National Multisectoral Nutrition Action Plan (NMNAP) 2021/22 – 2025/26

NATIONAL MULTISECTORAL NUTRITION ACTION PLAN United Republic of Tanzania Prime Minister’s Offce 2021/22 – 2025/26 iiiNational Multisectoral Nutrition Action Plan (NMNAP II) TABLE OF CONTENTS Keynote vii Foreword ix Statement of commitment xi Acknowledgements xiii Acronyms xv Executive Summary xix CHAPTER 1: INTRODUCTION TO THE NMNAP II 1 1.1 Background 1 1.2 Overview of the NMNAP 2016 – 2020/21 2 1.2.1 Success and lessons learnt 2 1.2.2 Gaps in the implementation of NMNAP I 2016-2020/21 2 1.3 The goal of the NMNAP II 3 1.4 Conceptual framework of the NMNAP II 3 1.5 Targeted audience for the NMNAP II 4 1.6 Development process of the NMNAP II 4 1.7 Organization of the NMNAP II document 5 CHAPTER 2: NUTRITION SITUATION ANALYSIS 6 2.1 Introduction 6 2.1.1 Trends in undernutrition 6 2.1.2 Trends in micronutrient defi ciencies 9 2.1.3 Trends in overweight and obesity 10 2.2 Causes of malnutrition in Tanzania 12 2.2.1 Conceptual framework 12 2.2.2 Causes of undernutrition and micronutrient defi ciency in Tanzania 15 2.2.3 Causes of overweight and obesity in Tanzania 15 2.3 Situation analysis of key systems for delivering nutrition 15 2.3.1 Food system 16 2.3.2 Health system 17 2.3.3 Water and sanitation system 18 2.3.4 Social protection system 18 2.3.5 Education system 19 iv National Multisectoral Nutrition Action Plan (NMNAP II) CHAPTER 3: NMNAP II DESIGN FRAMEWORK 20 3.1 Rationale 20 3.2 Vision, mission and guiding principles 20 3.3 Objective of the NMNAP II 21 3.4 Theory of change 21 CHAPTER 4: KEY RESULT AREAS, STRATEGIES, AND INTERVENTIONS 25 4.1 Overview of the chapter 25 4.2 KRAs with corresponding outcomes, outputs, strategies, actions and activities 28 4.2.1 Undernutrition priority actions and activities 28 4.2.2 Priority actions and activities to address micronutrient defi ciencies 33 4.2.3 Priority actions and activities to address overweight and obesity 42 4.2.4 Enabling environments for nutrition priority actions and activities 46 4.3 Key strategies 52 CHAPTER 5: COSTED ACTION PLANS OF NMNAP II 54 5.1 Context 54 5.2 Intervention prioritization 54 5.3 Costing approach 54 5.4 Financial resource needs for implementing the NMNAP II 55 5.5 Funding opportunities and sustainability plan for the NMNAP II 57 CHAPTER 6: GOVERNANCE, INSTITUTIONAL AND LEGAL FRAMEWORK FOR NMNAP II 60 6.1 Overview 60 6.2 Leadership, management and coordination structure 61 6.3 Key actors, their roles, and responsibilities 61 6.4. Human resources and institutional capacity requirements 67 6.5 Legal and regulatory framework for nutrition in the NMNAP II 68 CHAPTER 7: MONITORING, EVALUATION, ACCOUNTABILITY AND LEARNING 71 7.1 Overview 71 7.2 Multisectoral Nutrition Information System 71 7.3 Common Result, Resources, and Accountability Framework 72 7.4 NMNAP II monitoring process 73 7.5 NMNAP II evaluations 73 7.6 The NMNAP II planning, monitoring, evaluation and learning cycle 74 7.7 Financial tracking and budget analysis for nutrition 75 7.8 Research 75 7.9 Cost of monitoring, evaluation, accountability and learning 76 7.10 NMNAP II targets 76 vNational Multisectoral Nutrition Action Plan (NMNAP II) CHAPTER 8: RISK ANALYSIS AND MITIGATION (RAM) 79 8.1 Introduction 79 8.2 Risk analysis framework 79 8.3 Risk mitigation 81 BIBLIOGRAPHY 83 APPENDICES 85 LIST OF TABLES Table 1: NMNAP II key impact and outcome targets xxi Table 2: NMNAP II estimated annual budget xxiii Table 3: Key interventions for improving men, women, adolescents and children’s nutritional status 27 Table 4: Priority actions and activities to address undernutrition in Tanzania 29 Table 5: Priority actions and activities to address micronutrient defi ciencies in Tanzania 34 Table 6: Priority Actions and activities to address overweight and obesity in Tanzania 43 Table 7: Priority Actions and Activities for Enabling Environment for nutrition 47 Table 8: Summary of fi nancial resource needs for the NMNAP II per key delivery systems and enabling environment 56 Table 9: Summary of the NMNAP II budget per strategic outcomes for a period between 2021/22 and 2025/26 56 Table 10: Selected fi nancing options for funding the NMNAP II (2021/22 -2025/26) 58 Table 12: NMNAP II targets 76 Table 14: Risk analysis and mitigation strategies for the NMNAP II 82 Table 15: Summary of costed activities by delivery systems 85 Table 16: NMNAP II budget by delivery system 86 vi National Multisectoral Nutrition Action Plan (NMNAP II) LIST OF FIGURES Figure 1: Conceptual Framework for NMNAP II 4 Figure 2: Development Process of NMNAP II 5 Figure 3: Prevalence of stunting among children aged 0 to 59 months by region 7 Figure 4: Prevalence of wasting among children aged 0 to 59 months by region 8 Figure 5: Trends in the nutritional status of under-fi ve children according to WHO growth standards 2006 from 1991 to 2018 9 Figure 6: Prevalence of anaemia among women aged 15-49 years 10 Figure 7: Prevalence of anaemia among children aged 6-59 months 10 Figure 8: National trends in overweight/obesity in WRA, Tanzania, 1992-2015 11 Figure 9: Top fi ve regions with decreased prevalence of overweight among children in 2014–2018 11 Figure 10: Top fi ve regions with increased prevalence of overweight among children in 2014–2018 12 Figure 11: The 2020 UNICEF Conceptual Framework of the determinants of maternal and child nutrition (and the prevention of malnutrition in all its forms) 14 Figure 12: NMNAP II Theory of Change 23 Figure 13: Overview of the total budget of the NMNAP II for a period between 2021/22 and 2025/26 57 Figure 14: Coordination structure for the NMNAP II 61 Figure 15: Nutrition workforce pyramid 67 Figure 16: Results-based M&E framework for tracking the implementation of the NMNAP II 73 Figure 17: The NMNAP II PMELC 74 Figure 18: SWOT analysis for the NMNAP II 80 LIST OF BOXES Box 1: Necessary assumptions for the NMNAP II 24 Box 2: National policies and strategies 69 Box 3: Regional and global frameworks 70 viiNational Multisectoral Nutrition Action Plan (NMNAP II) KEYNOTE The Government of Tanzania has adopted various policies and legal frameworks that aim at addressing and reducing malnutrition at the national, regional, and local government levels. Despite this, more efforts are required to attain the desired levels of nutrition outcomes in the country. Lessons from the implementation of the National Multisectoral Nutrition Action Plan (NMNAP) 2016–2021 have revealed that more emphasis needs to be put on the fi ght against the triple burden of malnutrition – undernutrition, micronutrient defi ciencies, overweight and obesity. Other areas and actions which require emphasis are strengthening linkages within food systems; increasing fi nancial investment, especially in proven low cost and high impact nutrition interventions; research, development and innovation; and further strengthening nutrition coordination. The coordinated implementation of the NMNAP 2016–2021 has indicated that, generally, the intended targets were on track to a great extent due to increased accountability, commitment, and political will at all levels. The development of the NMNAP-II refl ects Tanzania’s continued commitment to address malnutrition by the current government led by the President of the United Republic of Tanzania, Her Excellency Samia Suluhu Hassan. The NMNAP II has been developed with the understanding that malnutrition is a developmental challenge and a threat to achieving our national socio-economic goals, including establishing ourselves as an industrial, knowledge-driven middle-income country by 2025. Hence, it continues to complement the long-term National Development Vision 2025. The NMNAP II has been designed to address the nutritional needs of people across life cycle and thus, the long-term desired change expected from implementing the NMNAP II is that “Women, Men, Children and Adolescents in Tanzania are better nourished living healthier and more productive lives”. It is intended that NMNAP II will continue to reduce the prevalence of the various forms of malnutrition even further from the current levels and strive to attain the national, regional and global nutrition targets. It will also contribute to the sustainable development goals (SDGs), specifi cally, on ending hunger and all forms of malnutrition by 2030. Finally, I would like to reiterate the Tanzanian Government’s commitment to support the implementation of the NMNAP II. The government will improve the multisectoral nutrition coordination system at all levels and track its progress through the Common Results, Resources, and the Accountability Framework (CRRAF) of the NMNAP II. The government’s commitment to addressing malnutrition will continue to be with the same vigor displayed in rooting out corruption and in collecting taxes for national development. While emphasizing the allocation of domestic resources for nutrition, the government has asked our development partners (DPs), civil society organizations (CSOs) and the private sector to join us in providing resources for facilitating the NMNAP II. Let us all work together towards achieving the noble goal of improving the quality of human life for the current and future generations. The Prime Minister’s Offi ce is committed to lead the way. Hon. Kassim Majaliwa Majaliwa (MP) The Prime Minister of the United Republic of Tanzania acilitating the NMNAP II. e goal of impppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppprorrrr vingggggggggggggggggggggggggggggggggggggggggggggggggggggggg ttttttttttttttttttttttttttttttthe quality of human life for ter’s Offi ce is cccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccccomo mittttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttt ed to lead the way. Hon. Kassisiisiisiiiiiiiiiiiisiiisiiiiiiiiiisssiiiiisississisiisiiisssssss mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm MaMaMMMMMaMaMaMaMaMMaaMaMaMaMaMaMaMaaMaMaMaMMMMMMMMaMMaMaMaMaMaMaMaMaMaMaMMMMMMaMMMMMaMaMaMaMaMaMaMaMMMMMMMMaMaMaMaMMMMMMMMaMaMaMaMaMaMaMaMaaMMMaMMMMaMaMaMMMMaMaMMMaMMMaMaMaMMMMMMMaMaaMMMMMMaMaMaMMMMMMMMMaMaMMMMMMaMaMaaMaMMMMMMaMaMaMaMMMMaMaaaMaMaMaMaaMaMaMMaaMMMMMaMaMMMaMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM jajajajajajjjjajjjjajjjajjajajjajajajjajjjjjjjajjajjjajjjjjjajjajajjjaajjjjjajajajjjjjajajjjjjjjajjjjjjajjjjjjjjjjajajjjjjaaaaaajjajjajaaaaajaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaalllililllllllllllllllll waww Majaliwa (MP) The Primmmmmmmmmeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee MMMiMMMM nister of the viii National Multisectoral Nutrition Action Plan (NMNAP II) ixNational Multisectoral Nutrition Action Plan (NMNAP II) FOREWORD Although we have made progress in reducing malnutrition following the implementation of the NMNAP 2016–2021, malnutrition still affects millions of Tanzanians in various ways. These include the impairment of educational achievements and economic productivity, high burden of health-care cost for the Government and the families due increased diet-related non-communicable diseases. The lessons learned from NMNAP I provide the framework for continued effort to address nutrition issues in the country to develop strong and quality human capital that will propel socioeconomic transformation. We are pleased that the factors that led to the persistent and sometimes worsening of some forms of malnutrition were identifi ed during the mid-term review (MTR) of NMNAP 2016–2021 and have been addressed in this NMNAP II. Based on the MTR 2019 fi ndings, the NMNAP II has placed more emphasis on scaling-up multisectoral interventions and community-based initiatives that have been proved to yield cost-effective results and on targeting areas and groups with the highest levels of malnutrition. Since economic models suggest that the returns to investments in nutrition have high cost-benefi t ratios, investment in nutrition should be a top development agenda. The Tanzanian Government hopes that investing in the fi ght against malnutrition will save lives and yield high economic returns for Tanzania. Every shilling invested in nutrition results in economic benefi ts worth at least six times more, and in the case of overweight and obesity, which is increasing in our country, investments in nutrition will prevent the loss of about 2.8 per cent of annual gross domestic product (GDP). The gains will benefi t the vulnerable individuals and households and the most disadvantaged as they will spend less money on treating malnutrition-related diseases and increase their productivity. Good nutrition is crucial for the health, growth and development of our people. Moreover, improving nutrition ensures considerable economic and social benefi ts, as it reduces morbidity and mortality, improves the learning and earning capacity of communities. Therefore, I call upon all national and international stakeholders to support Tanzania in the implementation of the NMNAP II 2021–2026. Hon. Dr. Dorothy Gwajima (MP) Minister of Health, Community Development, Gender, Elderly and Children . Dr. Dorothyhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh Gwajima (M x National Multisectoral Nutrition Action Plan (NMNAP II) xiNational Multisectoral Nutrition Action Plan (NMNAP II) STATEMENT OF COMMITMENT In recognizing the lessons learnt during the implementation of the NMNAP 2016–2021 and the statement made by the President of the United Republic of Tanzania, Her Excellency Samia Suluhu Hassan, on 24 August, 2017 (by the then Vice President of the United Republic of Tanzania), while tasking all the Regional Commissioners to be responsible for eliminating malnutrition in their respective regions, we affi rm our commitment to ensure the successful implementation of NMNAP II and of our respective Ministries. And in recognition of the good progress made in addressing malnutrition in NMNAP I, we believe more efforts are required because Tanzania is now facing the triple burden of malnutrition (undernutrition, micronutrient defi ciencies, overweight and obesity) which is denting the nation’s annual GDP by 2.5 per cent. And in understanding that investment in nutrition is a crucial component of sustainable development, we commit ourselves to the implementation of the NMNAP II based on the theory of change (which has a desired goal that women, men, children, and adolescents are better nourished and living healthier and more productive lives). Also recognizing the need to mobilize political will and support that place the elimination of malnutrition at a strategic position; we pledge to support the implementation of a wide range of specifi c commitments, and prioritize and fast track the sectoral and multisectoral nutrition actions contained in the NMNAP II, and be accountable for their implementation. Since we do acknowledge that the risk factors for malnutrition are multisectoral and multifactorial, and that malnutrition occurs in households and communities; we endorse the interventions proposed, which are multisectoral, address the multiple causative factors, and focus at the county level, to have the required community-level impact. Consequently, we, the undersigned, commit ourselves and the ministries we lead to support the implementation of the NMNAP II. We undertake to promote the provision of the required resources (human, fi nancial, and others) necessary to achieve the objectives of this plan. We acknowledge our responsibilities to the people of Tanzania to see that NMNAP II becomes successful. A Tanzania in which all its citizens are well nourished is a legacy of which we can all be proud. xii National Multisectoral Nutrition Action Plan (NMNAP II) Mr. Tixon T. Nzunda Permanent Secretary, Prime Minister’s Offi ce (Policy, Coordination, Parliament, Labour, Employment, Youth and Disabled) Mr. Emmanuel M. Tutuba Permanent Secretary, Ministry of Finance and Planning Dr. John Jingu Permanent Secretary, (Community Development), Ministry of Health, Community Development, Gender, Elderly and Children Prof. Abel N. Makubi Permanent Secretary (Health), Ministry of Health, Community Development, Gender, Elderly and Children Dr. Rashid A. Tamatamah Permanent Secretary (Fisheries), Ministry of Livestock and Fisheries Mr. Amosy K. Zephania Ag Permanent Secretariat (Livestock) Ministry of Livestock and Fisheries Mr. Andrew W. Massawe Permanent Secretary, Ministry of Agriculture Prof. Riziki S. Shemdoe Permanent Secretary, President’s Offi ce, Regional Administration and Local Government Mr. Doto M. James Permanent Secretary, Ministry of Industry and Trade Eng. Anthony D. Sanga Permanent Secretary, Ministry of Water Dr. Leonard D. Akwilapo Permanent Secretary, Ministry of Education, Science and Technology Dr. Zainab A. Chaula Permanent Secretary, Ministry of Information, Communications, and Information Technology Dr JoJJJJJJJJJ hn Jing D R hid A T P f Ri iki S Sh d nnnnngggggggggggggggg.gggggggggggggggggggg Anthony DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD. SaSaSaSSSaSaSaSSaSSaSSSSSaSSSSSSSSSSSSSSaaSSSaSaSaSSaSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS n DrDDDDDDrDDDDDDrDrDrDDDDDDrrDDrDrDDrDDDrDDrDDDDDDDrDDDrrrrDDrrrrrDDrrrDrrrrr. LeLL onard D. Akwilapo Dr. ZZaZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ inab A. Chaula xiiiNational Multisectoral Nutrition Action Plan (NMNAP II) ACKNOWLEDGEMENTS Our sincere gratitude goes to NMNAP II consultants for their distinguished performance and diligent work in the entire development process. Those were: Prof. John Msuya, who was the lead consultant and also responsible for the undernutrition component in this document; Prof. Twalib Ngoma, who was responsible for the overweight and obesity component; Dr. Mary Mayige, who was responsible for the micronutrient defi ciency component; and Mr. Patrick Kihenzile, who was also the team coordinator and responsible for the enabling environment component in NMNAP II. We acknowledge the role of Mr. Tixon Nzunda, the Permanent Secretary of the Prime Minister’s Offi ce, who chaired the NMNAP II High Level Steering Committee for Nutrition (HLSCN) and provided overall high-level oversight of the process. We also acknowledge the role of Mr. Paul Sangawe, the Director of Policy and Government Business Coordination at the Prime Minister’s Offi ce, who chaired the Coordination Committee (CC) and was supported by Ms. Sarah Mshiu, Mr. William Babu and all the Coordination Committee members in overseeing and coordinating the process on behalf of HLSCN. The development of NMNAP II would not have been possible without the technical guidance and quality assurance of the process provided by the NMNAP II Technical Committee. Sincere gratitude is conveyed to the chairperson of the NMNAP II Technical Committee, the Managing Director of TFNC, Dr. Germana Leyna, and her team comprising of Mr. Geoffrey Chiduo, Ms. Julieth Itatiro, Ms. Victoria Kariathi and Mr. Adam Hancy for providing quality assurance throughout the process. Gratitude is also expressed to the NMNAP thematic working groups (TWGs) for providing technical input to all the four key result areas (KRAs) of NMNAP II. Furthermore, we appreciate the valuable inputs received from the Ministries/Sectors during the stakeholders’ meetings, which are: Agriculture, Livestock, Fisheries, Health, Community Development, Education, Water, Industry and Trade, Finance and Planning and President’s Offi ce Regional Administration and Local Government. Last but not the least, we would like to acknowledge Nutrition International, USAID Advancing Nutrition, UNICEF, WFP, CRS, ACF, GAIN, Irish AID and ASPIRES for providing fi nancial and technical support. Other organizations/institutions which provided technical support were: SUA, UDOM, PANITA, USAID/PS3+, COUNSENUTH and SANKU. xiv National Multisectoral Nutrition Action Plan (NMNAP II) xvNational Multisectoral Nutrition Action Plan (NMNAP II) ACRONYMS ASDP Agriculture Strategic Development Plan BASATA Baraza la Sanaa Tanzania BCC Behaviour Change Communication BMI Body Mass Index CAG Controller and Auditors General CHMT Council Health Management Team CHW Community Health Worker CIP-IYCN Comprehensive Integrated Plan on Infant and Young Child Nutrition COVID Coronavirus Disease CRRAF Common Result, Resource and Accountability Framework CSO Civil Society Organizations DALY Disability-Adjusted Life Years DIT Dar es Salaam Institute of Technology DP Development Partner DRCHCo District Reproductive and Child Health Coordinator DRNCD Diet Related Non-Communicable Diseases ECD Early Childhood Development ETR End-Term Review FBO Faith Based Organizations FEFO Ferrous Sulphate and Folic Acid FFARS Facility Financial Accounting and Reporting System FYDP Five Year Development Plan GAM Global Acute Malnutrition GDP Gross Domestic Product GMP Good Manufacturing Practice HBS Household Budget Survey xvi National Multisectoral Nutrition Action Plan (NMNAP II) HCW Health-Care Worker HIV Human Immunodefi ciency Virus HLSC High Level Steering Committee HMIS Health Management Information System HSSP Health Sector Strategic Plan IEC Information, Education and Communication IFA Iron and Folic Acid IMAM Integrated Management of Acute Malnutrition IYCF Infant and Young Children Feeding IYCN Infant and Young Children Nutrition JMNR Joint Multi-Sectoral Nutrition Review KRAs Key Result Areas LGA Local Government Authority MAM Moderate Acute Malnutrition MDA Ministries, Departments and Agencies MDG Millennium Development Goals MEAL Monitoring, Evaluation, Accountability and Learning MHM Menstrual Hygiene Management MIS Management Information System MIYCAN Maternal, Infant, Young Child, Adolescent Nutrition MIYCN Maternal, Infant, Young Child Nutrition MKUKUTA Mkakati wa Kukuza Uchumi na Kupunguza Umasikini Tanzania MMS Multiple Micronutrient Supplementation MNIS Multisectoral Nutrition Information System MNP Micronutrient Powders MOHCDGEC Ministry of Health Community Development, Gender, Elderly and Children MoLF Ministry of Livestock and Fisheries MP Member of Parliament MSD Medical Store Department MTR Mid-term Review MUAC Mid-upper Arm Circumference MUCHALI Mfumo wa Uchambuzi wa Uhakiki wa Chakula na Lishe NAIA-AHW National Accelerated Investment Agenda for Adolescents Health and Wellbeing xviiNational Multisectoral Nutrition Action Plan (NMNAP II) NCCIDD National Council for Control of Iodine Defi ciency Disorders NCD Non-Communicable Disease NCHS National Center for Health Statistics NFBDG National Food Based Dietary Guideline NFFA National Food Fortifi cation Alliance NGO Non-Governmental Organization NHIF National Health Insurance Fund NIS Nutrition Information System NMNAP National Multisectoral Nutrition Action Plan NPS National Panel Survey NSI Nutrition Sensitive Intervention NTD Neural Tube Defects OPD Outpatient Department PLANREP Planning and Reporting System PMEL Planning, Monitoring, Evaluation and Learning PMELC Planning, Monitoring, Evaluation and Learning Cycle PMO Prime Minister’s Offi ce PO President Offi ce PO-RALG President Offi ce Regional Administration and Local Government PPP Public, Private, Partnership PSU Planning Support Unit RCH Reproductive and Child Health RHMT Regional Health Management Team RMNCAH Reproductive, Maternal, Newborn, Child, and Adolescent Health SBCC Social and Behavioural Change Communication SDG Sustainable Development Goal SIDO Small Industries Development Organization SME Small and Medium Enterprises SOP Standard Operating Procedure SSB Sugar Sweet Beverage SUN Scaling Up Nutrition TAPI Tanzania Association of Pharmaceutical Industries TASPA Tanzania Salt Producers Association xviii National Multisectoral Nutrition Action Plan (NMNAP II) TBS Tanzania Bureau of Standards TDHS Tanzania Demographic and Health Survey TFNC Tanzania Food and Nutrition Centre TIRDO Tanzania Industrial Research Development Organization TMDA Tanzania Medicines and Devices Agencies TNNS Tanzania National Nutrition Survey ToC Theory of Change ToR Terms of Reference TPMA Tanzania Pharmaceutical Manufacturers Association TWG Thematic Working Group TZS Tanzania Shillings UDHR Universal Declaration of Human Rights UN United Nations UNICEF United Nations Children’s Fund UNODC United Nations Offi ce on Drugs and Crime URT United Republic of Tanzania USD United States Dollar USI Universal Salt Iodization VETA Vocational Education and Training Authority VICOBA Village Community Bank WASH Water, Sanitation And Hygiene WFP World Food Programme WHA World Health Assembly WHO World Health Organization WRA Women of Reproductive Age xixNational Multisectoral Nutrition Action Plan (NMNAP II) EXECUTIVE SUMMARY The second NMNAP 2021–2026 is an evidence-based fi ve-year strategic action plan that seeks to address malnutrition in all its forms and for all ages in Tanzania. The NMNAP II follows after the implementation of the NMNAP I 2016–2021 and builds on the success, limitations, and opportunities from the previous fi ve years. The plan uses a life-cycle and systems approach and promotes multisectoral collaboration to address the social determinants of malnutrition. The overall expected result of the NMNAP II is, “Women, Men, Children and Adolescents in Tanzania are better nourished and living healthier and more productive lives”. The pathway of change for the NMNAP II is defi ned using the theory of change (ToC), which was used to develop a set of outcomes and outputs. According to the ToC, if the proposed preconditions (outcomes) are in place, and if the identifi ed strategies have been adopted and the relevant activities have been implemented, then the expected results for NMNAP II would be realized. The development process of the NMNAP II was overseen by the Prime Minister’s Offi ce and driven by the TFNC. The process was participatory, consultative and was comprised of three phases, namely, the preparatory phase, the development phase, and the validation/endorsement/launching phase. The process also involved wide consultation with all key nutrition stakeholders, including ministries, local governments, DPs, civil society organizations (CSOs), research and academic institutions, and the private sector. Furthermore, the process was evidence -based and recognized the successes, challenges and lessons learnt from the implementation of the NMNAP I. Mid-term review of the implementation of the NMNAP I indicated substantial achievements, including a reduction in stunting prevalence among under-fi ve children, improved breastfeeding practices, improved policy environment and improved collaboration among key stakeholders. The review also noted key challenges encountered during the implementation of the NMNAP I, including: Limited funds allocation from the government and inadequate funding for research to generate evidence, Weak linkages with other sectors, Inadequate institutional and human resource capacities Gaps in data generation, utilization and quality at various levels Inadequate focus on people with special nutrition and health needs, Inadequate involvement of the private sector, Failure to address the triple burden of malnutrition and food safety issues, and Inadequate monitoring and evaluation of the implementation of NMNAP I. xx National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 The NMNAP II targets policy and decision makers at all levels – from the national to the sub- national. At the operational level, the NMNAP II targets those responsible for implementing nutrition interventions, including governmental and non-governmental organizations (NGOs) and actors, DPs, CSOs, and the private sector. This document will also help the public at large to understand the government’s plans to ensure optimal nutrition for all Tanzanians. This document has a total of eight (8) chapters. Chapter one contains the introduction followed by Chapter two, which covers the analysis of the nutrition situation in Tanzania. Chapter three presents the design framework of the NMNAP II, while Chapter four highlights the KRAs, strategies, and interventions. Chapter fi ve presents the costed action plans of NMNAP II and Chapter six covers the governing laws and the institutional and legal framework for NMNAP II. Monitoring, evaluation, accountability, and lessons learnt are covered in Chapter seven, while Chapter eight concludes with the risk assessment, analysis and mitigation strategies. Further, the NMNAP II is organized into four KRAs, the fi rst three of which are directly tied to addressing the triple burden of malnutrition with the last KRA focusing on creating an enabling environment for nutrition. The KRAs are as follows: KRA 1: Reducing Undernutrition KRA 2: Reducing Micronutrient Defi ciencies KRA 3: Reducing Overweight and Obesity KRA 4: Strengthening the Enabling Environment The plan consists of fi ve strategic outcomes which were derived from the NMNAP II ToC. These outcomes are: Strategic Outcome 1: Increased coverage of adequate, equitable and quality nutrition services at the community and facility levels Strategic Outcome 2: Women, men, children, and adolescents practice appropriate nutrition behaviours Strategic Outcome 3: Sustainable and resilient food systems that are responsive to nutrition needs Strategic Outcome 4: Strengthened multisectoral and private sector engagement for nutrition Strategic Outcome 5: Enabling environment (adequate policies and frameworks) that are supportive of suitable human and fi nancial resources for nutrition The NMNAP II expected key impacts and outcome targets by 2026 are shown in Table 1. xxiNational Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Table 1: NMNAP II key impact and outcome targets Planned Results Baseline (Year) Target 2025/26 Means of Verifi cation IMPACT RESULTS 1. Reduced prevalence of stunting among children 0-59 months 31.8% (2018) 24% TNNS 2. Maintain prevalence of global acute malnutrition among children 0-59 months 3.5% (2018) <5% TNNS 3. Reduced prevalence of low birthweight 6.3% (2018) <5% TNNS 4. Reduced proportion of non-pregnant women 15-49 years with anaemia 28.8% (2018) 23% TNNS 5. Reduced prevalence of Vitamin A defi ciency among children aged 6-59 33% (2010) 20% TDHS 6. Maintain median urinary iodine of women of reproductive age between 100- 299 μg/L by 2026 100-299 ug/L (2010) 100-299 ug/L TDHS 7. Maintain prevalence of overweight among children under fi ve 2.8 (2018) <5% TNNS 8. Maintain prevalence of overweight/obesity among women aged 15-49 years 31.7% (2018) <32% TNNS 9. Maintain prevalence of overweight among adults 26% (2012) <30% STEPS OUTCOME RESULTS 1. Increased proportion of children aged 0-5 months who are exclusively breastfed 58.6% (2018) 70% TNNS 2. Increased proportion of children aged 6-23 months who receive a minimum acceptable diet 30.3% (2018) 50% TNNS 3. Increased proportion of children aged 6-59 months who received Vitamin A Supplement during the last 6 months 63.8% (2018) 90% TNNS 4. Increased proportion of households consuming adequately iodized salt 61.2% (2018) 90% TNNS 5. Increased proportion of pregnant women taking iron and folic acid (IFA) for 90+ days during pregnancy 28.5% (2018) 50% TNNS 6. Increased proportion of children under fi ve in need of SAM treatment who are admitted in the program annually 13% (2018) 75% BNA xxii National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Planned Results Baseline (Year) Target 2025/26 Means of Verifi cation 7. Increased proportion of children under fi ve in need of MAM treatment who are admitted in the program annually 8% (2018) 75% WFP Standard project Report 8. Reduced percentage of people who eat less than 5 servings of fruit and/or vegetables on average per day 97.2% (2012) 68% STEPS 9. Increased production of horticultural crops 6,556,102 tons 14,600,000 tons MoA reports 10. Increased milk production 3 Bil.L/yr (2020/21) 4.3 Bil.L/yr TDB/MLF 11. Increased per capital consumption of milk in Tanzanian population 54.7 Liters/ person/annum (2020/21) 100 Liters/ per person/per annum TDB/MLF 12. Increased number of primary schools implementing school milk feeding program 39 (2020/21) 5000 TDB/MLF 13. Increased Meat production 702.0(‘000.Mt/yr) (2020/21) 951.7(‘000.Mt/ yr) TMB/MLF 14. Increased per capital consumption of meat in Tanzanian population 15kg/person/ annum 25kg/per person/per annum TMB/MLF 15. Increased fi sh production 497,567 tons 2019/20) 600,000 tons MLF 16. Increased per capital consumption of fi sh in Tanzanian population 8.5kg/person/ annum (2019/20) 10.5kg/person/ annum MLF 17. Number of adolescents trained on health and wellbeing. 0 (2021) 2,000,000 MoH 18. Increased percentage of schools implementing school feeding program TBD MoEST 19. Percentage of rural population with access to piped or protected water as their main source. 70% (2020) 85% Water Sector Status report 20. Proportional of the households in Rural areas with improved sanitation facilities 36% (2020) 75% Water Sector Status report 21. Percentage of Regional Centre’s population with access to piped or protected water as their main source. 84% (2020) 95% Water Sector Status report xxiiiNational Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Planned Results Baseline (Year) Target 2025/26 Means of Verifi cation 22. Percentage increase of social protection coverage 20% (2020) 30% PMO 23. Increased coverage of Productive Social Safety Net Program (extreme poor households) 70% (2019) 100% TASAF Report 24. Increased percentage of SMEs food processors engage in food fortifi cation NA 20% Increase from Baseline MITI 25. Increased proportion of planned budget spent on nutrition sensitive interventions 33.7% (2019) 60% PMO/PO- RALG 26. Increased proportion of councils spending a minimum budget allocation per child under- fi ve to nutrition 52% (2019) 100% IMES/ PO- RALG The total cost to achieve these key results over the next fi ve years would be TZS 642,349,052,101 (USD 279,282,196.57). Table 2 presents the annual estimated budget requirements. Table 2: NMNAP II estimated annual budget Annual Estimated Budget in TZS Total Cost (TZS) Total Cost (USD-2300) Financial Year 2021/2022 2022/2023 2023/2024 2024/2025 2025/2026 2021-2026 2021-2026 Estimated Budget 147,103,720,656 145,499,773,784 128,716,950,883 104,867,379,443 116,161,227,336 642,349,052,101 279,282,196.57 The monitoring, evaluation, accountability, and learning (MEAL) framework as shown in Chapter seven will facilitate tracking and evaluation of the performance of set targets and it will serve as an accountability and learning framework for various nutrition stakeholders. In addition to supporting results and fi nancial tracking, the MEAL framework will also provide a mechanism for the local government authority, and national, and where relevant, for regional and global reporting; thereby aligning partners at the local, country, regional and global levels around a common approach to reporting. The evidence generated will inform planning, resource allocation, decision-making and adaptive management and will help in the real time monitoring of the nutrition actions. The MEAL framework further provides a summary of select results and indicators that will be mutually tracked and reported on by all the sectors responsible for the implementation of the NMNAP II. This summary is the CRRAF. The monitoring and evaluation (M&E) of NMNAP II will be an ongoing process with continuous periodic reporting. These will include quarterly or six-monthly reports from routine data collection, such as the Joint Multisectoral Health Information System, Nutrition Scorecard, Compact Agreement Scorecard, and feedback from coordinating structures, all of which will provide opportunities for the xxiv National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 adjustment of activities. Annual multisectoral and multistakeholder nutrition reviews will need to be established to review the overall progress, including the functionality, of the CRRAF and the multistakeholder coordination and collaboration. A MTR will be done in 2023/2024 to review the progress made in the two years of implementation and recommend adjustments in the strategy or review of the expected targets, wherever necessary. An end-term review (ETR) in 2026 will evaluate the overall performance of the NMNAP II and use the lessons learnt to develop the subsequent nutrition action plan. Key elements that will support the implementation of the NMNAP II include, a functional, legal framework which provides for legislation, regulations, and guidelines that ensure the availability and accessibility of adequate, safe, and good-quality food; and an adherence to the internationally- recognized standards and nutrition guidelines. Finally, an important component of the NMNAP II is to be able to identify and manage the risks that may affect its smooth implementation. 1National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 INTRODUCTION TO THE NMNAP II 1CHAPTER 1.1 Background This document articulates the NMNAP for the period between 2021/22 and 2025/2026. This period coincides with the third fi ve-year development plan (FYDP III) of the Tanzanian Government’s long- term strategic plan (2010-2025) for economic and social growth (MKUKUTA) and it provides a logical continuation of the fi ve-year NMNAP of 2016/2017-2020/2021. The NMNAP II has been developed to address the triple burden of malnutrition across the life cycle and guides all the nutrition-specifi c and the nutrition-sensitive interventions from various sectors including health, social protection, education, food, water, community development, fi nance, industry, and trade. Furthermore, the plan accommodates interventions for all age groups (life cycle approach) and those with special health and nutrition needs. The plan is designed based on four KRAs, which are: (1) reducing undernutrition, (2) reducing micronutrient defi ciency, (3) reducing overweight and obesity, and (4) strengthening an enabling environment for nutrition. The development of this plan is aligned with the objectives of national, regional, and global initiatives, including: Food and Nutrition Policy of 1992 The National Health Policy of 2007 Health Sector Strategic Plan V Five Year Development Plan III Agricultural Sector Development Plant 2 (ASDP-II) Ruling Party’s Election Manifesto 2020–2025 Other development sectoral policies, strategies, and plans East African Development Vision 2050 SADC Regional Food and Nutrition Strategy 2021 2 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 The Scaling-Up Nutrition (SUN) Movement launched in 2012 Sustainable Development Goals (SDGs) 2030 African Union Agenda 2063 NMNAP II focuses on strengthening further and scaling up successful interventions of NMNAP by critically addressing the identifi ed gaps and by strengthening the enabling environment for multisectoral nutrition actions. The action plan also addresses the importance of engaging the private sector to strengthen nutrition across the related sectors. 1.2 Overview of the NMNAP 2016 – 2020/21 1.2.1 Success and lessons learnt Community involvement and participation: Community-based programmes for scaling up maternal, infant, young child and adolescent nutrition (MIYCAN) have contributed to an increased coverage of MIYCAN services at both the community and the facility levels. Use of media: Delivering nutrition education through media was cost-effective and ensured that many people were reached within a short time. Similarly, the use of cultural dances had the same impact. Use of schools and organized groups as potential platforms to scale-up nutrition interventions: Schools, early childhood development (ECD) centres, or organized groups were used to provide nutrition education, micronutrient supplementation services and deworming. They also taught best practices to improve nutrition such as water, sanitation and hygiene, (WASH), gardening, menstrual hygiene, and cooking. The successful implementation of adolescent programmes needs multisectoral collaboration, adolescent engagement, and participation. Role of effective private sector engagement: It was learned that to facilitate the scale-up of micronutrient interventions such as universal salt iodization (USI) and micronutrient powders (MNP), the private sector had an important role. Furthermore, private sector engagement has played a role in ensuring the availability of supplies and in facilitating the implementation of nutrition interventions in the Councils in collaboration with the Central Government and the DPs. Engagement of political leaders: Experience has shown that the engagement of political leaders was important in creating community awareness, especially for interventions which aimed to prevent diet-related non-communicable diseases (DRNCDs). School-feeding programmes: Implementation of school-feeding programmes ensured the accessibility of nutritious food to many children and improved their school attendance. Hence, it is important to strengthen school-feeding programmes. 