. Six districts, namely Mbulu, Hanang and Simanjiro in Manyara and Mufindi, Njombe and Kilolo in Iringa were visited. A wide variety of local foods and local technologies used in food processing, preparation and preservation, some of which have been forgotten or being ignored was identified and documented. c. Development of training module for health and community care providers on nutritional care and support for pregnant and lactating women and children. The training packages will be used to improve knowledge and skills of health care providers working in RCH clinics and community care providers in nutritional care and support for children, pregnant and lactating women. d. Train care providers at RCH clinics on nutritional care and support to pregnant and lactating women, infants and children. The general objective of the training was to equip the participants with update information on maternal and child nutrition and impart skills in nutrition aspects among the RCH care providers so as to enable them improve the quality of nutritional care and support provided to pregnant women and children under five years of age. The training drew 25 participants from 6 hospitals in Iringa region. During the training the participants identified gaps and charted out strategies for improving nutritional care and support services in their respective working places. 300 copies of IEC materials on IYCF and maternal nutrition were distributed to the participants. Training of health care providers for Manyara and community care providers in Manyara and Iringa is expected to take place before the end of the year. 36

42 iii. Development of Training Package and Training of Health Care Providers in Nutrition and Non- Communicable Diet Related Diseases The Tanzania Diabetes Association (TDA) is implementing a program aiming at improving services for the prevention and management of NCDs. Among the activities to be carried out is building the capacity of health care providers in the Lake Zone (Mwanza, Shinyanga, Kagera and Mara) in the provision of quality nutritional care and support in the prevention and management of non communicable diet related diseases, and equip health care providers with tools to expand advocacy for prevention of NCDs. COUNSENUTH was contracted to prepare a training package on nutrition and non communicable diet related diseases and conduct 4 day training on nutrition and non communicable diet related diseases for 50 health care providers in Mwanza, Shinyanga, Kagera and Mara regions. To date a training package which is comprised of trainers guide, participant manual, one day orientation package for medical doctors and clinicians and sensitization manual for leaders has been developed. Pre-testing the training package was done during the training of health care providers on nutrition and NCD, which took place in Dare es salaam involving 31 participants. The training which aimed at equipping the health care providers with knowledge and skills for the provision of quality nutritional care and support in the prevention and management of 6 NCDs (diabetes, hypertension, cancer, heart, renal and respiratory diseases), involved Medical Doctors, Clinicians, Assistant Medical Officers and Nursing Officers working in NCD clinics. Changes have been made after pretesting of the materials and are ready for designing and typesetting. The training of 50 health care providers in Mwanza, Shinyanga, Kagera and Mara regions is expected to take place in November this year. iv. Training of care providers in infant feeding counseling in the HIV context COUNSENUTH has been providing technical support on nutrition to Global Fund Round 6 Program (GFR6) since May Based on COUNSENUTH s experience in the provision of capacity building to health care providers on nutrition, education and counseling, it was contracted by the Ministry of Health and Social Welfare (MoHSW) - Zanzibar to implement one of the main activities in capacity building of health care providers in order to facilitate provision of nutrition education and counseling of PLHIV attending CTC and RCH clinics. These activities are within the overall objective number one of the goal number 37

43 two of Global Fund Round 6 which focuses on increasing access and coverage of quality coordinated HIV and AIDS care and treatment service and HIV/TB comanagement throughout Zanzibar by The planned activities for 2011 were implemented in 2012 due to delay in release of funds. A training of care providers in infant feeding counseling in the HIV context was carried out during the reported period. The training was conducted with the aim of updating knowledge and imparting skills to health care providers working in the health facilities in Unguja. A total of 27 health care providers were trained, which included 18 Public Health Nurses, 1 Laboratory Technician, 2 MCH Aides, 5 Nurse Midwives and 1 senior officer from ZACP. During the training participants were able to provide their views on the current infant feeding practices in their health facilities and were required to identity and list changes they could make themselves and those which would require inputs from the administration. The attention was particularly drawn to the implementation of the ten steps to successful breastfeeding, counseling and provision of supportive services to mothers and children. At the end of the training each participant was able to develop simple Action Plans to effect practical improvements in infant and young child feeding services in their health facilities. The action plan will be followed up during supportive supervision. v. Supportive supervision to health care providers trained in nutritional care for PLHIV and infant feeding in the HIV context in Zanzibar. COUNSENUTH has been providing technical support on nutrition to Global Fund Round 6 Program (GFR6) in Zanzibar since May The support was mainly on building capacity of health care providers in order to facilitate provision of nutrition education and counseling of PLHIV attending CTC and RCH clinics. During the reported period COUNSENUTH conducted supportive supervision to health care providers trained in 2011 and 2012 in nutritional care for PLHIV and infant feeding. The supervision involved visiting 10 hospitals of North and South regions of Pemba and 10 hospitals of Urban, Central and South regions of Unguja. Activities carried out during the supportive supervision included: Observation of quality of services being provided in all relevant sections to identify strengths, gaps, opportunities; observation of routines which hinder or support delivery of quality services as well as presence or absence of job aids, IEC materials and guidelines 38

