19 September 2016

Tanzania: The State of the World's Diet, With Graça Machel

Dar es Salaam — Matters that relate to food for humans affect our lives every day, but are the ramifications of not eating right equivalent to an 11% annual loss in our GDP on the continent? A loss that is greater than the annual percentage loss in world GDP due to the global financial crisis of 2008-10. On the 20th of July this year, the Global Nutrition report 2016 was officially launched in Tanzania at the Protea Hotel in Dar es Salaam, it verifies this stat.

Worldwide the report was launched on the 14th of June in 7 countries one of them being South Africa, where the guest of honour was Mrs Graça Machel. At the launch in Tanzania the guest of honour was Vice President of Tanzania, Hon Samia Suluhu.

Also present at the launch in Tanzania were the Minster of Health, Community Development, Gender, Elderly and Children Hon. Ummy Mwalimu, Ms Isatou Jallow, the head Food Security and Nutrition Program Officer at NEPAD-New Partnership for African Development and Mr Tumaini Mikindo, the Director for PANITA (Partner for Nutrition in Tanzania).

Malnutrition is a sophisticated affliction that affects one in three people in the world. It shows up in different ways like in the case of child stunting, child wasting, overweight children, overweight adults, micronutrient deficiency, adult obesity and being prone to non-communicable diseases like diabetes, heart diseases and some cancers.

Child stunting is when children are too short for their age, child wasting which is what we commonly affiliate with malnutrition. It occurs when children are too thin for their height. The opposite to that are children with too much weight for their height, 'child overweight'.

Adult overweight, on the other hand, is carrying excess body fat with a body mass index >or-30. Micronutrient deficiency is when one is lacking iron, folic acid, vitamin A, zinc and iodine below healthy thresholds.

This annual report, which is in its third year, following the call from the Nutrition for Growth Summit in London 2013, was sourced by an independent expert group comprising of 22 leading researchers and practitioners, working across the world in the malnutrition spectrum with lead authors Lawrence Haddad and Corrina Hawkes. The report this year had the support of several institutions including; UNICEF, Irish Aid, City University London, USAid, UKaid, FAO, Children's Investment Fund Foundation-CIFF, Cellule de Lutte contre la Malnutrition-Senegal (CLM), the Governments of Ethiopia, Indonesia, Malawi, Nigeria and Pakistan among others to bring it to fruition.

The report clearly indicates Malnutrition and poor diet constitute the number one driver of the global burden of disease. Further substantiating that in a world population of 7 billion, about 2 billion of people suffer from micronutrient deficiency, where nearly 800 million people suffer from calorie deficiency. Out of 5 billion adults worldwide nearly 2 billion are overweight or obese, where one in 12 has type 2 diabetes. Out of 667 million children under 5 worldwide, 159 million are too short for their age (stunted). 50 million of these do not weigh enough for their height (wasted) and 41 million of them are overweight.

Now several countries in the world including Tanzania, Kenya, Uganda and Rwanda have signed onto global nutrition targets; through their participation in the World Health Assembly (WHA), under the World Health Organisation (WHO).The report shows that in order for these targets to succeed at the national level they need to be SMART (that is specific, measurable, achievable, relevant and time bound). The WHO team identified 122 nutrition plans at the national level from its member nations. Ideally each of the 122 plans would incorporate the full set of the six global maternal, infant, and young child nutrition targets and all would be SMART. The reality is that of the 122 plans which should yield 732 targets, there are only 358 targets and only 66 % of these are SMART.

So the world is behind in attaining an end to Malnutrition by 2030 as is the plan set by World Leaders, when they adopted the Sustainable Development Goals (SDG'S) last year. The report substantiates that nutrition is central to SDG's, as at least 12 of the 17 goals. Contain indicators that are highly relevant to nutrition. Improved nutrition is the platform for progress in health, education, employment, female empowerment and 'poverty & inequality' reduction.

"We all know that proper nutrition is a big corner stone in building a strong nation, this report is timely bearing in mind the rest of the world has begun to implement the first phase of the 17 Sustainable Development Goals, where goal number 2, 3 and 12 are directly linked with alleviating malnutrition... The goal of reducing stunting by 40% come 2025 in TZ may not be realised if we keep talking without acting" Hon Vice President of Tanzania Samia Suluhu says.

Sadly the ones who suffer most from malnutrition are children; where the first 1000 days between conception and the first two years are the most crucial in a child's life. This means the diet of a pregnant woman is just as important, in yielding children who are healthy and equipped to participate fully in the development of their nations. Stats say 2 in 5 children under the age of five in Sub-Saharan Africa, do not receive the right nutrients in the first 1000 days of life.

Thankfully there's hope as there's numerous efforts by Governments, Civil Society, Private Sector and Donor Partners worldwide, which have made commendable changes towards the ending of this malady. One such story is the case of Tanzania with regards to child stunting.