1.2.2 Gaps in the implementation of NMNAP I 2016-2020/21 The implementation of the NMNAP I was successful, as outlined in the MTR. However, several gaps were observed, which will be addressed in the NMNAP II as follows: 3National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Inadequate funding: The budget to fund nutrition interventions in Tanzania is still inadequate. However, experience gained through the implementation of NMNAP I has shown that it is diffi cult to track and report nutrition expenditure in all sectors, which may have contributed to the underreporting of resources allocated to nutrition interventions. Results have showed that at the MTR, budget execution was at 43 per cent, excluding nutrition-sensitive interventions, for which the DPs had contributed 83 per cent of the total budget. Over-reliance on donors’ funds has introduced a signifi cant degree of uncertainty in terms of the quantity and timing to implement nutrition activities. Human resources gap: Despite the outstanding human resource commitments at the regions and in the Councils responsible for providing technical support and coordinating nutrition interventions, for example, during the MTR of NMNAP I, it was noted that 47 per cent of the Councils had not yet employed professional nutrition offi cers. One of the signifi cant causes for this gap is the low prioritization afforded to employing nutritionists. Data gap: Data for nutrition are collected from different sectors and ministries with different systems. These systems do not communicate; therefore, the lack of communication makes the extraction of any information challenging. Furthermore, some of the current indicators for nutrition are ambiguous, hence, it becomes diffi cult to track the outcomes, outputs and nutritional progress. Inadequate focus on people with special nutrition and health needs: NMNAP I focused mainly on pregnant women and children and left behind the people from the other age groups, such as older people and adolescents. Inadequate engagement of private sector: Though experience has shown that the private sector is an important stakeholder for the success of nutrition outcomes, the implementation of the NMNAP I did not engage them adequately.. 1.3 The goal of the NMNAP II The goal of the NMNAP II is to provide directions to the nutrition stakeholders at all levels on the implementation of nutrition interventions, which address the triple burden of malnutrition in the country for the next fi ve years starting from 2021. 1.4 Conceptual framework of the NMNAP II The NMNAP II has been designed to address undernutrition, micronutrient defi ciencies, and overweight and obesity based on the life-cycle approach, while ensuring that the gender issues are clearly addressed in each stage and that the interventions are delivered through the existing systems, namely, through the food, health, education, social protection and WASH systems (see Figure 1). The NMNAP II has embraced the enabling environment built from NMNAP I to accelerate the gains achieved during the implementation of the latter by strengthening coordination and leadership; by strengthening information systems and research; by continuing capacity development; and by increasing investment in nutrition. 4 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 1.5 Targeted audience for the NMNAP II The NMNAP II targets the policy and decision makers at all levels, from the national to sub-national. At the operational level, the NMNAP II targets those responsible for implementing nutrition interventions at all levels, including government and NGOs and actors, DPs, CSOs and the private sector. The list of stakeholders is included in Table 7. 1.6 Development process of the NMNAP II The NMNAP II follows the implementation of the NMNAP I and builds on the success, limitations, and opportunities of the past fi ve years of implementing NMNAP I. The development process was participatory and consultative, and it was comprised of three phases, namely, the preparatory phase, the development phase, and the validation/endorsement/launching phase. Details of the activities undertaken in each phase are shown in Figure 2. Crosscutting issues: Gender, environment, etc. Enabling environment Capacity development, advocacy and communication, fi nance, information system and research, coordination and leadership, supply chain, service delivery, etc. Figure 1: Conceptual Framework for NMNAP II REDUCE THE RATE OF: Undernutrition Micronutrient defi ciencies Overweight and obesity 01 02 03 04 05 06 Early childhood Middle childhood Pregnancy/ utero Male/Female Adolescents Elderly HEALTH W A S H EDUCATION SOCIAL PROTECTION FO O D Nutrition Specifi c Interventions 5National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 1.7 Organization of the NMNAP II document The NMNAP II document has a total of eight (8) chapters, with Chapter one being the introduction followed by Chapter two which covers the analysis of the country’s nutrition situation. Chapter three presents the NMNAP II design framework, while Chapter four highlights the KRAs, strategies, and interventions. Chapter fi ve presents the costed action plans of NMNAP II and Chapter six covers the governance, institutional and legal frameworks for NMNAP II. Monitoring, evaluation, accountability, and learning is covered in Chapter seven, while Chapter eight concludes with the risk assessment, analysis, and mitigation strategies. Figure 2: Development Process of NMNAP II » Development of concept note » Kick-off meeting » Establishment of committees » Development of TORs for committees and consultants » Hiring of consultants Preparatory stage (July 2020- April 2021) » Inception meeting » Document review » Consultative meetings with Technical Working Groups (TWGs)/ stakeholders » Technical Committee & Coordination Committee (TC & CC) meeting » Drafting of the plan (action plan & CRRAF) Development Phase (May 2021- Mid July 2021) » A comprehensive NMNAP II validated » Endorsement by HLSCN » Designing and printing » Official launching Validation, endorsement and launching (Aug 2021- Oct 2021) Source: TFNC 6 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 NUTRITION SITUATION ANALYSIS 2CHAPTER 2.1 Introduction This chapter shows the nutrition situation in the Tanzania Mainland by highlighting the prevalence of the various forms of malnutrition, namely, undernutrition, micronutrient defi ciencies, and overweight and obesity. The situation analysis also includes the nutrition status of women and adolescents and portrays the trends and causes of malnutrition in Tanzania. Additionally, this chapter describes the current state of the fi ve systems in focus. 2.1.1 Trends in undernutrition Undernutrition signifi es the insuffi cient intake of energy and nutrients which meet an individual’s requirements to maintain good health. Undernutrition manifests itself mainly as stunting (low height for age or chronic undernutrition); wasting (low weight for height or acute undernutrition); underweight (low weight for age); and low birthweight (of less than 2.5 kg). 2.1.1.1 Stunting Stunting (Low height-for-age) is the result of chronic or recurrent undernutrition, which is associated with poor socioeconomic conditions, poor maternal health and nutrition, frequent illness, and/or inappropriate infant and young child feeding (IYCF) and care in early life. Stunting holds a child back from reaching its physical and cognitive potential. According to the Tanzania National Nutrition Survey (TNNS) 2018, 31.8 per cent of under-fi ve children are stunted, which is a signifi cant decrease from 34.7 per cent in 2014. [4] The results showed that 15 out of 26 regions had levels of stunting above 30 per cent, which is considered to be ‘very high’ (see Figure 3) based on the new WHO-UNICEF prevalence thresholds for stunting. [5] The survey also revealed great variations among the regions, with some having very high stunting prevalence, including the Njombe (53.6 per cent), Rukwa (47.9 per cent), and Iringa (47.1 per cent) regions, while the lowest stunting prevalence was recorded in the Kilimanjaro and Dar es Salaam regions (20.0 per cent and 20.1 per cent, respectively). 7National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 2.1.1.2 Wasting Low weight-for-height or wasting usually indicates recent and severe weight loss because a person has not had enough food to eat and/or has had infectious disease such as diarrhoea, which has caused them to lose weight. A young child who is moderately or severely wasted is at an increased risk of death if not treated. According to the TNNS 2018, Tanzania has achieved the World Health Assembly (WHA) target of maintaining the prevalence of global acute malnutrition (GAM) below 5 per cent. The prevalence of GAM exceeded the 5 per cent threshold only in the Singida region at about 5.2 per cent (see Figure 4). However, it was approximated that the number of children who were acute malnourished had increased from 440,000 in 2014 to 530,000 in 2018. Legend Prevalence of stunting (%) Very Low (<2.5) Low (2.5 – <10) Medium (10 – <20) High (20 – <30) Very High ( 30) 100 0 100 200 300 400 km Increase compared to 2014 Decrease compared to 2014Kagera 39.8 Geita 38.9 Shinyanga 32.1 Mwanza 29.2 Mara 26.2 Simiyu 31.2 Arusha 25.2 Kilimanjaro 20 Tabora 25.8 Singida 29.8 Dodoma 37.2 Manyara 36.1 Tanga 39.8 Mjini Magharibi 20.4 Dar es Salaam 20.1 Kusini Unguja 21.2 Kaskazini Unguja 23.8 Kaskazini Pemba 21.5 Kusini Pemba 20.8 Pwani 23.6 Mtwara 29.6 Iringa 47.1 Morogoro 26.4 Njombe 53.6 Ruvuma 41 Lindi 23.8 Mbeya 33.8 Rukwa 47.9 Songwe 43.3 Katavi 33.7 Kigoma 42.3 Figure 3: Prevalence of stunting among children aged 0 to 59 months by region Source: TNNS 2018 [4] 8 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Legend Prevalence of stunting (%) Very Low (<2.5) Low (2.5 – <5) Medium (5 – <10) High (10 – <15) Very High ( 15) 100 0 100 200 300 400 km Kagera 3.1 Geita 2.8 Shinyanga 4.3 Mwanza 1.7 Mara 3.6 Simiyu 4.6 Arusha 4.3 Kilimanjaro 1.5 Tabora 3.6 Singida 5.2 Dodoma 3.7 Manyara 3.8 Tanga 2.7 Mjini Magharibi 4.5 Dar es Salaam 4.3 Kusini Unguja 4.3 Kaskazini Unguja 7.7 Kaskazini Pemba 6 Kusini Pemba 5.3 Pwani 2.8 Mtwara 1.6 Iringa 3.7 Morogoro 3.7 Njombe 2.1 Ruvuma 3 Lindi 2.3 Mbeya 2.7 Rukwa 2.2 Songwe 2.3 Katavi 3.9 Kigoma 4.9 Figure 4: Prevalence of wasting among children aged 0 to 59 months by region Source: TNNS [4] 2.1.1.3 Underweight Underweight is referred as low weight-for-age. A person who is underweight may be stunted, wasted, or both. At the national level, the prevalence of underweight among children aged 0-59 months was at 14.6 per cent in 2018, which was signifi cantly higher than the 13.4 per cent in 2014. Trends in the nutritional status of children for the period 1991-92 to 2018 are shown in Figure 5. Underweight dropped from 25.1 per cent (1991-1992) to 13.4 per cent (2014) but increased from 13.4 per cent to 14.6 per cent between 2014 and 2018. 9National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Figure 5: Trends in the nutritional status of under-fi ve children according to WHO growth standards 2006 from 1991 to 2018 Wasting Underweight Stunting 60 50 40 30 20 10 0 1991-92 1996 1999 2005 2010 2014 2015-16 2018 7.9 8.5 5.6 3.5 4.9 3.8 4.5 3.5 25.1 26.9 25.3 16.7 16.2 13.4 13.7 14.6 49.7 49.7 48.3 44.4 42.5 34.7 34.4 31.8 Source: WHO Database TNNS 2014 and TNNS 2018 [4, 12] 2.1.2 Trends in micronutrient defi ciencies Tanzania has made striking progress in several health indicators, but the lack of micronutrients is a major public health problem. Most women of reproductive age (WRA) and children suffer from not one, but multiple micronutrient defi ciencies with lasting negative consequences on their health, immune functions, cognitive development, and economic potential. Long-term micronutrient deprivation leads to delayed mental development, poor school performance, and reduced intellectual capacity. According to the Tanzania Health and Demographic Survey (THDS) of 2015 [13], 57 per cent of children have some level of anaemia, which can harm their health, well-being, and cognitive development. Also, over one-half of pregnant women are anaemic, which is a major risk factor for maternal mortality. The most common cause of anaemia is an iron defi ciency; other important causes include vitamin and mineral defi ciencies such as folic acid, vitamin A and vitamin B12. A third of all women and children in Tanzania are vitamin A-defi cient, which increases mortality and morbidity and is the leading cause of preventable blindness. Forty-two percent of children are at risk of inadequate zinc intake, which impairs the immune system. 10 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 In recent years, Tanzania has experienced a downward trajectory of anaemia among women aged 15- 49 years As it can be seen from Figure 6, the rate of anaemia had dropped from 44 per cent in 2015- 16 to 28 per cent in 2018. [5] However, anaemia among children aged 6-59 months had increased from 40 per cent in 2010 to 57 per cent in 2015-2016 (see Figure 7). 2.1.3 Trends in overweight and obesity The prevalence of overweight and obesity, which is a risk factor to DRNCDs, has been increasing in children and adults. According to TNNS 2018, 2.8 per cent of under-fi ve children are overweight. [4] A few regions appear to be relatively worse than the rest, including Mbeya (5.3 per cent), Mtwara (4.4 per cent), Njombe (4.3 per cent), Ruvuma (4.2 per cent), Morogoro (4.1) and Dar es Salaam (4.0 per cent). The TNNS 2018 also showed that the prevalence of overweight and obesity among women aged 15-49 years has continued to increase and reached up to 31.7 per cent in 2018. This is the only nutrition indicator that has been increasing over the years. Overweight and obesity among women is most prevalent in the Kilimanjaro (49.0 per cent) and Dar es Salaam (48.6 per cent) regions. Figure 8 shows the overweight/obesity changes among WRA in Tanzania from the 1990’s to 2015, whereby there has been an overall increase throughout. Prevalence of overweight among under-fi ve children The NMNAP baseline for this indicator was set using the results from the TDHS 2015/16. [13] The results from the TNNS 2018 [4] report the prevalence of overweight among under-fi ve children to be at 2.8 per cent in 2018, which is a decline from 3.5 per cent. [12] At MTR of the NMNAP I, the end- line target had already been met (<5 per cent). [5] These results are in line with WHA global targets to ensure no increase in childhood overweight. 2004-2005 2010 2015-2016 2018 2004-2005 2010 2015-2016 48.0 40.0 44.0 28.0 Figure 6: Prevalence of anaemia among women aged 15-49 years Source: Tanzania Nutrition Survey [4] Figure 7: Prevalence of anaemia among children aged 6-59 months Source: TDHS [13] 80 70 60 50 40 30 20 10 0 80 70 60 50 40 30 20 10 0 72.0 40.0 57.0 P re va le n ce (% ) P re va le n ce (% ) 11National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Regions such as Katavi, Rukwa, Mwanza, Songwe and Shinyanga have shown a signifi cant reduction in overweight among children (see Figure 9). Regions such as Dodoma, Simiyu, Morogoro, Kagera and Mtwara, which had low ratios of overweight in 2014, have been reported to have increased prevalence in 2018 (see Figure 10). 2014 2018 10 8 6 4 2 0 Katavi Rukwa Mwanza Songwe Shinyanga 9.2 1.7 5.0 1.3 4.5 1.8 4.9 2.0 3.2 1.3 Regions Figure 9: Top fi ve regions with decreased prevalence of overweight among children in 2014–2018 P re va le n ce (% ) Source: MTR of NMNAP I [5] Figure 8: National trends in overweight/obesity in WRA, Tanzania, 1992-2015 Source: MTR of NMNAP I 2019 30 25 20 15 10 5 0 1992 1996 2005 2010 2015 11 13 18 21 28 Years P re va le n ce (% ) 12 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Figure 10: Top fi ve regions with increased prevalence of overweight among children in 2014–2018 P re va le n ce (% ) 5 4 3 2 1 0 2014 2018 Regions 1.5 3.0 1.0 1.5 2.8 4.1 2.0 2.7 3.3 4.4 Dodoma Simiyu Morogoro Kagera Mtwara Source: MTR of NMNAP I [5] Prevalence of overweight among women of reproductive age There has been an increase in the prevalence of overweight among women from 29 per cent in 2014 to 32 per cent in 2018. The targets for 2018/19 and the end-line (2020/21) targets are to ensure that the prevalence of overweight among women does not exceed 30 per cent. Unfortunately, at MTR of the NMNAP I, data indicate an increase in the prevalence of overweight. [5] These fi ndings follow global trends of an increase in the prevalence of overweight and obesity. While overall national data indicate an increase in the prevalence of overweight, some regions have shown a decrease. Regions that have shown increased prevalence of overweight are Kagera, Mwanza, Mtwara, Kilimanjaro and Tanga. 2.2 Causes of malnutrition in Tanzania 2.2.1 Conceptual framework The 2020 UNICEF conceptual framework of determinants of maternal and child nutrition was adapted to clearly explain the causes of all forms of malnutrition in Tanzania. The framework describes the determinants of malnutrition at three levels, which are: enabling (basic), underlying and immediate determinants (see Figure 11). 13National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 2.2.1.1 The enabling determinants The enabling determinants include the political, fi nancial, social, cultural, and environmental conditions that enable good nutrition for women and children. In the conceptual framework, the enabling determinants are organized into three categories: Governance: Good governance refers to the political, fi nancial, social, and public and private sector actions needed to enable women’s and children’s right to nutrition. Resources: Suffi cient resources refer to the environmental, fi nancial, social and human resources needed to enable women’s and children’s right to nutrition. Norms: Positive norms refer to the gender, cultural and social actions needed to enable women’s and children’s to nutrition. 2.2.1.2 The underlying determinants The underlying determinants are the food and nutrition services and practices available that enable good nutrition for women and children in their households, communities, and environments. In the conceptual framework, they are organized into three categories: Food, which comprises of age-appropriate, nutrient-rich foods – including breast milk and complementary foods for children in the fi rst two years of life – with safe drinking water and household food security for all children and women. Feeding, which comprises of age-appropriate dietary practices – including breastfeeding, responsive feeding and stimulation in early childhood – with adequate food preparation, food consumption and hygiene practices for all women and children. Environments, which comprise of healthy food environments, adequate nutrition, health and sanitation services, and healthy living environments that prevent disease and promote good diets and physical activity for all women and children. 14 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Figure 11: The 2020 UNICEF Conceptual Framework of the determinants of maternal and child nutrition (and the prevention of malnutrition in all its forms) Source: UNICEF Nutrition strategy 2020–2030 Outcomes For children and women MATERNAL AND CHILD NUTRITION DIETS CARE ENVIRONMENTSFEEDING FOOD RESOURCES GOVERNANCE NORMS Improved survival, health, physical growth, cognitive development, school readiness and school performance in children and adolescents; improved survival, health productivity and wages in women and adults; and improved prosperity and cohesion in societies. Immediate determinants Underlying determinants Enabling determinants Good care, driven by adequate services and practices for children and women Good diets, driven by adequate food and feeding for children and women Age-appropriate, nutrient- rich foods – including breastmilk in early childhood – with safe drinking water and household food security Suffi cient resources – including environmental, fi nancial, social and human resources- to enable children’s and women’s right to nutrition Good governance – including political fi nancial, social and public and private sector actions – to enable children’s and women’s right to nutrition Positive social and cultural norms and actions to advance children’s and women‘s right to nutrition Age- appropriate dietary practices – including responsive feeding and stimulation in early childhood – with adequate food preparation, food consumption and hygiene practices Healthy food environments, adequate nutrition health and sanitation services, and healthy living environments that promote good diets and physical activity 15National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 2.2.1.3 The immediate determinants The immediate determinants of maternal and child nutrition are diets and care, which infl uence each other. Good diets are driven by adequate food and feeding to support good nutrition for women and children. Good care is driven by adequate services and practices to support good nutrition for women and children. Accordingly, the co-occurrence of good diets and good care leads to adequate nutrition for women and children across their course of life. 2.2.1.4 The outcomes The outcomes resulting from improved nutrition for women and children manifest both in the short and long term, and include: In childhood and adolescence – Improved survival, health, physical growth, cognitive development, school readiness and school performance. In adulthood and for societies – Improved survival, health, productivity and wages in adults, and improved prosperity and social cohesion for societies. 2.2.2 Causes of undernutrition and micronutrient defi ciency in Tanzania Undernutrition and micronutrient defi ciencies are due to many causes such as suboptimal breastfeeding and complementary feeding practices among infants and young children, inadequate dietary diversity, unsafe food and water, poor sanitation and hygiene practices, inadequate knowledge, inadequate access, and diseases. The most vulnerable groups include WRA, especially pregnant mothers, adolescents, and preschool and under-fi ve children. The lack of knowledge of optimal food practices will need to be addressed to reduce the prevalence of undernutrition and micronutrient defi ciencies. The diets of most Tanzanians are undiversifi ed. Studies have shown that, on average, 71 per cent of all energy is obtained from staple foods and even in the richest part of the population, nearly 60 per cent of energy comes from staple foods alone. [17] These staple foods are often very low in micronutrients, either because the food is inherently low in micronutrients or because of the way it is processed or prepared. 2.2.3 Causes of overweight and obesity in Tanzania The contributing factors to overweight and obesity are mainly related to sedentary lifestyles, lack of exercise and excessive intake of unhealthy foods with high levels of fats and carbohydrates. Other signifi cant reasons include rising income, poverty, inadequate nutrition education and a lack of awareness about healthy dietary practices and non-supportive food system policies, including food industry regulations and controls. 2.3 Situation analysis of key systems for delivering nutrition The emerging problems of malnutrition in Tanzania demand a system approach that delivers diets, services and practices that support good nutrition for women, men, children, and adolescents, while sustaining nutrition-responsive development at every stage of life and in all contexts. In this 16 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 respect, the NMNAP II (see Section 1.4) considers fi ve important and crucial key systems, namely, food, health, education, WASH, and social protection. Similarly, it has been shown that, to improve the quality of children’s diets, a food system is required that produces a range of nutritious foods which are available and affordable to families; a health system is required, with well-trained staff at the facility and community levels to counsel caregivers on the benefi ts of a nutritious, diverse diet for children; a WASH system is required, that provides free, safe and palatable drinking water for a healthy diet and the safe preparation of foods; and a social protection system is required, that reduces inequalities by ensuring that nutritious foods are affordable to vulnerable children and families. [3, 16, 17] 2.3.1 Food system The food system comprises of the policies, services and actors along the value chain, which are needed to ensure the population’s access to good diets, which are defi ned as diets that are nutritious, safe, affordable, and sustainable. [16] Food systems bear critical responsibility for the nutritional quality, safety, availability, and affordability of people’s diets. However, food systems in Tanzania have often failed to account for the special nutritional needs of groups such as children, when determining what foods need to be produced, processed, packaged, stored, and marketed. Further, the cost of nutritious foods puts them out-of-reach for many households whereas ultra-processed and less-nutritious foods may be widely available, affordable, and marketed. Food environments are often profi t-driven rather than child-centred, making it challenging for children and families to make good food choices. The food system needs to operate in ways that empower individuals and families to demand nutritious foods. Secondly, it needs to ensure that nutritious foods are available and affordable. It also needs to create healthy food environments. The government must set standards that are 17National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 aligned with people’s best needs and create a level-playing fi eld for food producers and suppliers. Producers and suppliers need to ensure that their actions – including food production, labelling, and marketing – are aligned with such standards. Evidence shows that when nutritious options are affordable, convenient, and desirable, children and families make better food choices. The NMNAP II advocates for leveraging the policies, services, resources, and actors of the food system to make them more accountable in improving the diets and dietary practices of Tanzanians. The MTR of the NMNAP I revealed that there has been an improvement in the production of milk, fi sh, and meat at the national level. Improvements have been observed in the national food infl ation rate, which has decreased from 9.5 per cent in 2015/16 to 3.5 per cent in 2018/2019 and also in the national food self-suffi ciency ratio, which was maintained above 120 per cent. On the other hand, agriculture has remained the most important sector for livelihoods, which makes Tanzanian households very vulnerable to environmental stressors. Assessment of food security vulnerability in 16 selected districts between November 2019 and April 2020 [18] revealed that, 20 per cent out of the entire population in those districts had experienced severe food insecurity. Food insecurity is driven primarily by climate change and leads to prolonged dry spells, erratic rainfall, and pest infestations. 2.3.2 Health system The health system comprises of the policies, programmes and actors that ensure a population’s access to health services. Strong health systems promote nutritious and safe diets, deliver preventive nutrition services, treat severely undernourished children (and other individuals), and foster positive nutrition practices in households and communities. Health systems are a key delivery platform for the prevention and treatment of malnutrition, providing multiple contact opportunities with women and children, such as antenatal care (ANC) and postnatal care services, immunization and well- child visits, sick-child consultations, community-based services, and facility-based care. Empowering communities, especially through behaviour change communication (BCC) interventions, is important to ensure access to, and for the sustainable utilization of, preventive and curative health and nutrition services. However, the situation in Tanzania shows that health systems do not always effectively integrate nutrition services. It is paramount that the health system invests in the nutrition knowledge and skills of health workers at both the facility and community levels, as they are the front line between the health system, children, and families. Services to prevent malnutrition such as counselling and support for breastfeeding, complementary feeding, and maternal and child nutrition must be delivered during prenatal and postnatal health-care contacts [16] and through the use of media, interpersonal communication, and social and community mobilization. The Government of Tanzania has recognized and included nutrition services as key interventions into the Health Sector Strategic Plan (HSSP) V. [18] The MTR of the NMNAP I found good progress in most health-related indicators. Improved coverage was observed for malaria prevention and control services and HIV/AIDS screening during pregnancy. Furthermore, signifi cant improvement was reported in the proportion of women attending four or more ANC services from 39 per cent in 2015/16 to 64 per cent in 2018/19. Despite free maternal and child health services, since education and counselling were not systematically provided, key nutrition interventions such as integrated management of acute malnutrition (IMAM), vitamin A supplementation and deworming were not suffi ciently integrated into the health system. 18 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 2.3.3 Water, sanitation and hygiene system The water, sanitation and hygiene (WASH) system comprises of the policies, programmes, services, and actors needed to ensure a population’s access to safe drinking water, and safe sanitation and hygiene services. The WASH system plays a critical role in preventing all forms of malnutrition by ensuring access to free, safe, and palatable drinking water, and safe sanitation and hygiene services. In Tanzania, safe drinking water is an essential component of good diets, while safe sanitation and hygiene services help foster clean and healthy environments that protect individuals, especially children, from nutrient losses arising from diarrhoea, intestinal worm infections and environmental enteric dysfunction (EED), thus ensuring that their bodies can use nutrients fully. [1, 3, 16] Safe drinking water, sanitation and good hygiene are critically important in households, schools, health facilities and communities, in both the development and humanitarian contexts. Although investments in water and sanitation infrastructure are important, social and behaviour change communication (SBCC) to promote safe food handling, optimal feeding, and hygiene – including handwashing with soap at critical times – must be mainstreamed in the communities, health facilities and schools. The Government of Tanzania intends to leverage the policies, strategies and programmes of the water and sanitation systems to make them more accountable for improving the diets and nutrition of children, adolescents, men and women, in all contexts. In Tanzania, the reduction of diarrhoea incidence through improved WASH has contributed to a reduction in stunting and anaemia. The access to piped/protected water and improved toilets has slightly increased due to the engagement of local government leaders and community health workers (CHWs). On the other hand, SBCC had a limited focus on handling animal faeces to prevent faecal contamination among young children, which is a determinant of stunting because it increases the incidence of diarrhoea and enteropathy, a condition that limits the absorption of nutrients. 2.3.4 Social protection system Social protection comprised of a set of policies and programmes aimed at protecting all people against poverty, fragility, and social exclusion, with a particular emphasis on vulnerable groups. Experience in Tanzania has shown that the social protection system can provide a crucial safety net for improving the diets and nutrition of the most vulnerable families by addressing the underlying causes of malnutrition. Social protection programmes such as Tanzania Social Action Fund (TASAF) [20] provide food transfers and/or cash transfers to improve access to nutritious and diverse diets. It is expected that social protection systems should be the shock response in times of humanitarian and economic crises. The Government of Tanzania has designed social protection programmes to facilitate and ensure access to nutrition, health and education, and other services. These include providing incentives for accessing prenatal and postnatal care, and nutrition counselling or removing the barriers to school- based nutrition programmes. Since malnutrition is most prevalent among the poorest and most vulnerable people, reaching them is key to accelerating improvements in nutrition. Tanzania is on track to reach the most vulnerable households, with social protection on programmes such as cash transfers (89 per cent) and public works (87 per cent). The country is also making progress through the establishment of specifi c programmes for the economic empowerment of women. Performance of Council 19National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Women Development Fund has improved between 2015/16 and 2018/19 respectively, from TShs. 3,388,747,160 to TShs. 11,128,114,993. Similarly, the number of women reached by the programmes has increased from 21,167 to 44,210. The World Bank recommends spending at least USD $8 per child in nutrition-specifi c interventions and creating enabling environments for nutrition to meet the SDG of reducing stunting. To this end, Tanzania is supposed to increase the minimum budget allocation for nutrition at the local government authority (LGA) level from TShs. 500 per child in each Council to about TShs. 22,000 per child in each Council, by 2030. So far, the proportion of LGAs that disburse such budget allocations has increased from 1 per cent in 2016/17 to 7 per cent in 2018/19. However, the minimum budget allocation was only increased from TShs. 500 in 2015/16 to TShs. 1,000 in 2016/17, and was not increased further as planned in the subsequent years. 2.3.5 Education system The education system comprises of the policies, programmes, services, and actors that ensure a population’s access to education. In Tanzania, the education system offers a large infrastructure – including pre-primary, primary and secondary schools – to help children and adolescents acquire knowledge, develop skills, and realize their right to learn. The education system can offer an important platform for improving children’s diets, delivering nutrition services, and fostering positive nutrition practices among children, adolescents, and families across a range of contexts, including rural, urban, development and humanitarian settings. In schools, nutrition education should ensure that children and families learn how to choose nutritious foods. Schools should enable healthy food environments with access to nutritious foods; free, safe, and palatable drinking water; and promote zero tolerance for ‘junk’ food and beverages. School feeding programmes may be needed for vulnerable children. [1, 2, 16] Integrating nutrition with ECD interventions through parenting programmes and ECD centres have proven to be effective in terms of addressing nutrition challenges resulting in the child development and growth outcomes surviving and thriving well. [22] The education system has also been used to deliver programmes which address micronutrient defi ciencies through micronutrient supplementation and deworming prophylaxis. Schools can be a key platform to encourage and support dietary habits that promote healthy growth and development and to contribute in building a new generation of well-nourished and nutrition-literate boys and girls. Since secondary school completion by girls is the single most effective intervention to reduce stunting, Tanzania has made great efforts to create enabling environments for child education, including mandating a fee-free education policy for primary and secondary schools. This has contributed to increased enrolment in both primary and secondary schools. Schools are key platforms for reaching out to a high number of children with nutrition and related interventions, including the promotion of dietary diversity and physical activity, school feeding, and micronutrient supplementation programmes. However, there are challenges related to the low coverage and poor quality of school health programmes. There are also persistent social norms that prioritize boys over girls’ education, and there is also a non-availability of pre-school services at the national level. To this end, despite the efforts made by the government, the secondary education completion rate for girls and boys was slightly delayed (38 per cent achieved in 2018 as against the 43 percent target set for that year). The net enrolment rate for pre-primary education was also slightly delayed (40 per cent achieved in 2018 as the against 55 per cent target set for that year). 20 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 NMNAP II DESIGN FRAMEWORK 3CHAPTER 3.1 Rationale The rationale of developing the NMNAP II, covering the fi ve-year period between 2021/22 – 2025/26, is to replace the existing NMNAP I which came to an end in June 2021. The NMNAP II will address the triple burden of malnutrition, consider interventions within the life cycle system approach, and adopt four outcome areas (KRAs) which aim to address undernutrition, micronutrient defi ciencies, overweight and obesity, and strengthen enabling environments for nutrition. 3.2 Vision, mission and guiding principles Vision Women, men, children, and adolescents in Tanzania are better nourished, and living healthier and more productive lives. Mission To reduce all forms of malnutrition in Tanzania for all age groups using a well-coordinated multisectoral system and to introduce participatory approaches for the optimal health of all Tanzanians and for the country’s economic growth. Guiding principles Implementation of the NMNAP II will be guided by the following key principles: - i. Government will continue to be in the driving seat, ii. Human rights, iii. Focus on all dimensions of equity, especially gender, age, and economic state, iv. Build and reinforce effective community and private-sector engagement, 21National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 v. Quality, accountability, and impact – through evidence-led, result-oriented, scalable and sustainable interventions, vi. Adhere to the three “Ones”: one plan; one coordinating mechanism and one monitoring, evaluation and learning framework. 