44 Provision of technical support according to the identified gaps, strengths and opportunities on issues pertaining to infant feeding in the HIV context and nutritional care, Holding discussions with the hospital management on the observations and came up with feasible ways of improving the observed situation, and ; Provided feedback to the DMT and discussed ways to improve services provided at RCH and CTC. Major gaps identified included inadequate support and skills provided to mothers on issues relating to breastfeeding (positioning and attachment; delay in initiating breastfeeding; mothers interpreting growth charts of their children; age of introducing complementary feeding and types of foods appropriate for complementary feeding); Inadequate information provided to clients (PLHIV) regarding nutrition; sub-optimal infant feeding practices such as introduction of other fluids like infant formula by some health care providers to children born by caesarean section or by mothers who delay to produce breast milk; Staff shortages in almost all sections; inadequate skills of health workers in plotting growth curves on RCH cards. It was recommended that refresher courses on infant feeding and nutritional care and support should be done urgently to health care providers in all the sections visited for supportive supervision. In addition there is a need for initiating/strengthening community support on nutrition aspects and conduct regular supportive supervision to health care providers and community support groups should be considered. vi. Landscape Analysis Country Assessment COUNSENUTH represented Mwanzo Bora Nutrition Project, as a member of the task force for Landscape Analysis in-depth Country Assessment. The task force was responsible for planning the assessment through a series of preparations. The assessment was conducted in Makete, Chamwino, Lindi (U) and Nkasi. The task force conducted data analysis from February 29th to March 2nd: Through this participatory analysis, the country team reviewed the findings in terms of strengths and weaknesses in relation to an analytical framework for commitment and capacity. The team also finalized desk review and incorporated new findings, analyzed quantitative and qualitative data and prepared recommendations and suggested changes for the implementation plan. 39

45 The results and proposed recommendations were discussed and agreed by larger group of stakeholders in a consensus meeting which took place on the 6th March The analysis team included representatives from TFNC, WHO, USAID, UNICEF, WFP, FAO, COUNSENUTH/MBNP, MoAFSC and REACH/HQ. The process continues. vii. Scaling up the Management of Acute Malnutrition Services in Tanzania Participated in a meeting on the Scaling up the management of acute malnutrition services in Tanzania organized and hosted by TFNC. The objective of the meeting was to discuss strategies to scale up integrated management of acute malnutrition (MAM) services in Tanzania. Possible strategies agreed to be employed included: Comprehensive interventions rather than focusing on multiple, individual, parallel programs. A national strategy for prevention and control of SAM is being drafted, which will serve as a benchmark for scaling up the interventions and harmonization of activities and tools. The strategy will also emphasize more on prevention (community based nutrition promotion) rather than treatment. Harmonization of interventions and monitoring and evaluation Sharing the draft strategy with all stakeholders for inputs. viii. Biennial National Forum on Early Childhood Development Participated in the first Biennial National Forum on Early Childhood Development organized by the Government of Tanzania in Collaboration with the World Bank, Bernard van Leer Foundation, Children in Crossfire and UNICEF. The objectives of the meeting included: To educate key stakeholders in Tanzania on the scientific and economic arguments relating to the importance of Early Childhood Development To examine the role of Early Childhood Development in Tanzanian Policies and Programmes To develop a set of ECD commitments for the future 40

