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The United Republic of Tanzania
CAPACITY DEVELOPMENT PROJECT FOR HEALTH CARE PROVIDERS AND MOTHERS
ON INFANT AND YOUNG CHILD FEEDING IN THE CONTEXT OF HIV AND AIDS
TANZANIA PROGRESS REPORT
AUGUST 2013
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Capacity development project for health care providers and mothers on infant and young child feeding
in the context of HIV and AIDS
Tanzania progress report
Authors:
Luitfrid Nnally
Mary Kibona
Margreth Rwenyagira
Freddy Lwoga
Dr Joyceline Kaganda
Tanzania Food and Nutrition Centre
22 Ocean Road,
P.O. Box 977,
DAR ES SALAAM.
Phone: +255 22 2118137
Fax: +255 22 2116713
Website: www.tfnc.or.tz
E-mail: info@tfnc.or.tz
Under financial support from:
SADC through IBFAN Africa
@ Copyright, 2013
Tanzania Food and Nutrition Centre
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TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................................................... ii
LIST OF ABBREVIATIONS, ACRONYMS AND SYMBOLS……………………………………………………………………………..iv
EXECUTIVE SUMMARY ......................................................................................................................................... v
CHAPTER ONE ........................................................................................................................................................ 1
1.0
INTRODUCTION........................................................................................................................................... 1
1.1 Malnutrition among children .......................................................................................................................... 1
1.2 Maternal nutrition ........................................................................................................................................... 1
1.3 Determinants of malnutrition.......................................................................................................................... 2
1.4 HIV infection and malnutrition ...................................................................................................................... 2
1.5 Infant feeding knowledge, attitudes and practices............................................................................................ 3
1.6 Rationale for capacity development of community health workers .................................................................. 3
Objective ............................................................................................................................................................... 4
1.2 Specific objectives............................................................................................................................................ 4
CHAPTER TWO……………………………………………………………………………………………………………………………………......5
2.0
PROGRESS OF THE IMPLEMENTATION............................................................................................................. 5
2.1 Project design and conceptualization framework ............................................................................................. 5
2.1.1 Project inputs, processes, outputs and outcomes………………………………………………………………….5
2.1.2 A Dynamic Model for the project……………………………………………………………………………………....7
2.1.3 Planned activities………………………………………………………………………………………………………………7
2.1.4 Progress made ............................................................................................................................................ 8
2.2.1 Baseline study ............................................................................................................................................ 8
2.2.2 Sensitization seminars .............................................................................................................................. 10
2.2.3 Development of training materials and job aids ...................................................................................... 11
2.2.4 Stakeholders and project steering committee meeting ............................................................................. 12
2.2.5 Training of trainers .................................................................................................................................. 12
2.2.6 Training of community health workers cum peer counselors .................................................................. 12
2.2.7 Development of support materials for counseling ................................................................................... 13
2.2.8 Development of checklist for supportive supervision ............................................................................... 14
2.2.9 Development of tools for monitoring and evaluation .............................................................................. 14
2.3 Key Achievements .......................................................................................................................................... 14
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2.3.1 Development and launching of training materials ................................................................................... 14
2.3.2 Building capacities of community members............................................................................................. 15
2.3.3 Dissemination of correct information to communities ............................................................................ 16
2.3.4 Acceptance of the initiative by stakeholders............................................................................................. 16
2.3.5 Extending interpersonal communication and counseling to communities .............................................. 17
2.3.6 Barriers of optimal breastfeeding and complementation identified ......................................................... 17