3.3 Objective of the NMNAP II The objective of the NMNAP II is to address the triple burden of malnutrition in Tanzania with emphasis on nutrition-specifi c and nutrition-sensitive interventions from various sectors, including health, social protection, education, food, water, community development, fi nance, industry, and trade. The plan is expected to address the shortfalls of the previous plan, identify and propose high- impact low-cost interventions, and engage all sectors, while harnessing the benefi ts of the existing frameworks to ensure sustainability. The expected result or desired change for the NMNAP II is that all Tanzanians are better-nourished and leading healthier and more productive lives which contribute to the economic growth and sustainable development of the country. 3.4 Theory of change The NMNAP ToC is that if there are adequate policies and regulatory frameworks to support multisectoral nutrition actions, and if adequate multisectoral and multistakeholder collaboration and coordination for nutrition are adopted and supported with data use, generation and utilization and if there are strengthened human and fi nancial resources for nutrition then there will be an enabling environment that supports the prioritization and fi nancing of nutrition service delivery at the national and subnational levels. If national and subnational level capacity is strengthened for the nutrition commodity supply chain for improved service delivery, and if access to facility and community-based nutrition services is increased, then there will be increased coverage of adequate, equitable and quality nutrition services at the community and facility levels. If women, men, children, and adolescents have increased nutrition knowledge on optimal nutrition, if they are empowered to make necessary nutrition decisions, and if they have increased consumption of safe, nutritious, and adequate foods, then the women, men, children, and adolescents will practice appropriate nutrition behaviours. Lastly, if the food supply chain and the food environment are strengthened, and if there will be improved capacity among the private sector to produce safe and nutritious food across the value chain, with increased multi-sector engagement in delivering nutrition services in collaboration with key stakeholders with a common understanding of the people’s nutritional needs, then there will be effective and sustainable multisectoral partnerships for nutrition and resilient food systems that are responsive to the nutritional needs of the nation in addressing the triple burden of malnutrition. Figure 12 summarizes the key elements of the NMNAP II’s ToC, outlining fi ve different conditions for change (outcomes) to achieve that desired change. The fi ve conditions for change are an improvement from the NMNAP I. These are: Condition 1: “Children, adolescents, women and men have increased utilization of adequate, equitable and quality services at the community and facility levels” 22 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Condition 2: “Women, men, children, and adolescents increase adoption and practice appropriate nutrition behaviours” Condition 3: “Food systems must be enhanced, sustainable, resilient and responsive to the nutritional needs of children, adolescents, women and men” Condition 4: “Multisectoral and private sector engagement in nutrition must be strengthened” Condition 5: “The enabling environment must be strengthened and supportive of adequate human and fi nancial resources for nutrition” 23National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 THE NATIONAL MULTISECTORAL NATIONAL ACTION PLAN II 2021-2026 – THEORY OF CHANGE Impact Outcome Women, men, children and adolescents in Tanzania are better nourished living healthier and more productive lives 1. Increased coverage of adequate equitable and quality nutrition services at community and facility level 2. Women, men, children, and adolescents practice appropriate nutrition behaviors 3. Sustainable and resilient food systems that are responsive to nutrition needs 4. Effective multisectoral, public – private partnerships 5. Enabling environ- ment (adequate policies and frame-works) that is supportive of adequate human and fi nancial resources for nutrition R is k Outputs 1.1 Strengthened nutrition commodities supply – chain for service delivery 1.2 Increased access to facility and community based nutrition services to women, men, children and adolescents 2.1 Women, men, children and adolescents have increased nutrition knowledge 2.2 Women, men, and adolescents empowered to make necessary nutrition decisions 4.1 Improved capacity among private sector actors to produce safe and nutritious food across the value chain 4.2 Increased categories of private sector engaged in delivering nutrition interventions 4.3 Collaboration and coordination amongst public and private sector strengthened 4.4 Public and private sectors have a common understanding of the nutritional needs of the country 5.1 Adequate multisectoral and multi-stakeholder collaboration and coordination for nutrition 5.2 Adequate data generation and utilization 5.3 Human and fi nancial resources 5.4 Strengthened policies and frameworks supportive for nutrition 3.1 Strengthened food supply chain 3.2 Strengthened food environment that promote consumption of safe and nutritious foods E co no m ic s ho ck , O cc ur an ce o f na tu ra l d is as te rs a nd c lim at e sh oc k, p ol iti ca l i ns ta bi lit y, C ha ng e in g ov er nm en t pr io rit ie s at N at io na l a nd L oc al le ve l, C ha ng e in le ad er sh ip w ith in a nd a cr os s se ct or s, H ig h tu rn ov er o f ke y st af fs , O cc ur an ce o f pa nd em ic a nd e nd em ic s Strategies Capacity building, Strengthen Human resource for nutrition capacity across sectors, Advocacy for domestic fi nancing of nutrition interventions, Health systems strengthening for delivery of outreach services, Community engagement and social mobilization, Social Behavior Change and Communication, Institutional Capacity Building, Private sector engagement, Multi-sectoral and systems approach, Social mobilization A ss u m p ti o n s Communi- cation platforms are willing to support nutrition promotion Available, adequate and functional health facilities Government policies and regulations continues to support provision of nutrition services Local institution (SIDO, VETA, TIRDO, DIT) mainstream nutrition in their plan (e.g., Solar dryers, dossiers, iodation technology) Good infrastructure (including roads, water, electricity communi- cation) that will support the expansion of nutrition services Community members (Women, men children and adolescents) have an open mind towards good nutrition Tanzania maintains its current food production capacity so that alternatives to unhealthy processed food are available Stable economic growth Stakeholder Corporation Partners are willing to meet required national and international standards Demand for locally produced nutritious foods is sustainable Stakeholder will be willing to collaborate Political will for nutrition agenda continues Tanzania increases and diversifi es its food production Environment factors do not disrupt current production capacity Innovation and technology that support real time data Evidence based decision making Government fosters enabling environment for private sectors engagement Figure 12: NMNAP II THEORY OF CHANGE 24 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 These results will be contributed by nutrition-specifi c and sensitive sectors through the fi ve identifi ed systems of health, food, education, WASH and social protection. In recognizing that the conditions for change are not completely under the control of the actors implementing the NMNAP II but also depend on other unpredictable factors, the ToC also includes a set of 18 necessary assumptions shown in Box 1. Box 1: Necessary assumptions for the NMNAP II Policy related assumptions Government policies and regulations continue to support the provision of nutrition services Demand for locally produced nutritious foods is sustainable Tanzania maintains her current food production capacity so that alternatives to unhealthy processed foods are available Stable economic growth Partners are willing to meet the required national and international standards Government fosters enabling environments for private sector engagement Favorable policy environment Stakeholders are willing to collaborate Political will for nutrition agenda continues Tanzania increases and diversifi es its food production Innovation and technology that support real-time data are available Evidence-based decision making is prioritized at all levels Institutional related assumptions Adequate and functional health facilities are available Local institutions (e.g., small industries development organization (SIDO), Vocation Education and Training Authority (VETA), TIRDO, DIT) mainstream nutrition in their plans (e.g., solar dryers, dossiers, iodation technology) Good infrastructure (including roads, water, electricity and communication) that will support the expansion of nutrition services Communication platforms are willing to support nutrition promotion Stakeholders are willing to collaborate and cooperate with the government approaches Community related assumptions Community members (women, men children and adolescents) have an open mind towards good nutrition Demand for locally produced nutritious foods is sustainable 25National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 KEY RESULT AREAS, STRATEGIES, AND INTERVENTIONS 4CHAPTER 4.1 Overview of the chapter The desired change for the NMNAP II is that all Tanzanians are better nourished and leading healthier and more productive lives that contribute to the economic growth and sustainable development of the country. In order to achieve the expected result, a total of four (4) KRAs and fi ve (5) strategic outcomes have been defi ned as follows. KRAs: Reducing undernutrition Reducing micronutrient defi ciencies Reducing overweight and obesity Strengthening the enabling environments Strategic outcomes are: Strategic Outcome 1. Increased coverage of adequate, equitable and quality nutrition services at the community and facility levels. Strategic Outcome 2. Women, men, children and adolescents practice appropriate nutrition behaviours Strategic Outcome 3. Sustainable and resilient food systems that are responsive to nutritional needs Strategic Outcome 4. Strengthened multisectoral and private sector engagement for nutrition Strategic Outcome 5. Enabling environments (adequate policies and frameworks) that are supportive of adequate human and fi nancial resources for nutrition 26 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Table 3: Key interventions for improving men, women, adolescents and children’s nutritional status Pregnant and lactating women (15–49 years) Early childhood (0-59 months) School aged (5-9 years) adolescents (10-19 years) Adult men and women (19 years - 59 above) Elderly (60 years and above) Specifi c interventions Promotion of continued and consistent use of iron and folic acid (IFA) Promotion of diversifi ed diet Promotion of locally available foods, fortifi ed foods and biofortifi ed varieties Nutrition assessment and counselling Counselling and support on breastfeeding Promotion of healthy lifestyles Protect, promote, and support age- appropriate IYCF Management of acute malnutrition Vitamin A supplementation for children aged 6-59 months Growth and development monitoring Promotion of diversifi ed diet Promotion of locally available foods, fortifi ed foods and biofortifi ed varieties Provision of school meals using diversifi ed and fortifi ed foods Nutrition assessment, education and counseling support Management of acute malnutrition Promotion of healthy lifestyles Promotion of diversifi ed diet Promotion of locally available foods, fortifi ed foods and biofortifi ed varieties Nutrition assessment, education and counselling support Promotion of healthy lifestyles Promotion of diversifi ed diet Promotion of locally available foods, fortifi ed foods and biofortifi ed varieties Nutrition assessment, education and counselling support Promotion of healthy lifestyles Summary of key interventions for improving people’s nutritional status across the life cycle: NMNAP II accommodates interventions for all age groups, including for those with special health and nutritional needs. Specifi cally, this includes a special focus on nutrition-specifi c and nutrition-sensitive interventions in the fi rst 1,000 days which promote nutrition and early childhood development, and adolescent health and nutrition, and also those interventions which target people with special nutritional needs such as the elderly and those with chronic illnesses e.g., TB, HIV, cancer and diabetes. Also, the NMNAP II will focus on the vulnerable and the poor through social protection programmes and during emergency situations (see Table 3). 27National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Sensitive interventions ANC including HIV testing, care and support Integration of sexual and reproductive health (family planning) Deworming Promotion of hygiene and improved sanitation practices Women empowerment and male involvement Prevention of gender- based violence Zinc treatment for diarrhoea and deworming Prevention and treatment of infectious diseases and quality care of sick children Immunization and other routine child health services HIV testing, care and support Sexual and reproductive health education HIV testing, care and support Deworming Promotion of hygiene and improved sanitation practices Promotion of completion of secondary education Prevention of gender-based violence Promoting preconception and antenatal nutritional care for women HIV testing, care and support Promotion of hygiene and improved sanitation practices Prevention of gender-based violence Women empowerment and male involvement Promotion of hygiene and improved sanitation practices Prevention of gender-based violence Psychosocial support Provision of livelihoods support Home fruits and vegetables gardening Small animal keeping Appropriate infant feeding practices for HIV-exposed infants and PMTCT Promotion of hygiene and improved sanitation practices Promotion of good parenting and nurturing care practices for early child development Provision of livelihood support including income School and home fruits and vegetables gardening Small animal keeping Provision of livelihoods support including income Home fruits and vegetables gardening Small animal keeping Home fruits and vegetables gardening Small animal keeping 28 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 4.2 KRAs with corresponding outcomes, outputs, strategies, actions and activities 4.2.1 Undernutrition priority actions and activities Over the past two decades, Tanzania has seen a signifi cant achievement in the reduction of undernutrition, especially for under-fi ve children, owing to the rapid decline in stunting and underweight. Despite the signifi cant progress made, the levels are still high. Undernourished children have weaker immune systems and are thus more susceptible to infections and illnesses. The consequences of stunting on cognitive development are also remarkable. Various studies show that child stunting is likely to impact brain development and impair motor skills. Stunting in early life is linked to a 2–3-year delay in starting school and having a lower income in adulthood, between 22 and 45 per cent.1 The causes for undernutrition are complex and multifaceted. Undernutrition can be caused by insuffi cient diet intake, poor breastfeeding, or inadequate complementary foods. Other causes include inadequate access to safe water, sanitation and hygiene, and food safety, resulting in recurrent food intoxication and infectious diseases (such as diarrhoea and intestinal worms), leading to inhibition of the absorption and use of calories and nutrients, food insecurity and poor socioeconomic conditions. To achieve the desired outcomes, a series of activities with related outputs have been prioritized as shown in Table 4. 1 Maternal and Child Nutrition (2011), 7 (Suppl. 3), pp. 5–18. 29National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 T a b le 4 : P ri o ri ty a ct io n s an d a ct iv iti es to a d d re ss u n d er n u tr iti o n in T an za n ia S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s S tr at eg ic O u tc o m e 1: In cr ea se d c o ve ra g e o f ad eq u at e, e q u it ab le a n d q u al it y n u tr it io n s er vi ce s at t h e co m m u n it y an d fa ci lit y le ve ls 1. 1. S tr en gt he ne d nu tr iti on co m m od ity s up pl y ch ai n fo r se rv ic e de liv er y. 1. 1. 1 S tr en gt he n pr oc ur em en t of nu tr iti on c om m od iti es w ith in t he na tio na l s up pl y ch ai n To c on du ct b ia nn ua l s ta ke ho ld er s’ (m ed ic al s to re d ep ar tm en ts (M S D s) , r ep ro du ct iv e an d ch ild he al th s ec tio ns (R C H S ), M oH C D G E C -N ut rit io n S ec tio n, p la nn in g su pp or t un its (P S U s) , P re si de nt O ffi c e R eg io na l A dm in is tr at io n an d Lo ca l G ov er nm en t (P O -R A LG ) m ee tin gs t o st re am lin e th e pr oc ur em en t an d di st rib ut io n of n ut rit io n co m m od iti es To t ra in r eg io na l a nd d is tr ic t su pp ly o ffi c er s, t he D is tr ic t R ep ro du ct iv e an d C hi ld H ea lth C oo rd in at or s (D R C H C O s) , p ha rm ac is ts a nd n ut rit io ni st s on m an ag em en t (f or ec as tin g, re po rt in g an d or de rin g) o f nu tr iti on s up pl ie s (R U TF , F 75 , F 10 0, r es om al , v ita m in A , I FA , m ul tip le m ic ro nu tr ie nt s up pl em en ta tio n (M M S ), m id -u pp er a rm c irc um fe re nc e (M U A C ) t ap e, w ei gh t sc al e, le ng th b oa rd ) 1. 1. 2 Pr om ot e lo ca l p ro du ct io n of n ut rit io n co m m od iti es a nd su pp lie s (s pe ci al iz e nu tr iti ou s fo od s an d an th ro po m et ric eq ui pm en t’s ) To c on du ct a nn ua l s ta ke ho ld er m ee tin gs w ith r ep re se nt at iv es f ro m 2 6 re gi on s to a ss es s th e fe as ib ili ty o f pr od uc in g th e nu tr iti on c om m od iti es a nd s up pl ie s To d ev el op /r ev ie w g ui de lin es a nd s ta nd ar ds f or t he p ro du ct io n of n ut rit io n co m m od iti es a nd su pp lie s To c on du ct b ia nn ua l a dv oc ac y ac tiv iti es t o M in is tr y of In du st ry a nd T ra de (M IT ), S ID O , V ET A a nd S M E s to p ro m ot e th e an nu al lo ca l p ro du ct io n of n ut rit io n co m m od iti es a nd s up pl ie s 1. 1. 3 S tr en gt he n m on ito rin g an d ev al ua tio n of n ut rit io n co m m od iti es To c on du ct q ua rt er ly s up po rt iv e su pe rv is io n, m en to rs hi p an d co uc hi ng t o he al th f ac ili tie s to as se ss m an ag em en t of n ut rit io n co m m od iti es a nd s up pl ie s To c on du ct q ua rt er ly m on ito rin g of e nd u se rs /b en efi c ia rie s (e .g ., m ot he rs , c hi ld re n) t o en su re t he re ce ip t of a nd c om pl ia nc e to n ut rit io n co m m od iti es a nd s er vi ce s 1. 1. 4. S tr en gt he n av ai la bi lit y of n ut rit io n se rv ic es d ur in g em er ge nc ie s To d ev el op n ut rit io n in e m er ge nc y gu id el in es To a dv oc at e fo r th e op er at io na liz at io n of n ut rit io n in e m er ge nc y st an da rd o pe ra tin g pr oc ed ur e (S O P s) a t al l l ev el s To t ra in e m er ge nc y te am s on t he p ro vi si on o f nu tr iti on s er vi ce s du rin g em er ge nc ie s an d at a ll le ve ls 1. 2 In cr ea se d ac ce ss t o fa ci lit y an d co m m un ity - ba se d nu tr iti on 1. 2. 1 S tr en gt he n nu tr iti on t ec hn ic al ca pa ci ty o n th e pr ev en tio n an d m an ag em en t of u nd er nu tr iti on a t al l l ev el s To c on du ct a nn ua l a dv oc ac y m ee tin gs f or t he r ec ru itm en t of n ut rit io ni st s at a ll le ve ls 30 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s se rv ic es f or w om en , m en , ch ild re n an d ad ol es ce nt s. To t ra in e xt en si on w or ke rs , a t th e w ar d le ve l, on t he p re ve nt io n of u nd er nu tr iti on To t ra in h ea lth c ar e w or ke rs (H C W s) o n th e pr ev en tio n an d m an ag em en t of u nd er nu tr iti on To t ra in C H W s on t he p re ve nt io n of u nd er nu tr iti on 1. 2. 2 S ca le -u p nu tr iti on s er vi ce s at al l l ev el s To c on du ct b ia nn ua l a dv oc ac y m ee tin gs f or t he in st itu tio na liz at io n of C H W in ce nt iv es a t th e co un ci l l ev el To c on du ct n at io na l-l ev el a dv oc ac y m ee tin gs t o pr om ot e th e op er at io na liz at io n of c om m un ity - ba se d he al th c ar e se rv ic e gu id el in es To c on du ct a dv oc ac y to s ec to ra l m in is tr ie s fo r th e ut ili za tio n of e xt en si on w or ke rs t o im pl em en t nu tr iti on in te rv en tio ns To c on du ct a dv oc ac y fo r th e de ve lo pm en t of n ut rit io n gu id el in es f or E C D c en tr es (c re ch es , co m m un ity E C D c en tr es , p re –s ch oo ls a nd d ay -c ar e ce nt re s) To c on du ct a dv oc ac y to L G A s fo r th e in cl us io n of a do le sc en ts in n ut rit io n pr og ra m m es S tr at eg ic O u tc o m e 2: W o m en , m en , c h ild re n a n d a d o le sc en ts p ra ct ic e ap p ro p ri at e n u tr it io n b eh av io u rs 2. 1 W om en , m en , ch ild re n an d ad ol es ce nt s ha ve in cr ea se d nu tr iti on kn ow le dg e. 2. 1. 1 Pr om ot e nu tr iti on S B C C am on g co m m un ity m em be rs To d es ig n re le va nt lo ca liz ed a pp ro ac he s to p ro m ot e ap pr op ria te n ut rit io n be ha vi ou rs (p ro m ot io n m at er ia ls ) d ur in g th e fi r st t hr ee y ea rs To f ac ili ta te q ua rt er ly im pl em en ta tio n of n ut rit io n S B C C a ct iv iti es a t th e co m m un ity le ve l (m ed ia , t ra di tio na l g ro up s, E C D c en tr es , c om m un ity g ro up s, f ai th -b as ed o rg an iz at io n (F B O ,) in te rv en tio ns e tc .) To a do pt t he r el ev an t gl ob al a nd r eg io na l r ec om m en da tio ns f or t he im pr ov em en t of n ut rit io n To c om m em or at e at le as t tw o in te rn at io na l, re gi on al , n at io na l a nd lo ca l n ut rit io n ev en ts a t LG A s 2. 2 W om en , m en an d ad ol es ce nt s em po w er ed t o m ak e ne ce ss ar y nu tr iti on d ec is io ns 2. 2. 1 In cr ea se a cc es s an d co nt ro l of in co m e an d re so ur ce s To a dv oc at e fo r LG A a nd s et a si de t he r eq ui re d pe rc en ta ge o f lo ca l f un ds f or w om en a nd y ou th fu nd s To c on du ct s en si tiz at io n se ss io ns o f w om en g ro up s To c on du ct s en si tiz at io n m ee tin gs f or m al e in vo lv em en t in a ll co m m un ity n ut rit io n pr og ra m m es To a dv oc at e ag ai ns t cu ltu ra l p ra ct ic es t ha t hi nd er o pt im um n ut rit io n pr ac tic es To a dv oc at e fo r th e ow ne rs hi p of r es ou rc es a m on g w om en 31National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 2. 2. 2 S tr en gt he ne d in te gr at io n of nu tr iti on s er vi ce s in s oc ia l s af et y ne ts To a dv oc at e fo r th e in te gr at io n of n ut rit io n in to s oc ia l p ro te ct io n pr og ra m m es To c on du ct t ra in in g se ss io ns f or s oc ia l p ro te ct io n te am s on t he p la nn in g, b ud ge tin g, im pl em en ta tio n an d m on ito rin g of n ut rit io n in t he ir re sp ec tiv e se ct or s 2. 3 W om en , m en , c hi ld re n, an d ad ol es ce nt s ha ve in cr ea se d co ns um pt io n of sa fe , n ut rit io us a nd ad eq ua te f oo ds . 2. 3. 1 S tr en gt he n de liv er y of nu tr iti on -s en si tiv e in te rv en tio ns a t al l l ev el s (W A S H , d ew or m in g, f oo d sy st em ) To p ro m ot e W A S H p ra ct ic es a t al l l ev el s, in cl ud in g in no va tiv e nu tr iti on -s en si tiv e in te rv en tio ns (r e- us e of b io ga s, c lim at e re si lie nt ) To c on du ct s en si tiz at io n m ee tin gs a t th e w ar d le ve l t o pr om ot e W A S H p ra ct ic es To t ra in n ut rit io n fo ca l p er so ns o n nu tr iti on -s en si tiv e gu id el in es , i nc lu di ng s ch oo l-f ee di ng gu id el in es , p la nn in g an d bu dg et in g, t he N at io na l A cc el er at ed In ve st m en t A ge nd a (N A IA ), th e N at io na l E C D M ul tis ec to ra l P ro gr am , a cr os s th e m in is tr ie s, d ep ar tm en ts a nd a ge nc ie s (M D A s) , R eg io na l S ec re ta ria t (R S ) a nd t he c ou nc ils D ev el op /r ev ie w n ut rit io n ac co un ta bi lit y fr am ew or ks f or t he c en tr al a nd lo ca l g ov er nm en ts S tr at eg ic O u tc o m e 3: S u st ai n ab le a n d r es ili en t fo o d s ys te m s th at a re r es p o n si ve t o n u tr it io n al n ee d s 3. 1 S tr en gt he n fo od s up pl y ch ai ns th at s up po rt fu nc tio na l f oo d sy st em s’ a ct iv iti es 3. 1. 1 in cr ea se d av ai la bi lit y an d ac ce ss ib ili ty o f sa fe a nd n ut rit io us fo od s at a ll le ve ls To c on du ct s en si tiz at io n m ee tin gs w ith a gr ic ul tu re a nd li ve st oc k de al er s on t he s af e ut ili za tio n an d st or ag e of in pu ts f or c ro ps , a ni m al s an d fi s he rie s To a dv oc at e w ith t he m in is tr ie s of a gr ic ul tu re , i nd us tr y an d tr ad e, li ve st oc k an d fi s he rie s, a nd ot he r pa rt ne rs , t o di ve rs ify f oo d pr od uc tio n by a dd in g nu tr ie nt -r ic h fo od s To a dv oc at e w ith p riv at e se ct or a ct or s on t he p ro du ct io n, p ac ka gi ng a nd d is tr ib ut io n of co nv en ie nt , n ut rit io us , a ff or da bl e an d fo rt ifi ed f oo ds To e qu ip e xt en si on w or ke rs w ith t he a pp ro pr ia te s ki lls t o pr om ot e th e pr od uc tio n of s af e an d nu tr iti ou s fo od s at h ou se ho ld s To c on du ct s en si tiz at io n m ee tin gs t o pr om ot e th e us e of a pp ro pr ia te t ec hn ol og ie s to s up po rt t he av ai la bi lit y of n ut rit io us f oo ds (u rb an a gr ic ul tu re , s ac k ga rd en s, a qu ap on ic s, a gr op on ic s, p la st ic fi s hp on ds , s m al l a ni m al k ee pi ng ) To c on du ct s en si tiz at io n m ee tin gs o n pr om ot in g th e de ve lo pm en t of s af e an d nu tr iti ou s fo od pr od uc ts a m on g S M E s at t he r eg io na l l ev el To c on du ct s en si tiz at io n m ee tin gs f or S M E s an d fo od in du st rie s on t he u se o f te ch no lo gi es f or fo od p ro ce ss in g, p re se rv at io n an d st or ag e th at p re se rv e th e nu tr iti ve v al ue o f fo od s 32 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 3. 2 S tr en gt he n fo od e nv iro nm en ts th at p ro m ot e th e co ns um pt io n of sa fe a nd n ut rit io us fo od s 3. 2. 1 S tr en gt he n fo od q ua lit y an d sa fe ty s ta nd ar ds To d ev el op /r ei nf or ce g ui de lin es a nd s ta nd ar ds t ha t re gu la te t he m ar ke tin g of f oo ds To a dv oc at e fo r th e re in fo rc em en t of r el ev an t re gu la tio ns f or s af e an d nu tr iti ou s fo od s to f oo d m an uf ac tu re rs 3. 2. 2 Im pr ov ed m ar ke t an d tr ad e sy st em t o en su re a ff or da bl e, s af e an d nu tr iti ou s fo od s To a dv oc at e fo r th e m ar ke tin g of s af e an d nu tr iti ou s fo od in in st itu tio ns (s ch oo ls , h os pi ta ls , of fi c es ) 3. 2. 3 S tr en gt he n co ns um er ed uc at io n an d in fo rm at io n To a dv oc at e to c om m un ity m em be rs o n th e im po rt an ce o f fo od la be ls t o in fo rm h ea lth y fo od ch oi ce s S tr at eg ic O u tc o m e 4: S tr en g th en ed m u lt is ec to ra l a n d p ri va te s ec to r en g ag em en t fo r n u tr it io n 4. 1 C ol la bo ra tio n an d co or di na tio n am on gs t pu bl ic an d pr iv at e se ct or s st re ng th en ed . 4. 1. 1 S tr en gt he ne d pr iv at e se ct or e ng ag em en t in t he im pl em en ta tio n of u nd er nu tr iti on in te rv en tio ns To a dv oc at e to p riv at e se ct or a ct or s to e ng ag e in t he im pl em en ta tio n of n ut rit io n in te rv en tio ns (u nd er nu tr iti on , m ic ro nu tr ie nt d efi c ie nc ie s, o ve rw ei gh t an d ob es ity ) o nc e in e ve ry y ea r To d ev el op g ui de lin es /S O P s an d M em or an du m o f U nd es ta nd in g (M oU ) t o en ab le a pp ro pr ia te en ga ge m en t of t he p riv at e se ct or Pr ov id e re le va nt c ap ac ity b ui ld in g to p riv at e se ct or a ct or s on m ai ns tr ea m in g nu tr iti on To c on du ct t he a nn ua l m ap pi ng o f pr iv at e se ct or a ct or s w or ki ng in n ut rit io n ac ro ss t he c ou nt ry 33National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 4.2.2 Priority actions and activities to address micronutrient defi ciencies Micronutrient defi ciencies are of public health concern due to their devastating effect on the physical and mental well-being of the population. Micronutrient defi ciencies affect key development outcomes, including poor physical and mental development in children, vulnerability or exacerbation of disease, mental retardation, blindness, and general losses in productivity and potential. The health impacts of micronutrient defi ciencies are not always acutely visible; it is therefore sometimes termed as ‘hidden hunger’. The most common defi ciencies in Tanzania are of iron, folate, zinc, iodine and vitamin A. Folic acid defi ciency in pregnancy is a risk factor to neural tube defects (NTDs) in neonates and iodine defi ciency during pregnancy is the most common risk factor for preventable brain damage in neonates. The interventions applied in the prevention, control and management of micronutrient defi ciencies include, dietary diversifi cation, food fortifi cation, supplementation, and public health measures such as parasitic control, WASH, malaria control, health education and counselling. The proposed actions and activities to address micronutrient defi ciencies in Tanzania are shown in Table 5. 34 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 T a b le 5 : P ri o ri ty a ct io n s an d a ct iv iti es to a d d re ss m ic ro n u tr ie n t d efi c ie n ci es in T an za n ia S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s S tr at eg ic O u tc o m e 1. In cr ea se d c o ve ra g e o f ad eq u at e eq u it ab le a n d q u al it y n u tr it io n s er vi ce s at t h e co m m u n it y an d fa ci lit y le ve ls 1. 1 S tr en gt he ne d nu tr iti on co m m od ity s up pl y ch ai n fo r se rv ic e de liv er y 1. 1. 1 Ti m el y fo re ca st in g, pr oc ur em en t an d di st rib ut io n of t he r eq ui re d m ic ro nu tr ie nt su pp le m en ts (I FA , f er ro us s ul ph at e an d fo lic a ci d (F E FO )), v ita m in A , zi nc s ul ph at e, a nd f or tifi c an ts s uc h as p ot as si um io da te a nd o th er pr em ix es f or f or tifi c at io n) To c on du ct a nn ua l s ta ke ho ld er m ee tin gs t o st re am lin e th e pr oc ur em en t of m ic ro nu tr ie nt co m m od iti es To c on du ct t he a nn ua l t ra in in g of d is tr ic t an d fa ci lit y ph ar m ac is t an d nu tr iti on o ffi c er s on t he fo re ca st in g, r ep or tin g an d or de rin g of m ic ro nu tr ie nt c om m od iti es To c oo rd in at e th e fo re ca st in g an d pr oc ur em en t of m ic ro nu tr ie nt c om m od iti es a t al l l ev el s To p ro cu re a nn ua l s to ck a nd d is tr ib ut e m ic ro nu tr ie nt c om m od iti es t o he al th f ac ili tie s, E C D ce nt re s an d sc ho ol p ro gr am m es To c on du ct b ia nn ua l s ta ke ho ld er s’ m ee tin gs t o ad vo ca te f or lo ca l p ro du ct io n of m ic ro nu tr ie nt , pr em ix a nd s up pl em en ts . 1. 2 In cr ea se d ac ce ss t o fa ci lit y an d co m m un ity - ba se d nu tr iti on se rv ic es t o w om en , m en , ch ild re n an d ad ol es ce nt s 1. 2. 1 Pr ov is io n of t he a pp ro pr ia te su pp le m en ts t o ch ild re n, ad ol es ce nt s, p re gn an t an d la ct at in g w om en , m en , e ld er ly a nd sp ec ia l g ro up s at b ot h th e he al th fa ci lit ie s an d in t he c om m un iti es To a dv oc at e fo r nu tr iti on p ac ka ge s an d sp ec ifi c nu tr iti on r ec om m en da tio ns f or t he p re ve nt io n, ea rly id en tifi c at io n (d ia gn os is ) a nd t re at m en t of m ic ro nu tr ie nt d efi c ie nc ie s fo r di ff er en t se rv ic e de liv er y ch an ne ls t ar ge tin g ch ild re n, a do le sc en ts , a du lts a nd v ul ne ra bl e gr ou ps To t ra in p ro vi de rs a t re pr od uc tiv e, m at er na l, ne w bo rn , c hi ld a nd a do le sc en t he al th (R M N A C H ) cl in ic s on t he b ur de n of m ic ro nu tr ie nt d efi c ie nc ie s an d th ei r pr ev en tio n an d m an ag em en t To t ra in s er vi ce p ro vi de rs a t O P D d ep ar tm en ts t o en su re t he p re ve nt io n an d ea rly m an ag em en t of m ic ro nu tr ie nt d efi c ie nc ie s (in s ic k ch ild re n) To t ra in p ro vi de rs a t H IV /T B c lin ic s on t he b ur de n of m ic ro nu tr ie nt d efi c ie nc ie s an d th ei r pr ev en tio n an d m an ag em en t To t ra in E C D c en tr es ’ c hi ld -c ar e w or ke rs , s ch oo l h ea lth p ro gr am m e st af f an d co or di na to rs o n th e bu rd en o f m ic ro nu tr ie nt d efi c ie nc ie s, t he ir pr ev en tio n, m an ag em en t an d th e op po rt un iti es f or th ei r pr ev en tio n in s ch oo l e nv iro nm en ts To t ra in p ro vi de rs a t N C D a nd m en ta l h ea lth c lin ic s on t he b ur de n, p re ve nt io n an d m an ag em en t of m ic ro nu tr ie nt d efi c ie nc ie s to e ns ur e se rv ic e in te gr at io n To t ra in C H W s on t he b ur de n of m ic ro nu tr ie nt d efi c ie nc ie s an d th ei r pr ev en tio n an d m an ag em en t to s tr en gt he n co m m un ity s ys te m s to id en tif y an d re fe r ca se s fr om t he c om m un ity an d de liv er c om m un ity -le ve l i nt er ve nt io ns To t ra in /a dv oc at e fo r he al th m an ag em en t te am s at a ll le ve ls o n th e bu rd en , p re ve nt io n an d m an ag em en t of m ic ro nu tr ie nt d efi c ie nc ie s to e na bl e th e pr io rit iz at io n of n ut rit io n se rv ic es 35National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s To c on du ct n at io nw id e as se ss m en ts o f th e fa ct or s co nt rib ut in g to n on -a dh er en ce t o IF A su pp le m en ts To c on du ct b ia nn ua l n at io na l v ita m in A s up pl em en ta tio n in c hi ld re n (a ge d 6- 59 m on th s) a nd de w or m in g ca m pa ig ns f or c hi ld re n (a ge d1 2- 59 m on th s) , i nc lu di ng s cr ee ni ng f or n ut rit io na l s ta tu s To c on du ct m on ito rin g an d su pe rv is io n of v ita m in A s up pl em en ta tio n ca m pa ig ns To c on du ct b as el in e as se ss m en ts t o es ta bl is h th e cu rr en t pr ev al en ce o f w or m in fe st at io n an d as se ss t he n ee d fo r co nt in ue d de w or m in g ca m pa ig ns 1. 2. 2 S ca le -u p nu tr iti on in te rv en tio ns f or E C D c en tr es a nd sc ho ol -a ge c hi ld re n (a ge d < 5 ye ar s an d 6- 19 y ea rs ) To d es ig n an d im pl em en t a co m pr eh en si ve p re -s ch oo l a nd s ch oo l-b as ed m od el f or n ut rit io n in fo rm at io n an d co un se lli ng , a nd f or s er vi ce s on t he p re ve nt io n of m ic ro nu tr ie nt d efi c ie nc ie s To o rie nt C H W s, s ch oo l t ea ch er s, c hi ld -c ar e w or ke rs , c om m un ity d ev el op m en t of fi c er s an d ot he r co m m un ity m ob ili ze rs o n th e de si gn ed E C D c en tr es a nd s ch oo l-b as ed m od el s fo r nu tr iti on in fo rm at io n an d co un se lli ng To r ev ie w a nd u pd at e th e ex is tin g tr ai ni ng m at er ia ls o n nu tr iti on e du ca tio n an d co un se lli ng f or ch ild re n an d ad ol es ce nt s To p ro vi de a t le as t on e fo rt ifi ed m ea l a t th e E C D c en tr es a nd a t th e sc ho ol le ve l a cc or di ng t o th e sc ho ol -fe ed in g gu id el in e of 2 02 0 To p ro m ot e th e in te gr at io n of a n ut rit io n ag en da w ith t he im pl em en ta tio n of n ut rit io n- se ns iti ve in te rv en tio ns s uc h as W A S H , M H M a nd d ew or m in g ca m pa ig ns a t sc ho ol s, b y ho ld in g jo in t ca m pa ig ns 1. 2. 3 In cr ea se a cc es s to m ic ro nu tr ie nt c om m od iti es a nd fo rt ifi ca nt s fo r th e co m m un ity To p ro m ot e th e su pp ly a nd in ta ke o f M N P a nd p re m ix es f or h om e an d fo od f or tifi c at io n as p ar t of im pr ov in g IY C F pr ac tic es To s tr en gt he n di st rib ut io n ch an ne ls f or M N P a nd o th er f oo d fo rt ifi ca nt s/ pr em ix es f or h om e an d in du st ria l f or tifi c at io n 1. 2. 4 S tr en gt he n th e av ai la bi lit y of a pp ro pr ia te s er vi ce s fo r th e pr ev en tio n an d tr ea tm en t of m ic ro nu tr ie nt d efi c ie nc ie s du rin g em er ge nc ie s an d di sa st er s To r ev ie w t he n at io na l n ut rit io n em er ge nc y gu id el in es a nd in cl ud e th e pr ov is io n of d iv er si fi e d m ic ro nu tr ie nt -r ic h fo od s du rin g em er ge nc ie s an d di sa st er s 36 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s S tr at eg ic O u tc o m e 2. W o m en , m en , c h ild re n , a n d a d o le sc en ts p ra ct ic e ap p ro p ri at e n u tr it io n b eh av io u rs 2. 1 W om en , m en , c hi ld re n, ad ol es ce nt s ha ve in cr ea se d kn ow le dg e of nu tr iti on 2. 1. 1 E nh an ce B C C t o cr ea te de m an d an d in cr ea se t he up ta ke o f se rv ic es b y ra is in g aw ar en es s on t he im po rt an ce of m ic ro nu tr ie nt s an d nu tr iti on se rv ic es a m on g w om en , m en , ch ild re n, a do le sc en ts a nd g ro up s w ith s pe ci al n ee ds To d ev el op n ut rit io n S B C C s tr at eg ie s to a dd re ss m ic ro nu tr ie nt d efi c ie nc ie s To b ui ld e vi de nc e fo r so ci al a nd b eh av io ur al c ha ng e th ro ug h kn ow le dg e, a tt itu de , a nd p ra ct ic e in re ga rd s to t he h ea lth b en efi t s of m ic ro nu tr ie nt s To c on du ct s ta ke ho ld er m ee tin gs t o de ve lo p th e th em at ic a re as a nd B C C o pe ra tio na l p la ns To d ev el op n at io na l c am pa ig ns b y en ga gi ng w ith t he r el ev an t m in is tr ie s an d or ga ni za tio ns , e .g ., th e M in is tr y of In fo rm at io n, C ul tu re A rt s an d S po rt s an d B A SA TA , a nd t o cr ea te p ar tn er sh ip s fo r ef fe ct iv e B C C p ro gr am m es To c on du ct n at io na l B C C p ro gr am m es f or m ic ro nu tr ie nt d efi c ie nc ie s fo r th e pr om ot io n of po si tiv e nu tr iti on in fo rm at io n an d to d em ys tif y ne ga tiv e nu tr iti on m yt hs To c on du ct S B C C c am pa ig ns t o pr om ot e lo ca lly -p ro du ce d m ic ro nu tr ie nt -r ic h fo od s an d em ph as iz e th e lin ka ge s of s uc h fo od s to h ea lth o ut co m es To c on du ct s oc ia l h ea th m ar ke tin g ca m pa ig ns o n su pp le m en ta tio n, f or tifi c at io n, b io fo rt ifi ca tio n an d di et ar y di ve rs ifi ca tio n 2. 1. 2 E st ab lis h an d us e th e ex is tin g sc ho ol a nd E C D pr og ra m m es t o pr om ot e th e im po rt an ce o f m ic ro nu tr ie nt s to t he E C D c en tr e (u nd er -fi ve ch ild re n) a nd s ch oo l-a ge d ch ild re n (a ge d 6- 19 y ea rs ) To c on du ct m ic ro nu tr ie nt a w ar en es s ca m pa ig ns a m on g ch ild -c ar e w or ke rs , t ea ch er s an d sc ho ol co m m itt ee m em be rs To c on du ct t he t ra in in g of t ra in er s (T oT ) a m on g se le ct ed t ea ch er s an d le ad er s of n ut rit io n cl ub s on t he p re ve nt io n an d m an ag em en t of m ic ro nu tr ie nt d efi c ie nc ie s To e st ab lis h nu tr iti on c lu bs in s ch oo ls t o in cr ea se a w ar en es s on t he p ro du ct io n of m ic ro nu tr ie nt - ric h fo od s To e ng ag e yo ut hs a nd a do le sc en ts t hr ou gh e ss ay c om pe tit io ns a nd d eb at es o n m ic ro nu tr ie nt s To c on du ct c on tin uo us s up po rt iv e su pe rv is io n of s ch oo l a nd E C D c en tr e ga rd en s an d to k ee p sm al l a ni m al p ro gr am m es in s ch oo ls To p ro vi de s up po rt t o sc ho ol g ar de ni ng p ro gr am m es 37National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 2. 1. 3 S tr en gt he n se rv ic es f or t he pr ov is io n of e du ca tio n on t he im po rt an ce o f m ic ro nu tr ie nt s in th e co m m un ity To le ve ra ge t ec hn ol og y fo r th e pr ov is io n of n ut rit io n ed uc at io n e. g. , t he u se o f so ci al m ed ia a nd w eb -b as ed a pp s to p ro vi de n ut rit io n ed uc at io n on t he im po rt an ce o f m ic ro nu tr ie nt s To m ap t he s ta ke ho ld er s w ho a re t o be jo in tly e ng ag ed in d ev el op in g co m m un ity o ut re ac h m ic ro nu tr ie nt e du ca tio n pr og ra m m es To c on du ct t he t ra in in g of C H W s an d st ak eh ol de rs e ng ag ed in m ic ro nu tr ie nt o ut re ac h pr og ra m m es To im pl em en t co m m un ity o ut re ac h ac tiv iti es f or e du ca tio n on m ic ro nu tr ie nt n ut rit io n 2. 