46 Key Recommendations included: Invest in ECD Develop a policy framework for ECD Strengthen management of ECD at all levels Build the capacity of institutions and individuals to provide quality ECD services Support parents and care-givers to better cater for the needs of young children (Target women pre-pregnancy with integrated interventions (including nutrition interventions)) Strengthen partnerships to ensure quality ECD delivery Objective 3: Capacity of COUNSENUTH and other CSOS in scaling up of nutrition begins to be enhanced 3.1 Institutional strengthening of COUNSENUTH Institutional strengthening of COUNSENUTH to implement development programs is among the components of the MBNP program. In 2012 MBNP conducted an institutional assessment of COUNSENUTH. The assessment involved a review of key documents of the organization, conducted key informant interviews with the organization s staff and conducted interviews with key stakeholders. The draft report was shared with MBNP and was discussed in the validation meeting with MBNP staff. Despite COUNSENUTH being a credible and strong local organisation, due to lack of funding over the last years, it has remained with very few staff and inadequate management systems. As part of MBNP and other efforts, COUNSENUTH will strive to significantly upgrade itself to be a local CSO to reckon with in leading other CSOs in delivering nutrition interventions at community level. Objective 4: COUNSENUTH innovative projects to improve infant nutrition, reduce non-communicable diseases and enhancing youth life skills strengthened 4.1 Counselling services During the reported period we were able to conduct 24 counselling sessions. The types of counselling held were individual, adolescent and their parents and persons in intimate relationship. The clients age ranged from 13 to 59 years. We have not as yet widely advertised the service as our human resource capacity is still small but public demand is high for youth counseling and services are normally provided on requests from parents aiming to prepare their youth for life outside college or prepare them for a new environment a higher education or travel abroad. The problem presented centered on the following: 41

47 Lack of self-awareness and self asteem Unhealthy relationship Non-functioning families Poor communication Lack of direction in life Lack of decision making skills Resource management (including time management) Substance abuse and resultant behaviors Parent-child relationship Bed wetting Attention deficit disorder Retirement issues In the future regular group counseling with adolescents/youth will be conducted 4.2 Nutritional Care and Support Services at Ocean Road Cancer Institute COUNSENUTH through volunteer graduate program provided nutrition care and support services to cancer patients and survivors at Ocean Road Cancer Institute (ORCI). The project that was founded in early 2011 was earlier funded by Twiga Bancorp Limited as a corporate social responsibility; however in 2012 COUNSENUTH funded the project from its own sources. The main goal of this initiative is to contribute to the improvement of the quality of life of cancer patients and survivors through nutritional care and support. Our volunteers provided large and small group as well as one to one nutrition education sessions to outpatients, inpatients and caregivers. The sessions were held daily from morning till midday, and from Monday to Friday. Simple Kiswahili booklets on nutrition and cancer were also distributed to the beneficiaries; however COUNSENUTH could not well meet the high demand due to meager funding for the project. Efforts are made to hand out few leaflets that are available on the subject and looking for funds to reprint them. In average, nutrition education is given to about patients everyday COUNSENUTH Internship program COUNSENUTH received 3 students for internship and field work in The students were: Two undergraduate students from the Department of Nutrition at Sokoine University, Morogoro An undergraduate student from Institute of Social Work, Dar es Salaam. 42

48 The Centre for Counselling, Nutrition and Health Care (COUNSENUTH) The students were oriented in a number of activities including: Preparation of intervention and orientation packages for community and health facility care providers (under MBNP) Assessment nutrition service and initiate maternal and child nutrition interventions in 2 health facilities under MBNP Nutrition education and counseling of cancer patients at Ocean Road Cancer Institute. Objective 5: Best practices from implementation of program recorded, reported and widely disseminate to inform planning Activities under this objective involves conducting operational research, monitoring and evaluation of the Centre s work, and document best practices that will inform future national policy and planning for nutrition among CSOs/FBOs. Activities have not been funded this year; however some activities such as research, lessons learned, success stories and M&E are partly covered under the MBNP. Efforts to mobilize funding for activities under this objective are still going on. The following is one of the success stories documented while implementing MBNP: Changing Behaviors One Woman at a Time Mwanzo Bora Nutrition Program (MBNP) is one among 6 other Feed the Future programs in Tanzania working in the Zone of Influence. In Mvomero district, MBNP in partnership with TAPP and Nafaka are working with a UWAWAKUDA, a rice farmers association in Dakawa village with a membership of about 900 individuals. Aisha Majuto is a member of the UWAWAKUDA rice farmers association. During a visit to the group by MBNP in February 2012, she was seven months pregnant. Her first ANC visit was at four months of pregnancy, however during that visit there was a stock out of iron tablets at the dispensary and therefore she was not given any tablets. During a second visit at five months of pregnancy, she was provided with some iron tablets, however, she did not take them regularly as advised at the health facility, reason being that she did not understand why it was important to do so as she was not feeling sick, hence so no need for medication. 43