"In Tanzania the statistics show we've had a 16% decline in child stunting since the 1990's where 8% of this happened in the last 5 years, this is a huge gain. Particularly for stunting which for those who know it in depth, requires a lot of time to turn around. I think this emanates from the great political will that was shown by the former president Dr Jakaya Kikwete. I think he was a global champion in this matter.

"So there was great political will but this was further translated down to actions following the country's joining with SUN-Scaling UP Nutrition in 2010. Here a lot of changes were made systematically to improve cohesion, among the various stakeholders in the government dealing with nutrition. I have my colleague here with me, Mr. Obey N. Assery, he is the Director at the Prime Minister's Office, in the Dept of Coordination of Government Business. He can tell you more about this. They provided space for various actors towards this goal throughout the development picture like the civil society, donor community and private sector to work cohesively," says Mr Tumaini Mikindo (PANITA) in SA.

"Malnutrition isn't destiny... it's a political choice."-Lawrence Haddad affirms at the launch of the report in South Africa, citing examples of countries whose governments are enforcing change which are further explained in the report.

Like Argentina where the law now commits to the intake of 5 grams of salt per person per day by 2020; this policy has SMART targets as it has identified that 70 percent of salt intake is from processed foods, especially bread. Therefore a focus on ensuring processed foods and bread undergo salt reduction. Research conducted show that for each gram of salt reduction 2,000 annual deaths from cardiovascular disease are avoided.

Other countries like Malawi now have a section in their parliament solely dealing with nutrition. In Chile since 2014, the government implemented an 8% tax on sugar-sweetened beverages relative to other beverages. Also as of July'16, food companies in Chile are required to place in front of their products a warning label. This for processed foods and beverages high in sugars, sodium, saturated fats and energy, plus they will be prohibited from advertising and marketing these products to children 14 years and younger. This marketing constriction in Chile represents the most comprehensive in the world to date.

Thankfully Kenya is starting to sound the horn on the issue that many countries south of the Sahara including Tanzania are afflicted with; namely the prevalence of overweight and obesity among women 19 to 49 years old, approaching 50 percent in urban areas (MOSUN 2016). This through the publishing from Kenya's Ministry of Health, of a National Strategy for the prevention and control of Non-communicable Diseases (NCD's) 2015-2020. It includes a target of no increase in obesity and diabetes among adults.

Kenya's National Nutrition Plan 2012-2017, outlines specific activities to address the overweight and obesity rates in the country. Including review, develop and dissemination of a comprehensive strategy and guideline for preventing, managing and controlling nutrition-related NCD's. According to the report while Kenya is taking steps in the right direction, the country still needs to allocate more funds for obesity programming as well as greater funding for nutrition in general.

It's worth it to note then, that malnutrition is chronically underfunded worldwide and requires a three-fold increase, if we're to end the crisis in 2030. The report indicates however that for every 1USD invested in nutrition, there's a 16USD yield in return. Also data gaps remain a significant roadblock to assessing progress on nutrition for various countries worldwide; where Tanzania for example has the lowest coverage data in the world for iron supplementation to its children under 5.

On the gap of data provided on nutrition by different countries, Mrs Graça Machel at the launch in SA, insisted that governments in Sub Sahara involve NGO's and the UN family to assist them in providing the same

"The main reason why they're there is to help our countries govern well using the knowledge which is out there globally. You know, they're in a great position to say 'Oh Indonesia is doing very well in this, then they can bring Indonesia experts to Malawi to share their experience and knowledge... I'm just citing examples but I think.

The AU, NEPAD and all these organisations have to move from being nice to Heads of State and begin to demand results on the basis of targets by being enforcers of change. I'll give you an example, when did our Heads of State sign up to put 15% of their budget to health, when did they sign up to the principle of putting at least 10% to agriculture? A long time ago... it's not happening. No one is asking in an enforced way, where they feel obliged to respond."

Perhaps Hon Samia answered this question when she cited at the launch of the report in Tanzania. "We know that the targets set in Abuja to allocate 15% of the Governments overall budget, to health haven't been met, we're working on that... I can't stress enough the importance of education particularly for the young mothers in the rural areas. It's high time the chores at the family level for the mother are shared, so she can get the time to prepare nutritious meals for her family. I'd like Civil Society Organisations present, to keep working on this issue and I promise you that the government will show ample support even at the district level, in ensuring ending malnutrition is given high priority."

Currently the budget of 2016/17 in Tanzania allocates 500TSHS (US$ 0.23) per chid for Nutrition interventions, this is short of the US$8.5 required to be on track to ending malnutrition by 2030.

You can get the report to find out key information on the topic by visiting and follow the conversation online by using the #NutritionReport.

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