1. 4 In cr ea se e ng ag em en t of po lit ic al le ad er s an d po si tiv e so ci al in fl u en ce rs a t al l l ev el s, in t he ad vo ca cy f or o r th e pr ev en tio n of m ic ro nu tr ie nt d efi c ie nc ie s To c on du ct a dv oc ac y m ee tin gs in cl ud in g pa rli am en ta ria ns To d ev el op , p rin t an d di st rib ut e po lic y br ie fs a nd s ho rt c om m un ic at io ns o n m ic ro nu tr ie nt s to t he ea rm ar ke d gr ou ps To c on du ct a w ar en es s ca m pa ig ns f or d ec is io n m ak er s on t he im po rt an ce o f m ic ro nu tr ie nt s an d fo od f or tifi c at io n 2. 2 W om en , m en an d ad ol es ce nt s em po w er ed t o m ak e ne ce ss ar y nu tr iti on d ec is io ns 2. 2. 1 G en de r m ai ns tr ea m in g in nu tr iti on in te rv en tio ns - A dd re ss th e po te nt ia l o f w om en ’s w or kl oa d in a ff ec tin g ch ild -c ar e pr ac tic es an d nu tr iti on al s ta tu s To c on du ct s ta ke ho ld er m ee tin gs t o ad vo ca te f or t he in cl us io n of t he m ic ro nu tr ie nt a ge nd a in th e ex is tin g fi l m in du st ry a s a fe at ur ed t he m e To c on du ct a dv oc ac y of m ic ro nu tr ie nt c am pa ig ns , w hi ch a dd re ss t he p ot en tia l o f w om en ’s w or kl oa d in a ff ec tin g ch ild -c ar e pr ac tic es a nd n ut rit io n ou tc om es , t hr ou gh r el ig io us le ad er s, V IC O B A g ro up s, a nd v oc at io na l t ra in in g ce nt er s w hi ch t ar ge t ou t- of -s ch oo l a do le sc en t gi rls To d ev el op m ic ro nu tr ie nt in fo rm at io n, e du ca tio n an d co m m un ic at io n (IE C ) m at er ia ls To d is se m in at e IE C m at er ia ls o n m ic ro nu tr ie nt s an d th e ro le o f w om en in a dv an ci ng n ut rit io n, th ro ug h th e ap pr op ria te c ha nn el s 2. 2. 2 In cr ea se d aw ar en es s an d pa rt ic ip at io n of m en o n th e be ne fi t s of m ic ro nu tr ie nt s. To d ev el op IE C m at er ia ls o n m ic ro nu tr ie nt s an d th e ro le o f m en in p ro m ot in g m ic ro nu tr ie nt co ns um pt io n To d is se m in at e IE C m at er ia ls o n m ic ro nu tr ie nt s an d th e ro le o f m en in a dv an ci ng n ut rit io n, th ro ug h th e ap pr op ria te c ha nn el s To in cr ea se t he p ar tic ip at io n of m en in R M N C H b y ad vo ca tin g fo r m en -f rie nd ly c lin ic s 38 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s S tr at eg ic O u tc o m e 3. S u st ai n ab le a n d r es ili en t fo o d s ys te m s th at a re r es p o n si ve t o n u tr it io n n ee d s 3. 1 S tr en gt he n fo od s up pl y ch ai ns th at s up po rt fu nc tio na l f oo d sy st em s 3. 1. 1 Pr om ot e th e av ai la bi lit y of sa fe a nd m ic ro nu tr ie nt -r ic h fo od w ith in t he f oo d sy st em To c on du ct t ra in in g of e xt en si on o ffi c er s/ fa rm er s gr ou ps o n th e lin ka ge s be tw ee n fo od sy st em s an d m ic ro nu tr ie nt d efi c ie nc ie s an d on p re ve nt io n st ra te gi es in cl ud in g fo od s af et y an d th e pr op er u se o f pe st ic id es To c on du ct r eg ul ar s ur ve ill an ce o f th e co nt am in an ts in f oo d pr od uc ts , e sp ec ia lly f ru its a nd ve ge ta bl es , t o in fo rm c on tr ol o ve r th e ap pr op ria te u se o f pe st ic id es 3. 1. 2 In cr ea se u til iz at io n of s m ar t nu tr iti on t ec hn ol og ie s fo r th e pr od uc tio n an d pr oc es si ng o f sa fe fo od To a da pt a ff or da bl e an d us ef ul e xi st in g an d ne w t ec hn ol og ie s, in cl ud in g ur ba n fa rm in g te ch ni qu es , b io te ch no lo gy a nd g ra ft in g To e ng ag e th e bi ot ec hn ol og y fo ru m s To c on du ct h ig h- le ve l t ra in in g of b io te ch no lo gi st s an d nu tr iti on is ts o n th e m ic ro nu tr ie nt en ha nc em en t of f oo ds To in cr ea se p ar tic ip at io n in r el ev an t ex ch an ge f or um s, t ra de f ai rs a nd m ee tin gs , i nc lu di ng in te rn at io na l c ol la bo ra tio ns c on ce rn in g m ic ro nu tr ie nt s To c on du ct fe as ib ili ty s tu di es t o id en tif y ot he r fo od v eh ic le s of m ic ro nu tr ie nt s, a nd o th er fo od s ric h in m ic ro nu tr ie nt s to b e us ed s el ec tiv el y fo r fo od -t o- fo od f or tifi c at io n, w hi ch h el ps t o op tim iz e th e av ai la bl e m ic ro nu tr ie nt s To c re at e aw ar en es s an d re cr ui t pr od uc er s fo r th e pi lo t pr od uc tio n of m ic ro nu tr ie nt -r ic h fo od s To c on du ct t ra in in g of p ro du ce rs o n pr ac tic al f or tifi c at io n, b io fo rt ifi ca tio n, t he s up pl em en ta tio n pr oc es s, a nd g oo d m an uf ac tu rin g pr ac tic es (G M P s) t o m in im iz e m yc ot ox in c on ta m in at io n 3. 1. 3 S tr en gt he n th e ut ili za tio n of g oo d po st -h ar ve st h an dl in g pr oc es se s (c ol d ch ai n st or ag e an d pr es er va tio n) To c on du ct a dv oc ac y m ee tin gs t o pr om ot e th e im pl em en ta tio n of t he N at io na l P os t- H ar ve st M an ag em en t S tr at eg y (N P H M S ) 2 01 9- 20 29 39National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 3. 2 S tr en gt he n fo od e nv iro nm en ts th at p ro m ot e th e co ns um pt io n of sa fe a nd n ut rit io us fo od s 3. 2. 1 S tr en gt he n fo od q ua lit y an d sa fe ty s ta nd ar ds To p ro m ot e be st p ra ct ic es a cr os s th e va lu e ch ai n fo r fo od p ro du ct io n, h ar ve st in g, p ro ce ss in g an d st or ag e pr ac tic es 3. 2. 2 Im pr ov e pr e- a nd p os t- m ar ke tin g m on ito rin g sy st em s fo r fo rt ifi ed a nd b io fo rt ifi ed f oo ds To c on du ct r ou tin e m on ito rin g of t he p ro du ct io n of m ic ro nu tr ie nt -r ic h fo od p ro du ct s, in cl ud in g fo rt ifi ed a nd b io fo rt ifi ed f oo ds To c on du ct r ou tin e m on ito rin g of t he p os t- m ar ke t su rv ei lla nc e of f or tifi e d an d bi of or tifi e d fo od s To e st ab lis h la bo ra to ry c ap ac ity a nd h um an r es ou rc es f or t he la bo ra to ry a ss es sm en ts o f fo rt ifi ed an d bi of or tifi e d fo od s To e nf or ce c ap ac ity b ui ld in g fo r pe rs on ne l ( of fi c er s/ in sp ec to rs ) i nv ol ve d in t he s ur ve ill an ce a nd m on ito rin g of m ic ro nu tr ie nt -r ic h fo od s S tr at eg ic O u tc o m e 4. S tr en g th en ed m u lt is ec to ra l a n d p ri va te s ec to r en g ag em en t fo r n u tr it io n 4. 1 Im pr ov ed ca pa ci ty a m on g pr iv at e se ct or ac to rs t o pr od uc e sa fe a nd n ut rit io us fo od a cr os s th e va lu e ch ai n 4. 1. 1 E ns ur e th e pr ov is io n of ne ce ss ar y su pp or t an d th e av ai la bi lit y of f un ct io na l s up po rt st ru ct ur es , i nc lu di ng p ol ic ie s, gu id el in es a nd in ce nt iv es f or fo od p ro du ct io n, p ro ce ss in g, st or ag e an d m ar ke tin g th ro ug h su pp le m en ta tio n, f or tifi c at io n an d di et ar y di ve rs ity To e qu ip a nd s tr en gt he n sm al l a nd m ed iu m -s ca le m ill er s to im pl em en t fo od f or tifi c at io n ac co rd in g to t he p re sc rib ed s ta nd ar ds To a dv oc at e fo r nu tr iti on -s en si tiv e po lic ie s to s ta ke ho ld er s To p ro m ot e im pl em en ta tio n of t he f oo d fo rt ifi ca tio n re gu la tio n, t he f oo d bi of or tifi c at io n gu id el in e, th e fo od r eg is tr at io n an d sa fe ty a ct , a nd o th er n ut rit io n- fr ie nd ly a gr ic ul tu ra l p ol ic ie s To d ev el op p ol ic y br ie fs o n m ic ro nu tr ie nt is su es a lo ng t he f oo d sy st em s To f or ge s tr at eg ic p ar tn er sh ip s by a dv oc at in g fo r in ve st m en t in t he p ro du ct io n of m ic ro nu tr ie nt - ric h co m m od iti es , i n fo od p ro ce ss in g, d is tr ib ut io n, a nd a gr ib us in es s 4. 1. 2. S up po rt t he e ng ag em en t of t he p riv at e se ct or t ow ar ds t he pr of es si on al iz at io n of t he s al t in du st ry To a dv oc at e fo r l ar ge a nd m ed iu m s al t p ro du ce rs to a do pt th e co ns ol id at io n m od el fo r s al t i od at io n To c ap ac ita te s m al l-s ca le s al t pr od uc er s to p ro du ce q ua lit y sa lt To s tr en gt he n th e su rv ei lla nc e sy st em f or t he a va ila bi lit y of io da te d sa lt in t he c ou nt ry To s tr en gt he n la w e nf or ce m en t in s al t pr od uc tio n an d to s tr en gt he n th e pr oc es si ng , d is tr ib ut io n an d th e po in t of s al e of io da te d sa lt in t he c ou nt ry 4. 1. 3 In te ns ify s oc ia l m ar ke tin g of f or tifi e d m ai ze fl ou r ac ro ss t he m aj or m ai ze -c on su m in g re gi on s To d es ig n an d en su re t he b ra nd in g of t he m ill er s’ p ac ka gi ng m at er ia ls t o fa ci lit at e th e ea sy vi si bi lit y of t he p ro du ct s an d to c at ch t he a tt en tio n of t he c on su m er s To o pe n m ar ke ts f or f or tifi e d m ai ze fl ou r th ro ug h m ar ke tin g lin ka ge s To c on du ct m ed ia s em in ar s to t al k ab ou t fo rt ifi ca tio n re gu la tio ns a nd t he h ea lth b en efi t s of co ns um in g fo rt ifi ed f oo ds 40 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s To p re pa re a nd d is se m in at e w ar d- le ve l e xt er na l m on ito rin g (Q A /Q C ) g ui de lin es f or f oo d fo rt ifi ca tio n by S M E s 4. 2 In cr ea se d ca te go rie s of pr iv at e se ct or en ga ge d in de liv er in g nu tr iti on in te rv en tio ns 4. 2. 1 S tr en gt he n th e co or di na tio n of t he p riv at e se ct or u si ng t he ex is tin g nu tr iti on p la tf or m s an d cr ea te s us ta in ab le c oo rd in at io n m ec ha ni sm s To m ap k ey s ta ke ho ld er s th at a re e ng ag ed in t he m ic ro nu tr ie nt n ut rit io n se ct or a nd e st ab lis h lin ka ge s th ro ug h th e ex is tin g pl at fo rm s To d ev el op c le ar T oR o n th e en ga ge m en t of t he p riv at e se ct or To p re pa re a nd d is se m in at e pr iv at e se ct or e ng ag em en t ro ad m ap s w hi ch w ill id en tif y th e in te rs ec tio n po in t be tw ee n th e go ve rn m en t an d th e pr iv at e se ct or To c on du ct a dv oc ac y m ee tin gs w ith m aj or f oo d pr od uc er s, im po rt er s, a nd t ra de rs o n th e nu tr iti on al n ee ds o f th e po pu la tio n S tr at eg ic O u tc o m e 5. E n ab lin g e n vi ro n m en ts ( ad eq u at e p o lic ie s an d f ra m ew o rk s) t h at a re s u p p o rt iv e o f ad eq u at e h u m an a n d fi n an ci al r es o u rc es fo r n u tr it io n 5. 1 A de qu at e m ul tis ec to ra l a nd m ul tis ta ke ho ld er co lla bo ra tio ns a nd co or di na tio n fo r nu tr iti on 5. 1. 1 S tr en gt he n m ul tis ec to ra l an d m ul tis ta ke ho ld er c oo rd in at io n an d co lla bo ra tio n am on g nu tr iti on ac to rs s uc h as p ub lic s ec to r (T FN C , P O -R A LG , t he M in is tr y of H ea lth C om m un ity D ev el op m en t, G en de r, E ld er ly a nd C hi ld re n (M O H C D G E C ), Ta nz an ia B ur ea u of S ta nd ar ds (T B S ), th e Ta nz an ia M ed ic in es a nd D ev ic es A ge nc ie s (T M D A )), p riv at e se ct or , N G O s/ C S O s, a ca de m ic in st itu tio ns a nd D P s To c on du ct q ua rt er ly m ic ro nu tr ie nt t he m at ic w or ki ng g ro up (T W G ) m ee tin gs To c on du ct b ia nn ua l N at io na l C ou nc il fo r C on tr ol o f Io di ne D efi c ie nc y D is or de rs (N C C ID D ) m ee tin gs To c on du ct b ia nn ua l N at io na l F oo d Fo rt ifi ca tio n A lli an ce (N FF A ) m ee tin gs 5. 1. 2 E m ph as iz e th e av ai la bi lit y an d im pl em en ta tio n of t he le gi sl at io ns a nd g ui de lin es f or nu tr iti on w ith c om pr eh en si ve m an da to ry s ta nd ar ds f or a ll m ar ke te d fo od p ro du ct s an d su pp le m en ts To r ev ie w m ic ro nu tr ie nt g ui de lin es a nd s ta nd ar ds a s ap pr op ria te To c on du ct a dv oc ac y m ee tin gs t o pr om ot e in ve st m en t in n ut rit io n To a dv oc at e fo r im pl em en ta tio n an d en fo rc em en t of t he a va ila bl e le gi sl at io n on m ic ro nu tr ie nt fo rt ifi ca tio n To a dv oc at e fo r th e de ve lo pm en t of le gi sl at io ns /r eg ul at io ns w hi ch g ov er n fo od s af et y an d th e pr oc es si ng a nd m ar ke tin g of f or tifi e d an d bi of or tifi e d fo od p ro du ct s 41National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s To e st ab lis h TW G s on t he le gi sl at io ns /p ol ic y en vi ro nm en ts o n nu tr iti on To im pr ov e th e po lic ie s an d en su re t ha t th e fr am ew or ks w hi ch a re s up po rt iv e of m ic ro nu tr ie nt nu tr iti on a re in p la ce . 5. 1. 3 C on tin ue s en si tiz at io n an d ad vo ca cy t o bu ild in st itu tio na l a nd hu m an r es ou rc e ca pa ci ty f or t he ef fe ct iv e de liv er y of m ic ro nu tr ie nt nu tr iti on in te rv en tio ns in b ot h th e pu bl ic a nd t he p riv at e se ct or To d ev el op IE C m at er ia ls o n m ic ro nu tr ie nt s, f oo d fo rt ifi ca tio n, b io fo rt ifi ca tio n an d sa lt io da tio n fo r pu bl ic a nd p riv at e se ct or s en si tiz at io n To d is se m in at e th e IE C m at er ia ls t he u si ng a pp ro pr ia te c ha nn el s To c on du ct c ap ac ity -b ui ld in g se ss io ns f or t he p riv at e se ct or o n th e de liv er y of m ic ro nu tr ie nt in te rv en tio ns 5. 2 A de qu at e da ta ge ne ra tio n an d ut ili za tio n 5. 2. 1 G en er at e da ta o n m ic ro nu tr ie nt d efi c ie nc y in di ca to rs fo r vu ln er ab le g ro up s to b e in cl ud ed e .g ., ch ild re n ag ed le ss th an t w o ye ar s, a do le sc en ts , a nd th e el de rly To c on du ct p er io di c na tio na l m ic ro nu tr ie nt s ur ve ys t o ge ne ra te d at a on t he c ou nt ry ’s s ta tu s re ga rd in g fo llo w in g ke y m ic ro nu tr ie nt s su ch a s vi ta m in A , v ita m in B 12 , i ro n/ fe rr iti n, f ol at e, z in c, vi ta m in d , c al ci um a nd io di ne To e ng ag e re se ar ch a nd a ca de m ic in st itu tio ns t o de ve lo p re se ar ch p rio rit ie s on t he p re ve nt io n an d co nt ro l o f m ic ro nu tr ie nt d efi c ie nc ie s To e nh an ce fi na nc ia l s up po rt f or o pe ra tio na l r es ea rc h ac tiv iti es o n m ic ro nu tr ie nt s To m on ito r m ic ro nu tr ie nt d efi c ie nc ie s th ro ug h ro ut in e da ta c ol le ct ed f ro m t he h ea lth m an ag em en t in fo rm at io n sy st em (H M IS ) To e st ab lis h hu m an r es ou rc e ca pa ci ty f or t he la bo ra to ry a ss es sm en t of m ic ro nu tr ie nt de fi c ie nc ie s To e st ab lis h la bo ra to ry c ap ac ity f or t he m on ito rin g of m ic ro nu tr ie nt d efi c ie nc ie s 5. 3. H um an a nd fi n an ci al r es ou rc es 5. 3. 1 E ns ur e ad eq ua te h um an an d fi n an ci al r es ou rc es t o de liv er in te rv en tio ns o n m ic ro nu tr ie nt de fi c ie nc ie s To a dv oc at e fo r ad eq ua te h um an a nd fi na nc ia l r es ou rc es t o de liv er m ic ro nu tr ie nt n ut rit io n se rv ic es 42 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 4.2.3 Priority actions and activities to address overweight and obesity Tanzania is facing signifi cant health and economic challenges from overweight and obesity, which cause the loss of about 2.8 per cent of its annual GDP. The prevalence of obesity and overweight in adults aged 25-69 years is 30 per cent, [5] while the prevalence among women has been noted to increase from 29 per cent in 2014 to 32 per cent in 2018. Also, the trend of overweight among under-fi ve children has declined from 3.5 per cent in 2014 to 2.8 per cent in 2018. This implies that despite several interventions2 initiated by the government, the problem of overweight and obesity has continued to rise, particularly in adults aged 25-69 years. The strategies which can be applied in the prevention, control, and management of overweight and obesity include: Strengthening health-care infrastructures Strengthening overweight and obesity interventions at the workplace and community levels Advocacy of fi scal policies on sugar and sweetened beverages (SSBs) Strengthening partnerships, including public–private sector engagement Implementing National Food Based Dietary Guidelines (NFBDGs) The proposed interventions and activities to address overweight and obesity in Tanzania are shown in Table 6. 2 Among the signifi cant interventions is development and implementation of the fi rst National Multisectoral Nutrition Action Plan (NMNAP I) for the period 2016/17 – 2020/21 (United Republic of Tanzania, 2016) 43National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 T a b le 6 : P ri o ri ty A ct io n s an d a ct iv iti es to a d d re ss o ve rw ei g h t a n d o b es ity in T an za n ia S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s S tr at eg ic O u tc o m e 1. In cr ea se d c o ve ra g e o f ad eq u at e eq u it ab le a n d q u al it y n u tr it io n s er vi ce s at t h e co m m u n it y an d fa ci lit y le ve ls 1. 1 S tr en gt he ne d nu tr iti on co m m od ity s up pl y ch ai ns f or s er vi ce de liv er y 1. 1. 1 S tr en gt he n th e av ai la bi lit y of nu tr iti on c om m od iti es a t al l l ev el s To p ro cu re a nd d is tr ib ut e eq ui pm en t an d to ol s fo r nu tr iti on a ss es sm en ts a nd v ill ag e he al th an d nu tr iti on d ay s (V H N D s) (e .g ., w ei gh in g sc al es , h ei gh t bo ar ds , M U A C , s ki n- fo ld c al ip er s, bi oe le ct ric al im pe da nc e, in di re ct c al or im et ry a nd D ex a m ac hi ne s) To p ro cu re n ut rit io n- re la te d co m m od iti es (e nt er al a nd p ar en te ra l f ee ds e .g ., fr ee a m in o ac id s IV an d fa tt y ac id s IV ) f or t he m an ag em en t of D R N C D s an d ch ro ni c ill ne ss es To c on du ct a dv oc ac y m ee tin gs f or t he in cl us io n of n ut rit io n co m m od iti es in to t he n at io na l h ea lth in su ra nc e sc he m e 1. 2 In cr ea se d ac ce ss t o fa ci lit y an d co m m un ity - ba se d nu tr iti on se rv ic es t o w om en , m en , ch ild re n, a nd ad ol es ce nt s 1. 2. 1 S tr en gt he n nu tr iti on s er vi ce s in r ep ro du ct iv e an d ch ild h ea lth (R C H ) d ur in g pr en at al a nd po st na ta l p er io ds f or t he p ur po se of p re ve nt in g ex ce ss iv e w ei gh t ga in a nd im pr ov in g in fa nt -fe ed in g pr ac tic es To r ev ie w IY C F gu id el in es t o in cl ud e th e pr ev en tio n an d m an ag em en t of o ve rw ei gh t an d ob es ity (w or ki ng s es si on s, v al id at io ns , p rin tin g) To c on du ct T oT o n th e pr ev en tio n an d m an ag em en t of o ve rw ei gh t an d ob es ity (n at io na l a nd re gi on al t ra in in g) 1. 2. 2 S tr en gt he n th e pr ev en tio n an d nu tr iti on m an ag em en t of d ie t- re la te d N C D s an d ch ro ni c di se as es at h ea lth f ac ili tie s To d ev el op g ui de lin es /S O P s on n ut rit io n m an ag em en t of D R N C D s an d ch ro ni c ill ne ss es a t th e fa ci lit y le ve l ( w or ki ng s es si on s an d va lid at io n) To c on du ct t ra in in g of H C W s on n ut rit io n m an ag em en t of N C D s To c on du ct a dv oc ac y m ee tin gs w ith c om m un ity h ea lth m an ag em en t te am s (C H M Ts )/r eg io na l he al th m an ag em en t te am s (R H M Ts ) t o in cl ud e sc re en in g fo r ov er w ei gh t an d ob es ity in to o th er ex is tin g he al th p ro gr am m es e .g ., TB a nd H IV , a s pa rt o f vi ta l a ss es sm en ts in h ea lth f ac ili tie s 1. 2. 3 S tr en gt he n nu tr iti on in te rv en tio ns a t fo rm al w or kp la ce s To c on du ct s tu di es t o id en tif y th e ga ps in n ut rit io n in te rv en tio ns a t w or kp la ce s (p re pa ra tio n, fi el d w or k, a na ly si s, r ep or t w rit in g) To d ev el op n ut rit io n pa ck ag es f or w or kp la ce in te rv en tio ns b as ed o n th e id en tifi e d ga ps To c on du ct a dv oc ac y m ee tin gs w ith e m pl oy er s to im pl em en t nu tr iti on p ac ka ge s at w or kp la ce s, in cl ud in g th e pr ev en tio n of o ve rw ei gh t an d ob es ity To c on du ct s en si tiz at io n m ee tin gs a m on g fo od v en do rs in a nd a ro un d w or kp la ce s to p re pa re a nd se rv e he al th y fo od s, s na ck s, a nd d rin ks 44 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 1. 2. 4 E nh an ce c om m un ity pa rt ic ip at io n in h ea lth a nd n ut rit io n pr og ra m m es , p ar tic ul ar ly o n th e pr ev en tio n of o ve rw ei gh t an d ob es ity To d ev el op g ui de lin es o n th e sc re en in g an d in te rp re ta tio n of o ve rw ei gh t an d ob es ity f or C H W s To c on du ct t ra in in g fo r C H W s on t he s cr ee ni ng o f ov er w ei gh t an d ob es ity a t th e co m m un ity le ve l To c om m em or at e an nu al h ea lth li fe st yl e/ N C D w ee k (c oo ki ng d em on st ra tio ns , a nd b on an za s on th e pr ep ar at io n an d co ns um pt io n of f ru its a nd v eg et ab le s) 1. 2. 5 Im pr ov e E C D c en tr e an d sc ho ol -fe ed in g en vi ro nm en ts t o pr om ot e he al th ie r fo od c ho ic es an d ph ys ic al a ct iv ity To c on du ct t ra in in g fo r he al th a nd n ut rit io n te ac he rs /c oo rd in at or s, c hi ld -c ar e w or ke rs , a nd s ch oo l co m m itt ee s on t he im pl em en ta tio n of s ch oo l-f ee di ng g ui de lin es in E C D c en tr es , p rim ar y an d se co nd ar y sc ho ol s To d ev el op g ui de lin es f or f oo d ve nd or s in a nd a ro un d sc ho ol e nv iro nm en ts To c on du ct n at io na l/r eg io na l E C D c en tr es a nd s ch oo l c am pa ig ns o n nu tr iti on a nd h ea lth y lif es ty le s S tr at eg ic O u tc o m e 2: W o m en , m en , c h ild re n , a n d a d o le sc en ts p ra ct ic e ap p ro p ri at e n u tr it io n b eh av io u rs 2. 1 W om en , m en , ch ild re n, a nd ad ol es ce nt s ha ve in cr ea se d nu tr iti on kn ow le dg e an d sk ill s 2. 1. 1 S tr en gt he n S B C C To c on du ct s en si tiz at io n m ee tin gs o n he al th y lif es ty le s w ith p ol ic y m ak er s, r el ig io us le ad er s, a nd in fl u en tia l p eo pl e To c on du ct s en si tiz at io n se ss io ns f or a rt is ts a nd c el eb rit ie s on h ea lth y lif es ty le s To d ev el op /r ev ie w m es sa ge s on h ea lth y lif es ty le s am on g so ci al m ed ia h ou se s an d ar tis ts To c on du ct p ub lic a w ar en es s ca m pa ig ns o n he al th y lif es ty le s at t he r eg io na l a nd n at io na l l ev el s To c on du ct s en si tiz at io n se m in ar s on h ea lth y lif es ty le s fo r jo ur na lis ts , e di to rs a nd h ou se m ed ia in cl ud in g so ci al m ed ia S tr at eg ic O u tc o m e 3. S u st ai n ab le a n d r es ili en t fo o d s ys te m s th at a re r es p o n si ve t o n u tr it io n al n ee d s 3. 1 S tr en gt he n fo od s up pl y ch ai ns th at s up po rt fu nc tio na l f oo d sy st em s 3. 1. 1 In cr ea se t he a va ila bi lit y of nu tr ie nt -r ic h an d di ve rs ifi ed f oo ds To c on du ct a dv oc ac y m ee tin gs w ith p ol ic y/ de ci si on m ak er s on b et te r in pu t su pp ly , a nd im pr ov ed va rie tie s To c on du ct t ra in in g of a gr ic ul tu ra l e xt en si on w or ke rs o n th e pr od uc tio n of n ut rit io us f oo d To c on du ct a dv oc ac y m ee tin gs o n th e pr ov is io n of in ce nt iv es t o fa rm er s an d di st rib ut or s pr od uc in g nu tr iti ou s fo od , e .g ., fr ui ts a nd v eg et ab le s an d ke ep in g an im al s ou rc es 45National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 3. 2 S tr en gt he n fo od e nv iro nm en ts th at p ro m ot e th e co ns um pt io n of sa fe a nd n ut rit io us fo od s 3. 2. 1 S tr en gt he n fi s ca l p ol ic ie s an d re gu la te f oo d m ar ke tin g an d la be lli ng To u pd at e an d di ss em in at e th e na tio na l f oo d co m po si tio n ta bl e To c on du ct a dv oc ac y m ee tin gs w ith p ol ic y m ak er s on t ax r eg ul at io ns o n fo od s w ith h ig h co nt en t of s ug ar , s al t an d fa ts , a nd o n re st ric tio ns o f im po rt ed f oo ds w ith lo w n ut rit iv e va lu e To a da pt t he N ut rie nt P ro fi l e M od el f or t he W H O A fr ic an R eg io n fo r ce rt ai n id en tifi e d fo od s to b e re st ric te d to c hi ld re n To r ev ie w t he F oo d La be lli ng R eg ul at io ns o f 20 06 t o in cl ud e m an da to ry f ro nt -o f- pa ck n ut rit io n la be lli ng a nd m en u la be lli ng w hi ch w ill b e us ed b y fo od s er vi ce o pe ra to rs To c on du ct a dv oc ac y se ss io ns w ith le gi sl at or s an d re gu la to rs o n th e be ne fi t s of a nd t he n ee d to en fo rc e m ar ke tin g re st ric tio ns a nd la be l n ut rit iv e va lu es To c on du ct c on su lta tiv e m ee tin gs w ith f oo d in du st ry s pe ci al is ts o n th e fo rm ul at io n an d re fo rm ul at io n of f oo d pr od uc ts t ha t ar e nu tr iti on -s en si tiv e To d ev el op p ol ic ie s to c on tr ol f oo ds a nd S S B s th at a re m ar ke te d to c hi ld re n th ro ug h te le vi si on , ra di o, w ith in E C D c en tr es , s ch oo ls a nd o th er p la ce s w he re c hi ld re n ga th er (e .g ., sp or ts c lu bs ), in th e st re et s an d in d ig ita l m ed ia To c on du ct a dv oc ac y m ee tin gs o n th e ad op tio n an d en fo rc em en t of t he im pl em en ta tio n of fi sc al an d ot he r po lic ie s to c on tr ol f oo ds a nd S S B s th at a re m ar ke te d to c hi ld re n th ro ug h te le vi si on , ra di o, w ith in E C D c en tr es , s ch oo ls a nd o th er p la ce s w he re c hi ld re n ga th er (e .g ., sp or ts c lu bs ), in th e st re et s an d in d ig ita l m ed ia S tr at eg ic O u tc o m e 4: S tr en g th en ed m u lt is ec to ra l a n d p ri va te -s ec to r en g ag em en t fo r n u tr it io n 4. 1 Im pr ov ed ca pa ci ty a m on g pr iv at e se ct or ac to rs t o pr od uc e sa fe a nd n ut rit io us fo od a cr os s th e va lu e ch ai n 4. 1. 1 In cr ea se a w ar en es s on th e pr od uc tio n an d di st rib ut io n of h ea lth y fo od s am on g fo od pr od uc er s an d di st rib ut or s To c on du ct a dv oc ac y m ee tin gs w ith la rg e- sc al e fo od p ro ce ss or s on t he p ro du ct io n of h ea lth y fo od s at t he r eg io na l l ev el To o rie nt s m al l a nd m ed iu m -s ca le f oo d pr oc es so rs o n st an da rd iz ed f oo d pr oc es si ng a nd pa ck ag in g 4. 2 S tr en gt he ne d co lla bo ra tio n an d co or di na tio n am on g pu bl ic a nd pr iv at e se ct or s 4. 2. 1 S tr en gt he n co un ci l, re gi on al an d na tio na l m ul tis ta ke ho ld er pl at fo rm s/ ne tw or ks t o co or di na te ef fo rt s to r ed uc e an d pr ev en t ov er w ei gh t an d ob es ity To c on du ct s ta ke ho ld er m ee tin gs o n th e pr ev en tio n of o ve rw ei gh t an d ob es ity a t al l l ev el s 46 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 4.2.4 Enabling environments for nutrition priority actions and activities Enabling environment is the engine which achieves the impacts, outcomes, outputs, and strategies of the NMNAP II. It includes Governance; Financial and human resource mobilization; and Nutrition Information System. The nutrition information system facilitates the achievement of evidence- based information which can support the advocacy strategy for transforming food systems and nutrition security. Effective governance through political processes to achieve policies, and legal and regulatory frameworks which address all the key components of nutrition, if well-organized and sustainably conducted, will yield signifi cant achievement of the NMNAP II and eventually lead to the end of malnutrition in Tanzania. The enabling environment for nutrition in implementing NMNAP II will therefore focus on three areas: Governance: Multisectoral nutrition governance is strengthened whereby effi cient and effective multisectoral coordination at all levels should be considered through ensuring accountability, user-friendly policies, legal and regulatory frameworks, political leadership, and commitment for nutrition. Resource mobilization: Financial and human resources for the implementation of the NMNAP II mobilized at all levels. Nutrition information system: Multisectoral nutrition data generation and utilization is improved. This will be enhanced through the strategic outputs of multisectoral nutrition data- generation systems, improved national nutrition and related surveys, and operational research. The proposed actions and activities to strengthen the enabling environment for nutrition in Tanzania are shown in the following Table 7. 47National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 T a b le 7 : P ri o ri ty A ct io n s an d A ct iv iti es fo r E n ab lin g E n vi ro n m en t f o r n u tr iti o n S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s S tr at eg ic O u tc o m e 5: E n ab lin g e n vi ro n m en ts ( ad eq u at e p o lic ie s an d f ra m ew o rk s) t h at a re s u p p o rt iv e o f ad eq u at e h u m an a n d fi n an ci al r es o u rc es fo r n u tr it io n 5. 1 S tr en gt he ne d m ul tis ec to ra l co or di na tio n at a ll le ve ls 5. 1. 1 S tr en gt he n m ul tis ec to ra l nu tr iti on c oo rd in at io n pl at fo rm s To r ev ie w t he p er fo rm an ce o f th e m ul tis ec to ra l-l ev el c oo rd in at io n pl at fo rm s at a ll le ve ls (J M N R ) To u nd er ta ke r ef re sh er t ra in in gs f or m ul tis ec to ra l c oo rd in at io n pl at fo rm s at a ll le ve ls – (H ig h- le ve l S te er in g C om m itt ee f or N ut rit io n (H LS C N ) a nd R eg io na l/ C ou nc il M ul tis ec to ra l N ut rit io n S te er in g C om m itt ee (R /C M N S C ) To f ac ili ta te t he o pe ra tio na liz at io n of t he a ca de m ia p la tf or m s at t he E C D c en tr es , p rim ar y, se co nd ar y, c ol le gi at e an d un iv er si ty le ve ls To c on du ct p er io di c m ul tis ec to ra l n ut rit io n co or di na tio n m ee tin gs a t al l l ev el s (T W G , H LS C , R / C M N S C ) To a dv oc at e fo r im pr ov ed n ut rit io n go ve rn an ce t o al l m ul tis ec to ra l n ut rit io n co or di na tio n pl at fo rm s at a ll le ve ls (f ro m L G A s to h ig he r le ve ls ) 5. 1. 2 S tr en gt he n th e co nt rib ut io n of t he n ut rit io n- se ns iti ve s ec to r in t he im pl em en ta tio n of n ut rit io n in te rv en tio ns To c on du ct n ut rit io n or ie nt at io n m ee tin gs w ith n ut rit io n- se ns iti ve s ec to rs To f ac ili ta te p er io di c le ss on s an d ex pe rie nc e- sh ar in g am on g nu tr iti on -s en si tiv e se ct or s To m ai ns tr ea m t he n ut rit io n ag en da in to t he s ec to ra l a nn ua l e xh ib iti on s (i. e. , N an en an e, M ilk W ee k, S ID O , W or ld F oo d D ay , e tc .) To d ev el op a nd o pe ra tio na liz e ac co un ta bi lit y m ec ha ni sm s in n ut rit io n- se ns iti ve s ec to rs To c ap ac ita te k ey n at io na l n ut rit io n co or di na tio n in st itu tio ns To d ev el op T oR o f nu tr iti on f oc al p er so ns a nd e va lu at e th ei r pe rf or m an ce To c on du ct o rie nt at io n m ee tin gs o n N M N A P II w ith n ut rit io n- se ns iti ve s ec to rs 5. 1. 3 Le ve ra ge a nd p ro m ot e th e in no va tiv e in vo lv em en t of t he pr iv at e se ct or f or n ut rit io n To c on du ct m ap pi ng f or p riv at e- se ct or e nt iti es in vo lv ed in n ut rit io n To d ev el op a r oa d m ap f or p riv at e se ct or p ar tic ip at io n in t he im pl em en ta tio n of t he N M N A P II To u nd er ta ke p er io di c pr iv at e se ct or e ng ag em en t m ee tin gs To r ev ie w a nd e va lu at e pr iv at e se ct or e ng ag em en t in n ut rit io n in te rv en tio ns To c on du ct a n as se ss m en t on t he v ia bi lit y of p riv at e se ct or e ng ag em en t pl at fo rm s fo r nu tr iti on To a dv oc at e fo r in cr ea se d pr iv at e se ct or c on tr ib ut io ns t o nu tr iti on 48 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 5. 2 E na bl in g po lic ie s, a nd le ga l an d re gu la to ry fr am ew or ks 5. 2. 1 A de qu at e po lic ie s an d re gu la to ry f ra m ew or ks t o su pp or t m ul tis ec to ra l n ut rit io n ac tio ns To r ev ie w t he f oo d an d nu tr iti on p ol ic y of 1 99 2 to a cc om m od at e th e m ul tis ec to ra l n ut rit io n po lic y ac tio ns To r ev ie w a nd a dv oc at e th e m ai ns tr ea m in g of n ut rit io n in s ec to ra l p ol ic ie s an d pr og ra m m es To r ev ie w t he n at io na l f or tifi c at io n re gu la tio ns To d ev el op a nd d is se m in at e re gu la r po lic y br ie fs o n ke y nu tr iti on is su es To a dv oc at e fo r th e re vi si on a nd o pe ra tio na liz at io n of r el ev an t nu tr iti on -s en si tiv e re gu la tio ns To a dv oc at e fo r th e in cl us io n of n ut rit io n as a c ro ss -c ut tin g is su e in t he n at io na l p ol ic y gu id el in es 5. 2. 2 E nh an ce d en fo rc em en t of n ut rit io n- re le va nt la w s an d re gu la tio n To c ap ac ita te r eg ul at or y au th or iti es o n th e en fo rc em en t of t he r el ev an t la w s an d re gu la tio ns To p re pa re a nd d is se m in at e a di re ct or y of a ll th e ke y la w s an d re gu la tio ns t ha t af fe ct n ut rit io n To s en si tiz e st ak eh ol de rs o n w ill in g co m pl ia nc e w ith t he r el ev an t la w s an d re gu la tio ns To d ev el op b y- la w s fo r th e im pl em en ta tio n an d en fo rc em en t of n ut rit io n at t he d ec en tr al iz ed le ve l 5. 3 Po lit ic al le ad er sh ip a nd co m m itm en t fo r nu tr iti on st re ng th en ed 5. 3. 1 S tr en gt he n en ga ge m en t of t he p ar lia m en t an d pa rli am en ta ria ns in s ca lin g- up nu tr iti on To p ro vi de c ap ac ity b ui ld in g to M em be rs o f Pa rli am en t (M P s) o n nu tr iti on is su es To s en si tiz e M P s on t he n ee d to in cr ea se d om es tic r es ou rc es f or n ut rit io n To s en si tiz e M P s (C om m itt ee s) o n th e ne ed f or s us ta in ab le a nd e qu ita bl e fu nd in g fo r th e nu tr iti on s ec to r To a dv oc at e fo r nu tr iti on s ec to r vi si bi lit y w ith in t he p ar lia m en ta ry s ta nd in g co m m itt ee s (F ac t sh ee ts a nd g ui de lin es ) To a dv oc at e fo r de ta ile d C on tr ol le r an d A ud ito rs G en er al (C A G ) r ep or ts o n th e co un ci ls ’ o w n so ur ce e xp en di tu re f or n ut rit io n (P ar lia m en t to s up po rt b y pu tt in g re so lu tio ns d ire ct in g C A G t o de m an d th is ) To d ev el op a n ad vo ca cy a nd in fo rm at io n pa ck ag e fo r th e pa rli am en ta ria ns 5. 3. 2 Pr om ot e po lit ic al en ga ge m en t in s ca lin g- up n ut rit io n in te rv en tio ns To s en si tiz e po lit ic al le ad er s in n ut rit io n an d th e ne ed f or in cr ea se d po lit ic al s up po rt (n at io na l a nd su bn at io na l l ev el s) To id en tif y an d ca pa ci ta te n ut rit io n ch am pi on s To e va lu at e th e im pl em en ta tio n of n ut rit io n di re ct iv es in t he r ul in g pa rt y m an ife st o To d ev el op a nd d is se m in at e ad vo ca cy m at er ia ls f or p ol iti ca l l ea de rs 49National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 5. 3. 3 S tr en gt he n ac co un ta bi lit y m ec ha ni sm s fo r nu tr iti on a t al l le ve ls To c on du ct s ec to ra l p er io di c as se ss m en ts a nd a cc ou nt ab ili ty m ee tin gs To c on du ct c om pa ct e va lu at io n m ee tin gs a t th e na tio na l, re gi on al , a nd c ou nc il le ve ls To r ev ie w n ut rit io n co m pa ct a nd a cc ou nt ab ili ty t oo ls (s co re ca rd s) a t th e de ce nt ra liz ed le ve l To d ev el op a m ec ha ni sm f or s oc ia l a cc ou nt ab ili ty o f nu tr iti on a t th e co m m un ity le ve l To u nd er ta ke a nn ua l r ev ie w s an d le ar ni ng p la tf or m s fo r nu tr iti on To c on du ct C S O s’ a cc ou nt ab ili ty f or n ut rit io n at a ll le ve ls 5. 4 Im pr ov ed fi n an ci ng f or nu tr iti on 5. 4. 1 Im pr ov e fi n an ci ng s ys te m s fo r nu tr iti on To d ev el op , l au nc h, d is se m in at e an d us e th e na tio na l r es ou rc e m ob ili za tio n st ra te gy f or n ut rit io n To c on du ct a p re -p la nn in g se ss io n fo r nu tr iti on a t al l l ev el s To c on du ct n ut rit io n bu dg et s cr ut in iz at io n of t he s ec to r m in is tr ie s To a dv oc at e fo r th e fo rm ul at io n of n ut rit io n ob je ct iv es a nd b ud ge t lin es f or n ut rit io n su pp lie s To c on du ct a p ub lic e xp en di tu re r ev ie w (P E R ) f or n ut rit io n To a dv oc at e fo r in cr ea se d nu tr iti on f un di ng f ro m t he D P s To c on du ct a dv oc ac y to L G A s on o w n so ur ce f un di ng f or n ut rit io n To c on du ct a s tu dy o n th e in no va tio ns w ith in n ut rit io n th at c al l f or D P s an d th e pr iv at e se ct or ’s en ga ge m en t To u nd er ta ke b ud ge tin g se ss io ns t o in te gr at e nu tr iti on is su es in to t he p la n an d bu dg et s ys te m (r in g fe nc in g an d co di ng ) 5. 4. 2 S tr en gt he n th e pr iv at e se ct or ’s fi na nc ia l c on tr ib ut io n in nu tr iti on To s en si tiz e pr iv at e- se ct or e nt iti es t o fi n an ce r el ev an t nu tr iti on in te rv en tio ns To a dv oc at e fo r nu tr iti on -s en si tiv e m ic ro cr ed it sc he m es To p ro m ot e pr iv at e se ct or in ve st m en t in f oo d fo rt ifi ca tio n an d bi of or tifi c at io n To s en si tiz e na tio na l a nd in te rn at io na l D P s to e st ab lis h th e N at io na l N ut rit io n B as ke t Fu nd 5. 5 S tr en gt he n hu m an r es ou rc es fo r nu tr iti on a t al l le ve ls 5. 5. 1 S tr en gt he n hu m an r es ou rc es fo r nu tr iti on a t al l l ev el s To b ui ld t he c ap ac ity o f th e nu tr iti on o ffi c er s an d th e re le va nt s ta ff o n th e ef fe ct iv e im pl em en ta tio n of n ut rit io n ac tiv iti es To c ap ac ita te t he h ea lth -c ar e w or kf or ce o n di et et ic s an d cl in ic al n ut rit io ni st s To p re pa re h um an r es ou rc e re qu ire m en ts f or n ut rit io n (n ut rit io ni st s, d ie tit ia ns a nd o th er n ut rit io n re la te d pr of es si on s) a t al l l ev el s an d sh ar e th em w ith t he r es po ns ib le in st itu tio ns 50 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s To d ev el op a nd o pe ra tio na liz e th e Ta nz an ia N ut rit io n Le ad er sh ip p ro gr am m e To r ev ie w a nd im pl em en t th e sc he m e of s er vi ce f or n ut rit io ni st s, d ie tic ia ns , a nd o th er n ut rit io n re la te d pr of es si on s To f or m ul at e an d op er at io na liz e th e pr of es si on al b od ie s fo r nu tr iti on is ts a nd d ie tit ia ns 5. 6 Im pr ov ed m ul tis ec to ra l nu tr iti on d at a ge ne ra tio n an d ut ili za tio n 5. 6. 1 E nh an ce t he a va ila bi lit y of re le va nt d at a re la te d to n ut rit io n fr om s ec to ra l a nd d ec en tr al iz ed da ta s ys te m s To t ra in k ey n ut rit io n ac to rs o n ro ut in e da ta m an ag em en t an d re po rt g en er at io n To o rie nt n ut rit io n fo ca l p er so ns a nd t he r el ev an t of fi c er s fr om k ey li ne m in is tr ie s on M ul tis ec to ra l N ut rit io n In fo rm at io n Sy st em (M N IS ) To im pr ov e M N IS t o ac co m m od at e M E A L fr om t he N M N A P II To a dv oc at e fo r th e in cl us io n of m is si ng n ut rit io n- se ns iti ve in di ca to rs in t he ir re sp ec tiv e M N IS To d ev el op a nd d is se m in at e pe rio di c nu tr iti on f ac t sh ee ts To r ev ie w t he a va ila bl e se ct or al s ys te m s to f ac ili ta te t he N IS p er io di c up da te To r ev ie w a nd in te gr at e ov er w ei gh t an d ob es ity in di ca to rs in t he a va ila bl e in fo rm at io n sy st em pl at fo rm s ac ro ss a ll ag e gr ou ps To c on du ct r es ea rc h on t he c ul tu ra l f ac to rs a nd t he ir co nt rib ut io n to o ve rw ei gh t an d ob es ity To u nd er ta ke r ev ie w s to a lig n m aj or n at io na l a ss es sm en ts a nd s ur ve ys t o en su re t he c ov er ag e of o ve rw ei gh t an d ob es ity in di ca to rs a m on g al l a ge g ro up s (e .g ., TD H S, S TE P S, T N N S, M al ar ia N ut rit io n S ur ve ys , H B S ) 5. 6. 