49 A nutritionist with the MBNP counseled her on the importance of good nutrition and taking iron tablets regularly. She was followed up for adherence. After taking the tablet regularly for a blood volume tremendously increased, and she also gained some weight. On March 26, 2012, Aisha delivered a healthy baby named Lubanga Sauli, weighing 4 kgs. During a follow up visit by MBNP nutritionist she was counseled on the importance of exclusive breastfeeding for the first six months. After three months of exclusive breastfeeding, her husband insisted that she introduces complementary foods apart from the breast milk. She explained to him why she had to exclusively breast feed as explained to her by the MBNP nutritionist. However, the husband was adamant. To convince her husband, she called the MBNP nutritionist and explained the challenge she was facing. The nutritionist called back and talked to the husband, who at first could not believe it was possible for a woman to exclusively breastfeed and the child be fully satisfied. His other concern was that by his wife exclusively breastfeeding, she would need to eat more and thereby burdening him with bringing home more food. To further convince him, MBNP nutritionist connected him to her own husband who shared with him his own experience. The husband was eventually convinced and noted that he was not there when his wife was counseled. Had he been there he would have understood and supported his wife. On September 20th 2012, Aisha completed six months of exclusive breastfeeding with the support of the husband. Her child is healthy and she has introduced complementary foods to the child s diet in line with advice from MBNP nutritionist. This experience underscores the importance of male engagement and a supportive environment to pregnant and lactating women. MBNP understands the need for creating such a supportive environment and this is at the heart of its community engagement strategy. The Power of Technology in communicating nutrition/health messages As part of the national campaign to celebrate the World Breastfeeding week, Mwanzo Bora Nutrition Program in partnership with the M- Health program and Tanzania Food and Nutrition Center (TFNC) conducted a national SMS text message campaign promoting breastfeeding. During the campaign, MBNP through the media promoted a short code number to which people sent the word Maziwa (Milk) and thereby subscribed to receive one SMS text message per day on various breastfeeding topics for the seven days of the breastfeeding week. The SMS text messages also promoted male involvement. During the campaign a total of 7,930 people subscribed to receive SMS text messages translating to a total of 55,510 SMS text messages sent during the campaign. The Maziwa SMS campaign marked Tanzania government first national effort to use SMS text messaging to support social and behaviour change communication for nutrition. 44

50 V. CHALLENGES The Centre for Counselling, Nutrition and Health Care (COUNSENUTH) The main challenge continues to be dependency on donor funding to implement nutrition activities. As a result attention has to focus on donor interest rather than COUNSENUTH vision and mission. Lack or unavailability of tools, supplements and other supplies in Health facilities. Few examples are persistent stock outs of IFA at the facility level due to ineffective supply chain, and shortage of RCH cards at the facilities for monitoring child s growth and development; Acute human resource at most Primary Health Facilities compounded by inadequate knowledge among some health care providers on nutrition guidelines for deworming, IFA supplementation, nutritional status assessment, IYCN as well as unfriendly welcome attitude for clients. These are the cause for the observed poor case management skills; Poor recognition of Village Health Workers and lack of working gears, IEC materials, transport, and incentives to CHWs has limited community outreach services; and Poor male involvement on all issues related to improving maternal and child health and nutrition; as well as poor female involvement in decision making; existing local myths and beliefs regarding early ANC booking, IFA intake, breastfeeding and health facility based delivery that affect nutrition behaviors targeting pregnant and lactating women and children. The implementation of activities started behind the scheduled time hence some of the Year 1 planned activities were not accomplished as planned. 45