2.4.1 Selection of community health workers cum peer counselors .................................................................. 17
2.4.2 Incentive for community health workers cum peer counselors ................................................................ 18
2.4.3 Social and behaviour change communication strategy ............................................................................. 18
2.5 Lessoned learned ........................................................................................................................................... 18
2.6 Opportunities ................................................................................................................................................ 18
2.7 Recommendations ......................................................................................................................................... 20
BIBLIOGRAPHY ....................................................................................................................................... 252
Annex 1: Physical implantation of capacity development project - Tanzania: June 2012 - July 2013 ...................... 254
Annex 2. List of Participants Trained from 2012 – 2013………………………………………………………………………..26
Annex 3. Target population reached with home visits and counseling services……………………………………………..36
List of Figure:
Figure 1: The project dynamic model (Developed by the authors) ............................................................................. 7
Figure 2: Documentation of infant feeding knowledge, attitudes and practices using key informants ....................... 9
Figure 3: Prevalence of malnutrition among children 6 - 24 months ....................................................................... 10
Figure 4: Four resource materials for training toolkit ............................................................................................... 11
Figure 5: Community health workers cum peer counselors in a training session ..................................................... 13
Figure 6: Training materials were launched by Honorable Salma Kikwete, the wife to the President of the United
Republic of Tanzania…………………………………………………………………………………………………………………………………..15
Figure7: Community health workers cum peer counselors practicing communication skills in the villages………….16
Figure 8: President of the United Republic of Tanzania, Excellency Jakaya Kikwete during the event of inauguration
of the presidential call for action on nutrition in Dar es salaam, 16 June 2013……………………………………………….. 20
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LIST OF ABBREVIATIONS, ACRONYMS AND SYMBOLS
AIDS
ANC
ANOVA
ARV
CBO
CHMT
COUNSENUTH
DHMT
ENA
FBO
HAZ
HIV
IBFAN
IEC
IMCI
IYCF
KAP
MoHSW
MTCT
NACP
NBS
PMTCT
RCH
RCHS
SBCC
SD
SEK
SES
SPSS
TDHS
TFNC
UNAIDS
UNICEF
URT
WAZ
WHO
WHZ
p
Acquired Immunodeficiency Syndrome
Antenatal Care
Analysis of Variance
Anti Retroviral Drugs
Community Based Organization
Council Health Management Team
The Centre for Counselling, Nutrition and Health care
District Health Management Team
Essential Nutrition Actions
Faith Based Organization
Height-for-Age Z score
Human Immunodeficiency Virus
International Baby Food Action Network
Information, Education and Communication
Integrated Management of Childhood Illnesses
Infant and Young Child Feeding
Knowledge, Attitude and Practices
Ministry of Health and Social Welfare
Mother To Child Transmission
National AIDS Control Program
National Bureau of Statistics
Prevention of Mother-to-Child Transmission of HIV
Reproductive and Child Health
Reproductive and Child Health Services
Social and Behaviour Change Communication
Standard Deviation
Standard Error of Kurtosis
Standard Error of Skewness
Statistical Package for Social Sciences
Tanzania Demographic and Health Survey
Tanzania Food and Nutrition Centre
United Nations AIDS
United Nations Children‘s Fund
United Republic of Tanzania
Weight-for-Age Z score
World Health Organization
Weight-for-Height Z score
P – value
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EXECUTIVE SUMMARY
This is a technical progress report for the Capacity Development Project for Health care providers and
mother on infant feeding in the context of HIV and AIDS from the year 2011- 2013 under taken in
Tanzania, Ruangwa district, Lindi region. During the period under review (January 2011 – August 2013)
the project team in collaboration with district resource persons and Council Health Management Team in
Ruangwa district have accomplished a number of tasks.
Implemented activities includes the baseline study on infant and young child feeding knowledge, attitude
and practices to heath care providers and mother with children aged 6 – 24 months in Ruangwa district as
regards to various recommended infant feeding practices and issues. The study findings shows that among
other things the levels of malnutrition among children aged 6-24 months were unacceptably high. For
instance, the prevalence of stunting among HIV exposed and non-exposed children were 32 percent and
43 percent respectively; the prevalence of wasting were 13 percent and 15 percent for HIV exposed and
non-exposed children respectively; whereas that of underweight among HIV exposed children were 23
percent and among non-exposed children were 31 percent.
Sensitization seminars to introduce and familiarize leaders at various levels with this important
intervention was conducted to 25 National Consultative Group on Infant and Young Child Feeding
members , Regional Health Management Team in Lindi region 8 members attended the seminar, also 14
Council Health Management Team members from Ruangwa district were also sensitized. Following the
initiation of peer counseling activities at the village level the need was recognized and leaders from five
wards in Ruangwa district were also sensitized plus 50 Village Executive Officers were sensitized so that to
win their support.