2 E st ab lis h a m ec ha ni sm f or ca pt ur in g an d tr ac ki ng n ut rit io n- re le va nt d at a fr om t he p riv at e se ct or To m ap t he a va ila bl e nu tr iti on d at a fr om t he p riv at e se ct or To d ev el op d at a to ol s fo r ca pt ur in g da ta f ro m t he p riv at e se ct or To im pr ov e M N IS t o ac co m m od at e re le va nt d at a ge ne ra te d fr om t he p riv at e se ct or To o rie nt k ey a ct or s fr om t he p riv at e se ct or o n da ta c ol le ct io n, a na ly si s an d m an ag em en t 5. 6. 3 O pe ra tio na liz e a co m pr eh en si ve M E A L fr am ew or k fo r th e N M N A P II To im pr ov e M N IS t o ac co m m od at e M E A L fr om t he N M N A P II To p re pa re a nd d is se m in at e th e an nu al M E A L re po rt To r ev ie w a nd u pd at e m ul tis ec to ra l n ut rit io n sc or ec ar ds t o in co rp or at e M E A L fr om t he N M N A P II 51National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O u tp u t P ri o ri ty A ct io n s A ct iv it ie s 5. 6. 4 S us ta in a nd im pr ov e na tio na l nu tr iti on a nd o th er r el at ed s ur ve ys , an d op er at io na l r es ea rc h To u nd er ta ke w or ki ng s es si on s fo r th e in cl us io n of n ut rit io n co m po ne nt s su ch a s bi om ar ke rs in na tio na l s ur ve ys (T D H S -M IS , N P S, M U C H A LI ) To u nd er ta ke m id -li ne a nd e nd -li ne r ev ie w s fo r th e N M N A P II (a ct io n re se ar ch ) To d ev el op a nd o pe ra tio na liz e a m ec ha ni sm o f ca pt ur in g re se ar ch fi nd in gs f ro m t he r el ev an t hi gh er le ar ni ng in st itu tio ns To c on du ct In te gr at ed N at io na l N ut rit io n S M A R T su rv ey s To d ev el op a nd o pe ra tio na liz e th e na tio na l n ut rit io n re se ar ch r oa dm ap To t ra in t he r el ev an t nu tr iti on s ta ke ho ld er s on n ut rit io n su rv ey s an d da ta q ua lit y as se ss m en ts To d ev el op a nd o pe ra tio na liz e nu tr iti on d at a qu al ity t oo lk its 5. 6. 5 E nh an ce c ap ac ity o n m ul tis ec to ra l d at a us e w ith in a nd ac ro ss s ec to rs To u nd er ta ke c ap ac ity b ui ld in g on d at a an al ys is , i nt er pr et at io n an d th e us e of e vi de nc e- ba se d de ci si on m ak in g To b ui ld c ap ac ity o n nu tr iti on s ur ve ys a nd t he in te gr at io n of n ut rit io n su rv ey s in o th er so ci oe co no m ic , d em og ra ph ic , a nd e pi de m io lo gi ca l s ur ve ys To c on du ct w eb in ar s on t he u se o f nu tr iti on d at a an d da ta -u se p la tf or m s To d ev el op a nd d is se m in at e pe rio di c nu tr iti on f ac t sh ee ts To g en er at e th e pe rio di c pu bl ic at io n of r es ea rc he d, r el ia bl e, v al id at ed , a nd u p- to -d at e st at is tic s To c on du ct d at a an d in fo rm at io n sh ar in g w or ks ho ps b et w ee n re se ar ch in st itu tio ns , M D A s, pr iv at e se ct or s, a nd d ec is io n m ak er s at a ll le ve ls To d ev el op a nd o pe ra tio na liz e an o pe n da ta u se a nd in fo rm at io n sh ar in g pl at fo rm 52 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 4.3 Key strategies The following are the key strategies that will be adopted for the implementation of the NMNAP II: 1. Strengthen human resources for nutrition across all sectors – It is important to strengthen the nutrition capacities of workforces across the systems, through up-to-date technical guidance, pre-service and in-service knowledge, and skill development. 2. Advocacy for the domestic fi nancing of nutrition interventions – Financial investments are critical to reach the intended nutrition targets. It is therefore important to mobilize for increased domestic fi nancing, including innovative fi nancing mechanisms. Domestic fi nancing should be the primary means of funding the NMNAP II. The NMNAP II will also advocate for a more effi cient and equitable allocation of the existing fi nancial resources. 3. System strengthening for the delivery of nutrition services – The NMNAP II is promoting the delivery of evidence-based high-impact nutrition interventions across fi ve key systems, namely, food, health, WASH, education, and social protection. These systems are meant to deliver essential nutrition services for children, adolescents, women and men. 4. Community engagement and social mobilization – Community engagement seeks to mobilize communities to collectively participate in addressing the nutrition situation of children, adolescents, women, and men. By sharing knowledge, raising awareness, and strengthening capacities, communities will be made to participate in the analysis, design, implementation and monitoring of context-specifi c responses for nutrition. 5. SBCC – It is the strategic use of communication approaches to promote changes in knowledge, attitudes, norms, beliefs, and behaviours. It is a participatory process, engaging individuals and communities in identifying and demanding their rights, and adopting and sustaining positive behaviours. The NMNAP II will use SBCC to effectively understand and infl uence the individual practices and social norms which affect nutrition behaviours. 6. Institutional capacity building – The NMNAP II calls for the need to build capacity at all levels of the fi ve key systems involved in delivering nutritious diets, essential nutrition services, and encouraging positive nutrition practices for children, adolescents, women, and men. 7. Private sector engagement – While the national government has the primary accountability to uphold the people’s right to nutrition; however, the private sector has a key role to play. The NMNAP II calls for programmes to engage strategically with public and private-sector actors to advocate for business policies, practices, and products that support optimal nutrition in all contexts. 8. Advocacy and policy dialogues – The NMNAP II strives to have clear policy, strategy, and programme frameworks in place, along with legislation, dedicated budgets and the promotion of policy dialogue. This will help align actions taken by the governments and other partners, promote accountability and transparency across systems, and guide resource mobilization and drive fi nancial commitments for nutrition. 9. Innovation and research – The NMNAP II seeks to create an environment in which knowledge, innovations and learning are harnessed to drive advocacy, policies, programmes, and research to improve the quality of diets, nutrition services, and nutrition practices for children, adolescents, 53National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 women and men. It is important to conduct a systematic analysis of the nutrition situation and fi nd out the determinants and drivers, including the potential pathways for positive impact on nutrition outcomes. 10. Multisectoral and systems approach – The NMNAP II calls for strengthening the capacity and accountability of fi ve key systems – food, health, WASH, education, and social protection – to deliver nutritious diets, essential nutrition services, and positive nutrition practices for children, adolescents, women and men. 54 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 COSTED ACTION PLANS OF NMNAP II 5CHAPTER 5.1 Context The NMNAP II budget is costed at the national level. In selecting interventions, unfi nished businesses in NMNAP I, changes in the burden of malnutrition, and the available resource envelope, were all considered in the preparation of the costed action plan. The total cost of the NMNAP II is TZS 642,349,052,101.30 (USD 279,282,196.57). Financing the NMNAP II will require concerted efforts from the Government of Tanzania, DPs, CSOs, and the private sector. However, the major investor in these nutrition priorities will be the Government of Tanzania. 5.2 Intervention prioritization The intervention prioritization was based on the cost-effectiveness approach, the available resources such as fi nancial and human resources, unfi nished businesses identifi ed in MTR 2019, climate change, emergency preparedness and cross cutting issues on nutrition. 5.3 Costing approach The method used to cost the NMNAP II is referred to as results-based costing, which lays emphasis on results. The participatory approach was used during costing preparation whereby all relevant stakeholders such as government offi cials from the relevant ministries, DPs, and CSOs, were involved throughout the whole process. The steps followed were: Identifi cation of the inputs/resources needed to perform activities Estimation of the price of each resource/input Determination of the duration of each resource and its necessary assumptions Costing the needed resources/inputs based on the quantities and frequencies Calculation of the input costs to get the activity cost 55National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Costing all the activities necessary to achieve each of the expected outputs in each KRA and the categorization of each activity according to the fi ve delivery systems Summation of the total cost of each delivery system (food, health, education, social protection and WASH) and enabling environments 5.4 Financial resource needs for implementing the NMNAP II The total budget cost to achieve the fi ve delivery systems and the enabling environment outlined in the NMNAP II from 2021/2022 to 2025/2026, is TZS 642,349,052,101 (USD 279,282,196.57). There is variation in the fi nancial need across various delivery systems (see Table 8). The resource mobilization strategy for the NMNAP II provides details for the various sources of funds. About one- third of the total NMNAP II budget is allocated to food system (33 per cent) followed by the health system (28 per cent), education (10 per cent), WASH (8 per cent) and social protection (5 per cent). The interventions that are included as enabling environments have been allocated 16 per cent of the total NMNAP II budget. 56 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 T a b le 8 : S u m m ar y o f fi n an ci al re so u rc e n ee d s fo r t h e N M N A P II p er k ey d el iv er y sy st em s an d e n ab lin g e n vi ro n m en t D E LI V E R Y S Y S T E M Y ea r 1 (2 02 1/ 22 ) Y ea r 2 (2 02 2/ 23 ) Y ea r 3 (2 02 3/ 24 ) Y ea r 4 (2 02 4/ 25 ) Y ea r 5 (2 02 5/ 26 ) T O TA L T S H S . % P er c en t TO TA L E du ca tio n 1 3, 66 2, 26 5, 00 0 1 3, 87 8, 73 1, 94 6 1 2, 43 0, 97 8, 73 4 1 2, 94 6, 06 0, 07 9 1 3, 52 2, 19 1, 40 3 6 6, 44 0, 22 7, 16 2 10 p er c en t E na bl in g en vi ro nm en ts 2 1, 20 5, 14 0, 21 1 1 8, 64 8, 36 7, 91 3 2 0, 82 0, 37 7, 23 1 1 8, 01 1, 74 0, 75 8 2 2, 13 3, 71 0, 54 5 1 00 ,8 19 ,3 36 ,6 58 16 p er c en t Fo od s ys te m 4 6, 93 2, 08 6, 71 4 4 6, 78 7, 27 1, 01 3 4 2, 08 6, 13 2, 29 2 3 7, 84 4, 09 2, 78 9 3 9, 84 8, 51 5, 71 1 2 13 ,4 98 ,0 98 ,5 19 3 3 pe r ce nt H ea lth 4 2, 84 6, 15 0, 73 1 4 3, 02 4, 15 8, 66 8 2 9, 49 2, 42 6, 70 4 3 0, 83 0, 92 0, 54 6 3 4, 17 4, 36 3, 65 6 1 80 ,3 68 ,0 20 ,3 05 2 8 pe r ce nt S oc ia l p ro te ct io n 5 ,7 99 ,7 53 ,0 00 5 ,7 81 ,4 50 ,0 19 5 ,7 59 ,9 10 ,5 45 5 ,1 63 ,3 40 ,8 32 6 ,4 08 ,1 58 ,9 32 2 8, 91 2, 61 3, 32 8 5 pe r ce nt W A S H 1 6, 65 8, 32 5, 00 0 1 7, 37 9, 79 4, 22 5 1 8, 12 7, 12 5, 37 7 7 1, 22 4, 43 8 7 4, 28 7, 08 9 5 2, 31 0, 75 6, 12 9 8 pe r ce nt E na bl in g en vi ro nm en ts 21 ,2 05 ,1 40 ,2 11 18 ,6 48 ,3 67 ,9 13 20 ,8 20 ,3 77 ,2 31 18 ,0 11 ,7 40 ,7 58 22 ,1 33 ,7 10 ,5 45 10 0, 81 9, 33 6, 65 8 16 p er c en t To ta l 1 4 7, 10 3 ,7 2 0 ,6 5 6 1 4 5 ,4 9 9 ,7 7 3 ,7 8 4 1 2 8 ,7 16 ,9 5 0 ,8 8 3 1 0 4 ,8 6 7, 3 7 9 ,4 4 3 1 16 ,1 6 1 ,2 2 7, 3 3 6 6 4 2 ,3 4 9 ,0 5 2 ,1 01 1 0 0 p e r ce n t T a b le 9 : S u m m ar y o f t h e N M N A P II b u d g et p er s tr at eg ic o u tc o m es fo r a p er io d b et w ee n 2 0 2 1 /2 2 a n d 2 0 2 5 /2 6 S tr at eg ic O u tc o m e E st im at ed B u d g et ( In B ill io n T S H S .) To ta l (I n M ill io n U S D ) Y ea r 1 (2 02 1/ 22 ) Y ea r 2 (2 02 2/ 23 ) Y ea r 3 (2 02 3/ 24 ) Y ea r 4 (2 02 4/ 25 ) Y ea r 5 (2 02 5/ 26 ) T o ta l T S H S . 1. In cr ea se d co ve ra ge o f ad eq ua te , e qu ita bl e an d qu al ity n ut rit io n se rv ic es a t th e co m m un ity a nd f ac ili ty le ve ls 77 .0 4 79 .1 0 64 .4 3 66 .9 0 72 .9 1 36 0. 38 15 6. 69 2. W om en , m en , c hi ld re n, a nd a do le sc en ts p ra ct ic e ap pr op ria te nu tr iti on b eh av io ur s 38 .1 1 39 .7 2 39 .1 9 21 .2 4 22 .0 8 16 0. 33 69 .7 1 3. S us ta in ab le a nd r es ili en t fo od s ys te m s th at a re r es po ns iv e to nu tr iti on al n ee ds 11 .4 4 11 .8 2 8. 27 2. 73 3. 24 37 .5 1 16 .3 1 4. S tr en gt he ne d m ul tis ec to ra l a nd p riv at e se ct or e ng ag em en t fo r nu tr iti on 4. 43 3. 18 2. 11 2. 06 2. 15 13 .9 3 6. 06 5. E na bl in g en vi ro nm en ts (a de qu at e po lic ie s an d fr am ew or ks ) th at a re s up po rt iv e of a de qu at e hu m an a nd fi na nc ia l r es ou rc es fo r nu tr iti on 16 .0 8 11 .6 8 14 .7 1 11 .9 3 15 .7 9 70 .1 9 30 .5 2 To ta l 14 7. 10 14 5 .5 0 12 8 .7 2 10 4 .8 7 11 6 .1 6 6 4 2 .3 5 2 7 9 .2 8 57National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Figure 13: Overview of the total budget of the NMNAP II for a period between 2021/22 and 2025/26 700 600 500 400 300 200 100 0 Year 1 (2021/22) Year 2 (2022/23) Year 3 (2023/24) Year 4 (2024/25) Year 5 (2025/26) Annual Budget (TSHS.) Cumulative Budget B ud g et (i n B ill io n T S H S .) 147 293 421 526 642 145 129 105 116 5.5 Funding opportunities and sustainability plan for the NMNAP II Tanzania’s central and local governments, in alliance with other agencies and DPs, will fi nance the NMNAP II through focused resource reallocation within the existing budgets and through mainstreaming nutrition in various sector programmes to increase resource availability. This calls for making nutrition a high priority in national programmes, specifi cally in such sectors as health, agriculture, social development, fi nance, education, trade and tourism, and local development. For successful resource mobilization, a strong advocacy strategy will be used to demonstrate to the sectors and the DPs the cost-effectiveness of the improved investment in nutrition and the consequences of failing to do so. The government recognizes that the current domestic budgets will not be able to independently fi nance the NMNAP II at the level required to sustainably improve the nutrition indicators. While the government will seek to fund the NMNAP II through domestic revenues in the long-term, it will continue to depend on external resources in the short to medium term, while progressively reducing its reliance on such resources. Opportunities for initial resource mobilization will be through such forums as monthly local DP group meetings. The government will take further advantage of the existing and new global and regional initiatives, including WHO, WFP, and the United States Agency for International Development’s Advancing nutrition, to identify the potential sources for fi nancing the nutrition programmes. The current support for nutrition programmes is fragmented and has minimal impact on the nutrition indicators. Thus, at the national level, advocacy for basket funding will be adopted for nutrition 58 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 programmes, from the national nutrition DPs, to maximize the investments in nutrition. This will facilitate a more holistic approach to nutrition programming and implementation. Additionally, some DPs provide support directly to the CSOs, NGOs, and some districts outside the government budget. While this arrangement is not discouraged, it will be appropriate to share information on the level of support provided, and the activities of the NMNAP II being funded, to have an accurate assessment of the impact on the nutrition indicators. Experience shows that cooperation between the public and private sectors, in the form of public- private partnerships, can be a powerful incentive for improving the quality and effi ciency of public services and can also be a source for fi nancing public infrastructure. There will be strategic exploration of public-private partnerships with the highest cost-effectiveness in sustainably addressing the triple burden of malnutrition in Tanzania, especially through the value addition, energy, and labor-saving technologies. Existing and available resources for nutrition within the national budget and from the private sector and DPs must be coordinated effectively to maximize impact. Additionally, the government envisions encouraging the affected communities to take ownership of their nutrition problems. If communities recognize how these problems are affecting their development and see that they can help in identifying the strategies to address these problems, the community contribution to nutrition interventions would increase and help sustain more activities. Table 10 illustrates resource mobilization plan for NMNAP II from different sources to enable its implementation. Table 10: Selected fi nancing options for funding the NMNAP II (2021/22 -2025/26) No Detail Funds to be mobilized (In TZS billion) per cent of the NMNAP II Total Budget 1 Financing need as established by the NMNAP II 642.37 100 per cent 2 Committed funds to fi nance the NMNAP II from the PO-RALG - Inclusive of 1,000 per child allocated under the compact agreement 67.22 10.5 per cent 3 TFNC nutrition specifi c budget 33.83 5.2 4 Nutrition-specifi c budgets from the MDAs 16.52 2.6 5 Budgeted expenditure for school feeding from the Ministry responsible for Education, according to the NMNAP II 11.57 1.8 6 NMNAP II funding gap (No 1 minus sum of 2-5) 523.23 79.9 per cent Financing options to fi ll the funding gap Traditional domestic sources 7 Reprioritized funds from the MoHCDGEC via HSSP V3 182.90 28.5 per cent 8 Reprioritized funds from the Ministry of Agriculture via NSAAP4 21.62 3.4 per cent 9 Tax revenue - Sin Tax (or Earmarked tax)5 44.97 7.0 per cent Traditional external sources 10 Concessional loans6 64.24 10.0 per cent 59National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 11 DPs contribution (Grants)7, including TZS 51.5 billion contribution currently indicated by the DPs 256.94 40 per cent Non-traditional fi nancing instruments 12 New/innovative sources 12.84 2 per cent 13 PRIVATE SECTOR – FOOD FORTIFICATION INVESTMENT 14.09 2 per cent Total resources mobilized for the NMNAP II 597.6 93.0 per cent Difference between funds to be mobilized and funding gap (TZS 597.6 - 523.23)8 74.37 13.1 Source: NMNAP II Resource Mobilization Strategy Report 2021 3 The fi gures are estimated under the assumption that HSSP V will attain a moderate execution rate of 30 per cent. 4 The fi gures are calculated assuming that NSAAP will accomplish a moderate execution rate of 30 per cent. 5 It is envisaged that a small percent of the Sin Tax will be imposed on the unhealthy products (i.e., sugar-sweetened beverages (SSBs) and tobacco) in order to mobilize about 7 per cent of the resources for fi nancing NMNAP II. 6 Concessional loans will be used to mobilize around 10 per cent of the funds needed for NMNAP II, and this refl ects a relatively small funding amount for an important social investment like nutrition could be acquired as stand-alone loans or integrated into loans acquired to fi nance social assistance programmes implemented by TASAF and make nutrition a core part of the existing cash transfer programmes. 7 It should be noted that the amount to be mobilized from DPs includes the fi gures which have been indicated by various DPs that will be allocated to fi nance the NMNAP II. 8 If all fi nancing options are to be fully executed the NMNAP will be over funded by 13.1 per cent - the funds to be mobilized by the selected options (TZS 597.6 billion) plus the funds planned to fi nance NMNAP II from the government budget lines (TZS 129.14 billion) will mobilize around TZS billion 726.74 for the NMNAP II despite the NMNAP II budget being TZS 642.37 billion. This calculated move will provide a crucial cushion (5 per cent of NMNAP II total budget) to the efforts of generating funds for the NMNAP II in case some of the proposed fi nancing options fail to mobilize the expected number of resources. 60 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 6.1 Overview The implementation of the NMNAP II will require strong multisectoral coordination within the nutrition sector and between other sectors to ensure coherence and synergy, which is crucial for its success. Effective nutrition governance is required to ensure that multiple determinants of malnutrition (biological, social, cultural, economic, political) are addressed and that the understanding of policy and decision makers on the impact of malnutrition on national development is increased, thus linking policies to actions. Furthermore, ensuring functional, effi cient, effective, and strategic leadership and management that adequately supports the implementation of the NMNAP II is critical to meeting the desired outcomes and targets. GOVERNANCE, INSTITUTIONAL AND LEGAL FRAMEWORK FOR NMNAP II 6CHAPTER 61National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 6.3 Key actors, their roles, and responsibilities The proposed structure streamlines and harmonizes the coordination structures to improve upon strategic leadership, management, coordination, and functional linkages. Table 11 summarizes the roles and responsibilities of the key actors. Figure 14: Coordination structure for the NMNAP II Multisectoral Nutrition Technical Working Group (MNTWG) Chair: PMO (SUN focal person) Co-Chair: TFNC MD Secretariat: TFNC Members: Line ministries, Donors, CSOs, Business networks (technical), Academia Development Partners Group on Nutrition (DPG-N) Members: UN, Donors, CSOs, Business NMNAP II Thematic Working Groups 1. Undernutrition 2. Micronutrient Defi ciencies 3. Overweight and Obesity 4. Enabling Environment High-Level Steering Committee on Nutrition (HLSCN) Chair: PMO Secretariat: PMO/TFNC Members: Line ministries (PS), UN, Donors, CSOs, Business networks (CEOs), Academia Regional Steering Committee on Nutrition Council Steering Committee on Nutrition MDAs PO-RALG CSOs (NGOs, CBOs, FBOs) LGAs structure Private Sector Actors COMMUNITY Source: Modifi ed from the NMNAP I document 6.2 Leadership, management and coordination structure The NMNAP 2016–2021 coordination structure has been adopted to ensure effective leadership, management, and coordination that adequately supports the implementation of the NMNAP II, as shown in Figure 14. 62 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Table 11: Roles and responsibilities of key actors Actor Responsibilities Prime Minister’s Offi ce (PMO) » Overall coordination of the national response to nutrition, including effective contribution by sectors through the MDAs, » Support the multisectoral response to nutrition and ensuring that nutrition is adequately mainstreamed in the policies and strategies of key line ministries, » Provide oversight for the governance and accountability of all sectors and actors in nutrition, » Promote private sector engagement and participation for the improvement of nutrition, and » Oversee and provide policy-level guidance on the overall implementation of the NMNAP II. Ministry responsible for regional administration and local government authorities » Coordination, supervision, support, guidance and monitoring of the activities at the regional and local government authorities, » Guide and monitor the integration of nutrition interventions into the regional and local government authorities’ plans and by-laws, » Coordinate and facilitate the capacity development of regional and local government administrations to plan and implement nutrition improvement programmes at the community level, and » Coordinate and monitor nutrition interventions by all actors in the regional and local government authorities using the principle of the three ones: one plan, one coordinating mechanism and one monitoring and evaluation framework. Ministries responsible for agriculture, food security, cooperatives and irrigation » Contribute towards national food and nutrition security through the increased production, processing, and marketing of safe and diversifi ed food crops, » Promote skill building to ensure the regular availability of safe foods, » Promote the multiplication of seeds, seedlings, and cuttings of the nutrient-rich varieties of crops (orange-fl eshed sweet potatoes, high- protein maize, cassava, and vitamin A-rich bananas) and distribute them to farmers, » Promote the development and adoption of culturally acceptable smart technologies in agriculture, and » Encourage, undertake and coordinate research, development and training. Ministries responsible for livestock and fi sheries » Contribute towards national food security through the increased production, processing and marketing of livestock and fi sheries products to meet the national nutritional requirements, » Improve the standards of living, health, and nutrition of the people engaged in the livestock and fi sheries industry through increased income generation from the production and consumption of livestock and fi sheries’ products, and » Ensure quality and safety of the livestock and fi sheries’ products. 63National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Actor Responsibilities Ministry responsible for health » To facilitate the scaling-up of quality and equitable basic health services (health promotion, prevention, curative and rehabilitation services) which are essential for the improvement of nutrition in the country, up till the health facility and community levels, and » To facilitate the implementation, monitoring, and coordination of the essential health interventions for the improvement of nutritional status at all levels, through the development of policies, strategies, plans and legislations in line with the HSSP V. Ministry responsible for community development, gender, elders and children » Strengthen food and nutrition services for vulnerable groups, including children with multiple vulnerabilities (MVC), people with disability (PWD) and the elderly . » Promote integration of nutrition objectives in social protection programs. » Promote household-based strategies to increase food and nutrition security, » Promote nutrition-supportive behaviours and discourage behaviours that are barriers to the improvement of nutrition, and » Advocate for the mainstreaming of nutrition issues in community development. Ministry responsible for industry and trade » Contribute to human development and the creation of employment opportunities, » Enable economic transformation to achieve sustainable development and economic growth, and » Promote the increased processing, storage, and marketing of agricultural, livestock and fi sheries’ products. Ministry responsible for water » Ensure the sustainable supply of adequate, safe and clean water up till the household level, and » Promote safe WASH practices for improved nutrition outcomes. Ministry responsible for education, science and technology » Establish policies and guidelines that highlight the link between nutrition and education, » Design and implement school health programmes » Integrate nutrition education in school and college curricula, and » Promote nutritious feeding programmes in schools, colleges and other educational institutions. Ministry responsible for fi nance and planning » Mobilize and allocate funds for the implementation of the NMNAP II and expedite the timely disbursement of allocated funds to the responsible sectors and institutions, and » Establish policies and guidelines that highlight the link between nutrition, and the fi nance and planning sector. Ministry responsible for energy and minerals » Promote better and cheaper energy in both rural and urban areas to reduce women’s workload, prevent deforestation, and increase nutrition outcomes in households. Ministry responsible for natural resources management » Ensure the integration of the nutritional rights of communities surrounding wildlife and forest reserves in their resource’s sustainable management plan. 64 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Actor Responsibilities Ministry responsible for public service and good governance » Facilitate the establishment, recruitment, and development of nutrition cadres at all levels. Ministry responsible for labour, youth, employment and persons with disability » Sensitize employers, employees, and the national labour force on the importance of good nutrition in terms of good health and high productivity. Ministry responsible for home affairs » Strengthen the enforcement of laws and regulations that facilitate food and nutrition security in the country, and ensure that the food and nutritional rights of the people under incarceration, including the prisoners, are met. Ministry responsible for information, communications, and information technology » Promote increased media coverage and public awareness of the NMNAP II and the overall nutrition issues across the country, » Promote local expertise in science, technology, and innovation for the benefi t of nutrition outcomes, » Develop and maintain regulatory regimes that facilitate the free fl ow of information, including nutrition-related information, and » Deliver government news on nutrition issues to the public offi cials through the different types of media, such as the government spokesperson. Ministry responsible for culture, arts and sports » Promote and facilitate physical exercise by improving the access to, the quality, equity, and management of sports, games, traditional games, and sports infrastructure at all levels, and » Educate the society on issues related to good tradition and the customs relevant to nutrition. Ministries responsible for infrastructure development » Ensure that functional road networks, railway, and water transport services (where applicable) are in place to facilitate access and food transportation between the producing areas and markets across the country, throughout the year. TFNC » Advise the government and other stakeholders on all key matters related to nutrition in the country, including training, human resource deployment, and the accreditation of nutritionists, » Provide strategic and technical leadership and support on nutrition to all the sectors and actors, and » Strengthen multisector coordination and collaboration; advocate for nutrition resources; promote the harmonization and alignment of sector fi nancing; provide guidance, training and technical support to the implementing agencies; and to monitor and evaluate progress. Tanzania Bureau of Standards (TBS) » Ensure that nutrition concerns are addressed in the development and monitoring of food product quality and standards. Other MDAs » Ensure that nutrition is adequately refl ected in the MDA policies, strategic plans, programmes, legislations, regulations, guidelines, and » Identify, mobilize and allocate human, fi nancial and organizational resources for the discharge of responsibilities under the NMNAP II. 65National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Actor Responsibilities Regional secretariats » Identify nutrition problems, challenges and solutions in the regions, » Integrate food and nutrition objectives in the regional secretariat plans and strategies, and » Interpret policies and policy guidelines on nutrition; maintain norms and minimum standards; provide technical guidance and supportive supervision to local government authorities on nutrition; and coordinate, monitor and evaluate the implementation of the strategy by different stakeholders at the regional level. LGAs » Strengthen the multisectoral coordination committees at the LGA level on nutrition, » Integrate the NMNAP II components/activities into their comprehensive council development plans, » Ensure the implementation of the policies, strategies and guidelines within the respective districts, » Mobilize resources for the implementation of nutrition activities, » Sensitize and support the wards and communities to initiate, implement and monitor nutrition activities at the ward and community levels, and » Coordinate, provide technical support, and monitor the implementation of the NMNAP II at the ward and village/street levels. Ward and village/street levels » Identify food and nutrition opportunities and challenges at the respective levels. Community/households » Individuals and families hold the key to maintaining and improving their own health and nutrition conditions, and they are actors in their own development. The community will be responsible for mobilizing resources, initiating, implementing, and monitoring the implementation of nutrition activities in line with regional and LGAs priorities. CSOs » Advocate for nutrition as a human development issue, » Mobilize resources for the implementation of the NMNAP II, » Provide technical and fi nancial support to LGAs in the implementation of the NMNAP II, » Support LGAs in the capacity development and management of nutrition activities, » Incorporate nutrition interventions in community-based programmes and ensure effective linkages to the health-care system and other relevant sectors, » Advocate for the prioritization of nutrition in national, regional, LGA and community development plans, » Support community mobilization and the implementation of nutrition interventions down to the household level, » Support capacity development for the improvement of food and nutrition at all levels in the LGAs, » Integrate nutrition issues into CSO programmes, projects and activities which target communities and households, and » Align the nutrition plans with the government plans at the respective levels. 66 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Actor Responsibilities Media » Highlight the problem of malnutrition in Tanzania, advocate for action, and report on the progress, failures and successes of those actions to alleviate malnutrition. Higher learning, training and research institutions » Review and update pre-service, in-service, and continuing education curricula to ensure that nutrition is adequately integrated and to increase opportunities for training in nutrition. Professional bodies » Provide professional guidance, conduct research, set professional standards, and participate in the development of nutrition curricula for pre-service, in-service and continuing education, and to support nutrition outreach activities in communities. Development partners (DPs) » Mobilize and provide technical and funding support for the improved planning, implementation, monitoring and evaluation of nutrition services and interventions, in accordance with the national policies and priorities. Private sector » Responsible for supporting government and community actions and efforts geared towards the implementation of the NMNAP II, » Invest resources for the implementation of the NMNAP II in line with the laws, regulations and guidelines, » Increase investment in the production, processing, storage, and marketing of high-value nutritious products and in the provision of essential and basic social services (food, health and WASH) for improvement in nutrition, » Invest in the production and marketing of appropriate low-cost labor- saving technologies that improve food and nutrition status at the community level, » Integrate nutrition support into the corporate social responsibility plans and activities, » Make the appropriate technologies available for nutrition improvement, including for advocacy, creating public awareness, and for tracking progress, » Initiate and improve workplace nutrition programmes for their labor force, and » Ensure compliance with all national laws, regulations, guidelines, and international protocols for the protection of consumer rights, health, and the environment. Political parties » Incorporate food and nutrition improvement issues in their election manifestos and campaigns, » Support mobilization for improved food and nutrition security in the country, » Support initiatives to improve food and nutrition, especially in vulnerable groups, and » Advocate for the prioritization of nutrition in the national, regional, LGA and community development plans. 67National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 6.4. Human resources and institutional capacity requirements The successful implementation of the NMNAP II will depend on the adequate human resources and the capacity building of the institutions dealing with nutrition. Based on the conceptual framework of the NMNAP II implementation, which embraces the system approach, there is a need to strengthen the capacity of human resources and ensure collaboration across sectors. This entails capacitating the implementers of the plan from various sectors, including professionals working in nutrition- sensitive sectors such as extension offi cers and teachers, so that they can enrich their knowledge and skills on health, food, education, WASH and social protection systems. The nutrition workforce is best portrayed as a pyramid, representing the numbers, levels of training and the occupational profi les at those levels (see Figure 15). The base consists of community health, nutrition, and extension workers who need vocational or on-the-job training to deliver some nutrition services directly to the populations (e.g., child growth monitoring and its promotion). The upper levels are nutritionists (and dietitians, where relevant) with different levels of university training for different roles: from the implementation of programmes and nutrition counselling at the individual and community levels, through programming and coordination, up till planning, advocacy, and research at the national level. Bachelor- level nutritionists and dietitians could perform most of the required nutrition activities at the national and LGA levels, and their competence could be maintained through continuous education. Figure 15: Nutrition workforce pyramid Source: Adapted from Shrimpton et al [20] Professional profi le PhD Nutrition Master of Science Nutrition Bachelor of Science in Nutrition (or Dietetics) Health (other than nutrition), Agriculture and Education Professional Community Health, Nutrition and Extension Workers Advocacy and planning research training Programming and coordination supervision training Programme implementation counselling training Integrating nutrition interventions into their activities Delivering specifi c nutrition services to the community Principal nutrition tasks 01 02 04 05 03 68 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Institutional capacity covers the ability to engage and build consensus among the nutrition stakeholders, build skills to mobilize stakeholders across sectors and create partnerships and networks around nutrition issues. This also includes the ability of institutions to develop an enabling environment that facilitates in engaging all partners, mediating divergent interests, building consensus and establishing collaborative mechanisms. Relevant institutions are required to establish and maintain the stakeholders’ commitment and support to nutrition. The key capacity areas that need to be strengthened to ensure the successful implementation of the NMNAP II interventions include, the enforcement of laws and regulations, laboratory analysis, nutrition surveillance, M&E of fortifi cation programmes, and food safety. Other capacity areas are social marketing strategies in doing SBCC for nutrition, and the use of the information technology (IT) structure to facilitate the collection, analysis, dissemination, and utilization of nutrition information. For effective coordination, there should be timely reporting and supervision through the use of relevant tools such as ToR, standard agenda, action point-tracking tool and standardized minute format, as well as more frequent dialogue on nutrition among the stakeholders. 6.5 Legal and regulatory framework for nutrition in the NMNAP II This framework represents the Government of Tanzania’s political will and its commitments to nutrition through the formulation and operationalization of evidence-based multisectoral and sectoral policies, legislations, plans, and strategies that are relevant to nutrition outcomes. The government has also adopted various global and regional policies and legal frameworks that guide, support and inform relevant actions that aim to address and reduce the impact of malnutrition at the national and LGA levels. These policies, strategies, plans and guidelines are shown in Box 2 and Box 3. 