51 VI. FINANCIAL PROFILE AND STATEMENT 2012 The Major source of income for year 2012 was from the development partners mostly USAID under Mwanzo Bora Nutrition Program. Other development partners and projects which contributed to the Centre s income include Irish Aid, Global Fund Round 6 and FANTA II project. STATEMENT OF REVENUE AND EXPENSES FOR THE YEAR ENDED 31 DECEMBER 2012 REVENUE Notes TZS TZS Grants Income 3 1,862,296, ,959,873 Grants received during the year 1,862,296, ,959,873 Miscellaneous Income Office General 4 29,128,900 79,716,179 Other Income 4 19,018,170 Total 48,147,070 Total Revenue 1,910,443, ,676,052 EXPENSES Office General 5 22,723, ,465,708 Global Fund Round ,409,684 30,079,350 Irish Aid 7 60,015,022 9,964,743 Mwanzo Bora 8 1,237,082, ,867,607 FANTA II 9 31,273,200 0 Consult 10 86,791,361 35,703,927 OVC 11 4,591,399 0 Global Fund Round , ,000 URC Project 0 2,626,008 Tunajali 95, ,869,398 Total expenses for the year 1,478,783, ,686,741 Surplus/Deficit 431,659,628 18,989,311 STATEMENT OF ASSETS AND LIABILITIES FOR THE YEAR ENDED 31 DECEMBER 2012 ASSETS Notes TZS TZS Non Current Assets 2 103,778,534 1,914,333 Unapplied Grants Banked ,948,705 46,352,232 Cash and Bank Office General 13,480,022 11,925,122 46

52 Receivable 14 47,778, ,230,933 Total 409,985, ,422,620 COMMITMENTS Audit Fees 13,145,600 Consultancy Fees 10,000,000 TTCL 61,309 Salaries Arrears 86,657,963 Total 109,864,872 NOTES TO THE FINANCIAL STATEMENTS FIXED ASSETS TSHS TSHS TSHS TSHS Furniture Office and Fittings Equipment Total Computer Software COST As At January ,821,471 2,821, Additions / (Disposal) 40,324,760 12,801,891 64,503, ,629, As At December 31st 40,324,760 12,801,891 67,324, ,451,378 DEPRECIATION As At January 1st - - 1,107,139 1,107, Change for the Year 6,720, ,967 8,208,944 15,565, As At December 31st 6,720, ,967 9,316,083 16,672,843 NBV ,603,967 12,165,924 58,008, ,778,534 FUNDS RECEIVED FROM DONORS Funds received from Donors were as follows: TZS Mwanzo Bora Grants Received 1,378,344,444 Transfer from Unapplied ,749,749 Total Income 1,380,094,193 Irish AID Grants Received 233,782,000 Transfer from Unapplied ,204,637 Total Income 234,986,637 Global Fund R6 Grants Received - Transfer from Unapplied ,770,950 47

53 Total Income 40,770,950 FANTA II Grants Received 115,093,448 Transfer from Unapplied Total Income 115,093,448 CONSULT Grants Received 88,723,920 Total Income 88,723,920 Global Fund 4 Grants Received - Transfer from Unapplied ,791 Total Income 95,791 Tunajali Grants Received Transfer from Unapplied ,531,106 Total Income 2,531,106 Grand Total 1,862,296,045 Office General Income Received 7,155,640 Transfer from Unapplied Total Income 7,155,640 Grand Total 1,869,451,685 MISCELLANEOUS INCOME Office General TZS Funds from Selian Lutheran Hospital 7,155,640 Miscellaneous Income 21,973,260 Other Income CONSULT 13,618,170 OVC 5,400,000 TOTAL 48,147,070 OFFICE GENERAL TZS Personnel 5,923,300 Fringe Benefits 0 Travel & Transport 837,500 Other Direct Costs: Stationery 2,220,900 Allowances 660,000 48

54 Telephone 620,799 Internet Services 500,000 Postage and Courier Service 80,000 Electricity 1,185,000 Office Rent 3,387,271 Security Services 100,000 Motor Vehicle Fuel 1,200,000 Motor Vehicle Insurance 1,711,500 Maintenance Computer Software and Hardware 15,000 Maintenance Office Equipment 409,223 Cleaning 150,000 Transport 340,000 Condolences 135,000 Venue and Refreshment 758,400 Water Bill 81,003 TOTAL 22,723,796 GLOBAL FUND R6 TZS Personnel - Fringe Benefits - Travel & Transport: Stationery 710,608 Printing & Photocopying 1,020,200 Allowances 3,000,000 Postage and Courier Service 138,600 Transport 2,763,000 Travelling on Duty Allowance 16,945,000 Venue & Refreshments 6,193,000 Communication Allowances 320,000 Demonstration Materials 192,300 Other Direct Costs: Electricity 100,000 Bank Charges Institutional Costs 296,976 3,730,000 TOTAL 35,409,684 49