Development of training Toolkit which is comprised of four books namely the Trainers Guide; Participant
Manual; Flip Chart; and Community Health Worker Record Keeping Workbook was done. The toolkit
contains four types of brochures that can be used by the clients such as pregnant and lactating women as
well as child caretakers. The brochures titles are: Maternal Nutrition (for nutritional care of pregnant and
lactating women); How to Breastfeed a Child Aged 0 – 6 Months; Complementary Feeding (6 – 24
months); and How to Express Breastmilk and Cup Feeding a Child.
Other accomplishments include conducting stakeholders and project steering committee meetings; 4
meetings were organized to engage the stakeholders in the project. These include project Steering meeting
under the chairman ship of the Tanzania Commission for AIDS; the Ministry of Health and social
Welfare – particularly the Reproductive and Child Health Section and the National Programme on
Prevention of Mother – To – Child Transmission of HIV and AIDS; Centre for Counseling on Nutrition
and Health Care and TFNC. Other meetings involved the National Consultative Group on Infant and
Young Child Nutrition which is the overseer of all infant and young child issues in the country.
Further, the training of district level resource persons were by a multsectrol team was formed and
comprised of 19 people from district departments of Health, Agriculture, Community development and
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Water and sanitation was conducted . The TOTs training was followed by conducting training of 220
community health workers cum peer counselors from 90 Ruangwa villages.
Furthermore, support equipment for counseling of pregnant and lactating mothers was developed
includes 230 bags.The bags are used to keep resource and reader materials that are used by the said
frontline workers in their quest to support infant and young child feeding in their communities.
The tools for supportive supervision at the district and community level were developed. The said tool is
in a form of checklist. Also a log frame, tool for guiding project management, monitoring and evaluation
was developed by adopting the IBFAN proposed framework for monitoring the progress of the project.
According to available data from January 2013 to June 2013 they have listed a total of 733 pregnant
women; 989 children aged 0-6 months and 1642 children aged 7 – 24 months. Among the listed clients
the trained community health workers cum lay counselors have conducted home visits and counseled a
total of 711 listed pregnant women; 855 parents of the listed children aged 0-6 months and 1233 parents
of children aged 7 – 24 months.
The project Challenges includes the Selection of community health workers cum peer counselors,
Incentive for community health workers cum peer counselors and Social and behaviour change
communication strategy. But there are several lessoned learned from the project such as the intervention
of building capacities of frontline workers and volunteers at community level was well accepted by various
stakeholders and communities. Also, the available human resource at TFNC is well capable of
implementing project activities professionally. Involvement of leaders at all level is paramount not only for
familiarizing them with the project design, objectives and its link to national developmental targets but
also to gain their support. Also, the involvement of national level leadership and nutrition champions
such as Honorable Salma Kikwete who is the wife of the incumbent president of Tanzania; the Minister of
Health and Social Welfare; the Chief Medical Officer of the Government among others has helped to
spread correct information about infant feeding and community support. The initiative can be easily
copied and replicated in many communities with little technical support from central level.
In operating the project there are some opportunities includes the presence of many stakeholders
implementing nutrition activities in the country. These include the public sector, private sector, civil
society organizations and development partners such as UN agencies, multi-lateral and bilateral
organizations(The United Republic of Tanzania, 2011). Another opportunity is the presence of the
Tanzania Food and Nutrition Centre (TFNC) which is the implementing institution fully mandated to
coordinate and oversee nutrition activities in the country. Its mandate includes nutrition policy
formulation, planning and initiation of nutrition programmes, advocacy, capacity development,
harmonization, coordination, research, monitoring and evaluation of nutrition services in the country.
The currently adequate political commitment to support nutrition from higher officials is great
opportunity. The project team recommends to stakeholders to think of and devise some incentive
schemes for community health workers cum peer counselors who move house to house doing counselling.
