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Will We Ever Get Back? The Derailing of Tanzanian Nutrition in the 1990s

Dolan, C. and Levinson, F. J. (2000) Will We Ever Get Back? The Derailing of Tanzanian Nutrition in the 1990s. Discussion Paper. UNSPECIFIED. (Unpublished)

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“We Will Never Go Back”, published in 1993, tells the story of nutrition and, more generally,community-based program development in the Iringa Region of Tanzania during the 1980s, and the expansion of this effective programmatic approach to other areas of the country as the Child Survival and Development programme. Despite the impressive nature of the program, the buoyant title of the monograph proved overly optimistic. During the 1990s, the Child Survival and Development programme, and nutrition activity more generally in the country, faced an onslaught of economic decline, government wide and health sector reform, decentralised authority to ill-equipped and poorly financed district authorities, and a high proportion of distressed communities no longer able to support village workers. The result has been a serious decline in the quantity and quality of nutrition-related services in Tanzania, a stagnating of earlier declines in malnutrition, and the virtual disappearance of nutrition from the country’s
policy agenda. This case study seeks to examine this derailing of nutrition during the 1990's by briefly reviewing the history of nutrition in the country and nutritional status trends, indicating the roles of the World Bank and UNICEF in this history, and then presenting the following three policy narratives seeking both to explicate the precipitous decline and to identify signs of hope for the future: Health Sector Reform and Sector Wide Approaches: The Disappearance of Nutrition,The Peripheralizing of the Tanzania Food and Nutrition Centre,New Beginnings The history of nutrition in Tanzania featuring, as major actors, the Tanzania Food and Nutrition
Centre and the Swedish International Development Agency in addition to UNICEF, roughly parallels developments and understandings of nutrition taking place internationally. During the 1960s and early 1970s, malnutrition was associated primarily with the "food cycle," tracing
shortfalls in production through to consumption consequences. By the 1980's this conceptualisation was largely swept aside as the country experienced a massive expansion of nutrition programming supported by quantum leaps in conceptual underpinning. Swedish International Development Agency, Tanzania Food and Nutrition Centre and UNICEF were important partners in developing and pioneering the use of what became UNICEF's conceptual framework and the accompanying Triple A Cycle approach to community-based
problem solving. These understandings led, in turn, to the Joint Nutrition Support Program in Iringa Region, a landmark project placing emphasis on social mobilisation and community animation, processes of local problem assessments and action plans, and tailor made combinations of nutrition and food security at the community level. The dramatic success of the Joint Nutrition Support Programme in reducing the prevalence of severe malnutrition led to its
rapid expansion through the 1980's and early 1990's to other areas of the country as the Child Survival and Development program. The Child Survival and Development programme, and the consciousness of nutrition and community-based action it engendered, is surely responsible, at least in part, for declines in the prevalence of childhood malnutrition in the country from an estimated 50 percent underweight in the 1970s and early 1980s (based, unfortunately on a paucity of representative data) to roughly 30 percent by the early 1990's. Through the course of the 1990's, however, these levels plateaued, while infant and child mortality appear to be increasing (along with declining utilisation of maternal and child health services in the country.) Vitamin A, iron and iodine deficiencies remain high despite considerable efforts to address these problems. UNICEF, which along with Swedish International Development Assistance, has been the primary donor supporting nutrition-related activity in the country during the 1980s and early 1990s and which provided major assistance to the Child Survival and Development programme
as well as for micronutrient activities, experienced a relative lull during the mid 1990's, but has now resurfaced as the major supporter of nutrition and community-based services in the country. The Bank, originally intending to support explicitly the expansion of the Child Survival and
Development programme as part of its Health and Nutrition Project initiated in 1990, subsumed this intention under a broader effort to support district health plans in consonance with the health sector reforms being developed at the time. Responsibility for the inclusion of nutrition in these plans and for technical assistance to the districts was given to the Tanzania Food and Nutrition
Centre which received support under the Project. Most nutrition support in the project (nutrition activities constituted 3 percent of the total budget) was directed to the support of national micronutrient activities. A new Health Sector Development Program (discussed in Narrative 1)
includes little mention of nutrition; nor does the Bank-assisted Tanzania Social Action Fund.

Item Type: Report (Discussion Paper)
Keywords: Nutrition;Food;Iringa;Tanzania
Subjects: Nutrition & food security > Food security
Divisions: Other
Depositing User: Mr Joseph Madata
Date Deposited: 05 Dec 2012 06:25
Last Modified: 05 Dec 2012 06:25

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