69National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Box 2: National policies and strategies National Food and Nutrition Policy (1992) Community Development Policy (1996) National Trade Policy (2003) National Population Policy (2006) National Livestock Policy (2006) National Health Policy (2007) National Agriculture Policy (2013) National Fisheries Policy (2015) Policy Guidelines for Micronutrient Supplementation (1997) Tanzania National Strategy on Infant and Young Child Nutrition (2004) National Strategy for Gender Development (2005) National Population Policy Implementation Strategy (2007) National Policy Guidelines on Infant and Young Child Nutrition (2007) Livestock Sector Development Strategy (2010) The Tanzanian Food, Drugs and Cosmetics (Iodated Salt) Regulations, 2010 Food Fortifi cation Regulations (2011) International Code of Marketing of Breastmilk Substitutes (the Code) 1981 Implementation Plan for Biotechnology Policy (2011) Tanzania Agriculture and Food Security Investment Plan (2011–2020) National Nutrition Social and Behavior Change Communication Strategy (2013–2018) National Multisectoral Nutrition Action Plan (2016–2021) Health Sector Strategic Plan V (2021 – 2026) The Ruling Party Election Manifesto 2020 – 2025 National Guidelines on Nutrition Care and Support for People Living with HIV 2016 National Accelerated Investment Agenda for Adolescents Health and Well Being (NAIA-AW) National Guideline on School Feeding and Nutrition Services to Basic Education Services National Action Plan for Non-Communicable Diseases (NCDs) (2016/2020 and 2021/2026 Draft) Marketing of Food and Designated Products for infants and Young Children Regulations (2013) Updated February 2018 70 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Box 3: Regional and global frameworks The right to good food and nutrition as a human right with the Universal Declaration of Human Rights (UDHR) with Article 25, protecting the right for people to feed themselves in dignity, formally recognized by the United Nations in 1948 The UN General Assembly 2030 Agenda for SDGs WHA Targets 2025 The WHA voluntary Global NCD Targets and Global NCD Action Plan of 2014 The WHA Comprehensive Integrated Plan on Infant and Young Child Nutrition (CIP-IYCN) 2012 The Scaling-Up Nutrition (SUN) movement launched in 2012 The 2016-2025 Decade of Action on Nutrition launched by the UN General Assembly SADC Food and Nutrition Security Strategy 2015 - 2025 AU Agenda 2063 71National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 7.1 Overview Monitoring, evaluation, accountability and learning (MEAL) is a very important tool to assess the progress of the NMNAP II in achieving the set targets and in serving as an accountability and learning framework for the various nutrition stakeholders in Tanzania. This MEAL plan will be used to track the performance, implementation and outputs, and measure the effectiveness and lessons learned during the implementation of the NMNAP II. The NMNAP II ToC highlights the desired impact to be achieved by 2026, which is ‘’Women, men, children and adolescents in Tanzania are better nourished, living healthier and more productive lives’’. To achieve this impact, the MEAL framework clarifi es the process and the interventions that will lead to the desired NMNAP II outputs. There are several notable platforms that generate data to track the implementation of nutrition interventions, however, further strengthening of data generation, quality and utilization to support nutrition is of paramount importance. The country needs to ensure that, nationally-representative nutrition surveys are conducted every 4-5 years. The National Nutrition Scorecard rolled out in all the districts of the country offers a web-based tool to support vertical accountability, providing quarterly snapshots of each district’s performance in delivering the nutrition interventions and targets specifi ed in the NMNAP II. The annual Joint Multi-Sectoral Nutrition Review (JMNR) also provides a strong platform for the follow-up and review of the progress in implementing the nutritional plans. The JMNR convenes a wide range of partners from ministries, agencies, DPs, the private sector and research institutions, alongside members of the parliament, district and regional nutrition offi cers and civil society representatives. The multiple day-long reviews examine the cross-sectoral implementation of the NMNAP II by using the latest data to facilitate unprecedented joint capacity building and learning across subnational and national administrations. 7.2 Multisectoral Nutrition Information System The Multisectoral Nutrition Information System (MNIS) enables the collection, analysis, interpretation, and reporting of information on the nutritional status of the population, and most importantly, MONITORING, EVALUATION, ACCOUNTABILITY AND LEARNING 7CHAPTER 72 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 uses this information to inform appropriate response strategies. The MNIS is characterized by a coordinated set of processes for collecting, storing, analysing, and disseminating nutrition data and information. Sources of nutrition data will also include various population-based surveys, sentinel sites and health facility programme data, which are used in nutrition surveillance and monitoring. The information system aims to integrate data from a variety of sources with the following objectives: To facilitate nutrition data collection To facilitate the monitoring of progress in the fi ght against malnutrition To strengthen mechanisms for mutual accountability between stakeholders, accountability to the State, the donors, and most importantly, the citizens To promote transparency in the investment in nutrition 7.3 Common Result, Resources, and Accountability Framework A CRRAF is a single and agreed-upon set of expected results for the improvement of nutrition, generated through the engagement of different sectors and stakeholders. CRRAF serves as the framework for NMNAP I and enables multiple stakeholders, including different government ministries and external partners, to work toward these results and to agree on the allocation of responsibilities for their implementation and achievement amongst different sectors. The CRRAF uses a logical results framework at three levels – impacts, outcomes, and output results (see Figure 16). The common results framework will continue to be implemented to: Further establish ownership from all stakeholders, otherwise it risks irrelevance. Ensure that the results and actions included in the CRRAF refl ect the realities of the people suffering from malnutrition and are grounded in evidence. Context is critical, and there is no one-size-fi ts-all approach. Ensure that nutrition-sensitive strategies are implemented across sectors with the appropriate nutrition-relevant goals in various sector plans, including health, agriculture, social protection and WASH. Specifi c attention to the nutritional needs of vulnerable individuals and communities. Ensure the prioritization of nutrition actions by the relevant partners in the “fi rst 1,000 days” window of opportunity between conception and a child’s second birthday. Create the enabling environment that is required by children and WRA, including adolescent girls, to get effective benefi ts from the nutrition-specifi c actions. Ensure the development of local-level plans informed by national recommendations, by effectively engaging the regions and councils; and Translate the common result areas into indicators for monitoring the progress of the implementation. 73National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Figure 16: Results-based M&E framework for tracking the implementation of the NMNAP II 7.4 NMNAP II monitoring process Progress monitoring of the implementation of the NMNAP II will be an ongoing process with continuous periodic reporting. Monitoring the performance and progress of the implementation will be done through quarterly and annual reports, joint annual nutrition review meetings, and through the Nutrition Score cards. At the subnational level, there are tools to collect, analyse, and communicate nutrition indicators, including the multisectoral nutrition scorecard, bottleneck analysis, COMPACT scorecard, and the annual work plans. Regions and councils produce quarterly reports which indicate the progress on the implementation of the nutrition actions taken in their respective areas. These reports are collected and analysed by PO-RALG. 7.5 NMNAP II evaluations Evaluation will be done at two points during the implementation process. Mid-Term Review The MTR is proposed to be done in 2023/24 to assess the progress made towards the implementation of the proposed and agreed interventions, to achieve the agreed objectives, and to review the relevance of the interventions. The MTR will provide an opportunity to make modifi cations to ensure the achievement of these objectives within the NMNAP II timelines. Goals Objectives Activities/ inputs Output Outcome Inputs Focus on evaluation Focus on monitoring 74 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 End-Term Review The ETR will be carried out in the year 2026 in order to: Assess performance as per the foreseen targets and indicators of achievement at the output level; and also assess the strategies and implementation arrangements, including the partnership arrangements, constraints, and opportunities Evaluate the impact of the NMNAP II against the desired outcomes as defi ned in the ToC Provide strategic and operational recommendations and highlight the lessons learnt to inform the planning of the NMNAP III 7.6 The NMNAP II planning, monitoring, evaluation and learning cycle The planning, monitoring, evaluation and learning cycle (PMELC) is an integral part of the design, implementation, and completion of the NMNAP II; PMELC is presently at the planning stage and will be implemented at all stages within the NMNAP II. The PMELC is summarized in Figure 17. Figure 17: The NMNAP II PMELC Source: Adapted from the UNODC, Evaluation Handbook • Needs assessment • Stakeholders analysis/mapping • Project design & logframe • M&E plan • Baseline study • Use of evaluation • Mid-term evaluation • Monitoring • Use of evaluation • Final evaluation Continuous learning 3. E valuation 1. Planning Evaluation results 2 . Im pl em en ta ti on Good m an ag em en t p ra ct ic es E valu atio n norm s and standards 75National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 The PMELC started with the initial needs assessment, where four KRAs were identifi ed (undernutrition, overweight and obesity, micronutrients defi ciencies and enabling environments) that needed to be addressed in the NMNAP II. These ideas were generated by learning from the existing NMNAP I, the sector policies, NMNAP MTR, global nutrition documents, other relevant documents, and through conversations with partners, communities, and funders. The in-depth understanding of the need or the problem, its underlying causes, and how it affected the target communities, was conducted through the situation analysis and stakeholders’ meetings, where the conceptual framework and the ToC were developed and adapted. During the implementation, the monitoring will be done through the existing structures outlined in the M&E plan, including a mid-term evaluation, which will provide valuable lessons to take stock of where NMNAP II is, and whether the country is on target to achieve the desired outcomes. Towards the end of the NMNAP II, a fi nal evaluation will be conducted to assess the outcome and impact of implementing the NMNAP II, which will provide the opportunity to use this learning as important inputs for the planning cycle of the NMNAP III. 7.7 Financial tracking and budget analysis for nutrition PO-RALG audits the implementation of nutrition interventions through the joint supervision and scrutinization of council plans, to ensure that funding for these interventions is properly planned and allocated according to the action plans. PO-RALG have created nutrition objectives within the government planning and reporting system, which help to track the nutritional and fi nancial resources of the councils. Expenditure for nutrition at Local Government Authorities is tracked through the planning and reporting system (PLANREP) to determine the amount of funds allocated for nutrition at decentralized levels). Nutrition activities planned at the health facility level are being tracked through the Epicor and FFARS systems, which are also linked to PLANREP. There are government machineries at all levels, which conduct the monitoring and tracking of the fi nancial expenditures for nutrition, e.g., fi nance committees at the regional and council levels. 7.8 Research Operational research and basic research are explicitly encouraged to be part-and-parcel of the implementation of the NMNAP II. Research will help to identify and test novel discoveries in nutrition and also test the feasibility of taking such innovative interventions to scale. Various operational research activities have been identifi ed to support the effective implementation of the NMNAP II, to generate data for evidence-based decision making and policy planning. Examples of the proposed activities include: To undertake working sessions for the inclusion of nutrition components such as biomarkers in national surveys (TDHS-MIS, NPS, MUCHALI) To undertake mid-line and end-line reviews for NMNAP II (action research) To develop and operationalize a mechanism for capturing research fi ndings from relevant higher- learning institutions 76 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 To conduct Integrated National Nutrition SMART surveys To develop and operationalize national nutrition research roadmaps To train the relevant nutrition stakeholders on nutrition surveys and data quality assessments To develop and operationalize a nutrition data quality toolkit 7.9 Cost of monitoring, evaluation, accountability and learning The M&E budget has been considered in the costing of the NMNAP II, to ensure that the specifi c M&E activities are carried out according to the plan. The cost of M&E is expected to be 15,881,418,200.00, which refl ects 2.4 per cent of the entire NMNAP II budget. 7.10 NMNAP II targets The key planned targets are adapted from the globally-agreed WHA nutrition targets by 2025, and the NMNAP II aims to achieve 28 key nutrition targets. The selected 28 nutrition targets constitute the CRRAF (see Appendix 2), and if achieved, will contribute signifi cantly to the desired change i.e., “Women, Men, Children and adolescents in Tanzania are better nourished living healthier and more productive lives’’. Table 12 shows the Tanzania nutrition targets for 2021-2026. Table 12: NMNAP II targets Planned Results Baseline (Year) Target 2025/26 Means of Verifi cation IMPACT RESULTS 1. Reduced prevalence of stunting among children 0-59 months 31.8% (2018) 24% TNNS 2. Maintain prevalence of global acute malnutrition among children 0-59 months 3.5% (2018) <5% TNNS 3. Reduced prevalence of low birthweight 6.3% (2018) <5% TNNS 4. Reduced proportion of non-pregnant women 15-49 years with anaemia 28.8% (2018) 23% TNNS 5. Reduced prevalence of Vitamin A defi ciency among children aged 6-59 33% (2010) 20% TDHS 6. Maintain median urinary iodine of women of reproductive age between 100- 299 μg/L by 2026 100-299 ug/L (2010) 100-299 ug/L TDHS 7. Maintain prevalence of overweight among children under fi ve 2.8 (2018) <5% TNNS 8. Maintain prevalence of overweight/obesity among women aged 15-49 years 31.7% (2018) <32% TNNS 9. Maintain prevalence of overweight among adults 26% (2012) <30% STEPS 77National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Planned Results Baseline (Year) Target 2025/26 Means of Verifi cation OUTCOME RESULTS 1. Increased proportion of children aged 0-5 months who are exclusively breastfed 58.6% (2018) 70% TNNS 2. Increased proportion of children aged 6-23 months who receive a minimum acceptable diet 30.3% (2018) 50% TNNS 3. Increased proportion of children aged 6-59 months who received Vitamin A Supplement during the last 6 months 63.8% (2018) 90% TNNS 4. Increased proportion of households consuming adequately iodized salt 61.2% (2018) 90% TNNS 5. Increased proportion of pregnant women taking iron and folic acid (IFA) for 90+ days during pregnancy 28.5% (2018) 50% TNNS 6. Increased proportion of children under fi ve in need of SAM treatment who are admitted in the program annually 13% (2018) 75% BNA 7. Increased proportion of children under fi ve in need of MAM treatment who are admitted in the program annually 8% (2018) 75% WFP Standard project Report 8. Reduced percentage of people who eat less than 5 servings of fruit and/or vegetables on average per day 97.2% (2012) 68% STEPS 9. Increased production of horticultural crops 6,556,102 tons 14,600,000 tons MoA reports 10. Increased milk production 3 Bil.L/yr (2020/21) 4.3 Bil.L/yr TDB/MLF 11. Increased per capital consumption of milk in Tanzanian population 54.7 Liters/ person/annum (2020/21) 100 Liters/ per person/per annum TDB/MLF 12. Increased number of primary schools implementing school milk feeding program 39 (2020/21) 5000 TDB/MLF 13. Increased Meat production 702.0(‘000.Mt/yr) (2020/21) 951.7(‘000.Mt/ yr) TMB/MLF 14. Increased per capital consumption of meat in Tanzanian population 15kg/person/ annum 25kg/per person/per annum TMB/MLF 15. Increased fi sh production 497,567 tons 2019/20) 600,000 tons MLF 16. Increased per capital consumption of fi sh in Tanzanian population 8.5kg/person/ annum (2019/20) 10.5kg/person/ annum MLF 17. Number of adolescents trained on health and wellbeing. 0 (2021) 2,000,000 MoH 78 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Planned Results Baseline (Year) Target 2025/26 Means of Verifi cation 18. Increased percentage of schools implementing school feeding program TBD MoEST 19. Percentage of rural population with access to piped or protected water as their main source. 70% (2020) 85% Water Sector Status report 20. Proportional of the households in Rural areas with improved sanitation facilities 36% (2020) 75% Water Sector Status report 21. Percentage of Regional Centre’s population with access to piped or protected water as their main source. 84% (2020) 95% Water Sector Status report 22. Percentage increase of social protection coverage 20% (2020) 30% PMO 23. Increased coverage of Productive Social Safety Net Program (extreme poor households) 70% (2019) 100% TASAF Report 24. Increased percentage of SMEs food processors engage in food fortifi cation NA 20% Increase from Baseline MITI 25. Increased proportion of planned budget spent on nutrition sensitive interventions 33.7% (2019) 60% PMO/PO- RALG 26. Increased proportion of councils spending a minimum budget allocation per child under fi ve to nutrition 52% (2019) 100% IMES/ PO- RALG 79National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 8.1 Introduction Risk analysis and management is the systematic use of the available nutrition information to determine the likelihood of specifi ed adverse events occurring, their magnitude, and consequences of the uncertainty of the forecasted cash fl ow streams and how to mitigate them. Risk analysis and management is one of the cornerstones of modern scientifi c and risk-based approaches to planning, and it refers to the probability of a project’s success or failure, hence its inclusion in the development of the NMNAP II. All plans face certain risks; without risks, rewards are less likely. The problem is that too much risk can lead to failure. Risk analysis allows a balance to be struck between taking risks and reducing them. 8.2 Risk analysis framework The risk analysis framework shown in Table 13, coupled with the SWOT analysis approach, is used in the assessment of risks involved in implementing the NMNAP II. SWOT stands for strengths, opportunities, weaknesses, and threats, as follows: Strengths – What advantages does the NMNAP II have in addressing malnutrition in Tanzania? How can they be used effectively to assure good implementation? Weaknesses – Are there any internal disadvantages in the plan? What should be done to address them? Opportunities – What are the current external trends which are waiting to be taken advantage of? How should this be done? Threats – Are there any external factors which may cause a problem and have a negative impact on the plan? Results of the SWOT analysis for the NMNAP II are summarized in Figure 18. Using the risk analysis framework, the risk analysis for the NMNAP II can be summarized as shown in Table 13. The results consider the likelihood of occurrence, the consequence if it occurs, the overall risk prioritization, and the possible mitigation measures. RISK ANALYSIS AND MITIGATION (RAM) 8CHAPTER 80 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Table 13: The risk analysis framework Li ke lih oo d le ve l 5-Near certain Low Medium High High High 4-Highly likely Low Medium Medium High High 3-Likely Low Low Medium Medium High 2-Unlikely Low Low Low Medium Medium 1-Remote Low Low Low Low Low 1- Negligible 2-Minor 3-Marginal 4-Critical 5-Catastrophic Consequence/impact level • NMNAP ll uses lessons learnt from previous NNAP • Brings all nutrition strategic plans together • Plan developed on basis of stakeholder participation and consensus • Presence of agreed coordination structures at all levels • CRRAF strengthens tracking of progress on results and fi nances at a strategic level • Impact of climate change: seasonal droughts and fl oods • Inadequate resources for implementation • Changing political climate • Political good will and government commitment (Vision 2025) • Improved multisectoral and global framework for nutrition actions • Existing package of high impact interventions • Local government structure under President’s Offi ce available to implement nutrition actions at all levels • Low human resource capacity • Inadequate capacity to produce nutrition commodities • Coordination and collaboration challenges in multisectoral approaches Threats Strengths Opportunities Weaknesses Figure 18: SWOT analysis for the NMNAP II 81National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 8.3 Risk mitigation An important component of the NMNAP II is to be able to identify and manage risks that may affect its smooth implementation. A summary of the results of risk analysis is presented in Table 14. It is the process of developing options and actions to enhance the opportunities and reduce the threats to the achievement of the desired objectives. The process involves: Risk identifi cation – defi ne risk events and their relationship. Risk impact assessment – assess the probability (likelihood) of their occurrence and their consequences (impacts). Consequences may include cost, schedule, technical performance; impacts as well as capability or functionality. Risk prioritization analysis – identify risk events from most to least critical. Risk mitigation – The ultimate purpose of risk identifi cation and analysis is to prepare for risk mitigation. Mitigation includes a reduction in the likelihood of a risk event occurring and/or a reduction in the effect of a risk event, even if it does occur. The interpretation of a risk is based on the likelihood of its occurrence and the level of its consequences. Risk mitigation handling options include: (i) Assume/accept: Acknowledge the existence of a particular risk, and make a deliberate decision to accept it without engaging in special efforts to control it. (ii) Avoid: Adjust programme requirements or constraints to eliminate or reduce the risk. This adjustment could be accommodated by a change in the funding, the schedule, or the technical requirements. (iii) Control: Implement actions to minimize the impact or the likelihood of the risk. (iv) Transfer: Reassign organizational accountability, responsibility, and authority to another stakeholder who is willing to accept the risk. (v) Watch/monitor: Monitor the environment for changes that might affect the nature and/or the impact of the risk and respond appropriately. 82 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 Table 14: Risk analysis and mitigation strategies for the NMNAP II Sn. Identifi ed risk Likelihood of occurrence Impact if it occurs Overall risk Risk mitigation 1 Low institutional capacity to lead and manage the NMNAP II Medium Medium Medium Develops capacity of the NMNAP- lead institutions to be able to effectively lead, coordinate and manage implementation of the NMNAP-. Include the capacities of TFNC, PMO-SUN Focal point, PO-RALG and MOHCDGEC nutrition sections 2 Low functional skilled human resource capacity especially at community level Medium Medium Medium Government to prioritize human resource development in nutrition and allocate adequate number of skilled staff to implement the NMNAP- at all levels especially at the community level 3 Inadequate funding of NMNAP II Medium High Medium Prioritize interventions and activities. TFNC in collaboration with MoHCDGEC, PMO, PO-RALG and developmental partners to develop a funding mobilization strategy 4 Low commitment and collaboration by some key stakeholders Medium Medium Medium Continue to advocate and actively coordinate with stakeholders to ensure their policies, strategies and plans on nutrition are aligned with the NMNAP- 5 Political will and government- commitment wavers Low High Low Advocacy to continue keeping nutrition high on the country’s development agenda. Monitor and track inclusion of nutrition in nutrition relevant MDAs, parliament and political parties 6 Occurrence of natural disasters (e.g. fl oods, drought, earthquake, COVID-19) Medium High Medium Accept and prepare for natural (and related) disasters. They are likely to be localized in drought/fl ood prone areas. Such areas should be prioritized in emergency/disaster-response plans. Need to monitor all possible disasters closely and respond appropriately. Develop a strategy for nutrition and climate change 7 Political instability or civil confl ict Low High Medium Monitor closely. Though the likelihood of occurring is low, overall risk is medium for low-intensity political tensions. The consequences are critical/ catastrophic if political instability occurs 8 Global and/ or national economic shocks Medium High Medium Monitor closely and adjust plan as appropriate 83National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 BIBLIOGRAPHY [1] World Bank, Tanzania: Early Childhood Development, SABER Country Report, World Bank, Washington D.C. [2] Prime Minister’s Offi ce (PMO), National Accelerated Investment Agenda for Adolescent Health & Wellbeing, PMO, Dar es Salaam, 2019. [3] South African Development Community, SADC Food and Nutrition Security Strategy 2015- 2025, SADC, Gaborone, 2014. 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[7] Lillie, Margaret, et al., ‘Nutritional status among young adolescents attending primary school in Tanzania: Contributions of mid-upper arm circumference (MUAC) for adolescent assessment’, BMC Public Health, vol. 19, no. 1, December 2019, pp. 1–2. [8] Maleta, Ken, ‘Undernutrition in Malawi’, Malawi Medical Journal, vol. 18, no. 4, 2006, pp. 189– 205. [9] Sunguya, Bruno F., et al.. ‘Trends in prevalence and determinants of stunting in Tanzania: An analysis of Tanzania demographic health surveys (1991-2016)’, Nutrition Journal, vol. 18, no. 1, Dec 2019. [10] Food and Agriculture Organization (FAO), The State of Food Security and Nutrition in the World, FAO, Rome, 2019. [11] World Health Organization, Global nutrition targets 2025: wasting policy brief, 30 December 2014, <https://www.who.int/publications/i/item/WHO-NMH-NHD-14.8>, accessed 3 September 2021. [12] Tanzania Food and Nutrition Center (TFNC), Tanzania National Nutrition Survey, TFNC, Dar Es Salaam, 2014. 84 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 [13] National Bureau of Statistics (Tanzania), Tanzania Demographic Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-16, National Bureau of Statistics, Dar es Salaam, 2016. [14] National Bureau of Statistics (Tanzania), Tanzania Demographic and Health Survey 2010, National Bureau of Statistics, Dar es Salaam, Tanzania, ICF Macro Calverton, Maryland, USA, 2011. [15] National Institute for Medical Research (Tanzania), World Health Organization (WHO), Tanzania STEPS Noncommunicable Disease Risk Factors Survey, 2012. [16] United Nations Children’s Fund (UNICEF), Nutrition, for Every Child: UNICEF Nutrition Strategy 2020–2030, UNICEF, New York, December 2020. [17] World Bank, Advancing Nutrition for Long-Term Equitable Growth, World Bank Group, Washington D.C., December 2007, <https://documents.worldbank.org/en/publication/documents-reports/ documentdetail/294311468312030062/tanzania- advancing-nutrition-for-long-term-equitable- growth>, accessed 03 September 2021. [18] Prime Minister’s Offi ce (Tanzania), Comprehensive Food Security and Nutrition Assessment Report, PMO (Tanzania), Dar Es Salaam, 2020. [19] Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC, Tanzania Mainland), Health Sector Strategic Plan V, MoHCDGEC Dar Es Salaam, Tanzania, 2021. [20] President’s Offi ce (Tanzania), ‘Tanzania Social Action Fund’, <https://www.tasaf.go.tz/>, accessed 17 September 2021. [21] Shrimpton, Roger, et al., ‘Nutrition capacity development: a practice framework’, Public Health Nutrition, vol. 17, no. 3, 2021, pp. 682–688. [22] Kristen M Hurley, Aisha K Yousafzai, 6 and Florencia Lopez-Boo Early Child Development and Nutrition: A Review of the Benefi ts and Challenges of Implementing Integrated Interventions; doi:10.3945/an.115.010363). D el iv er y S ys te m s Y ea r 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 T O TA L (T sh s) TO TA L (U S D )* E du ca tio n 13 ,6 62 ,2 65 ,0 00 .0 0 13 ,8 78 ,7 31 ,9 46 12 ,4 30 ,9 78 ,7 34 12 ,9 46 ,0 60 ,0 79 13 ,5 22 ,1 91 ,4 03 66 ,4 40 ,2 27 ,1 61 .7 2 28 ,8 87 ,0 55 .2 9 E na bl in g E nv iro nm en t 21 ,2 05 ,1 40 ,2 11 .0 0 18 ,6 48 ,3 67 ,9 13 20 ,8 20 ,3 77 ,2 31 18 ,0 11 ,7 40 ,7 58 22 ,1 33 ,7 10 ,5 45 10 0, 81 9, 33 6, 65 8. 44 4 3, 83 4, 49 4. 20 Fo od S ys te m 46 ,9 32 ,0 86 ,7 14 .0 0 46 ,7 87 ,2 71 ,0 13 42 ,0 86 ,1 32 ,2 92 37 ,8 44 ,0 92 ,7 89 39 ,8 48 ,5 15 ,7 11 21 3, 49 8, 09 8, 51 8. 73 92 ,8 25 ,2 60 .2 3 H ea lth 42 ,8 46 ,1 50 ,7 31 .3 1 43 ,0 24 ,1 58 ,6 68 29 ,4 92 ,4 26 ,7 04 30 ,8 30 ,9 20 ,5 46 34 ,1 74 ,3 63 ,6 56 18 0, 36 8, 02 0, 30 5. 20 78 ,4 20 ,8 78 .3 9 S oc ia l P ro te ct io n 5, 79 9, 75 3, 00 0. 00 5, 78 1, 45 0, 01 9 5, 75 9, 91 0, 54 5 5, 16 3, 34 0, 83 2 6, 40 8, 15 8, 93 2 28 ,9 12 ,6 13 ,3 27 .8 5 12 ,5 70 ,7 01 .4 5 W A S H 16 ,6 58 ,3 25 ,0 00 .0 0 17 ,3 79 ,7 94 ,2 25 18 ,1 27 ,1 25 ,3 77 71 ,2 24 ,4 38 74 ,2 87 ,0 89 52 ,3 10 ,7 56 ,1 29 .3 6 22 ,7 43 ,8 07 .0 1 TO TA L 14 7, 10 3, 72 0, 65 6. 31 14 5, 49 9, 77 3, 78 4 12 8, 71 6, 95 0, 88 3 10 4, 86 7, 37 9, 44 3 11 6, 16 1, 22 7, 33 6 64 2, 34 9, 05 2, 10 1. 30 27 9, 28 2, 19 6. 57 *E xc ha ng e ra te 1 U S D = 2 30 0 Ts hs . S U M M A R Y O F T H E C O S T E D A C T IV IT IE S T a b le 1 5 : S u m m ar y o f c o st ed a ct iv iti es b y d el iv er y sy st em s 1 A P P E N D IX S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 1 Tr ai n ex te ns io n w or ke rs a t th e w ar d le ve l o n th e pr ev en tio n of un de rn ut rit io n 1, 48 6, 05 0, 00 0. 00 1, 54 9, 95 0, 15 0 – – – 3, 03 6, 00 0, 15 0. 00 2 C on du ct s en si tiz at io n m ee tin g to ag ric ul tu re a nd li ve st oc k de al er s on s af e ut ili za tio n an d st or ag e of in pu ts f or c ro ps , a ni m al s an d fi s he rie s 1, 10 6, 70 0, 00 0. 00 1, 15 4, 28 8, 10 0 – – – 2 ,2 60 ,9 88 ,1 00 .0 0 3 A dv oc at e w ith t he m in is tr y of ag ric ul tu re , m in is tr y of in du st ry an d tr ad e, m in is tr y of li ve st oc k an d fi s he rie s, a nd p ar tn er s to d iv er si fy fo od p ro du ct io n w ith n ut rie nt r ic h fo od s 9, 86 0, 00 0. 00 10 ,2 83 ,9 80 – – – 20 ,1 43 ,9 80 .0 0 4 A dv oc at e w ith t he p riv at e se ct or ac to rs o n pr od uc tio n, p ac ka gi ng , an d di st rib ut io n of c on ve ni en t nu tr iti ou s, a ff or da bl e, a nd f or tifi e d fo od s 22 ,1 30 ,0 00 .0 0 23 ,0 81 ,5 90 24 ,0 74 ,0 98 – – 69 ,2 85 ,6 88 .3 7 5 E qu ip e E xt en si on w or ke rs w ith ap pr op ria te s ki lls t o pr om ot e pr od uc tio n of s af e an d nu tr iti ou s fo od s at h ou se ho ld s. 1, 56 6, 17 0, 00 0. 00 1, 63 3, 51 5, 31 0 – – – 3, 19 9, 68 5, 31 0. 00 N M N A P II B U D G E T T a b le 1 6 : N M N A P II b u d g et b y d el iv er y sy st em F O O D S Y S T E M (3 3 P E R C E N T O F N M N A P II T O TA L B U D G E T ) 2 A P P E N D IX 87National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 6 C on du ct s en si tiz at io n m ee tin g to p ro m ot e us e of a pp ro pr ia te te ch no lo gi es t o su pp or t av ai la bi lit y of n ut rit io us f oo ds (u rb an a gr ic ul tu re , s ac k ga rd en s, aq ua po ni cs , a gr yp no tic s, p la st ic fi s hp on ds , s m al l a ni m al k ee pi ng ) 1, 56 6, 17 0, 00 0. 00 1, 63 3, 51 5, 31 0 1, 70 3, 75 6, 46 8 – – 4, 90 3, 44 1, 77 8. 33 7 C on du ct s en si tiz at io n m ee tin gs on p ro m ot io n of d ev el op m en t of sa fe a nd n ut rit io us f oo d pr od uc ts am on g S M E s at r eg io na l l ev el 15 8, 27 5, 00 0. 00 16 5, 08 0, 82 5 – – – 32 3, 35 5, 82 5. 00 8 C on du ct s en si tiz at io n m ee tin gs to S M E s an d fo od in du st rie s on th e us e of t ec hn ol og ie s fo r fo od pr oc es si ng , p re se rv at io n an d st or ag e th at p re se rv e nu tr iti ve va lu e of f oo ds 15 8, 27 5, 00 0. 00 16 5, 08 0, 82 5 17 2, 17 9, 30 0 – – 49 5, 53 5, 12 5. 48 9 D ev el op / r ei nf or ce g ui de lin es a nd st an da rd s th at r eg ul at e m ar ke tin g of f oo ds . 47 ,7 20 ,0 00 .0 0 49 ,7 71 ,9 60 – – – 97 ,4 91 ,9 60 .0 0 10 A dv oc at e fo r re in fo rc em en t of re le va nt r eg ul at io ns f or s af e an d nu tr iti ou s fo od s to f oo d m an uf ac tu re s 21 ,9 90 ,0 00 .0 0 22 ,9 35 ,5 70 – – – 44 ,9 25 ,5 70 .0 0 11 A dv oc at e fo r m ar ke tin g of s af e an d nu tr iti ou s fo od in in st itu tio ns (s ch oo ls , h os pi ta ls , o ffi c es ) 1, 00 4, 86 5, 00 0. 00 1, 04 8, 07 4, 19 5 1, 09 3, 14 1, 38 5 – – 3, 14 6, 08 0, 58 0. 39 12 A dv oc at e to c om m un ity m em be rs on t he im po rt an ce o f fo od la be ls t o in fo rm f oo d ch oi ce s. 2, 03 6, 70 0, 00 0. 00 2, 12 4, 27 8, 10 0 2, 21 5, 62 2, 05 8 – – 6, 37 6, 60 0, 15 8. 30 13 To c on du ct s en si tiz at io n m ee tin gs am on g fo od v en do rs in a nd a ro un d w or ki ng p la ce s to p re pa re a nd se rv e he al th y fo od s, s na ck s an d dr in ks 65 ,9 00 ,0 00 .0 0 – – – – 65 ,9 00 ,0 00 .0 0 14 To c on du ct a dv oc ac y m ee tin gs w ith la rg e- sc al e fo od p ro ce ss or s on p ro du ct io n of h ea lth y fo od s at re gi on al le ve l – 7, 24 8, 85 0 7, 56 0, 55 1 7, 88 5, 65 4 8, 22 4, 73 7 30 ,9 19 ,7 92 .1 3 88 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 15 To o rie nt s m al l a nd m ed iu m s ca le fo od p ro ce ss or s on s ta nd ar di ze d fo od p ro ce ss in g an d pa ck ag in g – 11 ,9 68 ,4 25 12 ,4 83 ,0 67 13 ,0 19 ,8 39 13 ,5 79 ,6 92 51 ,0 51 ,0 23 .6 9 16 To c on du ct a dv oc ac y m ee tin g fo r po lic y/ de ci si on -m ak er s on be tt er in pu t su pp ly , a nd im pr ov ed va rie tie s to s ta ke ho ld er s – 59 ,0 33 ,8 00 61 ,5 72 ,2 53 64 ,2 19 ,8 60 – 18 4, 82 5, 91 3. 70 17 To im pa rt t ra in in g to a gr ic ul tu ra l ex te ns io n w or ke rs o n pr od uc tio n of n ut rit io us f oo d – 36 2, 75 5, 40 0 37 8, 35 3, 88 2 39 4, 62 3, 09 9 41 1, 59 1, 89 2 1, 54 7, 32 4, 27 3. 73 18 To c on du ct a dv oc ac y m ee tin g on pr ov is io n of in ce nt iv es t o fa rm er s an d di st rib ut or s, p ro du ci ng nu tr iti ou s fo od , e .g . f ru its a nd ve ge ta bl es , a nd a ni m al s ou rc es – – – – – – 19 To u pd at e an d di ss em in at e th e na tio na l f oo d co m po si tio n ta bl e 11 7, 70 0, 00 0. 00 – – – – 11 7, 70 0, 00 0. 00 20 To c on du ct a dv oc ac y se ss io ns w ith le gi sl at or s an d re gu la to rs o n th e be ne fi t s an d ne ed f or n ut rit io n- la be lli ng a nd e nf or ci ng m ar ke tin g re st ric tio n. 55 ,1 80 ,0 00 .0 0 57 ,5 52 ,7 40 – – – 11 2, 73 2, 74 0. 00 21 To c on du ct c on su lta tiv e m ee tin gs w ith f oo d in du st ry o n fo rm ul at io n an d re fo rm ul at io n of f oo d pr od uc t th at n ut rit io n se ns iti ve . – 40 ,3 64 ,1 00 42 ,0 99 ,7 56 43 ,9 10 ,0 46 – 12 6, 37 3, 90 2. 12 22 To d ev el op p ol ic ie s to c on tr ol fo od s an d be ve ra ge s th at a re m ar ke te d to c hi ld re n th ro ug h TV , ra di o or w ith in s ch oo ls o r ot he r pl ac es w he re c hi ld re n ga th er (e .g . s po rt s cl ub s) , i n th e st re et & D ig ita l m ed ia – 0 77 07 41 01 .6 5 80 38 82 88 .0 2 0 15 7, 46 2, 38 9. 67 23 To c on du ct a dv oc ac y m ee tin gs o n en fo rc em en t of im pl em en ta tio n of p ol ic ie s to c on tr ol f oo ds a nd be ve ra ge s th at a re m ar ke te d to ch ild re n th ro ug h TV , r ad io o r w ith in sc ho ol s or o th er p la ce s w he re ch ild re n ga th er (e .g . s po rt s cl ub s) , in t he s tr ee t, a nd d ig ita l m ed ia – 0 14 00 87 75 5 14 61 11 52 8. 4 0 28 6, 19 9, 28 3. 41 89National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 24 Fa ci lit at e av ai la bi lit y an d di st rib ut io n of m ic ro nu tr ie nt fo rt ifi ca nt s /p re m ix es f or f oo d pr oc es si ng in du st ry 28 ,5 27 ,7 21 ,7 14 .0 0 29 ,7 54 ,4 13 ,7 48 31 ,0 33 ,8 53 ,5 39 32 ,3 68 ,3 09 ,2 41 33 ,7 60 ,1 46 ,5 38 15 5, 44 4, 44 4, 77 9. 97 25 P ro m ot e ap pr op ria te u se o f m ic ro nu tr ie nt f or tifi c an ts /p re m ix es fo r fo od p ro ce ss in g in du st ry - A ct iv ity c os te d un de r tr ai ni ng o f in du st ry o n fo rt ifi ca tio n – – – – – – 26 S tr en gt he n di st rib ut io n ch an ne ls fo r m ic ro nu tr ie nt p ow de rs a nd ot he r fo od f or tifi c an ts /p re m ix es fo r ho m e an d fo od p ro ce ss in g fa ci lit ie s fo rt ifi ca tio n 55 ,1 40 ,0 00 .0 0 57 ,5 11 ,0 20 59 ,9 83 ,9 94 62 ,5 63 ,3 06 65 ,2 53 ,5 28 30 0, 45 1, 84 7. 19 27 C on du ct S B C C c am pa ig ns t o pr om ot e lo ca l m ic ro nu tr ie nt r ic h fo od s an d th ei r lin ka ge t o he al th ou tc om es 73 ,7 05 ,0 00 .0 0 76 ,8 74 ,3 15 80 ,1 79 ,9 11 – – 23 0, 75 9, 22 5. 55 28 C on du ct s oc ia l h ea th m ar ke tin g ca m pa ig ns o n su pp le m en ta tio n, fo rt ifi ca tio n, b io fo rt ifi ca tio n an d di et ar y di ve rs ifi ca tio n 81 ,9 05 ,0 00 .0 0 85 ,4 26 ,9 15 89 ,1 00 ,2 72 92 ,9 31 ,5 84 96 ,9 27 ,6 42 44 6, 29 1, 41 3. 57 29 E qu ip a nd s tr en gt he n sm al l a nd m ed iu m s ca le m ill er s to d o fo od fo rt ifi ca tio n ac co rd in g to s ta nd ar ds 1, 09 5, 36 0, 00 0. 00 1, 14 2, 46 0, 48 0 – 18 1, 99 4, 09 2 – 2, 41 9, 81 4, 57 1. 72 30 A dv oc ac y of n ut rit io n- se ns iti ve po lic ie s am on g st ak eh ol de rs t o pr om ot e th e im pl em en ta tio n of th e fo od f or tifi c at io n re gu la tio n, fo od b io fo rt ifi ca tio n gu id el in e, f oo d re gi st ra tio n an d sa fe ty a ct , a nd ot he r nu tr iti on -f rie nd ly a gr ic ul tu ra l po lic ie s 17 ,7 30 ,0 00 .0 0 18 ,4 92 ,3 90 19 ,2 87 ,5 63 20 ,1 16 ,9 28 20 ,9 81 ,9 56 96 ,6 08 ,8 36 .6 1 31 C on du ct N at io na l D ia lo gu e an d de ve lo p po lic y br ie fs o n m ic ro nu tr ie nt is su es a lo ng t he fo od s ys te m s 41 ,3 75 ,0 00 .0 0 – 45 ,0 09 ,7 52 – – 86 ,3 84 ,7 52 .3 8 90 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 32 Fo rg e st ra te gi c pa rt ne rs hi ps b y ad vo ca tin g fo r in ve st m en t in pr od uc tio n of m ic ro nu tr ie nt r ic h co m m od iti es , f oo d pr oc es si ng , di st rib ut io n, a nd a gr ib us in es s 29 2, 60 0, 00 0. 