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CHAPTER ONE
1.0 INTRODUCTION
1.1 Malnutrition among children
The first 1000 days of child’s life, counted from the start of pregnancy to the child’s 2 year birthday is too
critical to prevent malnutrition. Failure to intervene in this period may result not only into increased child
morbidity and mortality, but also detrimental and irreversible consequences later in adult life. The major
nutritional problems facing Tanzanian children are severe and acute malnutrition, vitamin A deficiency,
iron deficiency anemia, and iodine deficiency disorders. The Tanzania Demographic and Health Survey
(TDHS) 2011 revealed that five percent of under-five children in Tanzania suffer from wasting which is a
manifestation of acute or chronic malnutrition or both. Moreover, 42 percent of children in this age
group were stunted, meaning that they are chronically malnourished; while 16 percent were underweight,
which is a manifestation of acute form of malnutrition (National Bureau of Statistics Tanzania and ICF
Macro, 2011). Age disaggregated data show that the prevalence of severe and acute malnutrition was
higher in children at critical age for optimal growth, health and development which is 2 years. For
instance 55 percent of children aged 18–23 months were wasted; 11 percent of children 6-8 months were
stunted; and 21 percent of children 18-23 months were underweight (National Bureau of Statistics
Tanzania and ICF Macro, 2011) Further evidence shows that other forms of malnutrition exist. For
instance, anemia was found to affect 59 percent of children aged 6-59 months and 41 percent of women
of reproductive age (URT, 2011). The prevalence of other micronutrients deficiencies in Tanzania is little
known. However, using Household Dietary Diversity Score (HDDS) as a proxy indicator, data shows that
most diets of children are undiversified, with less consumption of meat, animal products, veggies and
fruits (Ministry of Health and Social Welfare, 2012); National Bureau of Statistics Tanzania and ICF
Macro, 2011). Hence, it is very likely that zinc, Vitamins B1 and B2 deficiencies are problems of public
health significance. According to extrapolations 37.5 percent of the Tanzanian population is at risk of
inadequate zinc intake (IZiNCG, 2004).
1.2 Maternal nutrition
The socio-biological link between maternal and child nutrition is too strong to be ignored. Evidence shows
that the health and nutritional status of mothers and children are closely linked. Therefore, efforts to
improve nutritional and health status of children and women should go hand in hand (Ministry of Health
and Social Welfare, 2012). Low Birth Weight (giving birth to a child weighing less than 2.5kg) is a proxy
indicator of maternal nutrition status during pregnancy. Available data shows that in Tanzania, the
prevalence of low birth weight stands at 7 percent (URT, 2011). Low birth weight increases the risk of
diet-related non-communicable diseases in adulthood, particularly among overweight adults (Barker,
1998). Further evidence show that 11 percent of women aged 15-49 years had BMI less than 18.5
centimeters (cm), meaning that they were thin or undernourished. The proportion of women below the
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height of 145 cm in Tanzania was 3 percent; prevalence of anemia in women of reproductive age was 40
percent. The likelihood of pregnant women to be anemic was higher than that of women who were
neither pregnant nor breastfeeding (National Bureau of Statistics Tanzania and ICF Macro, 2011).
1.3 Determinants of malnutrition
Apart from food insecurity, other known causes of malnutrition in infants and young children are suboptimal feeding practices. Although more than 97 percent of postpartum women in Tanzania do
breastfeed, only 49 percent of children were breastfed within the first hour of birth; only 50 percent of
infants aged less than six months were exclusively breastfed (National Bureau of Statistics Tanzania and
ICF Macro, 2011). Further evidence shows that as the age of the infant (in 0 – 6 months age category)
increases the likelihood of being exclusively breastfeed diminishes rapidly. For instance, while the
percentage of exclusively breastfed infants aged 0-1 was 81 percent, for infants aged 2-3 months it declined
to 51 percent; to as low as 23 percent of infants aged 4-5 months (National Bureau of Statistics Tanzania
and ICF Macro, 2011). In Tanzania there is widespread practice of early introduction of complementary
foods before the recommended 6 months. Furthermore data shows that 5 percent of infants were fed
from bottles. The amount of complementary food given to infants is inadequate, the feeding frequencies
are low, and the dietary diversity is poor. Inadequate hygiene practices, poor sanitation and poor access to
safe or clean water are among the common problems which affect the quality of complementary foods
(National Bureau of Statistics Tanzania and ICF Macro, 2011; Ministry of Health and Social Welfare,
2012). Overall, only 21 percent of children aged 6-23 months receive a “minimum acceptable diet”,
defined as containing breast milk, milk or milk products, adequate number of meals per day and adequate
diversity (National Bureau of Statistics Tanzania and ICF Macro, 2011).