55 IRISH AID TZS Personnel 40,229,326 Fringe Benefits 8,939,850 Travel & Transport: Stationery 340,396 Printing & Photocopying 20,500 Allowances 1,762,500 Motor Vehicle Fuel 2,247,000 Motor Vehicle Repair & Maintenance 319,600 Transport 1,299,500 Travelling on Duty Allowance 3,597,500 Venue & Refreshments 97,000 Communication Allowances 150,000 Other Direct Costs: Bank Charges 1,011,850 TOTAL 60,015,022 MWANZO BORA TZS Personnel 561,178,893 Fringe Benefits 138,724,216 Travel & Transport: Stationery 20,085,614 Printing & Photocopying 24,722,455 Allowances 26,770,000 Motor Vehicle Fuel 16,636,530 Motor Vehicle Repair & Maintenance 127,000 Transport 17,556,650 Travelling on Duty Allowance 240,823,096 Venue & Refreshments 51, Communication Allowances 1,795,000 Bank Charges 274,000 Demonstration Materials 4,673,200 Sundry Expenses 328,100 Other Direct Costs: Stationery 10,823,289 Allowances 3,280,000 50

56 Telephone 4,952,762 Internet Services 3,011,670 Postage and Courier Service 35,400 Gain or Loss Account 10,948,969 Electricity 4,708,400 Office Rent 626,648 Security Services 100,000 Motor Vehicle Fuel 7,622,000 Maintenance Computer Software and Hardware 1,245,600 Maintenance Office Equipment 1,260,000 Depreciation Computer Software and Hardware 6,720,393 Depreciation Furniture & Fittings 635,967 Depreciation Office Furniture 7,485,577 Cleaning 767,000 Transport 168,000 Maintenance Land and Buildings 291,700 Motor Vehicle Repair & Maintenance 11,282,990 Newspaper 85,000 Printing and Photocopying 1,602,720 Recruitment Cost 3,148,910 Bank Charges 1,032,914 Sundry Expenses 5,303,250 Audit fees 13,145,600 Refreshments 15,000 Water Bill 107,047 Advocacy, Advertisement & Promotion 250,300 Staff Development 2,062,970 Contractual Consultancies 29,368,193 TOTAL 1,237,082,866 FANTA II TZS Personnel 2,890,000 Fringe Benefits 528,000 Travel & Transport: Travelling on Duty Allowance 270,000 Other Direct Costs: Stationery 283,200 51

57 Printing & Photocopy 147,500 Allowances 2,920,000 Motor Vehicle Fuel 549,000 Motor Vehicle Repair & Maintenance 13,000 Venue and Refreshments 768,000 Bank Charges 244,500 Contractual: Consultancies 7,700,000 Consultancies 7,480,000 Consultancies 7,480,000 TOTAL 31,273,200 CONSULT TZS Personnel 6,358,800 Fringe Benefits 2,940,000 Travel & Transport: Stationery 3,443,746 Printing & Photocopying 7,670,000 Allowances 5,950,200 Motor Vehicle Fuel 2,169,000 Motor Vehicle Repair & Maintenance 2,582,215 Transport 4,123,000 Travelling on Duty Allowance 26,660,000 Venue & Refreshments 4,605,000 Communication Allowances 340,000 Bank Charges 40,000 Demonstration Materials 369,800 Other Direct Costs: Allowances 9,880,000 Internet Services 200,000 Electricity 300,000 Security Services 50,000 Cleaning 60,000 Bank Charges 258,500 Sundry Expenses 237,100 News Papers 14,000 Institutional Costs 4,900,000 Contractual: 52

58 Consultancies 3,000,000 Consultancies 640,000 TOTAL 86,791,361 OVC TZS Other Direct Costs: Education 4,351,950 Bank Charges 239,449 TOTAL 4,591,399 GLOBAL FUND R4 TZS Other Direct Costs: Depreciation Expense 705,368 Bank Charges 95,791 TOTAL 801,159 UNAPPLIED GRANTS TZS Unapplied Grants Mwanzo Bora Nutrition Project - Bank 13,027,484 Mwanzo Bora Nutrition Project Petty Cash 427,500 IRISH AID 171,329,716 Global Fund R6 5,011,442 Consult 11,673,579 Fanta II 42,670,383 OVC 808,601 TOTAL 244,948,705 RECEIVABLE TZS Prepaid Expenses 37,810,923 Staff Imprest 5,867,700 Staff Loans 4,000,000 Staff Advance 100,000 47,778,623 53