00 – 32 1, 75 0, 64 1 – 35 0, 01 6, 11 3 96 4, 36 6, 75 4. 06 33 A dv oc at e fo r sa lt pr oc es so rs in du st ry , a nd m ed iu m a nd s m al l- sc al e sa lt pr od uc er s to a do pt s al t co ns ol id at io n m od el s 45 1, 58 5, 00 0. 00 8, 02 0, 67 0 – 17 8, 65 2, 61 7 – 63 8, 25 8, 28 6. 66 34 C ap ac ita te s m al l-s ca le s al t pr od uc er s to p ro du ce q ua lit y sa lt 1, 89 7, 61 0, 00 0. 00 1, 69 2, 72 6, 42 0 1, 34 6, 69 1, 79 1 1, 40 4, 59 9, 53 8 1, 46 4, 99 7, 31 8 7, 80 6, 62 5, 06 7. 35 35 S tr en gt he n su rv ei lla nc e sy st em fo r av ai la bi lit y of io di se d sa lt in th e co un tr y; c ha ng e th is a ct iv ity to m on ito rin g vi si ts - 26 r eg io ns , vi si te d bi an nu al ly 12 ,6 40 ,0 00 .0 0 – 13 ,7 50 ,4 11 – 14 ,9 58 ,3 71 41 ,3 48 ,7 82 .6 1 36 S tr en gt he n la w -e nf or ce m en t in s al t pr od uc tio n, p ro ce ss in g, di st rib ut io n an d po in t of s al e in r eg ar d to io di se d sa lt in t he co un tr y- T B S , T M D A , M O IT , M w an as he ria M K U U , M oH , P M O , TS PA , N FF A , G A IN , U N IC E F 20 ,1 20 ,0 00 .0 0 20 ,9 85 ,1 60 21 ,8 87 ,5 22 22 ,8 28 ,6 85 23 ,8 10 ,3 19 10 9, 63 1, 68 5. 99 37 D es ig ni ng a nd b ra nd in g of m ill er s’ pa ck ag in g m at er ia ls t o fa ci lit at e ea sy f ea si bi lit y an d ca tc h th e at te nt io n of t he c on su m er – B C C ca m pa ig n on b ra nd in g of f or tifi e d fo od s in cl ud in g sa lt 29 ,2 20 ,0 00 .0 0 – – – – 29 ,2 20 ,0 00 .0 0 38 O pe n up m ar ke ts f or f or tifi e d m ai ze fl ou r th ro ug h m ar ke tin g lin ka ge s 69 ,7 00 ,0 00 .0 0 72 ,6 97 ,1 00 75 ,8 23 ,0 75 - – 21 8, 22 0, 17 5. 30 39 M ed ia s em in ar s to t al k ab ou t th e he al th b en efi t s of c on su m in g fo rt ifi ed f oo ds a nd f or tifi c at io n re gu la tio ns 47 ,9 00 ,0 00 .0 0 49 ,9 59 ,7 00 52 ,1 07 ,9 67 54 ,3 48 ,6 10 56 ,6 85 ,6 00 26 1, 00 1, 87 6. 69 40 P re pa rin g an d di ss em in at in g w ar d le ve l e xt er na l m on ito rin g (Q A / Q C ) g ui de lin e fo r S M E s fo od fo rt ifi ca tio n 23 9, 36 0, 00 0. 00 – – – – 2 39 ,3 60 ,0 00 .0 0 91National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 41 D ev el op IE C m at er ia ls o n m ic ro nu tr ie nt s, f oo d fo rt ifi ca tio n, bi of or tifi c at io n, a nd s al t io da tio n, fo r pu bl ic a nd p riv at e se ct or se ns iti za tio n 12 2, 65 0, 00 0. 00 – – – – 12 2, 65 0, 00 0. 00 42 D is se m in at e th e IE C m at er ia ls us in g ap pr op ria te c ha nn el s – – – – – – 43 S tr en gt he n la bo ra to ry c ap ac ity fo r m on ito rin g of m ic ro nu tr ie nt de fi c ie nc ie s (T FN C L ab ) 86 0, 00 0, 00 0. 00 64 6, 66 0, 00 0 67 4, 46 6, 38 0 70 3, 46 8, 43 4 73 3, 71 7, 57 7 3, 61 8, 31 2, 39 1. 36 44 C on du ct t ra in in g to e xt en si on of fi c er s / f ar m er s gr ou ps o n th e lin k be tw ee n fo od s ys te m s an d m ic ro nu tr ie nt d efi c ie nc ie s an d pr ev en tio n st ra te gi es in cl ud in g fo od s af et y an d pr op er u se o f pe st ic id es 41 5, 18 0, 00 0. 00 43 3, 03 2, 74 0 – – – 84 8, 21 2, 74 0. 00 45 C on du ct r eg ul ar s ur ve ill an ce o f he av y m et al s in f oo d pr od uc ts es pe ci al ly f ru its a nd v eg et ab le s to in fo rm c on tr ol o f an d ap pr op ria te us e of p es tic id es (T B S, G C LA ) 41 9, 54 5, 00 0. 00 – 43 7, 58 5, 43 5 – 45 6, 40 1, 60 9 1, 31 3, 53 2, 04 3. 71 46 A da pt a ff or da bl e an d us ef ul ex is tin g an d ne w t ec hn ol og ie s in cl ud in g ur ba n fa rm in g te ch ni qu es , b io te ch no lo gy , gr af tin g 13 7, 35 0, 00 0. 00 14 3, 25 6, 05 0 14 9, 41 6, 06 0 15 5, 84 0, 95 1 16 2, 54 2, 11 2 74 8, 40 5, 17 2. 50 47 E ng ag e in du st ry a nd h ig he r le ar ni ng in st itu tio ns t o id en tif y in no va tio ns a nd t ak e in no va tio ns to s ca le 26 ,3 00 ,0 00 .0 0 27 ,4 30 ,9 00 28 ,6 10 ,4 29 29 ,8 40 ,6 77 31 ,1 23 ,8 26 14 3, 30 5, 83 2. 08 48 E ng ag e bi ot ec hn ol og y fo ru m 55 ,4 00 ,0 00 .0 0 57 ,7 82 ,2 00 60 ,2 66 ,8 35 62 ,8 58 ,3 08 65 ,5 61 ,2 16 30 1, 86 8, 55 8. 84 49 C on du ct h ig h- le ve l t ra in in g of bi ot ec hn ol og is ts a nd n ut rit io ni st s on m ic ro nu tr ie nt e nh an ce m en t on fo od s 25 ,1 00 ,0 00 .0 0 26 ,1 79 ,3 00 27 ,3 05 ,0 10 28 ,4 79 ,1 25 29 ,7 03 ,7 28 13 6, 76 7, 16 2. 94 50 In cr ea se p ar tic ip at io n in r el ev an t ex ch an ge f or um s, t ra de f ai rs a nd m ee tin gs , i nc lu di ng in te rn at io na l co lla bo ra tio ns c on ce rn in g m ic ro nu tr ie nt s – – – – – – 92 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 51 C on du ct f ea si bi lit y st ud ie s to id en tif y ot he r fo od v eh ic le s of m ic ro nu tr ie nt s an d ot he r fo od s ric h in m ic ro nu tr ie nt s to b e us ed in se le ct ed f oo d- to -f oo d fo rt ifi ca tio n fo r op tim iz at io n of a va ila bl e m ic ro nu tr ie nt s 20 0, 00 0, 00 0. 00 22 0, 00 0, 00 0 24 2, 00 0, 00 0 26 6, 20 0, 00 0 29 2, 82 0, 00 0 1, 22 1, 02 0, 00 0. 00 52 C re at e aw ar en es s an d re cr ui t (p ro du ce rs ) f or p ilo t pr od uc tio n of m ic ro nu tr ie nt r ic h fo od s – – – – – – 53 Tr ai ni ng o f pr od uc er s on p ra ct ic al fo rt ifi ca tio n, b io fo rt ifi ca tio n an d go od m an uf ac tu rin g pr ac tic es (G M P s) t o m in im iz e m yc ot ox in s- co nt am in at io n – 21 2, 35 4, 80 0 – – 24 0, 94 3, 38 5 45 3, 29 8, 18 4. 97 54 C on du ct a ss es sm en t to a sc er ta in in st al le d an d ut ili ze d pr od uc tio n ca pa ci ty o f pr od uc er s fo r fo rt ifi ca tio n of s el ec te d fo od ve hi cl es 42 8, 09 5, 00 0. 00 – - – – 42 8, 09 5, 00 0. 00 55 C on du ct r ou tin e m on ito rin g of pr od uc tio n of m ic ro nu tr ie nt r ic h (in cl ud in g fo rt ifi ed a nd b io fo rt ifi ed fo od s) f oo d pr od uc ts 29 8, 98 5, 00 0. 00 31 1, 84 1, 35 5 32 5, 25 0, 53 3 33 9, 23 6, 30 6 35 3, 82 3, 46 7 1, 62 9, 13 6, 66 1. 82 56 C on du ct r ou tin e m on ito rin g of p os t- m ar ke t su rv ei lla nc e of fo rt ifi ed a nd b io fo rt ifi ed f oo ds 32 6, 98 5, 00 0. 00 35 9, 68 3, 50 0 39 5, 65 1, 85 0 43 5, 21 7, 03 5 47 8, 73 8, 73 9 1, 99 6, 27 6, 12 3. 50 57 S tr en gt he n la bo ra to ry c ap ac ity an d hu m an r es ou rc e fo r la bo ra to ry as se ss m en t fo r fo rt ifi ed a nd bi of or tifi e d fo od s 94 5, 00 0, 00 0. 00 94 3, 91 5, 00 0 65 8, 14 8, 64 5 68 6, 44 9, 03 7 71 5, 96 6, 34 5 3, 94 9, 47 9, 02 7. 05 58 E nf or ce c ap ac ity b ui ld in g fo r pe rs on ne l ( of fi c er s/ in sp ec to rs ) in vo lv ed in s ur ve ill an ce a nd m on ito rin g of f or tifi c at io n pr og ra m at t he C ou nc il le ve ls . 29 4, 14 0, 00 0. 00 30 6, 78 8, 02 0 – – – 60 0, 92 8, 02 0. 00 TO TA L FO O D S YS TE M 46 ,9 32 ,0 86 ,7 14 46 ,7 87 ,2 71 ,0 13 42 ,0 86 ,1 32 ,2 92 37 ,8 44 ,0 92 ,7 89 39 ,8 48 ,5 15 ,7 11 21 3, 49 8, 09 8, 51 8. 73 93National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 H E A LT H S Y S T E M (2 8 P E R C E N T O F N M N A P II T O TA L B U D G E T ) S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 1 C on du ct b ia nn ua l s ta ke ho ld er s’ (M S D , R C H S , M oH - N S a nd P S U , P O R A LG ) m ee tin gs to s tr ea m lin e pr oc ur em en t an d di st rib ut io n of n ut rit io n co m m od iti es 9, 90 0, 00 0. 00 10 ,3 25 ,7 00 10 ,7 69 ,7 05 – – 30 ,9 95 ,4 05 .1 0 2 Tr ai n re gi on al a nd D is tr ic t S up pl y O ffi c er s, D R C C H O , p ha rm ac is ts an d nu tr iti on is ts o n m an ag em en t (f or ec as tin g, r ep or tin g, a nd or de rin g) o f nu tr iti on s up pl ie s 44 0, 95 0, 00 0. 00 45 9, 91 0, 85 0 – – – 90 0, 86 0, 85 0. 00 3 C on du ct a nn ua l s ta ke ho ld er s m ee tin g of 2 6 re gi on s to a ss es s th e fe as ib ili ty o f pr od uc in g th e nu tr iti on c om m od iti es a nd su pp lie s 80 ,7 00 ,0 00 .0 0 81 ,0 35 ,4 00 81 ,3 85 ,2 22 81 ,7 50 ,0 87 82 ,1 30 ,6 40 40 7, 00 1, 34 9. 44 4 D ev el op / r ev ie w g ui de lin es an d st an da rd s fo r pr od uc tio n of n ut rit io n co m m od iti es a nd su pp lie s 42 ,9 00 ,0 00 .0 0 43 ,0 93 ,5 00 – – – 85 ,9 93 ,5 00 .0 0 5 C on du ct b ia nn ua l a dv oc ac y ac tiv iti es t o M oI T, S ID O , V E TA a nd S M E s to p ro m ot e lo ca l p ro du ct io n of n ut rit io n co m m od iti es a nd s up pl ie s an nu al ly 8, 30 0, 00 0. 00 – – – – 8, 30 0, 00 0. 00 6 C on du ct q ua rt er ly s up po rt iv e su pe rv is io n, m en to rs hi p an d co uc hi ng t o he al th f ac ili tie s to as se ss m an ag em en t of n ut rit io n co m m od iti es a nd s up pl ie s 24 6, 45 0, 00 0. 00 25 7, 04 7, 35 0 26 8, 10 0, 38 6 27 9, 62 8, 70 3 29 1, 65 2, 73 7 1, 34 2, 87 9, 17 5. 56 7 C on du ct m on ito rin g of e nd u se rs / be ne fi c ia rie s (e .g ., m ot he rs , ch ild re n) t o en su re r ec ei pt an d co m pl ia nc e to n ut rit io n co m m od iti es a nd s er vi ce s – 13 1, 41 8, 00 0 13 7, 06 8, 97 4 14 2, 96 2, 94 0 – 41 1, 44 9, 91 3. 88 8 C on du ct a nn ua l a dv oc ac y m ee tin gs f or r ec ru itm en t of nu tr iti on is ts a t al l l ev el s 4, 75 0, 00 0. 00 4, 95 4, 25 0 5, 16 7, 28 3 5, 38 9, 47 6 – 20 ,2 61 ,0 08 .6 6 94 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 9 Tr ai n he al th c ar e w or ke rs o n pr ev en tio n an d m an ag em en t of un de rn ut rit io n 5, 84 5, 75 0, 00 0. 00 6, 09 7, 11 7, 25 0 – – – 11 ,9 42 ,8 67 ,2 50 .0 0 10 Tr ai n co m m un ity h ea lth w or ke rs on p re ve nt io n of u nd er nu tr iti on 4, 74 1, 11 0, 00 0. 00 4, 94 4, 97 7, 73 0 – – – 9, 68 6, 08 7, 73 0. 00 11 C on du ct b ia nn ua l a dv oc ac y fo r in st itu tio na liz at io n of C H W in ce nt iv es a nd c ou nc il le ve l 7, 65 0, 00 0. 00 7, 97 8, 95 0 8, 32 2, 04 5 8, 67 9, 89 3 9, 05 3, 12 8 41 ,6 84 ,0 15 .8 0 12 C on du ct n at io na l-l ev el ad vo ca cy m ee tin g to p ro m ot e op er at io na liz at io n of c om m un ity - ba se d he al th c ar e se rv ic es gu id el in e 7, 65 0, 00 0. 00 7, 97 8, 95 0 8, 32 2, 04 5 – – 23 ,9 50 ,9 94 .8 5 13 To d es ig n re le va nt lo ca liz ed ap pr oa ch es t o pr om ot e ap pr op ria te n ut rit io n be ha vi ou rs (p ro m ot io n m at er ia ls ) d ur in g th e fi r st t hr ee y ea rs 18 ,4 75 ,0 00 .0 0 19 ,2 69 ,4 25 20 ,0 98 ,0 10 – – 57 ,8 42 ,4 35 .2 8 14 To f ac ili ta te q ua rt er ly im pl em en ta tio n of n ut rit io n S B C C a ct iv iti es a t co m m un ity le ve l ( m ed ia , t ra di tio na l g ro up s, co m m un ity g ro up s, F B O s in te rv en tio ns , e tc .) 51 ,4 00 ,0 00 .0 0 53 ,6 10 ,2 00 55 ,9 15 ,4 39 58 ,3 19 ,8 02 60 ,8 27 ,5 54 28 0, 07 2, 99 5. 03 15 To p ro cu re a nd d is tr ib ut e eq ui pm en t an d to ol s fo r nu tr iti on a ss es sm en t an d V ill ag e H ea lth a nd N ut rit io n D ay s (e .g ., w ei gh in g sc al es , an d he ig ht b oa rd s, M U A C , sk in -f ol d ca lli pe rs , b io -e le ct ric al im pe da nc e, in di re ct c al or im et ry , D ex a m ac hi ne s) 10 0, 54 5, 00 0. 00 10 4, 86 8, 43 5 10 9, 37 7, 77 8 11 4, 08 1, 02 2 11 8, 98 6, 50 6 54 7, 85 8, 74 0. 95 16 To p ro cu re n ut rit io n- re la te d co m m od iti es (e nt er al a nd pa re nt er al f ee ds , e .g ., fr ee am in o ac id s IV , f at ty a ci ds IV ) f or m an ag em en t of D R N C D s an d ch ro ni c di se as es – – – – – – 95National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 17 To c on du ct a dv oc ac y m ee tin g fo r in cl us io n of n ut rit io n co m m od iti es in to n at io na l h ea lth in su ra nc e sc he m e 27 ,1 50 ,0 00 .0 0 28 ,3 17 ,4 50 29 ,5 35 ,1 00 30 ,8 05 ,1 10 – 11 5, 80 7, 66 0. 02 18 To r ev ie w IY C F gu id el in es to in cl ud e pr ev en tio n an d m an ag em en t of o ve rw ei gh t an d ob es ity (w or ki ng s es si on s, va lid at io ns , p rin tin g) 65 ,5 50 ,0 00 .0 0 – – – – 65 ,5 50 ,0 00 .0 0 19 To c on du ct T oT o n pr ev en tio n an d m an ag em en t of o ve rw ei gh t an d ob es ity (n at io na l a nd r eg io na l tr ai ni ng ) 96 ,8 42 ,5 50 .0 0 – – – – 96 ,8 42 ,5 50 .0 0 20 To d ev el op g ui de /S O P s on nu tr iti on al m an ag em en t of D R N C D s an d ch ro ni c di se as es at f ac ili ty le ve l ( w or ki ng s es si on s an d va lid at io n) 73 ,2 00 ,0 00 .0 0 – – – – 73 ,2 00 ,0 00 .0 0 21 To c on du ct t ra in in g of H ea lth C ar e W or ke rs (H C W s) o n nu tr iti on al m an ag em en t of N C D s – 15 0, 60 9, 20 0 15 7, 08 5, 39 6 16 3, 84 0, 06 8 17 0, 88 5, 19 1 64 2, 41 9, 85 3. 73 22 To c on du ct a dv oc ac y m ee tin g to C H M T/ R H M T fo r sc re en in g fo r ov er w ei gh t an d ob es ity in to o th er e xi st in g he al th pr og ra m s, e .g ., TB , H IV a s pa rt of v ita l a ss es sm en t in t he h ea lth fa ci lit ie s 16 9, 75 0, 00 0. 00 18 5, 51 6, 60 0 19 3, 49 3, 81 4 20 1, 81 4, 04 8 21 0, 49 2, 05 2 96 1, 06 6, 51 3. 44 23 To c on du ct s tu dy t o id en tif y ga ps in n ut rit io n in te rv en tio ns at w or kp la ce (p re pa ra tio n, fi e ld w or k, a na ly si s, r ep or t w rit in g) 64 ,0 75 ,0 00 .0 0 – – – – 64 ,0 75 ,0 00 .0 0 24 To d ev el op n ut rit io n pa ck ag e fo r w or kp la ce in te rv en tio ns b as ed o n id en tifi e d ga ps – 61 ,8 49 ,9 00 – – – 61 ,8 49 ,9 00 .0 0 96 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 25 To c on du ct a dv oc ac y m ee tin g w ith e m pl oy er s to im pl em en t nu tr iti on p ac ka ge a t w or ki ng pl ac e in cl ud in g pr ev en tio n of ov er w ei gh t an d ob es ity a t th e w or kp la ce – – – – – – 26 To d ev el op g ui de o n sc re en in g an d in te rp re ta tio n of o ve rw ei gh t an d ob es ity f or C om m un ity H ea lth W or ke rs (C H W s) 59 ,3 00 ,0 00 .0 0 61 ,8 49 ,9 00 64 ,5 09 ,4 46 67 ,2 83 ,3 52 70 ,1 76 ,5 36 32 3, 11 9, 23 3. 56 27 To c on du ct t ra in in g to C H W s on s cr ee ni ng o f ov er w ei gh t an d ob es ity a t co m m un ity le ve l – 70 ,9 24 ,0 00 73 ,9 73 ,7 32 77 ,1 54 ,6 02 80 ,4 72 ,2 50 30 2, 52 4, 58 4. 86 28 To c om m em or at e an nu al h ea lth lif es ty le / N C D w ee k (c oo ki ng de m on st ra tio ns , a nd b on an za o n pr ep ar at io n an d co ns um pt io n of fr ui ts a nd v eg et ab le s) 85 ,5 00 ,0 00 .0 0 89 ,1 76 ,5 00 93 ,0 11 ,0 90 97 ,0 10 ,5 66 10 1, 18 2, 02 1 46 5, 88 0, 17 6. 55 29 To c on du ct s en si tiz at io n m ee tin g fo r p ol ic y m ak er s, r el ig io us le ad er s an d in fl u en tia l p eo pl e on he al th y lif es ty le s 16 ,8 00 ,0 00 .0 0 17 ,5 22 ,4 00 18 ,2 75 ,8 63 19 ,0 61 ,7 25 – 71 ,6 59 ,9 88 .5 2 30 To c on du ct s en si tiz at io n se ss io ns fo r ar tis ts a nd c el eb rit ie s on he al th y lif es ty le s 13 ,3 50 ,0 00 .0 0 13 ,9 24 ,0 50 14 ,5 22 ,7 84 15 ,1 47 ,2 64 15 ,7 98 ,5 96 72 ,7 42 ,6 94 .2 3 31 To d ev el op /r ev ie w m es sa ge s on he al th y lif es ty le s am on g so ci al m ed ia h ou se s an d ar tis ts 59 ,4 50 ,0 00 .0 0 – – 67 ,4 53 ,5 46 – 12 6, 90 3, 54 5. 84 32 To c on du ct p ub lic a w ar en es s ca m pa ig ns o n he al th y lif es ty le a t re gi on al a nd n at io na l l ev el – 1, 03 2, 30 9, 25 0 1, 07 6, 69 8, 54 8 1, 12 2, 99 6, 58 5 1, 17 1, 28 5, 43 8 4, 40 3, 28 9, 82 1. 52 33 To c on du ct s en si tiz at io n se m in ar s on h ea lth y lif es ty le s fo r jo ur na lis ts , e di to rs a nd h ou se m ed ia in cl ud in g so ci al m ed ia 10 ,4 25 ,0 00 .0 0 10 ,8 73 ,2 75 11 ,3 40 ,8 26 11 ,8 28 ,4 81 12 ,3 37 ,1 06 56 ,8 04 ,6 88 .1 9 34 To c on du ct s ta ke ho ld er s m ee tin g on p re ve nt io n of o ve rw ei gh t an d ob es ity a t al l l ev el s – 36 ,1 92 ,1 00 37 ,7 48 ,3 60 39 ,3 71 ,5 40 41 ,0 64 ,5 16 15 4, 37 6, 51 6. 10 97National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 35 C ap ac ita te h ea lth ca re w or kf or ce on d ie te tic s an d cl in ic al nu tr iti on is ts 27 0, 55 0, 00 0. 00 28 2, 18 3, 65 0 29 4, 31 7, 54 7 30 6, 97 3, 20 1 32 0, 17 3, 04 9 1, 47 4, 19 7, 44 7. 55 36 To c on du ct r es ea rc h on c ul tu ra l fa ct or s an d its c on tr ib ut io n to ov er w ei gh t an d ob es ity in 8 A gr o- ec ol og ic al Z on es 81 7, 20 0, 00 0. 00 – – – – 81 7, 20 0, 00 0. 00 37 C on du ct a nn ua l s ta ke ho ld er s m ee tin g to s tr ea m lin e pr oc ur em en t of m ic ro nu tr ie nt co m m od iti es 20 ,4 00 ,0 00 .0 0 41 ,6 77 ,2 00 8 5, 14 6, 52 0 17 3, 95 4, 34 0 35 5, 38 8, 71 6 67 6, 56 6, 77 4. 83 38 C on du ct t ra in in g of d is tr ic t an d fa ci lit y ph ar m ac is ts a nd n ut rit io n of fi c er s on f or ec as tin g, r ep or tin g, an d or de rin g of m ic ro nu tr ie nt pr e- m ix , a nd s up pl em en ts 23 9, 40 0, 00 0. 00 – – – – 23 9, 40 0, 00 0. 00 39 P ro cu re a nn ua l s to ck a nd di st rib ut e m ic ro nu tr ie nt co m m od iti es – t o he al th f ac ili tie s an d sc ho ol p ro gr am s 24 ,1 72 ,8 40 ,6 81 .3 1 25 ,2 12 ,2 72 ,8 31 26 ,2 96 ,4 00 ,5 62 27 ,4 27 ,1 45 ,7 87 28 ,6 06 ,5 13 ,0 55 13 1, 71 5, 17 2, 91 6. 06 40 C on du ct s ta ke ho ld er s’ m ee tin gs to a dv oc at e fo r lo ca l p ro du ct io n of m ic ro nu tr ie nt , p re -m ix , a nd su pp le m en ts – 2 3, 57 1, 80 0 – – – 23 ,5 71 ,8 00 .0 0 41 A dv oc at e fo r nu tr iti on pa ck ag e an d sp ec ifi c nu tr iti on re co m m en da tio ns f or p re ve nt io n, ea rly id en tifi c at io n (d ia gn os is ) an d tr ea tm en t of m ic ro nu tr ie nt de fi c ie nc ie s fo r di ff er en t se rv ic e de liv er y ch an ne ls 69 1, 87 5, 00 0. 00 72 1, 62 5, 62 5 – – – 1, 41 3, 50 0, 62 5. 00 42 Tr ai ni ng o f pr ov id er s at R M N C H c lin ic s on t he b ur de n of m ic ro nu tr ie nt d efi c ie nc ie s, pr ev en tio n, a nd m an ag em en t. 68 ,3 00 ,0 00 .0 0 71 ,2 36 ,9 00 – – 7, 12 3, 69 0 14 6, 66 0, 59 0. 00 43 Tr ai ni ng o f se rv ic e pr ov id er s at O P D d ep ar tm en t to en su re p re ve nt io n an d ea rly m an ag em en t of m ic ro nu tr ie nt de fi c ie nc ie s (s ic k ch ild ) 50 1, 75 7, 50 0. 00 52 3, 33 3, 07 3 – – 59 3, 78 7, 57 6 1, 61 8, 87 8, 14 8. 55 98 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 44 Tr ai ni ng o f pr ov id er s at H IV / TB C lin ic , o n th e bu rd en o f m ic ro nu tr ie nt d efi c ie nc ie s, pr ev en tio n, a nd m an ag em en t 42 6, 29 0, 00 0. 00 44 4, 62 0, 47 0 – – 5 04 ,4 78 ,1 71 1, 37 5, 38 8, 64 0. 82 45 Tr ai ni ng o f pr ov id er s at N C D an d M en ta l H ea lth C lin ic s on th e bu rd en o f m ic ro nu tr ie nt de fi c ie nc ie s, p re ve nt io n an d m an ag em en t to e ns ur e se rv ic e in te gr at io n 43 0, 36 5, 00 0. 00 44 8, 87 0, 69 5 – – – 87 9, 23 5, 69 5. 00 46 Tr ai ni ng o f C om m un ity H ea lth W or ke rs o n th e bu rd en o f m ic ro nu tr ie nt d efi c ie nc ie s, pr ev en tio n an d m an ag em en t to st re ng th en c om m un ity s ys te m s to id en tif y, r ef er c as es f ro m th e co m m un ity a nd a ls o de liv er co m m un ity le ve l i nt er ve nt io ns 86 0, 73 0, 00 0. 00 89 7, 74 1, 39 0 – – 1, 01 8, 60 1, 17 8 2, 77 7, 07 2, 56 7. 53 47 C on du ct n N at io na l- w id e aA ss es sm en t of f ac to rs co nt rib ut in g to n on - a dh er en ce t o IF A s up pl em en ts 31 9, 10 0, 00 0. 00 – – – – 31 9, 10 0, 00 0. 00 48 C on du ct b B i a nn ua l n N at io na l V ita m in IT A s up pl em en ta tio n in c hi ld re n (6 -5 9 m on th s) a nd de w or m in g (1 2 to 5 9 m on th s) ca m pa ig ns in cl ud in g sc re en in g fo r nN ut rit io n sS ta tu s 18 ,3 00 ,0 00 .0 0 19 ,0 86 ,9 00 19 ,9 07 ,6 37 20 ,7 63 ,6 65 21 ,6 56 ,5 03 99 ,7 14 ,7 04 .4 5 49 C on du ct s up po rt s up er vi si on o f V ita m in A s S up pl em en ta tio n 19 9, 16 0, 00 0. 00 20 7, 72 3, 88 0 21 6, 65 6, 00 7 22 5, 97 2, 21 5 23 5, 68 9, 02 0 1, 08 5, 20 1, 12 2. 36 50 C on du ct b as el in e as se ss m en t to es ta bl is h cu rr en t pr ev al en ce o f w or m in fe st at io n an d as se ss t he ne ed f or c on tin ue d de w or m in g ca m pa ig ns 32 6, 07 5, 00 0. 00 – – – – 32 6, 07 5, 00 0. 00 51 P ro m ot e sS up pl y an d in ta ke of m ic ro nu tr ie nt p ow de rs a nd pr e- m ix es f or h om e an d fo od fo rt ifi ca tio n as p ar t of im pr ov in g IY C F pr ac tic es 55 ,0 45 ,0 00 .0 0 65 ,7 55 ,9 35 68 ,5 83 ,4 40 71 ,5 32 ,5 28 74 ,6 08 ,4 27 33 5, 52 5, 33 0. 18 99National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 52 D ev el op ‘N ut rit io n S oc ia l a nd B eh av io r C ha ng e C om m un ic at io n S tr at eg y’ t o ad dr es s m ic ro nu tr ie nt d efi c ie nc ie s 62 ,0 00 ,0 00 .0 0 – – – – 62 ,0 00 ,0 00 .0 0 53 B ui ld e vi de nc e fo r S oc ia l B eh av io ur al C ha ng e th ro ug h K no w le dg e, A at tit ud es , a nd P pr ac tic e w ith r eg ar d to m ic ro nu tr ie nt s’ h ea lth b en efi t s 32 5, 77 5, 00 0. 00 – – – – 32 5, 77 5, 00 0. 00 54 C on du ct s S ta ke ho ld er ’s ’ m ee tin g to d ev el op t he m at ic a re as a nd B C C o pe ra tio na l p la n 29 ,9 25 ,0 00 .0 0 31 ,2 11 ,7 75 – – – 61 ,1 36 ,7 75 .0 0 55 D ev el op n at io na l c am pa ig n by en ga gi ng w ith r el ev an t m in is tr ie s an d or ga ni za tio ns , e .g ., M in is tr y of In fo rm at io n, C ul tu re , A rt s aA nd S po rt s, a nd B A SA TA t o cr ea te p ar tn er sh ip s fo r ef fe ct iv e B C C p ro gr am m es 14 ,7 80 ,0 00 .0 0 15 ,4 15 ,5 40 – – – 30 ,1 95 ,5 40 .0 0 56 C on du ct n at io na l B C C f or m ic ro nu tr ie nt d efi c ie nc ie s fo r pr om ot io n of p os iti ve n ut rit io n in fo rm at io n an d de m ys tif yi ng ne ga tiv e nu tr iti on m yt hs 33 ,7 30 ,0 00 .0 0 35 ,1 80 ,3 90 36 ,6 93 ,1 47 – – 10 5, 60 3, 53 6. 77 57 Tr ai ni ng o f C om m un ity H ea lth W or ke rs a nd s ta ke ho ld er s en ga ge d in m ic ro nu tr ie nt s ou tr ea ch p ro gr am s 15 9, 90 0, 00 0. 00 – – – – 15 9, 90 0, 00 0. 00 58 Im pl em en t co m m un ity o ut re ac h ac tiv iti es f or m ic ro nu tr ie nt s- nu tr iti on e du ca tio n – – – – – – 59 M on ito r m ic ro nu tr ie nt de fi c ie nc ie s th ro ug h ro ut in e da ta co lle ct ed in H M IS – – – – – – 60 S tr en gt he n hu m an r es ou rc e ca pa ci ty f or la bo ra to ry as se ss m en t of m ic ro nu tr ie nt s de fi c ie nc ie s. 45 4, 73 0, 00 0. 00 – – – – 45 4, 73 0, 00 0. 00 TO TA L H E A LT H 42 ,8 46 ,1 50 ,7 31 .3 1 43 ,0 24 ,1 58 ,6 68 29 ,4 92 ,4 26 ,7 04 30 ,8 30 ,9 20 ,5 46 34 ,1 74 ,3 63 ,6 56 18 0, 36 8, 02 0, 30 5. 20 100 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 E D U C A T IO N S Y S T E M (1 0 P E R C E N T O F N M N A P II T O TA L B U D G E T ) S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 1 To c on du ct t ra in in g fo r he al th a nd nu tr iti on t ea ch er s/ co or di na to rs , an d sc ho ol c om m itt ee s on im pl em en ta tio n of s ch oo l fe ed in g gu id el in es in p rim ar y an d se co nd ar y sc ho ol s 34 ,4 25 ,0 00 .0 0 35 ,9 05 ,2 75 3 7, 44 9, 20 2 39 ,0 59 ,5 18 40 ,7 39 ,0 77 18 7, 57 8, 07 1. 08 2 To d ev el op g ui de lin es f or f oo d ve nd or s in a nd a ro un d th e sc ho ol en vi ro nm en t 57 ,5 00 ,0 00 .0 0 – – – – 57 ,5 00 ,0 00 .0 0 3 To c on du ct n at io na l/r eg io na l sc ho ol c am pa ig ns o n nu tr iti on an d he al th y lif es ty le 18 2, 20 0, 00 0. 00 19 0, 03 4, 60 0 19 8, 20 6, 08 8 20 6, 72 8, 95 0 21 5, 61 8, 29 4 99 2, 78 7, 93 1. 78 4 Tr ai ni ng o f th e S ch oo l H ea lth P ro gr am s ta ff a nd c oo rd in at or s on t he b ur de n of m ic ro nu tr ie nt de fi c ie nc ie s, p re ve nt io n an d m an ag em en t an d op po rt un ity fo r pr ev en tio n in t he s ch oo l en vi ro nm en t 12 9, 84 0, 00 0. 00 – – – – 12 9, 84 0, 00 0. 00 5 D es ig n an d im pl em en t a co m pr eh en si ve s ch oo l-b as ed m od el s fo r nu tr iti on in fo rm at io n an d se rv ic es o n th e pr ev en tio n of m ic ro nu tr ie nt d efi c ie nc ie s 48 ,9 00 ,0 00 .0 0 – – – – 48 ,9 00 ,0 00 .0 0 6 R ev ie w a nd u pd at e ex is tin g tr ai ni ng m at er ia ls o n nu tr iti on ed uc at io n an d co un se lli ng f or ch ild re n an d ad ol es ce nt s 37 ,4 90 ,0 00 .0 0 10 8, 11 7, 67 6 – – – 14 5, 60 7, 67 6. 00 7 A dv oc at e fo r im pl em en ta tio n of rR ev ie w ed t ra in in g m at er ia ls , an d nu tr iti on e du ca tio n an d co un se lli ng p ac ka ge t hr ou gh m ed ia – 6, 02 3, 32 5 – – – 6, 02 3, 32 5. 00 8 C on du ct M ic ro nu tr ie nt A w ar en es s C am pa ig ns a m on g te ac he rs a nd s ch oo l c om m itt ee m em be rs 1, 24 0, 10 0, 00 0. 00 1, 29 3, 42 4, 30 0 – – – 2, 53 3, 52 4, 30 0. 00 101National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 9 Tr ai ni ng o f T ra in er s am on g se le ct ed t ea ch er s an d le ad er s of n ut rit io n cl ub s on p re ve nt io n, in cl ud in g fo od - b as ed a pp ro ac he s an d m an ag em en t of m ic ro nu tr ie nt de fi c ie nc ie s 17 3, 54 0, 00 0. 00 – – – – 17 3, 54 0, 00 0. 00 10 E st ab lis h N ut rit io n C lu bs in sc ho ol s to in cr ea se a w ar en es s on th e pr od uc tio n of m ic ro nu tr ie nt ric h fo od s in s ch oo ls 54 7, 04 0, 00 0. 00 57 0, 56 2, 72 0 – – – 1, 11 7, 60 2, 72 0. 00 11 E ng ag e yo ut hs a nd a do le sc en ts th ro ug h es sa y co m pe tit io ns a nd de ba te s on m ic ro nu tr ie nt s 14 ,1 50 ,0 00 .0 0 14 ,7 58 ,4 50 15 ,3 93 ,0 63 16 ,0 54 ,9 65 16 ,7 45 ,3 29 77 ,1 01 ,8 07 .0 0 12 C on du ct c on tin uo us s up po rt iv e su pe rv is io n of s ch oo l g ar de ns an d ke ep in g of s m al l a ni m al pr og ra m pr og ra m m es s in s ch oo ls 33 1, 20 0, 00 0. 00 34 5, 44 1, 60 0 36 0, 29 5, 58 9 37 5, 78 8, 29 9 39 1, 94 7, 19 6 1, 80 4, 67 2, 68 3. 90 13 P ro vi de s up po rt b y ex te ns io n of fi c er s to t he s ch oo l g ar de ni ng pr og ra m m es -– in cl ud e s up po rt t o sc ho ol p ro gr am m es in e xt en si on of fi c er s TO R s 10 ,8 48 ,0 00 ,0 00 .0 0 11 ,3 14 ,4 64 ,0 00 11 ,8 00 ,9 85 ,9 52 12 ,3 08 ,4 28 ,3 48 12 ,8 37 ,6 90 ,7 67 59 ,1 09 ,5 69 ,0 66 .8 3 14 Le ve ra ge t ec hn ol og y in p ro vi si on of n ut rit io n ed uc at io n, e .g ., us e of s oc ia l m ed ia a nd w eb -b as ed ap pl ic at io ns t o pr ov id e nu tr iti on ed uc at io n on t he im po rt an ce o f m ic ro nu tr ie nt s. 17 ,8 80 ,0 00 .0 0 – 18 ,6 48 ,8 40 – 19 ,4 50 ,7 40 55 ,9 79 ,5 80 .1 2 TO TA L E D U C A TI O N 13 ,6 62 ,2 65 ,0 00 .0 0 13 ,8 78 ,7 31 ,9 46 12 ,4 30 ,9 78 ,7 34 12 ,9 46 ,0 60 ,0 79 13 ,5 22 ,1 91 ,4 03 66 ,4 40 ,2 27 ,1 61 .7 2 102 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 W A S H S Y S T E M (8 P E R C E N T O F N M N A P II T O TA L B U D G E T ) S n. A ct iv iti es Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 1 P ro m ot e w at er , h yg ie ne a nd sa ni ta tio n pr ac tic es a t al l l ev el s in cl ud in g in no va tiv e nu tr iti on - se ns iti ve in te rv en tio ns (r e us e of bi og as , c lim at e re si lie nt ) 30 ,0 00 ,0 00 .0 0 31 ,2 36 ,2 50 32 ,5 79 ,4 09 33 ,9 80 ,3 23 35 ,4 41 ,4 77 16 3, 23 7, 45 9. 31 2 C on du ct s en si tiz at io n m ee tin gs at w ar d le ve l t o pr om ot e w at er , hy gi en e, a nd s an ita tio n pr ac tic es 16 ,6 00 ,5 00 ,0 00 .0 0 17 ,3 14 ,3 21 ,5 00 18 ,0 58 ,8 37 ,3 25 – – 51 ,9 73 ,6 58 ,8 24 .5 0 3 P ro m ot e in te gr at io n of n ut rit io n ag en da w ith im pl em en ta tio n of nu tr iti on s en si tiv e in te rv en tio ns su ch a s W A S H , M H M a nd de w or m in g ca m pa ig ns a t th e sc ho ol s by h ol di ng jo in t ca m pa ig ns (d ev el op m en t of IE C , tr ai ni ng p ac ka ge , m ed ia s em in ar ki t, a nd m ed ia s em in ar m ee tin gs ) A irt im e co st . 27 ,8 25 ,0 00 .0 0 34 ,2 36 ,4 75 35 ,7 08 ,6 43 37 ,2 44 ,1 15 38 ,8 45 ,6 12 17 3, 85 9, 84 5. 56 TO TA L W A S H 16 ,6 58 ,3 25 ,0 00 .0 0 17 ,3 79 ,7 94 ,2 25 18 ,1 27 ,1 25 ,3 77 71 ,2 24 ,4 38 74 ,2 87 ,0 89 52 ,3 10 ,7 56 ,1 29 .3 6 103National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S O C IA L P R O T E C T IO N (5 P E R C E N T O F N M N A P II T O TA L B U D G E T ) S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 1 D ev el op n ut rit io n- in - e m er ge nc ie s gu id el in es 28 ,7 00 ,0 00 .0 0 – – – – 28 ,7 00 ,0 00 .0 0 2 O pe ra tio na liz at io n of n ut rit io n- in - em er ge nc ie s S O P s at a ll le ve ls . 5, 02 0, 80 5, 00 0. 00 5, 02 1, 69 9, 61 5 5, 02 2, 63 2, 69 8 5, 00 0, 00 0, 00 0 6, 23 7, 79 4, 44 4 26 ,3 02 ,9 31 ,7 57 .4 5 3 Tr ai n em er ge nc y te am s on pr ov is io n of n ut rit io n se rv ic es du rin g em er ge nc y at a ll le ve ls . 10 2, 36 5, 00 0. 00 10 6, 76 6, 69 5 11 1, 35 7, 66 3 – – 32 0, 48 9, 35 7. 89 4 C To c on du ct s en si tiz at io n am on gt o w om en ’s g ro up s on qu al ifi ca tio ns r el at ed t o ac ce ss in g lo an s fo ro f w om en a nd y ou th gr ou ps 13 9, 35 0, 00 0. 00 14 5, 34 2, 05 0 15 1, 56 0, 36 4 – – 43 6, 25 2, 41 3. 85 5 C on du ct s en si tiz at io n m ee tin gs fo r m al e in vo lv em en t in a ll co m m un ity n ut rit io n pr og ra m m es 13 9, 39 3, 00 0. 00 14 5, 38 6, 89 9 15 1, 63 8, 53 6 – – 43 6, 41 8, 43 4. 66 6 A dv oc at e ag ai ns t cu ltu ra l pr ac tic es t ha t hi nd er o pt im um nu tr iti on p ra ct ic es 50 ,9 00 ,0 00 .0 0 53 ,0 88 ,7 00 55 ,3 71 ,5 14 – – 15 9, 36 0, 21 4. 10 7 A dv oc at e fo r ow ne rs hi p of re so ur ce s am on g w om en 50 ,9 00 ,0 00 .0 0 53 ,0 88 ,7 00 55 ,3 71 ,5 14 – – 15 9, 36 0, 21 4. 10 8 A dv oc at e fo r in te gr at io n of nu tr iti on t o so ci al p ro te ct io n pr og ra m m es 50 ,9 00 ,0 00 .0 0 53 ,0 88 ,7 00 5 5, 37 1, 51 4 – – 15 9, 36 0, 21 4. 10 9 To C on du ct t ra in in g se ss io ns fo rt o so ci al p ro te ct io n te am s on p la nn in g, b ud ge tin g, im pl em en ta tio n, a nd m on ito rin g of n ut rit io n in t he ir re sp ec tiv e se ct or s (N at io na l- lL ev el iI nv iti ng rR eg io ns ) 16 ,9 80 ,0 00 .0 0 17 ,7 10 ,1 40 – – – 34 ,6 90 ,1 40 .0 0 10 A dv oc at e fo r im pl em en ta tio n of t he n at io na l e m er ge nc y pr ep ar ed ne ss p la n at a ll le ve ls in cl ud in g pr ov is io n of d iv er si fi e d m ic ro nu tr ie nt s ric h fo od s du rin g em er ge nc ie s an d di sa st er s -– (a ct iv ity c os te d un de r - un de rn ut rit io n) – – – – – – 104 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 11 C ap ac ity b ui ld in g of c ou nc il an d re gi on al e m er ge nc y pr ep ar ed ne ss te am s on t he p re ve nt io n of m ic ro nu tr ie nt d efi c ie nc ie s in t he im pl em en ta tio n of t he N at io na l E m er ge nc y P re pa re dn es s P la n – – – – – – 12 C on du ct a dv oc ac y m ic ro nu tr ie nt s ca m pa ig ns t o ad dr es s th e po te nt ia l o f w om en w or kl oa d in a ff ec tin g ch ild ca re p ra ct ic es an d nu tr iti on o ut co m es t hr ou gh re lig io us le ad er s, V IC O B A g ro up s, an d vo ca tio na l t ra in in g ce nt er s ta rg et in g ou t- of -s ch oo l a do le sc en t gi rls 20 ,4 55 ,0 00 .0 0 21 ,3 34 ,5 65 22 ,2 51 ,9 51 2 3, 20 8, 78 5 24 ,2 06 ,7 63 11 1, 45 7, 06 4. 46 13 D ev el op IE C m at er ia ls o n m ic ro nu tr ie nt s IE C m at er ia ls 33 ,6 80 ,0 00 .0 0 35 ,1 28 ,2 40 – – – 68 ,8 08 ,2 40 .0 0 14 D is se m in at e m ic ro nu tr ie nt s IE C m at er ia ls t hr ou gh a pp ro pr ia te ch an ne ls o n th e ro le o f w om en in ad va nc in g nu tr iti on 27 ,6 25 ,0 00 .0 0 28 ,8 12 ,8 75 30 ,0 51 ,8 29 31 ,3 44 ,0 57 32 ,6 91 ,8 52 15 0, 52 5, 61 2. 60 15 D ev el op m ic ro nu tr ie nt s IE C m at er ia ls o n th e ro le o f m en in p ro m ot in g m ic ro nu tr ie nt s co ns um pt io n 21 ,8 20 ,0 00 .0 0 – – – – 21 ,8 20 ,0 00 .0 0 16 D is se m in at e m ic ro nu tr ie nt s IE C m at er ia ls t hr ou gh a pp ro pr ia te ch an ne ls o n th e ro le o f m en in ad va nc in g nu tr iti on 95 ,8 80 ,0 00 .0 0 10 0, 00 2, 84 0 10 4, 30 2, 96 2 10 8, 78 7, 98 9 11 3, 46 5, 87 3 52 2, 43 9, 66 4. 65 17 In cr ea se p ar tic ip at io n of m en in R M N C H b y ad vo ca tin g fo r m en - fr ie nd ly c lin ic s – – – – – – To ta l S o ci al P ro te ct io n 5, 79 9, 75 3, 00 0. 00 5, 78 1, 45 0, 01 9 5, 75 9, 91 0, 54 5 5, 16 3, 34 0, 83 2 6, 40 8, 15 8, 93 2 28 ,9 12 ,6 13 ,3 27 .8 5 105National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 E N A B L IN G E N V IR O N M E N T (1 6 P E R C E N T O F N M N A P II T O TA L B U D G E T ) S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 1 C on du ct a dv oc ac y to s ec to ra l m in is tr ie s fo r ut ili za tio n of ex te ns io n w or ke rs t o im pl em en t nu tr iti on in te rv en tio ns 7, 65 0, 00 0. 00 7, 97 8, 95 0 8, 32 2, 04 5 – – 23 ,9 50 ,9 94 .8 5 2 C on du ct a dv oc ac y to L G A s fo r in cl us io n of a do le sc en t in nu tr iti on p ro gr am m es 71 6, 10 0, 00 0. 00 74 6, 89 2, 30 0 1, 46 2, 99 2, 30 0. 00 3 To a do pt r el ev an t gl ob al a nd re gi on al r ec om m en da tio ns fo r im pr ov em en t o f nu tr iti on 32 ,2 40 ,0 00 .0 0 33 ,6 26 ,3 20 35 ,0 72 ,2 52 – 10 0, 93 8, 57 1. 76 4 To c om m em or at e at le as t tw o in te rn at io na l, re gi on al , n at io na l an d lo ca l n ut rit io n ev en ts a t LG A s 6, 12 7, 20 0, 00 0. 00 6, 39 0, 66 9, 60 0 6, 66 5, 46 8, 39 3 6, 95 2, 08 3, 53 4 7, 25 1, 02 3, 12 6 33 ,3 86 ,4 44 ,6 52 .1 3 5 A dv oc at e fo r LG A s to s et t he re qu ire d pe rc en ta ge o f lo ca l fu nd s to w om en a nd y ou th f un ds 13 9, 35 0, 00 0. 00 14 5, 34 2, 05 0 15 1, 59 1, 75 8 43 6, 28 3, 80 8. 15 6 Tr ai n nu tr iti on fo ca ls o n nu tr iti on - se ns iti ve g ui de lin es in cl ud in g sc ho ol fe ed in g gu id el in es , pl an ni ng a nd b ud ge tin g, N A IA ,) ac ro ss N SI M D A s, R S an d co un ci ls (t ra in in g fo rt o nu tr iti on fo ca ls ) 22 ,5 00 ,0 00 .0 0 23 ,4 67 ,5 00 – – – 45 ,9 67 ,5 00 .0 0 7 D ev el op / r R ev ie w n ut rit io n ac co un ta bi lit y fr am ew or ks fo r ce nt ra l a nd lo ca l g ov er nm en t 31 ,7 50 ,0 00 .0 0 33 ,1 15 ,2 50 – – – 64 ,8 65 ,2 50 .0 0 8 To a dv oc at e to p riv at e se ct or a ct or s to e ng ag e in im pl em en ta tio n of n ut rit io n in te rv en tio ns (u nd er nu tr iti on , m ic ro nu tr ie nt s, o ve rw ei gh t an d ob es ity ) o nc e in e ve ry y ea r 51 ,9 00 ,0 00 .0 0 54 ,1 31 ,7 00 56 ,4 59 ,3 63 58 ,8 87 ,1 16 61 ,4 19 ,2 62 28 2, 79 7, 44 0. 50 9 To d ev el op g ui de lin es / SO Ps an d M oU t o en ab le a pp ro pr ia te en ga ge m en t o f PP P 45 ,0 25 ,0 00 .0 0 – – – – 45 ,0 25 ,0 00 .0 0 106 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 10 Pr ov id e re le va nt c ap ac ity b ui ld in g to p riv at e se ct or a ct or s on m ai ns tr ea m in g nu tr iti on 17 ,9 80 ,0 00 .0 0 17 ,9 92 ,9 00 18 ,7 66 ,5 95 – – 54 ,7 39 ,4 94 .7 0 11 M ap pi ng o f nu tr iti on p riv at e se ct or a ct or s ac ro ss t he c ou nt ry (1 m ee tin g) d ur in g th e fi r st y ea r of im pl em en ta tio n 6, 60 0, 00 0. 00 – – – – 6, 60 0, 00 0. 00 12 To c on du ct a dv oc ac y m ee tin g am on gt o po lic y m ak er s on t ax re gu la tio ns o n fo od s w ith h ig h co nt en t o f su ga r, sa lt an d fa ts , an d re st ric tio ns o nf im po rt ed s fo od s w ith lo w n ut rit iv e va lu e – 36 ,0 66 ,9 40 37 ,6 17 ,8 18 – – 73 ,6 84 ,7 58 .4 2 13 To a da pt A fr o W H O n ut rie nt pr ofi le m od el fo r id en tif yi ng fo od s to b e re st ric te d to c hi ld re n. – 78 ,2 51 ,0 75 – – – 78 ,2 51 ,0 75 .0 0 14 To r ev ie w t he F oo d La be lli ng R eg ul at io ns o f 20 06 t o in cl ud e m an da to ry f ro nt -o f- p ac k nu tr iti on la be lli ng a nd m en u la be lli ng t o be us ed b y fo od s er vi ce o pe ra to rs – 11 5, 46 0, 10 0 – – – 11 5, 46 0, 10 0. 00 15 To r ev ie w t he p er fo rm an ce o f m ul tis ec to ra l l ev el c oo rd in at io n pl at fo rm ( JM N R ) 23 9, 60 0, 00 0. 00 24 9, 90 2, 80 0 26 0, 64 8, 62 0 27 1, 85 6, 51 1 28 3, 54 6, 34 1 1, 30 5, 55 4, 27 2. 53 16 To u nd er ta ke r ef re sh er t ra in in gs fo r m ul tis ec to ra l c oo rd in at io n pl at fo rm s at a ll le ve ls (H LS C , R / C M N SC ) 17 ,9 90 ,0 00 .0 0 18 ,7 63 ,5 70 19 ,5 70 ,4 04 20 ,4 11 ,9 31 21 ,2 89 ,6 44 98 ,0 25 ,5 48 .2 6 17 Fa ci lit at e th e op er at io na liz at io n of th e ac ad em ia p la tf or m 37 ,3 00 ,0 00 .0 0 38 ,9 03 ,9 00 40 ,5 76 ,7 68 42 ,3 21 ,5 69 44 ,1 41 ,3 96 20 3, 24 3, 63 2. 58 18 C on du ct p er io di c m ul tis ec to ra l nu tr iti on c oo rd in at io n m ee tin gs at a ll le ve ls (T W G , H LS C , R / C M N SC ) 1, 33 4, 70 0, 00 0. 00 1, 39 2, 09 2, 10 0 1, 45 1, 95 2, 06 0 1, 51 4, 38 5, 99 9 1, 57 9, 50 4, 59 7 7, 27 2, 63 4, 75 6. 04 19 A dv oc at e fo r im pr ov ed n ut rit io n go ve rn an ce t o al l m ul tis ec to ra l nu tr iti on c oo rd in at io n pl at fo rm s at a ll le ve l. 34 1, 16 0, 00 0. 00 35 5, 82 9, 88 0 37 1, 13 0, 56 5 38 7, 08 9, 17 9 40 3, 73 4, 01 4 1, 85 8, 94 3, 63 7. 80 107National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 20 C on du ct n ut rit io n or ie nt at io n m ee tin gs t o nu tr iti on - s en si tiv e se ct or s 28 ,2 00 ,0 00 .0 0 29 ,4 12 ,6 00 30 ,6 77 ,3 42 31 ,9 96 ,4 67 33 ,3 72 ,3 16 15 3, 65 8, 72 4. 90 21 Fa ci lit at e pe rio di c le ss on s an d ex pe rie nc e sh ar in g am on g nu tr iti on - s en si tiv e se ct or s 17 ,9 40 ,0 00 .0 0 18 ,7 11 ,4 20 19 ,5 16 ,0 11 20 ,3 55 ,2 00 21 ,2 30 ,4 73 97 ,7 53 ,1 03 .7 1 22 M ai ns tr ea m n ut rit io n ag en da in to se ct or al a nn ua l e xh ib iti on s (i. e. , N an en an e, M ilk W ee k, S ID O , W or ld F oo d D ay , e tc .) 32 3, 52 0, 00 0. 00 33 7, 43 1, 36 0 35 1, 94 0, 90 8 36 7, 07 4, 36 8 38 2, 85 8, 56 5 1, 76 2, 82 5, 20 1. 37 23 D ev el op a nd o pe ra tio na liz e ac co un ta bi lit y m ec ha ni sm t o nu tr iti on - s en si tiv e se ct or s 33 ,0 00 ,0 00 .0 0 34 ,4 19 ,0 00 35 ,8 99 ,0 17 37 ,4 42 ,6 75 39 ,0 52 ,7 10 17 9, 81 3, 40 1. 48 24 C ap ac ita te k ey n at io na l n ut rit io n co or di na tio n in st itu tio ns 70 ,2 30 ,0 00 .0 0 73 ,2 49 ,8 90 76 ,3 99 ,6 35 79 ,6 84 ,8 20 83 ,1 11 ,2 67 38 2, 67 5, 61 1. 69 25 D ev el op T oO R fo r N ut rit io n Fo ca l P er so ns a nd e va lu at e th ei r pe rf or m an ce 12 6, 40 0, 00 0. 00 13 1, 83 5, 20 0 13 7, 50 4, 11 4 14 3, 41 6, 79 0 14 9, 58 3, 71 2 68 8, 73 9, 81 6. 56 26 C on du ct o rie nt at io n m ee tin gs to n ut rit io n se ns iti ve s ec to rs o n N M N A P II 55 ,3 00 ,0 00 .0 0 57 ,6 77 ,9 00 60 ,1 58 ,0 50 62 ,7 44 ,8 46 65 ,4 42 ,8 74 30 1, 32 3, 66 9. 75 27 C on du ct m ap pi ng fo r th e pr iv at e se ct or e nt iti es in vo lv ed in nu tr iti on 20 9, 50 0, 00 0. 00 – – – – 20 9, 50 0, 00 0. 00 28 D ev el op a r oa d m ap fo r pr iv at e se ct or p ar tic ip at io n in t he im pl em en ta tio n of N M N A P II 34 ,8 50 ,0 00 .0 0 36 ,3 48 ,5 50 37 ,9 11 ,5 38 39 ,5 41 ,7 34 41 ,2 42 ,0 28 18 9, 89 3, 84 9. 74 29 U nd er ta ke p er io di c pr iv at e se ct or s en ga ge m en t m ee tin gs an d le ar ni ng p la tf or m s 41 ,1 40 ,0 00 .0 0 42 ,9 09 ,0 20 44 ,7 54 ,1 08 46 ,6 78 ,5 34 48 ,6 85 ,7 11 22 4, 16 7, 37 3. 84 30 R ev ie w a nd e va lu at e pr iv at e se ct or s en ga ge m en t in n ut rit io n in te rv en tio ns 19 ,8 00 ,0 00 .0 0 20 ,6 51 ,4 00 21 ,5 39 ,4 10 22 ,4 65 ,6 05 23 ,4 31 ,6 26 10 7, 88 8, 04 0. 89 31 C on du ct a n as se ss m en t o n vi ab ili ty o f PP P ar ra ng em en t fo r nu tr iti on 6, 95 0, 00 0. 00 7, 24 8, 85 0 7, 56 0, 55 1 7, 88 5, 65 4 8, 22 4, 73 7 37 ,8 69 ,7 92 .1 3 108 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 32 A dv oc at e fo r an in cr ea se d pr iv at e se ct or c on tr ib ut io n to n ut rit io n 20 ,3 10 ,0 00 .0 0 21 ,1 83 ,3 30 22 ,0 94 ,2 13 23 ,0 44 ,2 64 24 ,0 35 ,1 68 11 0, 66 6, 97 5. 27 33 R ev ie w t he fo od a nd n ut rit io n po lic y of 1 99 2 to a cc om m od at e m ul tis ec to ra l n ut rit io n po lic y ac tio ns 38 1, 77 0, 00 0. 00 21 0, 44 6, 11 0 – – – 59 2, 21 6, 11 0. 00 34 R ev ie w a nd a dv oc at e m ai ns tr ea m in g of n ut rit io n in se ct or al p ol ic ie s an d pr og ra m m es 44 2, 00 0, 00 0. 00 22 1, 11 6, 00 0 – – – 66 3, 11 6, 00 0. 00 35 R ev ie w t he n at io na l f or tifi c at io n re gu la tio ns 54 ,7 50 ,0 00 .0 0 57 ,1 04 ,2 50 59 ,5 59 ,7 33 62 ,1 20 ,8 01 64 ,7 91 ,9 96 29 8, 32 6, 77 9. 72 36 D ev el op a nd d is se m in at e re gu la r po lic y br ie fs o n ke y nu tr iti on is su es 57 ,9 00 ,0 00 .0 0 60 ,3 89 ,7 00 62 ,9 86 ,4 57 65 ,6 94 ,8 75 68 ,5 19 ,7 54 31 5, 49 0, 78 6. 23 37 A dv oc at e fo r re vi si on a nd op er at io na liz at io n of r el ev an t nu tr iti on - s en si tiv e re gu la tio ns 12 7, 10 0, 00 0. 00 13 2, 56 5, 30 0 13 8, 26 5, 60 8 14 4, 21 1, 02 9 15 0, 41 2, 10 3 69 2, 55 4, 04 0. 