1.4 HIV infection and malnutrition
The plight of infants and young child feeding has been jeopardized by the advent of Human
Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) particularly MotherTo-Child Transmission (MTCT) of HIV through breastfeeding. Due to the perceived fear and risk of
MTCT, infant and child feeding practices has been a challenge not only among HIV infected women but
also non-infected women as well. Data on the prevalence of HIV infection in Tanzania show that 6.2
percent of women of reproductive age were infected (TACAIDS et.al., 2013). This prevalence is higher
than that of men (5.1 percent) although it slightly declined from 6.6 percent that was reported in 20072008 survey (TACAIDS, et.al., 2013). Infant feeding counselling services play a major role in ensuring that
MTCT of HIV through breastfeeding is reduced. Through counselling mothers are provided with
information about infant feeding options for them to make decision. According to the PMTCT and
Paediatric HIV scale up plan (2009-2013), 75 percent of all HIV infected women were counseled and
intended to exclusively breastfeed their babies (Ministry of Health and Social Welfare, 2009).
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1.5 Infant feeding knowledge, attitudes and practices
Malnutrition is known to be the major contributor of deaths among children aged below five years each
year. Its dismay fact to note that about two third of these deaths occur during the first year of child’s life.
Moreover, these deaths are closely related with sub-optimal child feeding practices particularly poor
breastfeeding and complementary feeding practices(UNICEF and WHO, 2001). Available evidence shows
that the prevalence of exclusively breastfeeding during the first months of life in Tanzania is unacceptably
low (National Bureau of Statistics Tanzania and ICF Macro, 2011). To add salt to the injury, the
complementary foods given to children starting at the age of 6 months is not only often unsafe but also
both inappropriate and inadequate. Inadequate knowledge, unfavorable socio attitudes and poor feeding
practices contributes to the problem of malnutrition among children of under-five years of age (TFNC,
2012) and consequently violation of children’s rights as well as threatening their socio-economic
development (UNICEF and WHO, 2001).
It’s around this background that Tanzania has been developing and implementing a number of policies,
strategies, guidelines and programmes to address maternal and child nutrition and particularly infant and
young child feeding challenges (Ministry of Health and Social Welfare, 2012). Evidence based
interventions to address the high rates of infant and young child under nutrition and morbidity include
the promotion of exclusive breastfeeding from birth to six months postpartum and continued
breastfeeding to two years or beyond along with appropriate complementary feeding from the age of 6
months (WHO,, 2002); (PAHO, 2003).
1.6 Rationale for capacity development of community health workers
Although Tanzania has made substantial strides in reducing malnutrition in under-five children, the levels
of child under-nutrition particularly underweight and stunting basing on World Health Organization
criteria are still high (WHO, 1995). A significant proportion of Tanzanian children and women remain to
suffer from various visible and hidden forms of malnutrition under-nutrition, including low birth weight,
vitamin A deficiency, iodine deficiency disorders and anemia (TFNC, 2002).
Despite the implementation of nutrition relevant actions in Tanzania still faces huge challenges. Undernutrition places children at increased risk of morbidity and mortality. HIV transmission during childbirth
or breastfeeding is the second most common way that the HIV virus is spread to children in most of subSaharan Africa, and this necessitates the need for an effective intervention. Community based quality
counselling on infant feeding is considered to play an important role in changing the behaviour of
mothers towards choosing most appropriate infant feeding methods that are expected to reduce MTCT of
HIV, and improve HIV free survival children. Sub optimal breastfeeding practices which contribute to
increase risk of MTCT often results from inconsistency messages and information as well as inadequate
counselling on infant feeding among others.