59 VII. COUNSENUTHE BOARD AND STAFF IN 2012 COUNSENUTH BOARD MEMBERS SN NAME DESIGNATION ORGANIZATION 1. Dr. Fatma Mrisho Chairperson TACAIDS 2. Hon. Lediana Mafuru Member Member of Parliament 3. Dr. Calista Simbakalia member Private sector 4. Mr. Tryphone Rutazamba Member Private sector 5. Prof. Joyce kinabo Member Professor SUA 6. Dr. Festo Kavishe member UNICEF - Asia COUNSENUTH STAFF SN NAME TITLE 1. Pauline Kisanga Executive Director (MSc Nutrition) 2. Mary Materu Director of Programs (MSc Nutrition) 3. Wanoga Mramba Senior Finance and Admin Manager (ACCA) 4. Dr. Lunna Kyungu Principal Program Officer (PhD Nutrition) 5. Restituta Shirima Principal Programme Officer (MSc Nutrition) 6. Virginia Kainamula Principal Program Officer (MSc Sociology) 7. Mr. Elias Ntandu Monitoring and Evaluation Officer (MSc) 8. Dr. Daniel Nyagawa Senior Program Manager (MD, MPhilos, MBA) 9. Prudence Masako Senior Program Officer (MSc Nutrition) 10. Stella Fungo Senior Program Officer (MSc Nutrition) 11. Belinda Liana Senior Program Officer (MSc Nutrition) 12. Tuzie Edwin Senior Program Officer (MPH) 13. Medina Wandella Senior Program Officer (MSc Nutrition) 14. Dolores Msimbira Senior Program Officer (MSc Nutrition) 15. Mercy Tarimo Senior Program Officer (MSc Nutrition) 16. Agnes Mahembe Senior Program Officer (MSc Nutrition) 17. Emile Ruturagara Accountant (BSc Accounting) 18. Edward Gatunge Office Assistant (Dipl Accounting) 19. Clara Mashio Nurse Midwife 20. Harriet Ngowi Volunteer (Bsc. Nutrition) 21. Lucy Assenga Volunteer (Dipl. ICT) 22. Sarah Luzungi Volunteer (BSc. Nutrition) 23. Cecilia Thomas Volunteer (MSc Purchasing) 24. Flora Kibusi Volunteer (Dipl Accounting) 25. Faraja Silla Driver 26. Emanuel Matee Driver 27. Joel Kimaro Driver 28. Zablon Migambo Driver 29. Pancrasia Shirima House keeper 54

60 The late Harriet Ngowi The Centre for Counselling, Nutrition and Health Care (COUNSENUTH) VIII. NEWS AND EVENTS New COUNSENUTH Staff In year 2012 all needed staff for implementing Mwanzo Bora nutrition component and program support were recruited, sensitized on the program and provided with job descriptions for the work. In addition, a number of supporting staff and volunteers were recruited. Table below show the staff and volunteers recruited. STAFF AND VOLUNTEERS RECRUITED IN 2012 S/N Name Title 1 Dr. Daniel Nyagawa Senior Program manager Wanoga Nkalango ngo Prudence Masako Medina Wandella Elias Ntandu Mercy Tarimo Dolores Msimbira Agnes Mahembe Emanuel Matee Zablon Migambo Flora Kibusi Pancrasia Shirima Senior Finance & Administration Manager Senior Program Officer / Training Coordinator Ag Senior Program Officer, Manyara Focal Person M/E Program Officer Senior Regional Nutrition Officer-Manyara Senior Regional Nutrition Officer -Dodoma Senior Regional Nutrition Officer -Morogoro Driver Driver Short term Support-Accounts House Keeper Sad Demise of Harrieth Ngowi COUNSENUTH staff was deeply saddened by the passing away of one of its colleagues, Ms. Harriet Ngowi. Harriet who died after a long struggle with cancer served our Centre as a volunteer for more than 2 years. COUNSENUTH will always remember her contributions in providing nutritional care and support services at ORCI and her big contribution in the development of NACS community materials. Our deepest condolences go to her family members. We all pray to the Almighty to rest her soul in peace and to give her husband, daughter and relatives all strength and courage to overcome this great loss. 55