Building Strong Nutrition Systems (completed)

Implementation science in support of scaling up nutrition in Tanzania

During a nutrition engagement workshop, Mentor Akwilina Mwanri (right) brainstorms with community stakeholders ways to add nutrition goals to current agricultural activities [photo: Christina Stark].

Scaling Up Nutrition (SUN) programs require an adequately skilled workforce to deliver effective interventions. Tanzania has a strong commitment to the SUN Movement and a progressive National Multi-sectoral Nutrition Action Plan (available here). However, the difficulty of translating policies into effective nutrition interventions is well known. Implementation challenges continue to affect the health and well being of Tanzania’s 7.3 million young children and 10.9 million women of reproductive age, as well as the social and economic development of the nation. We conducted a two-stage implementation research project in Tanzania, titled “Building Strong Nutrition Systems,” in collaboration with nutrition experts from five leading Tanzanian institutions. The aim was to understand the challenges and opportunities in the planning and delivery of joint nutrition activities across sectors. The results present learning strategies for scaling up intersectoral nutrition action at the district level in Tanzania (learn more about intersectoral nutrition action here).

Formative research: Intersectoral collaboration for nutrition

Our fabulous field research team, during pretesting in Marangu. Left to right: Pili, Clara Mollay, Mary Mosha, Dorah, Akwilina Mwanri, Julius and Rune Philemon.

Our phenomenal field research team. Left to right: Pili Nyindo, Clara Mollay, Mary Mosha, Dora Mrema, Akwilina Mwanri, Julius Ntwenya & Rune Philemon.

The SUN movement is centered on intersectoral collaboration. Formative research was conducted in Tanzania to understand intersectoral collaboration for nutrition at the district, ward, and village levels. We conducted qualitative interviews with 46 frontline workers across eight sectors to explore their perceptions of nutrition, the work they perform, existing and potential intersectoral collaborations, and opportunities for integrating nutrition into ongoing community programs. We also conducted 11 focus group discussions with community members to gain understanding of their nutrition knowledge and opinions of services available at the community level. We identified four factors that facilitate intersectoral collaboration: shared understandings of nutrition, shared goals and outcomes, perceived benefits to integrating nutrition into other sectors, and a structure that allows people to work together.

Case studies: Strengthening Capacity of District Nutrition Officers (DNuOs) through Mentoring

Mentor Clara Mollay (back; center) encourages stakeholders from different sectors to document challenges & opportunities for working together on nutrition [photo: Christina Stark].

Mentoring is an experiential and dynamic learning model that has been shown to be effective in bridging knowledge gaps, addressing health systems issues, strengthening professional relationships and networks, and increasing work performance. Academic mentors supported DNuOs in two districts over one year. Mentors provided advice, counsel, and encouragement. Mentors helped DNuOs access and better utilize the knowledge and resources needed to improve and grow in their roles. Mentorship focused on four areas: goal setting, finding gaps, problem solving, and creating strategies and action plans. With mentor support, DNuOs conducted a landscape analysis, stakeholder mapping, and nutrition engagement workshops. These activities enhanced the ability of DNuO’s to work across sectors, reach communities, and lead new initiatives that supported improved intersectoral nutrition planning and outreach.

Research team: Rebecca Stoltzfus, Katherine DickinGina Chapleau, Christina Stark, Dadirai Fundira, Jeanne Moseley.

Research Collaborators: Luitfrid Nnally and Joyceline Kaganda (Tanzania Food and Nutrition Centre); Mary Mosha, Rune Philemon, Sia Msuya and Rachel Manongi (Kilimanjaro Christian Medical University College); Akwilina Mwanri and Joyce Kinabo (Sokoine University of Agriculture); Anna Kessy and Naomi Saronga (Muhimbili University of Health and Allied Sciences); Haikael Martin, Clara Mollay (Nelson Mandela African Institution of Science and Technology).

Funding: This research was funded by the Bill & Melinda Gates Foundation.

Materials and resources: Manual and Evidence-based Briefs on Strengthening District Capacity to Improve Multi-sectoral Nutrition (MSN) Planning and Action

Cornell in collaboration with the Tanzania Food and Nutrition Center (TFNC) developed a manual and a series of evidence-based practice briefs summarizing implementation-based information about how to strengthen MSN concepts, processes, models, and tools for district government, program planners, and service organizations. The three main sections and companion briefs focus on particular approaches to MSN systems strengthening including 1) mentoring, 2) mapping of community-based stakeholders, and 3) convening participatory nutrition engagement workshops. The introduction to the manual introduces key topics and terminology and provides an overview of the Building Strong Nutrition Systems project. See links below for the full documents:

Kiswahili version of the MSN manual and briefs:

For more information about these materials, please contact Mr. Luitfrid Peter Nnally at nluitfrid@gmail.com or visit www.tfnc.go.tz

Publicity: News Articles on the Project

Wilensky, J. Nutritionists from Tanzania turn knowledge into action.Cornell Chronicle [Ithaca] 30 Oct. 2015; 1. Web.

Scaling Up Nutrition (SUN). “Researchers in Tanzania scale up nutrition knowledge for local level nutrition interventions.” SUN News Blogs 2 Nov. 2015; 1. Web.

Jonas Kira (DNuO) presents district stakeholder mapping results of nutrition-sensitive actions to Heads of Department and stakeholder representatives [photo: Gina Chapleau].