23 38 A dv oc at e fo r in cl us io n of n ut rit io n as a c ro ss -c ut tin g is su e in t he na tio na l p ol ic y gu id el in es 33 ,0 00 ,0 00 .0 0 34 ,4 19 ,0 00 35 ,8 99 ,0 17 37 ,4 42 ,6 75 39 ,0 52 ,7 10 17 9, 81 3, 40 1. 48 39 C ap ac ita te r el ev an t re gu la to ry au th or iti es o n en fo rc em en t o f re le va nt la w s an d re gu la tio n. 33 8, 85 4, 21 1. 00 – – – – 33 8, 85 4, 21 1. 00 40 Pr ep ar e an d di ss em in at e a di re ct or y of a ll ke y la w s an d re gu la tio ns t ha t af fe ct n ut rit io n 18 ,3 00 ,0 00 .0 0 19 ,0 86 ,9 00 19 ,9 07 ,6 37 20 ,7 63 ,6 65 21 ,6 56 ,5 03 99 ,7 14 ,7 04 .4 5 41 Se ns iti ze s ta ke ho ld er s to on w ill in gl y co m pl ia nc e w ith r el ev an t la w s an d re gu la tio ns 33 ,1 20 ,0 00 .0 0 34 ,5 44 ,1 60 36 ,0 29 ,5 59 37 ,5 78 ,8 30 39 ,1 94 ,7 20 18 0, 46 7, 26 8. 39 42 D ev el op m en t o f by -la w s fo r im pl em en ta tio n an d en fo rc em en t o f nu tr iti on is su es at d ec en tr al iz ed le ve l 1, 17 1, 80 0, 00 0. 00 1, 22 2, 18 7, 40 0 1, 27 4, 74 1, 45 8 1, 32 9, 55 5, 34 1 1, 38 6, 72 6, 22 1 6, 38 5, 01 0, 41 9. 66 43 C ap ac ity b ui ld in g of to M Ps o n nu tr iti on is su es 13 4, 45 0, 00 0. 00 14 0, 23 1, 35 0 – – 15 9, 11 0, 20 7 43 3, 79 1, 55 6. 82 109National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 44 Se ns iti ze M Ps o n th e ne ed t o in cr ea se d om es tic r es ou rc es fo r nu tr iti on 13 5, 65 0, 00 0. 00 14 1, 48 2, 95 0 – – 16 0, 53 0, 30 5 43 7, 66 3, 25 5. 36 45 Se ns iti ze M Ps (C om m itt ee s) on t he n ee d fo r su st ai na bl e an d eq ui ta bl e fu nd in g fo r nu tr iti on se ct or 42 ,9 00 ,0 00 .0 0 44 ,7 44 ,7 00 46 ,6 68 ,7 22 48 ,6 75 ,4 77 50 ,7 68 ,5 23 23 3, 75 7, 42 1. 92 46 A dv oc at e fo r nu tr iti on se ct or v is ib ili ty w ith in t he pP ar lia m en ta ry s ta nd in g co m m itt ee s ( f ac t sh ee ts , gu id el in es ) 47 ,0 00 ,0 00 .0 0 49 ,0 21 ,0 00 51 ,1 28 ,9 03 53 ,3 27 ,4 46 55 ,6 20 ,5 26 25 6, 09 7, 87 4. 83 47 A dv oc at e fo r de ta ile d C A G re po rt s on c C ou nc ils ’ o O w n so ur ce e xp en di tu re fo r nu tr iti on 10 ,4 00 ,0 00 .0 0 10 ,8 47 ,2 00 11 ,3 13 ,6 30 11 ,8 00 ,1 16 12 ,3 07 ,5 21 56 ,6 68 ,4 65 .9 2 48 D ev el op a n ad vo ca cy a nd in fo rm at io n pa ck ag e fo r pa rli am en ta ria ns 42 ,1 25 ,0 00 .0 0 43 ,9 36 ,3 75 45 ,8 25 ,6 39 47 ,7 96 ,1 42 49 ,8 51 ,3 76 22 9, 53 4, 53 1. 43 49 Se ns iti ze p ol iti ca l l ea de rs t oi n nu tr iti on a nd n ee d fo r in cr ea se d po lit ic al s up po rt (N at io na l a nd sS ub -n at io na l L ev el s) 89 ,4 66 ,0 00 .0 0 93 ,3 13 ,0 38 97 ,3 25 ,4 99 10 1, 51 0, 49 5 10 5, 87 5, 44 6 48 7, 49 0, 47 8. 07 50 Id en tif y an d ca pa ci ta te n ut rit io n ch am pi on s 17 9, 10 0, 00 0. 00 19 1, 60 4, 60 0 19 9, 84 3, 59 8 20 8, 43 6, 87 3 21 7, 39 9, 65 8 99 6, 38 4, 72 8. 33 51 Ev al ua te t he im pl em en ta tio n of nu tr iti on d ire ct iv es in t he r ul in g pP ar ty m M an ife st o 28 ,9 70 ,0 00 .0 0 30 ,2 15 ,7 10 31 ,5 14 ,9 86 32 ,8 70 ,1 30 34 ,2 83 ,5 45 15 7, 85 4, 37 0. 93 52 D ev el op a nd d is se m in at e ad vo ca cy m at er ia ls fo r po lit ic al le ad er s 64 ,1 00 ,0 00 .0 0 66 ,8 56 ,3 00 69 ,7 31 ,1 21 72 ,7 29 ,5 59 75 ,8 56 ,9 30 34 9, 27 3, 91 0. 14 53 C on du ct s ec to ra l p er io di c as se ss m en t an d ac co un ta bi lit y m ee tin gs 37 ,3 50 ,0 00 .0 0 38 ,9 56 ,0 50 40 ,6 31 ,1 60 42 ,3 78 ,3 00 44 ,2 00 ,5 67 20 3, 51 6, 07 7. 12 54 C on du ct c om pa ct e va lu at io n m ee tin gs a t na tio na l, re gi on al an d co un ci l l ev el s 12 9, 81 0, 00 0. 00 13 5, 39 1, 83 0 14 1, 21 3, 67 9 14 7, 28 5, 86 7 15 3, 61 9, 15 9 70 7, 32 0, 53 4. 71 110 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 55 R ev ie w n ut rit io n cC om pa ct a nd ac co un ta bi lit y to ol s (s co re ca rd s) in cl ud in g so ci al p ro te ct io n in di ca to rs a nd a cc ou nt ab ili ty a t de ce nt ra liz ed le ve l 58 0, 89 0, 00 0. 00 60 5, 86 8, 27 0 63 1, 92 0, 60 6 65 9, 09 3, 19 2 68 7, 43 4, 19 9 3, 16 5, 20 6, 26 6. 15 56 D ev el op a m ec ha ni sm fo r so ci al ac co un ta bi lit y fo r nu tr iti on a t co m m un ity le ve l 74 0, 04 5, 00 0. 00 – 80 5, 05 7, 21 3 – 87 5, 78 0, 68 4 2, 42 0, 88 2, 89 7. 53 57 U nd er ta ke a nn ua l r ev ie w s an d le ar ni ng p la tf or m s fo r nu tr iti on 31 4, 40 0, 00 0. 00 32 7, 91 9, 20 0 34 2, 01 9, 72 6 35 6, 72 6, 57 4 37 2, 06 5, 81 6 1, 71 3, 13 1, 31 5. 88 58 D ev el op a n at io na l r es ou rc e m ob ili za tio n st ra te gy fo r nu tr iti on 34 ,8 45 ,0 00 .0 0 – – – – 34 ,8 45 ,0 00 .0 0 59 C on du ct a p re -p la nn in g se ss io n fo r nu tr iti on a t al l l ev el s 80 0, 97 0, 00 0. 00 83 5, 41 1, 71 0 87 1, 33 4, 41 4 90 8, 80 1, 79 3 94 7, 88 0, 27 0 4, 36 4, 39 8, 18 7. 27 60 C on du ct n ut rit io n bu dg et sc ru tin iz at io n of s ec to r m in is tr ie s 12 5, 70 0, 00 0. 00 13 1, 10 5, 10 0 13 6, 74 2, 61 9 14 2, 62 2, 55 2 14 8, 75 5, 32 2 68 4, 92 5, 59 2. 89 61 A dv oc at e fo r th e fo rm ul at io n of nu tr iti on o bj ec tiv e an d bu dg et lin e fo r nu tr iti on s up pl ie s 79 ,6 50 ,0 00 .0 0 83 ,0 74 ,9 50 86 ,6 47 ,1 73 90 ,3 73 ,0 01 94 ,2 59 ,0 40 43 4, 00 4, 16 4. 47 62 C on du ct P ub lic E xp en di tu re R ev ie w (P ER ) f or n ut rit io n 91 ,9 30 ,0 00 .0 0 95 ,8 82 ,9 90 10 0, 00 5, 95 9 10 4, 30 6, 21 5 1 08 ,7 91 ,3 82 50 0, 91 6, 54 5. 38 63 A dv oc at e fo r in cr ea se d nu tr iti on fu nd in g fr om D ev el op m en t Pa rt ne r( s) 86 ,0 00 ,0 00 .0 0 89 ,6 98 ,0 00 93 ,5 55 ,0 14 97 ,5 77 ,8 80 10 1, 77 3, 72 8 46 8, 60 4, 62 2. 03 64 C on du ct a dv oc ac y to L G A s on th ei r o w n so ur ce f un di ng fo r nu tr iti on 59 9, 01 0, 00 0. 00 62 4, 76 7, 43 0 65 1, 63 2, 42 9 67 9, 65 2, 62 4 70 8, 87 7, 68 7 3, 26 3, 94 0, 17 0. 24 65 C on du ct a s tu dy o n in no va tio ns w ith in n ut rit io n th at c al ls fo r D Ps ’ a nd t he p Pr iv at e sS ec to rs en ga ge m en t 83 ,2 20 ,0 00 .0 0 86 ,7 98 ,4 60 90 ,5 30 ,7 94 94 ,4 23 ,6 18 98 ,4 83 ,8 33 45 3, 45 6, 70 5. 18 66 To u nd er ta ke b ud ge tin g se ss io ns to e nt er gr at ei nt eg ra te n ut rit io n is su es in t he p al an a nd b ud ge t sy st em s (r in g fe nc in g’ a nd co di ng ) 27 7, 26 0, 00 0. 00 – – – – 27 7, 26 0, 00 0. 00 111National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 67 B ui ld c ap ac ity o f N ut rit io n O ffi c er s an d th e re le va nt s St af fs on t he e ff ec tiv e im pl em en ta tio n of t he n ut rit io n ac tiv iti es 53 2, 92 0, 00 0. 00 55 5, 83 5, 56 0 57 9, 73 6, 48 9 60 4, 66 5, 15 8 63 0, 66 5, 76 0 2, 90 3, 82 2, 96 7. 10 68 Pr ep ar e hu m an r es ou rc es re qu ire m en ts fo r nu tr iti on (n ut rit io ni st , d ie tit ia ns a nd o th er re la te d gr ou ps ) a t al l l ev el s an d sh ar e it w ith t he r es po ns ib le in st itu tio ns 81 ,9 00 ,0 00 .0 0 – – – – 81 ,9 00 ,0 00 .0 0 69 To d ev el op a nd o pe ra tio na liz e Ta nz an ia N ut rit io n Le ad er sh ip Pr og ra m 30 ,6 80 ,0 00 .0 0 31 ,9 99 ,2 40 33 ,3 75 ,2 07 34 ,8 10 ,3 41 36 ,3 07 ,1 86 16 7, 17 1, 97 4. 46 70 To r ev ie w a nd im pl em en t sc he m e of s er vi ce fo r nu tr iti on is ts , di et itc ia ns a nd o th er n ut rit io n- re la te d pr of es si on al s 12 ,5 00 ,0 00 .0 0 – 13 ,5 98 ,1 13 – 14 ,7 92 ,6 93 40 ,8 90 ,8 05 .5 9 71 To fo rm ul at e an d op er at io na liz e pr of es si on al b od ie s fo r nu tr iti on is ts a nd d ie tit ia ns 27 ,9 50 ,0 00 .0 0 29 ,1 51 ,8 50 30 ,4 05 ,3 80 31 ,7 12 ,8 11 33 ,0 76 ,4 62 15 2, 29 6, 50 2. 16 72 To t ra in k ey n ut rit io n ac to rs o n ro ut in e da ta m an ag em en t an d re po rt g en er at io n 22 4, 72 0, 00 0. 00 – 24 4, 46 1, 42 7 – 26 5, 93 7, 11 9 73 5, 11 8, 54 6. 49 73 To o rie nt N ut rit io n Fo ca l P er so ns an d re le va nt o ffi c er s fr om k ey lin e m M in is tr ie s on t he u se o f M N IS 15 ,9 30 ,0 00 .0 0 – 17 ,3 29 ,4 35 – 18 ,8 51 ,8 08 52 ,1 11 ,2 42 .6 4 74 To im pr ov e M N IS fo r ac co m m od at io n of M EA L Fr am ew or k in N M N A P II 13 7, 75 0, 00 0. 00 – 14 9, 85 1, 20 0 – – 28 7, 60 1, 19 9. 75 75 To a dv oc at e fo r in cl us io n of m is si ng n ut rit io n- s en si tiv e in di ca to rs in t he ir re sp ec tiv e IS 29 2, 00 0, 00 0. 00 – – – – 29 2, 00 0, 00 0. 00 76 To d ev el op a nd d is se m in at e pe rio di c nu tr iti on fa ct s he et s 60 ,7 00 ,0 00 .0 0 63 ,3 10 ,1 00 66 ,0 32 ,4 34 68 ,8 71 ,8 29 71 ,8 33 ,3 18 33 0, 74 7, 68 0. 90 77 To r ev ie w t he a va ila bl e se ct or al sy st em s to fa ci lit at e N IS p er io di c up da te 84 ,0 70 ,0 00 .0 0 – 91 ,4 55 ,4 65 – – 17 5, 52 5, 46 5. 43 112 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 78 To r ev ie w a nd in te gr at e ov er w ei gh t an d ob es ity in di ca to rs in t he a va ila bl e in fo rm at io n sy st em p la tf or m s ac ro ss a ll ag e gr ou ps . 12 ,6 40 ,0 00 .0 0 – 13 ,7 50 ,4 11 – – 26 ,3 90 ,4 11 .3 6 79 To u nd er ta ke r ev ie w in o rd er t o al ig n m aj or n at io na l a ss es sm en ts an d su rv ey s to e ns ur e co ve ra ge of o ve rw ei gh t an d ob es ity in di ca to rs a m on g al l a ge g ro up s (e .g ., TD H S, S TE PS , T N N S, M al ar ia N ut rit io n Su rv ey s, H B S) , 19 ,0 25 ,0 00 .0 0 – – – – 19 ,0 25 ,0 00 .0 0 80 To m ap t he a va ila bl e nu tr iti on da ta f ro m t he p riv at e se ct or w 16 ,8 00 ,0 00 .0 0 – – – – 16 ,8 00 ,0 00 .0 0 81 D ev el op d at a to ol s fo r ca pt ur in g da ta f ro m t he p riv at e se ct or 13 ,0 00 ,0 00 .0 0 – – – – 13 ,0 00 ,0 00 .0 0 82 To im pr ov e M N IS in o rd er t o ac co m m od at e re le va nt d at a ge ne ra te d fr om t he p Pr iv at e sS ec to r 16 ,8 00 ,0 00 .0 0 – – – – 16 ,8 00 ,0 00 .0 0 83 O rie nt k ey a ct or s fr om t he pr iv at e se ct or o n da ta c ol le ct io n, an al ys is a nd m an ag em en t 17 5, 20 0, 00 0. 00 – 19 0, 59 1, 14 5 – – 36 5, 79 1, 14 4. 80 84 To im pr ov e M N IS in o rd er to a cc om m od at e th e M EA L Fr am ew or k of N M N A P II 41 ,6 50 ,0 00 .0 0 – – – – 41 ,6 50 ,0 00 .0 0 85 To p re pa re a nd d is se m in at e th e an nu al M EA L re po rt 38 ,4 80 ,0 00 .0 0 40 ,1 34 ,6 40 41 ,8 60 ,4 30 43 ,6 60 ,4 28 45 ,5 37 ,8 26 20 9, 67 3, 32 3. 90 86 To r ev ie w a nd u pd at e m ul tis ec to ra l n ut rit io n sc or ec ar ds to in co rp or at e th e M EA L Fr am ew or k of N M N A P II 14 0, 50 0, 00 0. 00 14 6, 54 1, 50 0 15 2, 84 2, 78 5 15 9, 41 5, 02 4 16 6, 26 9, 87 0 76 5, 56 9, 17 9. 01 87 To u nd er ta ke w or ki ng s es si on s fo r in cl us io n of n ut rit io n co m po ne nt s su ch a s bi om ar ke rs in n at io na l s ur ve ys (T D H S- M IS , N PS , M U C H A LI ) 49 ,5 60 ,0 00 .0 0 51 ,6 91 ,0 80 53 ,9 13 ,7 96 56 ,2 32 ,0 90 58 ,6 50 ,0 70 27 0, 04 7, 03 5. 67 113National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 88 To u nd er ta ke m id -li ne a nd e nd - lin e re vi ew fo r N M N A P II (a ct io n re se ar ch ) – – 53 0, 76 1, 52 7 – 57 7, 38 8, 39 6 1, 10 8, 14 9, 92 3. 59 89 To d ev el op a nd o pe ra tio na liz e a m ec ha ni sm o f ca pt ur in g re se ar ch fi n di ng s fr om r el ev an t hi gh er le ar ni ng in st itu tio ns 17 6, 52 5, 00 0. 00 18 4, 11 5, 57 5 19 2, 03 2, 54 5 20 0, 28 9, 94 4 2 08 ,9 02 ,4 12 96 1, 86 5, 47 5. 62 90 To c on du ct in te gr at ed N at io na l N ut rit io n SM A R T Su rv ey s – – 1, 16 2, 69 3, 01 1 – 1, 26 4, 83 4, 43 0 2, 42 7, 52 7, 44 0. 74 91 To d ev el op a nd o pe ra tio na liz e N at io na l N ut rit io n R es ea rc h R oa dm ap 30 ,8 50 ,0 00 .0 0 32 ,1 76 ,5 50 33 ,5 60 ,1 42 35 ,0 03 ,2 28 36 ,5 08 ,3 67 16 8, 09 8, 28 5. 92 92 To t ra in r el ev an t nu tr iti on st ak eh ol de rs o n nu tr iti on s ur ve ys ’ da ta - q ua lit y as se ss m en t 44 ,4 00 ,0 00 .0 0 – 48 ,3 00 ,4 96 – – 92 ,7 00 ,4 95 .6 0 93 To d ev el op a nd o pe ra tio na liz e nu tr iti on d at a- q ua lit y to ol ki t 20 ,1 20 ,0 00 .0 0 20 ,9 85 ,1 60 21 ,8 87 ,5 22 22 ,8 28 ,6 85 23 ,8 10 ,3 19 10 9, 63 1, 68 5. 99 94 To t ra in N ut rit io n Fo ca l P er so ns at t he n N at io na l a nd r R eg io na l le ve ls o n da ta a na ly si s, in te rp re ta tio n an d us e fo r ev id en ce -b as ed d ec is io n m ak in g 74 ,8 60 ,0 00 .0 0 78 ,0 78 ,9 80 81 ,4 36 ,3 76 84 ,9 38 ,1 40 88 ,5 90 ,4 80 40 7, 90 3, 97 6. 80 95 To c on du ct w eb in ar s on n ut rit io n da ta - u se a nd d at a- u se p la tf or m s 71 ,2 00 ,0 00 .0 0 74 ,2 61 ,6 00 77 ,4 54 ,8 49 80 ,7 85 ,4 07 84 ,2 59 ,1 80 38 7, 96 1, 03 5. 91 96 M ap s ta ke ho ld er s to b e en ga ge d jo in tly in d ev el op in g co m m un ity ou tr ea ch m ic ro nu tr ie nt s ed uc at io n pr og ra m m es 48 ,0 05 ,0 00 .0 0 – – – – 48 ,0 05 ,0 00 .0 0 97 C on du ct a dv oc ac y m ee tin gs , in cl ud in g to fo r pa rli am en ta ria ns 13 2, 97 5, 00 0. 00 – – – – 13 2, 97 5, 00 0. 00 98 D ev el op , p rin t, a nd di st rib ut e po lic y br ie fs a nd sh or t co m m un ic at io ns o n m ic ro nu tr ie nt s to e ar m ar ke d gr ou ps 19 ,8 55 ,0 00 .0 0 – – – – 19 ,8 55 ,0 00 .0 0 114 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 99 C on du ct a w ar en es s ca m pa ig n to d ec is io n m ak er s (M P’ s) o n im po rt an ce o f m ic ro nu tr ie nt s an d fo od fo rt ifi ca tio ns 13 3, 90 0, 00 0. 00 13 9, 65 7, 70 0 – – – 27 3, 55 7, 70 0. 00 10 0 C on du ct s ta ke ho ld er s’ m ee tin g to a dv oc at e fo r in cl us io n of t he m ic ro nu tr ie nt a ge nd a in t he ex is tin g fi l m in du st ry a s fe at ur ed th em e 20 ,7 55 ,0 00 .0 0 21 ,6 47 ,4 65 22 ,5 78 ,3 06 – – 64 ,9 80 ,7 71 .0 0 10 1 M ap k ey s ta ke ho ld er s th at ar e en ga ge d in m ic ro nu tr ie nt nu tr iti on s ec to r an d es ta bl is h lin ka ge s th ro ug h ex is tin g pl at fo rm 29 ,3 75 ,0 00 .0 0 – 31 ,9 55 ,5 64 – 10 2 D ev el op c le ar T oO R o n th e en ga ge m en t o f th e pr iv at e se ct or 21 ,3 75 ,0 00 .0 0 – – 23 ,5 12 ,5 00 10 3 Pr ep ar in g an d di ss em in at in g a PP P ro ad m ap t ha t w ill id en tif y th e in te rs ec tio n po in t be tw ee n th e go ve rn m en t an d th e pr iv at e se ct or – – – – 10 4 C on du ct a dv oc ac y m ee tin g w ith m aj or fo od p ro du ce rs , i m po rt er s an d tr ad er s on t he n ut rit io n ne ed of t he p op ul at io n 46 ,6 00 ,0 00 .0 0 48 ,6 03 ,8 00 50 ,6 93 ,7 63 52 ,8 73 ,5 95 10 5 C on du ct q ua rt er ly M ic ro nu tr ie nt Th em at ic W or ki ng G ro up m ee tin gs 47 ,1 00 ,0 00 .0 0 49 ,1 25 ,3 00 51 ,2 37 ,6 88 53 ,4 40 ,9 08 10 6 C on du ct b i-a nn ua l N at io na l C ou nc il fo r C on tr ol o f Io di ne D efi c ie nc y D is or de rs (N C C ID D ) m ee tin gs - C on du ct b ia nn ua l N FF A M ee tin gs 37 ,9 00 ,0 00 .0 0 39 ,5 29 ,7 00 4 1, 22 9, 47 7 43 ,0 02 ,3 45 44 ,8 51 ,4 45 20 6, 51 2, 96 7. 15 10 7 R ev ie w m ic ro nu tr ie nt g ui de lin es an d st an da rd s as a pp ro pr ia te 47 ,6 75 ,0 00 .0 0 – – – – 47 ,6 75 ,0 00 .0 0 115National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S n . A ct iv it ie s Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 TO TA L (T sh s) 10 8 A dv oc ac y of t he in ve st m en t ca se fo r nu tr iti on 23 ,2 50 ,0 00 .0 0 24 ,2 49 ,7 50 25 ,2 92 ,4 89 26 ,3 80 ,0 66 27 ,5 14 ,4 09 12 6, 68 6, 71 4. 68 10 9 A dv oc ac y an d en fo rc em en t of a va ila bl e le gi sl at io n on m ic ro nu tr ie nt fo rt ifi ca tio n 14 ,0 75 ,0 00 .0 0 14 ,6 80 ,2 25 15 ,3 11 ,4 75 15 ,9 69 ,8 68 16 ,6 56 ,5 72 76 ,6 93 ,1 40 .1 7 11 0 A dv oc at e fo r th e dD ev el op m en t of le gi sl at io ns / r eg ul at io ns to g ov er n fo od s af et y an d pr oc es si ng , a nd m ar ke tin g of fo rt ifi ed a nd b io fo rt ifi ed fo od pr od uc ts 21 ,9 50 ,0 00 .0 0 22 ,8 93 ,8 50 23 ,8 78 ,2 86 2 4, 90 5, 05 2 25 ,9 75 ,9 69 11 9, 60 3, 15 6. 44 11 1 Es ta bl is h TW G o n le gi sl at io n/ po lic y en vi ro nm en t fo r nu tr iti on 24 ,3 50 ,0 00 .0 0 25 ,3 97 ,0 50 26 ,4 89 ,1 23 2 7, 62 8, 15 5 2 8, 81 6, 16 6 13 2, 68 0, 49 4. 73 11 2 Im pr ov e po lic ie s an d fr am ew or ks su pp or tiv e fo r m ic ro nu tr ie nt nu tr iti on in p la ce . – – – – – – 11 3 C ap ac ity b ui ld in g of t he p riv at e se ct or o n th e de liv er in g of m ic ro nu tr ie nt in te rv en tio ns – – – – – – 11 4 C on du ct p er io di c na tio na l m ic ro nu tr ie nt s ur ve y to g en er at e da ta o n co un tr y st at us o f th e fo llo w in g ke y m ic ro nu tr ie nt s - V it A , V it B 1 2, Ir on /F er rit in , F ol at e, Zi nc , V it D , C al ci um , I io di ne – – – – – – 11 5 En ga ge r R es ea rc h an d aA ca de m ic in st itu tio ns t o de ve lo p re se ar ch p rio rit ie s on th e pr ev en tio n an d co nt ro l o f m ic ro nu tr ie nt s de fi c ie nc y 23 ,2 50 ,0 00 .0 0 24 ,2 49 ,7 50 25 ,2 92 ,4 89 -2 6, 38 0, 06 6 27 ,5 14 ,4 09 12 6, 68 6, 71 4. 68 11 6 En ha nc e fi n an ci al s up po rt fo r m ic ro nu tr ie nt o pe ra tio na l re se ar ch a ct iv iti es 50 0, 00 0, 00 0. 00 52 1, 50 0, 00 0 54 3, 92 4, 50 0 56 7, 31 3, 25 4 59 1, 70 7, 72 3 2, 72 4, 44 5, 47 6. 90 TO TA L E N A B LI N G E N V IR O N M E N T 21 ,2 05 ,1 40 ,2 11 .0 0 18 ,6 48 ,3 67 ,9 13 20 ,8 20 ,3 77 ,2 31 18 ,0 11 ,7 40 ,7 58 22 ,1 33 ,7 10 ,5 45 00 ,8 19 ,3 36 ,6 58 .4 4 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng St ra te gi c O ut co m e 1: In cr ea se d co ve ra ge o f ad eq ua te eq ui ta bl e an d qu al ity n ut rit io n se rv ic es a t co m m un ity a nd fa ci lit y le ve l Pe rc en ta ge o f he al th fa ci lit ie s pr ov id in g in te gr at ed m an ag em en t o f m al nu tri tio n 50 % 20 19 60 % 65 % 70 % 75 % 80 % BN A TF N C M oH Pr op or tio n of ch ild re n un de r fi v e in n ee d of SA M tr ea tm en t w ho a re ad m itt ed in th e pr og ra m m e 13 % 20 18 15 % 18 % 37 % 56 % 75 % BN A an nu al ly C O M M O N R E S U LT S , R E S O U R C E S , A N D A C C O U N TA B IL IT Y F R A M E W O R K F O R N M N A P II 3 A P P E N D IX 117National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pr op or tio n of c hi ld re n un de r fi v e in ne ed o f M AM tre at m en t w ho ar e ad m itt ed in th e pr og ra m m e an nu al ly fr om le ss th an 8 p er ce nt 8% 20 18 12 % 18 % 37 % 56 % 75 % W FP St an da rd Pr oj ec t Re po rt 1. 1 St re ng th en ed nu tri tio n co m m od iti es su pp ly c ha in fo r s er vi ce de liv er y N um be r o f nu tri tio n co m m od iti es in cl ud ed in M SD ca ta lo gu es - (L en gt h bo ar ds / he ig ht b oa rd , M U AC ta pe s, RU TF (F 75 , F1 00 , P lu m py nu ts ), RC H c ar d N o1 /b oo kl et ) 0 20 20 2 4 M SD Ca ta lo gu e/ M TR a nd En dl in e Ev al ua tio n N S- M oH M SD , T FN C, PO -R AL G , P M O , D Ps YR 3 & Y R6 Ty pe s of lo ca lly pr od uc ed nu tri tio n co m m od iti es (s pe ci al ize d nu tri tio us fo od in cl ud in g M AM tre at m en t fl o ur , co m pl em en ta ry fl o ur , R UT F, he ig ht b oa rd ) i n th e m ar ke t 0 20 21 1 2 3 4 5 TB S Re po rts / M TR a nd En d Li ne Ev al ua tio n M IT TB S, P O -R AL G , M oI T, SI D O , SB N , D P, VE TA , Ac ad em ia YR 3 & Y R5 118 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge o f he al th fa ci lit ie s w ith n o st oc k ou t o f R UT F la st in g m or e th an o ne m on th in th e re po rti ng pe rio d 65 % 20 18 70 % 75 % 80 % 90 % 10 0% TF N C BN A Re po rt TF N C PO -R AL G , M oH N S, D Ps Bi a nn ua l Pe rc en ta ge o f he al th fa ci lit ie s w ith fu nc tio na l nu tri tio n eq ui pm en t i n th e re po rti ng p er io d (h ei gh t b oa rd s, w ei gh in g sc al es , M U AC ta pe s) 40 % (h ei gh t bo ar d) 20 18 Ca ta ly st Te am 50 % 60 % 80 % 90 % 10 0% TF N C Re po rt TF N C PO -R AL G , N S M O H , D Ps , VE TA , S ID O , An nu al ly Pe rc en ta ge o f he al th fa ci lit ie s w ith n o st oc ko ut of Ir on F ol ic Ac id (I FA ) l as tin g m or e th an o ne m on th in th e la st th re e m on th s 64 % BN A- 20 17 67 % 70 % 74 % 76 % 80 % BN A, H M IS TF N C "M SD U N IC EF , G AI N TM DA M O H " An nu al ly Pe rc en ta ge of h ea lth fa ci lit ie s w ith no s to ck ou ts of V ita m in A ca ps ul es la st in g m or e th an o ne w ee k in th e la st ro un d 93 % BN A- 20 17 94 % % 95 % 97 % 99 % 10 0% BN A/ AN N U AL VA S RE PO RT TF N C "M SD U N IC EF , G AI N TM DA M O H - Ph ar m ac y" An nu al ly 119National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng 1. 2 In cr ea se d ac ce ss to fa ci lit y an d co m m un ity - ba se d nu tri tio n se rv ic es fo r w om en , m en , ch ild re n an d ad ol es ce nt s Pe rc en ta ge o f vi lla ge s w ith a t le as t 1 a ct iv e CH W in th e re po rti ng p er io d (C H W s w ho pr ov id e qu ar te rly re po rts ) N A 20 20 10 0% M N IS /B N A TF N C/ PO - RA LG TF N C, N S- M oH , D Ps , M oH H P An nu al ly Pe rc en ta ge o f vi lla ge w ith a t le as t 1 h ea lth fa ci lit y pr ov id in g nu tri tio n se rv ic es fo r w om en , m en , ad ol es ce nt s an d ch ild re n N A 20 20 10 0% PO -R AL G PO -R AL G TF N C, N S M oH , D Ps , M oH H P An nu al ly Pe rc en ta ge of v ill ag es im pl em en tin g vi lla ge h ea lth an d nu tri tio n da ys N A 20 20 30 % 50 % 10 0% 10 0% PO -R AL G PO -R AL G TF N C, M oH N S An nu al ly Pe rc en ta ge o f he al th fa ci lit ie s w ith fu nc tio na l nu tri tio n de sk N A 20 20 20 % 40 % 70 % 85 % 10 0% M oH N S re po rt M oH N S, T FN C, P O - RA LG , D Ps An nu al ly 120 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge o f ch ild re n 6– 59 m on th s w ho ha ve re ce iv ed vi ta m in A su pp le m en ta tio n du rin g th e pr ev io us 6 m on th s 63 .8 % 20 18 65 .7 % 67 .7 % 70 .0 % 74 .0 % 90 % AN N U AL VA S RE PO RT TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I An nu al ly Pe rc en ta ge o f ch ild re n ag ed 6– 59 m on th s w ho re ce iv ed 2 an nu al d os es of V ita m in A su pp le m en ta tio n 97 % 20 17 10 0% VA S RE PO RT TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I An nu al ly Pe rc en ta ge o f ch ild re n 6– 23 m on th s gi ve n m ic ro nu tri en t po w de rs in th e pa st s ev en d ay s 2% 20 15 /1 6 3% 4. 50 % 6% 8% 10 % TD H S TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I An nu al ly Pe rc en ta ge o f pr im ar y an d se co nd ar y sc ho ol s pr ov id in g at le as t on e fo rti fi e d m ea l t o st ud en ts N o ba se lin e 20 21 2% 5% 8% 12 % 15 % PO -R AL G / M oE ST M oE ST , T FN C, PO -R AL G PO -R AL G , U N IC EF , W FP , FA O , G AI N An nu al ly 121National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge o f pr im ar y an d se co nd ar y sc ho ol s pr od uc in g m ic ro nu tri en ts de ns e fo od s (fr ui ts / ve ge ta bl es / bi of or tifi e d cr op s) in s ch oo l ga rd en s N o ba se lin e 20 21 2% 4% 6% 8% 12 % PO -R AL G / M oE ST M oE ST , T FN C, PO -R AL G PO -R AL G , U N IC EF , W FP , FA O , G AI N An nu al ly Pe rc en ta ge o f pr im ar y an d se co nd ar y sc ho ol s w ith ac tiv e nu tri tio n cl ub s N o ba se lin e 2% 5% 8% 12 % 15 % PO -R AL G / M oE ST M oE ST , T FN C, PO -R AL G PO -R AL G , U N IC EF , W FP , FA O , G AI N An nu al ly Pe rc en ta ge o f pr im ar y sc ho ol s im pl em en tin g sc ho ol m ilk fe ed in g pr og ra m m es 0. 27 % 20 20 34 % TD B/ M LF M oE ST , T FN C, PO -R AL G PO -R AL G , U N IC EF , W FP , FA O , G AI N An nu al ly Pr op or tio n of he al th fa ci lit ie s pr ov id es un iv er sa l nu tri tio n sc re en in g (B M I as se ss m en t) an d co un se lli ng on n ut rit io n to c hi ld re n, ad ol es ce nt s an d ad ul ts no b as el in e 20 20 10 % 20 % 30 % 40 % 50 % M oH CD G EC An nu al ly 122 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pr op or tio n of he al th fa ci lit ie s pr ov id in g se rv ic es o n pr ev en tio n an d nu tri tio na l m an ag em en t of D RN CD s an d ch ro ni c di se as es no b as el in e 20 20 50 % BN A re po rt M oH CD G EC PO -R AL G Bi -a nn ua l Pr op or tio n of fo rm al s ec to r im pl em en tin g at le as t o ne nu tri tio n se rv ic es to th ei r em pl oy ee s no b as el in e 20 20 10 % 20 % 30 % 40 % 50 % SU RV EY Re po rt TF N C AT E, D Ps An nu al ly Pr op or tio n of s ch oo ls im pl em en t at le as t o ne nu tri tio n in te rv en tio ns no b as el in e 20 20 25 % 50 % su rv ey re po rt M oE ST , T FN C, PO -R AL G D Ps An nu al ly St ra te gi c O ut co m e 2: W om en , m en , ch ild re n an d ad ol es ce nt s pr ac tis e ap pr op ria te nu tri tio n be ha vi ou rs Pr op or tio n of in fa nt s 0– 5 m on th s of ag e w ho a re ex cl us iv el y br ea st fe d by re gi on s 59 % 20 18 65 % 70 % TN N S, T D H S N BS , T FN C M oH -N S, M oH - H P, PO -R AL G , D Ps An nu al ly Pr op or tio n of ad ul t p op ul at io n co ns um ed 5 o r m or e se rv in gs o f fru its /v eg et ab le pe r d ay 2. 8% 20 12 68 % ST EP S su rv ey Af te r F iv e Ye ar s 123National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge o f pr eg na nt w om en (1 5– 49 ) t ak in g iro n fo lic a ci d (IF A) fo r 9 0 da ys pl us d ur in g pr eg na nc y 28 .5 % 20 18 32 % 35 % 39 % 43 % 50 % TN N S/ TD H S TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I An nu al ly 2. 1 W om en , m en , ch ild re n an d ad ol es ce nt s ha ve in cr ea se d nu tri tio n kn ow le dg e Pe rc en ta ge of p re gn an t w om en a nd th ei r pa rtn er s w ho ha ve re ce iv ed co un se lli ng o n nu tri tio n fro m a he al th w or ke r (H W ) d ur in g th e la st fi sc al y ea r N A 20 21 4 0% 6 0% 8 0% 9 0% 10 0% IM ES re po rt PO -R AL G / M oH TF N C, M oH , D Ps An nu al ly Pe rc en ta ge of m ot he rs / ca re gi ve rs w ho re ce iv ed nu tri tio n co un se lli ng fr om CH W s at le as t on ce in a q ua rte r 65 % 20 19 70 % 80 % 10 0% 10 0% IM ES re po rt PO -R AL G TF N C, M oH , D Ps An nu al ly 2. 2 W om en , m en a nd ad ol es ce nt s em po w er ed to m ak e ne ce ss ar y nu tri tio n de ci si on s 124 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge of c ou nc ils w ith n ut rit io n pr og ra m m es th at ta rg et m al e pa rti ci pa nt s 20 21 50 % 10 0% PO -R AL G TA SA F, M oH H P, PO -R AL G , D Ps An nu al ly Pe rc en ta ge o f so ci al p ro te ct io n be ne fi c ia rie s re ac he d w ith nu tri tio n se rv ic es 20 21 20 % 50 % 10 0% 10 0% TA SA F/ PM O TA SA F, M oH H P, PO -R AL G , D Ps An nu al ly Pe rc en ta ge o f w om en a nd yo ut h re ce iv ed de ve lo pm en t lo an s by L G As 20 21 20 % 50 % 10 0% 10 0% co m m un ity de ve lo pm en t/ PO -R AL G PO -R AL G , M oH , D Ps An nu al ly Pr op or tio n of LG As s et th e re qu ire d 10 p er ce nt o f f un ds fo r w om en a nd ad ol es ce nt s an nu al ly 20 21 20 % 50 % 10 0% 10 0% co m m un ity de ve lo pm en t/ PO -R AL G M oH , D Ps An nu al ly 2. 3 W om en , m en , ch ild re n an d ad ol es ce nt s ha ve in cr ea se d co ns um pt io n of s af e, nu tri tio us an d ad eq ua te fo od s Pe rc en ta ge o f ho us eh ol d us in g ad eq ua te ly io da te d sa lt (1 5+ pp m ) 61 .2 % TN N S- 20 18 63 % 65 % 68 % 71 % 90 % TN N S/ TD H S TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I, N FF A, TA SP A An nu al ly 125National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge o f ho us eh ol ds re po rti ng u se of a de qu at el y fo rti fi e d m ai ze fl o ur 3. 3% FA CT -2 01 5 5% 7% 9% 12 % 15 % FA CT /T D H S TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I, N FF A An nu al ly Pe rc en ta ge o f ho us eh ol ds re po rti ng u se of a de qu at el y fo rti fi e d w he at fl o ur 18 .9 % FA CT -2 01 5 21 % 23 % 25 % 28 % 32 % FA CT /T D H S TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I, N FF A An nu al ly Pe rc en ta ge o f ho us eh ol ds re po rti ng u se of a de qu at el y fo rti fi e d oi l 16 .3 % FA CT -2 01 5 17 % 18 % 19 % 20 % 22 % FA CT /T D H S TF N C/ M O H / PO -R AL G U N IC EF , G AI N , N I, N FF A 3. S us ta in ab le an d re si lie nt fo od s ys te m s th at a re re sp on si ve to nu tri tio n ne ed s Pr op or tio n of ho us eh ol ds w ith lo w d ie ta ry di ve rs ity 41 % 20 18 20 % CF SN AR - M U CH AL I PM O M oA , M oL F An nu al ly In cr ea se d pe r c ap ita l co ns um pt io n of m ea t i n Ta nz an ia n po pu la tio n 2 0 kg 20 20 /2 02 1 2 5 kg T Z D ia ry Bo ar d (T D B) & M oL & F P O -R AL G , D Ps An nu al ly In cr ea se d pe r c ap ita l co ns um pt io n of m ilk in Ta nz an ia n po pu la tio n 5 4 lit re s 20 20 /2 02 1 6 0 lit re s T D B & M oL & F Re po rts T D B & M oL & F P O -R AL G , D Ps An nu al ly Pr op or tio n of c hi ld re n 6– 23 m on th s w ho re ce iv e m in im um ac ce pt ab le d ie t 31 % 20 18 T N N S 35 % 50 % 60 % 65 % 70 % TN N S, T D H S N BS , T FN C M oH -N S, M oH - H P, PO -R AL G , D Ps An nu al ly 126 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge of w om en 15 –4 9 ye ar s w ith m in im um d ie ta ry di ve rs ity N o ba se lin e N A 35 % 50 % 60 % 65 % 70 % TN N S, T D H S N BS , T FN C M oH -N S, M oH - H P, PO -R AL G , D Ps An nu al ly 3. 1 St re ng th en fo od s up pl y ch ai n th at su pp or t fu nc tio na l f oo d sy st em s In cr ea se pr od uc tio n of ho rti cu ltu ra l cr op s (fr om 6, 55 6, 10 2 to ns in 2 02 0 to 14 ,6 00 ,0 00 to ns by 2 02 5) 6. 5m to ns 20 20 /2 02 2 14 .6 m to ns M oA Re po rts M oA PO -R AL G , D Ps An nu al ly In cr ea se fi sh pr od uc tio n (fr om 80 ,0 00 to ns to 25 0, 00 0 to ns b y Ju ne 2 02 5) 80 ,0 00 to ns 20 20 /2 02 1 25 0, 00 0 to ns M oL & F Re po rts M oL & F PO -R AL G , D Ps An nu al ly Pe rc en ta ge of L G As w ith c lim at e re si lie nc e 47 % 20 20 M O A TC SA A, M O H , G AI N , S U N , N I, FA O , W FP An nu al ly Pe rc en ta ge o f LG As a do pt ed cl im at e sm ar t ag ric ul tu re pr ac tic es a nd te ch no lo gi es 47 .0 % 20 20 M O A TC SA A, M O H , G AI N , S U N , N I, FA O , W FP An nu al ly Pe rc en ta ge de cr ea se in po st ha rv es t lo ss es 35 % 20 20 17 .5 0% 127National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng 3. 2 St re ng th en fo od en vi ro nm en t th at p ro m ot e co ns um pt io n of s af e an d nu tri tio us fo od s Pe rc en ta ge o f co un ci ls th at ha ve c on du ct ed se ns iti za tio n ac tiv iti es o n th e im po rta nc e of fo od la be ls to in fo rm fo od ch oi ce s 10 0% TF N C an d Co m pa ct Re po rts PO -R AL G M oH , M oT I, D Ps An nu al ly Pe rc en ta ge of a w ar en es s of a fl a to xi n co nt am in at io n 15 % 20 20 60 % TF N C, M O A SI D O , N FF A, FA O , W FP , U N IC EF , P O - RA LG An nu al ly Pe rc en ta ge o f sa fe m ai ze a nd gr ou nd nu ts th at co m pl y w ith afl a to xi n m ai ze 8 6% , gr ou nd nu ts 92 % 20 20 10 0% TF N C, M O A SI D O , N FF A, FA O , W FP , U N IC EF , PO -R AL G , N AT IO N AL FO RT IF IC AT IO N AL LI AN CE An nu al ly St ra te gi c O ut co m e 4. St re ng th en ed m ul tis ec to ra l an d pr iv at e se ct or en ga ge m en t f or nu tri tio n Pe rc en ta ge of S M Es fo od pr oc es so rs en ga ge in fo od fo rti fi c at io n by 20 26 TB D 20 21 20 % St ak eh ol de rs M ap pi ng Re po rt M IT I N FF A, T FN C Pe rc en ta ge of S M Es en ga ge d in th e im pl em en ta tio n of n ut rit io n in te rv en tio ns TB D 20 21 St ak eh ol de rs M ap pi ng Re po rt M IT I TF N C Pe rio di c, Y 3 an d Y6 128 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng 4. 1 Im pr ov ed ca pa ci ty am on g pr iv at e se ct or a ct or s to p ro du ce sa fe a nd nu tri tio us fo od ac ro ss th e va lu e ch ai n Pe rc en ta ge o f fo od in du st rie s ad he rin g to fo od fo rti fi c at io n st an da rd s N A 20 21 20 % M IT I Pe rc en ta ge of s al t s ite s/ pr od uc er s pr op er ly io da tin g sa lts (4 0– 80 pp m su bj ec t t o th e cu rre nt re vi se d st an da rd ) 15 .4 % 20 19 20 % 25 % 30 % 40 % 50 % TF N C SA LT M AP PI N G RE PO RT An nu al ly Pe rc en ta ge o f co ns um er s' aw ar en es s of th e fo rti fi c at io n lo go 13 .3 % 20 15 30 % 50 % FA CT -2 01 5 Af te r fi v e ye ar s 4. 2 In cr ea se d ca te go rie s of pr iv at e se ct or en ga ge d in de liv er in g nu tri tio n in te rv en tio ns Pe rc en ta ge of S M Es en ga ge d in th e im pl em en ta tio n of n ut rit io n se rv ic es TB D 20 21 St ak eh ol de rs M ap pi ng Re po rt M IT I TF N C Pe rio di c, Y 3 an d Y6 129National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pe rc en ta ge of la rg e- sc al e in du st rie s en ga ge d in th e im pl em en ta tio n of n ut rit io n se rv ic es TB D 20 22 St ak eh ol de rs M ap pi ng Re po rt M IT I 4. 3 Co lla bo ra tio n an d co or di na tio n am on gs t pu bl ic a nd pr iv at e se ct or s st re ng th en s Pr op or tio n of (c ou nc il/ re gi on al ) he ld a t l ea st o ne m ul tis ta ke ho ld er pl at fo rm s on ov er w ei gh t a nd ob es ity N A 20 20 20 % Ac tiv ity re po rts TF N C PO -R AL G An nu al ly 5. E na bl in g en vi ro nm en t (a de qu at e po lic ie s an d fra m ew or ks ) t ha t is s up po rti ve o f ad eq ua te h um an an d fi n an ci al re so ur ce s fo r nu tri tio n Pr op or tio n of p la nn ed bu dg et s pe nt on n ut rit io n se ns iti ve in te rv en tio ns 33 .7 % 60 % PM O /P O - RA LG Pr op or tio n of c ou nc ils sp en di ng a m in im um b ud ge t al lo ca tio n pe r ch ild u nd er fi v e to n ut rit io n 52 % 20 19 70 % 10 0% Co m pa ct Ev al ua tio n 130 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng 5. 1 St re ng th en ed m ul tis ec to ra l co or di na tio n at al l l ev el s Pr op or tio n of co un ci ls th at ho ld q ua rte rly m ul tis ec to ra l co or di na tio n m ee tin gs 20 20 10 0% 10 0% 10 0% 10 0% 10 0% PO -R AL G re po rt PO -R AL G PM O An nu al ly Pr op or tio n of c ou nc ils im pl em en tin g th e m in im um bu dg et a llo ca tio n to n ut rit io n 20 20 10 0% 10 0% 10 0% 10 0% 10 0% PO -R AL G re po rt PO -R AL G PM O An nu al ly Pr op or tio n of b ud ge t fo r n ut rit io n se ns iti ve in te rv en tio ns in se ct or al b ud ge ts 20 20 Bu dg et sc ru tin i- iza tio n Re po rt PM O PM O /T FN C D Ps Pe rio di c Y R 3 an d YR 5 N um be r o f se ct or al m in is try su bm it in pu ts w ith in tw o w ee ks a fte r cl os ur e of th e qu ar te r 20 20 4 4 4 4 4 PM O PM O /T FN C PO -R AL G Q ua rte rly Pe rc en ta ge of a nn ua l pe rfo rm an ce o n ad he re nc e on nu tri tio n is su es am on g se ct or al m in is tri es 20 20 10 0 10 0 10 0 10 0 10 0 M TR a nd en d lin e ev al ua tio n of N M N AP II re po rts PM O /T FN C PO -R AL G An nu al ly 131National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng 5. 2 En ab lin g po lic ie s, le ga l an d re gu la to ry fra m ew or k Pe rc en ta ge o f im pl em en ta tio n pe rfo rm an ce o f se ct or m in is tri es on n ut rit io n in te rv en tio ns N A 20 21 10 0 10 0 PM O /P O - RA LG TF N C Pr iv at e se ct or co m pl ia nc e w ith le gi sl at io ns on m ar ke tin g of in fa nt s an d yo un g ch ild re n fo od s an d de si gn at ed pr od uc ts N A 20 21 M TR a nd en d lin e ev al ua tio n of N M N AP II re po rts PM O /P O - RA LG TF N C Pe rio di c Y R 3 an d YR 5 5. 3 Po lit ic al le ad er sh ip a nd co m m itm en t fo r n ut rit io n st re ng th en ed Pe rc en ta ge of M em be rs of P ar lia m en t se ns iti ze d on nu tri tio n is su es N A 20 21 An nu al ly Pe rc en ta ge o f go ve rn m en t bu dg et a llo ca te d fo r n ut rit io n 0. 6% 0. 8% 0. 9% 1. 0% 1. 2% 1. 3% 1. 5% An nu al ly 132 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng Pr op or tio n of re gi on s an d co un ci ls pr od uc in g se m i-a nn ua l a nd an nu al m ul ti- se ct or al n ut rit io n sc or ec ar ds An nu al ly 5. 4 Im pr ov ed fi n an ci ng fo r nu tri tio n In cr ea se d bu dg et ed ex pe nd itu re o n nu tri tio n ite m s at c ou nc il le ve l 52 % 20 21 70 % 10 0 Co m pa ct ev al ua tio n PO -R AL G TF N C, D Ps An nu al ly In cr ea se bu dg et ed ex pe nd itu re on n ut rit io n ite m s at s ec to r m in is tri es 60 20 21 10 0 PM O M in is tri es , TF N C, D Ps An nu al ly 5. 5 St re ng th en hu m an re so ur ce s fo r nu tri tio n at a ll le ve ls Pe rc en ta ge of L G As w ith qu al ifi ed nu tri tio ni st pe rs on ne l 54 % 20 21 70 % 10 0% PO -R AL G PO -R AL G Pe rc en ta ge o f di st ric t h os pi ta ls w ith d ie tit ia ns N A 20 % M O H 133National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 S tr at eg ic O ut co m e St ra te gi c O ut pu t Ba se lin e Ex pe ct ed Ta rg et s D at a So ur ce s In st itu ti on Re po rt in g Pe rio d In di ca to rs Va lu e Ye ar Ye ar 1 Ye ar 2 Ye ar 3 Ye ar 4 Ye ar 5 Le ad Co lla bo ra ti ng 5. 6 M ul tis ec to ra l nu tri tio n da ta ge ne ra tio n an d ut ili za tio n im pr ov ed Pr op or tio n of re gi on s an d co un ci ls pr od uc in g se m i-a nn ua l an d an nu al m ul tis ec to ra l sc or ec ar ds N A 20 20 M N IS TF N C PO -R AL G An nu al ly Pe rc en ta ge of d es ig na te d in di ca to rs w ith da ta N A 20 20 M N IS TF N C Pe rc en ta ge of la rg e an d m ed iu m s ca le in ve st or s in nu tri tio n re la te d in ve st m en t sh ar in g da ta a nd in fo rm at io n w ith G ov er nm en t N A 20 20 M N IS TF N C An nu al ly Pe rc en ta ge o f co m pr eh en si ve M on ito rin g, Ev al ua tio n an d Le ar ni ng fra m ew or k fo r N M N AP II op er at io na liz ed N A 20 20 M N IS TF N C Pr op or tio n of pl an ne d su rv ey s co m pl et ed an d re po rte d in a re qu ire d re po rti ng ti m e N A 20 20 M N IS TF N C 134 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 LIST OF PERSONS INVOLVED IN THE DEVELOPMENT OF NMNAP II 4Appendix NMNAP II Coordination Committee members SN Full Names Role Organization 1. Paul Sangawe Chairperson Director of Policy and Government Business Coordination - PMO 2. Dr. Germana Leyna Co-chair TFNC 3. Sara Mshiu Secretariat PMO 4. William Babu Secretariat PMO 5. Geoffrey Chiduo Secretariat TFNC 6. Mwita Waibe Member PORALG 7. Grace Moshi Member MoHCDGEC 8. Dr. Honest Kessy Member MoA 9. Kudakwashe Chimanya Member UNICEF 10. Debora Niyeha Member USAID Advancing Nutrition 11. Dr. Daniel Nyagawa Member NI 12. Theresia Jumbe Member SUA 13. Tumaini Mikindo Member PANITA 14. Juliana Muiruri Member WFP 15. Temina Mkumbwa Member USAID 16. Obey Assery Member GAIN 17. Prof. John Msuya Member NMNAP II Lead Consultants 135National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 NMNAP II Technical Committee members SN Full Names Role Organization 1. Dr. Germana H. Leyna TC Chairperson MD TFNC 2. Geoffrey Chiduo Secretariat TFNC 3. Julieth Itatiro Secretariat TFNC 4. Victoria Kariathi Secretariat TFNC 5. Dr. Nyamizi Bundala Member MLF 6. Festo Kapela Member MIT 7. Magreth Natai Member MoA 8. Stephen Motambi Member PORALG 9. Julitha Masanja Member Community Development MoHCDGEC 10. Grace U. Shileringo Member MOEST 11. Japhet J. Msoga Member MoHCDGEC 12. Evod Kanyamyoga Member MoFP 13. Joyce Ngegba Member UNICEF 14. Neema Shosho Member WFP 15. Dr. Leonard Katalambula Member - Academia UDOM 16. Ruth Mkopi Member - MIYCAN TFNC 17. Neema Joshua Member - MIYCAN TFNC 18. Abela Twinomujuni Member - Micronutrients TFNC 19. Elizabeth Lyimo Member -IMAM TFNC 20. Julieth Shine Member – Overweight &Obesity TFNC 21. Adelina Munuo Member – Overweight &Obesity TFNC 22. Jane Msagati Member - CSOs PANITA 23. Sofi a A. Makame Member DNuO – BAGAMOYO DC 24. Chacha Magige Member RNuO – SIMIYU RS 25. Sarah McClung Member USAID AN 26. Dr. Ray Masumo Member TFNC 27. Dr. Esther M. Nkuba Member TFNC 28. Tumain Charles Member ASPIRES 29. Bernard Makene Member NI 30. Magret Benjamin Member UNICEF 31. Dr. Analice Kamala Member TFNC 136 National Multisectoral Nutrition Action Plan 2021/22 – 2025/26 List of members from NMNAP II Consultative Sessions SN Full Names TWG Institution 1. Dr. Esther M. Nkuba MIYCAN TFNC 2. Fatoumata Lankoande MIYCAN UNICEF 3. Tuzie Edwin MIYCAN UNICEF 4. Anna Godfrey MIYCAN CRS 5. Belinda Liana MIYCAN COUNSENUTH 6. Glory Mhalu MIYCAN/ Micronutrients COUNSENUTH 7. Dr. Ray Masumo Micronutrients TFNC 8. Celestin Mgoba Micronutrients TFNC 9. Wessy Meghji Micronutrients TFNC 10. Beatha Mkojera Micronutrients SUA 11. Rose Msaki IMAM TFNC 12. Ramadhani Mwiru IMAM UNICEF 13. Maria Msangi IMAM TFNC 14. Lydia Mshengezi MIYCAN/IMAM ACF 15. Maria Ngilisho Overweight & Obesity TFNC 16. Janeth Lukanda NSI - Fisheries MLF 17. Richard Pangani NSI - Livestock MLF 18. David Katusabe Governance Independent Consultant 19. Mbaraka Stambuli Governance MLF 20. Josephine Manase Governance TFNC 21. Angela E. Shija Micronutrients NIMR 22. Esther Kabula MNIS TFNC 23. Aleswa Zebedayo MNIS TFNC 24. Medina Wandella MIYCAN TFNC 25. Angela Shija Micronutrients NIMR