The Government of Tanzania signed on to the scaling up nutrition (SUN) movement in June 2011 establishing a commitment to improving nutrition in the country. In order to effectively scale up nutrition, the Prime Minister’s Office prioritized three areas for SUN in Tanzania including the “translation of priority nutrition objectives into planned activities and budget allocations on an annual basis.”
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Other priority areas included improving capacity for nutrition at regional and district levels. Alongside the SUN commitments in 2011, the Tanzania National Nutrition Strategy (2009-2015) Implementation Plan was finalized, endorsed and costed at just over US$515 million, (approximately US$103 million per year). Of this amount, roughly US$331 million, or over US$66 million per year, was estimated as the funding necessary to implement direct nutrition services
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. In Tanzania’s decentralized government, nutrition services are the responsibility of district health departments, and therefore, planned and budgeted in the annual district health plans, known as the Comprehensive Council Health Plans (CCHP).
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CCHPs are funded from government grants, donor
health basket funds (HBFs), the districts’ own resources and non-governmental organizations.
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One of the only successful nutrition programs implemented at scale in Tanzania is the twice-yearly national vitamin A supplementation and deworming (VASD) program. With consistently high reported, coverage rates since 2001 (Figure 1), the distribution and coverage of vitamin A supplementation has been cited as a contributing factor in the decline in the under-five mortality rate (U5MR) of children in the last decade.
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Currently Tanzania’s VASD program reached approximately 6.8 million children twice a year. The process for institutionalization of VASD as a scaled-up nutrition intervention in the country was carefully monitored and shepherded by VAS stakeholders between 2005 and 2008. In August 2001, Helen Keller International (HKI), with support from the United States Agency for International Development (USAID) and the United Nations Children’s Emergency Fund (UNICEF), together with the Tanzania Food and Nutrition Centre (TFNC), began providing technical support, advocacy, and facilitation to all districts with the aim of ensuring a sufficient budget allocation for VASD in all district budgets. This advocacy and facilitation work was implemented twice-yearly through 8 zonal-level and 21 regional-level planning, budgeting, monitoring, and review workshops held at the beginning of the annual budgeting cycle and aimed at council and district health management team members including VASD focal persons and planning/finance officers. Instrumental to this advocacy and facilitation work was a planning and budgeting tool (PBT) for VASD, shown in Figure 2, which details the necessary delivery activities with standard costing values and standardized population targets to help district planning teams arrive at a realistic and justifiable budget for VASD programs. The summarised calculations obtained are then transferred into the CCHP. In addition, districts exhibiting low coverage rates after implementation were given additional support to identify weaknesses in their planning and budgeting efforts by using a sustainability assessment tool developed by USAID/A2Z project. These workshops and tools were implemented in all districts across the country, beginning in 2007 with USAID support and continuing from 2010 to-date with support from the Canadian government (DFATD). This paper presents the findings from the fiscal year (FY) 2010 annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in each district in FY 2010? (2) how many funds were allocated to twice-yearly VASD activities in each district in FY 2010?; and (3) how have VASD funding allocations changed over time?