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The majority of pregnant girls and women have inadequate information regarding transmission of HIV to
their infants and ways to prevent the transmission. Most of the women who give birth at home are
unlikely to receive information on mother to child transmission of HIV from the traditional birth
attendants who assist them. Information about mother-to-child transmission is not likely to be offered
even when women attend antenatal clinics because health facilities are often short-staffed and nurses are
usually too busy to talk with mothers. Community based counselling therefore provides an answer. This
will help among other things to improve on the infant feeding knowledge, attitudes and practices among
mothers, community members and health service providers. This will in turn not only contribute to the
improved nutrition and health status of mothers and children but also reduction of MTCT as well as
quality of life.
In view of this, the capacity development project for health care providers and mothers on infant and
young child feeding in the context of HIV and AIDS was initiated in Tanzania with support from the
International Baby Food Action Network through SADC funds.
Objective
General objective
To empower mothers and their families to make an informed decision and practice the appropriate or
recommended infant feeding practices and maternal nutrition in the context of HIV/AIDS, thereby
reducing infant and maternal morbidity and mortality; through building capacity of community health
workers so that they are able to help pregnant and lactating women, men and child care takers improve
child feeding practices through changing their attitudes and behaviours on matters related to maternal,
infant and young child nutrition.
1.2 Specific objectives
Specific objectives of the project are:

To build capacities of community volunteers on matters related to infant and young child feeding
counseling in the context of HIV and AIDs at community level.

To update community health workers with guidelines and recommended optimal child feeding
practices and maternal nutrition in the context of HIV and AIDS.

To extend infant and young child counseling and follow up of women and children to
communities beyond health facilities.

To Improve the knowledge and skills of health care providers and other extension workers on
providing quality Infant and IYCF counselling to pregnant women and lactating mothers of
children less than 2 years in the context of HIV and AID s.

To sensitize policy makers, community leaders, PMTCT programme managers and the community
at large on the benefits of infant feeding counselling to the mothers and their infants; and

To compile and consolidate best practices on the implementation of the project for replication in
non-project areas.
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CHAPTER TWO
2.0 PROGRESS OF THE IMPLEMENTATION
2.1 Project design and conceptualization framework
2.1.1 Project inputs, processes, outputs and outcomes
The project design is described by the inputs, processes, outputs and outcomes which are presented in a
HIPPOPOC table. This table is a simple tool that provides a clear, global and coherent picture of the
main components of a project (Pierre et. al., 2000). The HIPPOPOC table provides information on
inputs, processes, outputs and outcomes that gives insight about the project and its components. The table
also facilitates the forming of a global picture of the project and promotes the formation of clear project
objectives. Detailed information in the HIPPOPOC table includes inputs necessary for the
implementation of the intervention; processes which is a list of actions or interventions to be
implemented; outputs which are the immediate direct results of actions or interventions to be
implemented; and outcomes, that is changes induced by the project. These outcomes of a project may also
be influenced by external factors beyond the control of project activities. The expected outcome of this
project is social and behaviour changes in terms of improvement in infant feeding knowledge, attitudes
and practices. These will be manifested by improvements in a number of child feeding practices such as
initiation of breastfeeding within one hour of birth, proportion of infants who are exclusively breastfed for
six months; timely initiation of complementary foods, and median duration of breastfeeding among
others. The impact will include improved nutritional status of children (reduction of the prevalence of
stunting, wasting and underweight); and reduced child morbidity and mortality. Therefore a HIPPOPOC
table gives a full perspective of the interventions. It serves as a communication tool for the community;
helping to distinguish outputs from outcomes hence clarifying the hierarchy of the objectives; thus gives
the basis for setting up the Monitoring and Evaluation system and the operational plan.
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Table 1. HIPPOCOC table for the project
INPUTS
 Health facilities
(Dispensaries,
health centers and
hospitals)
 Educational
material
 National and
District level
Trainers
 Community health
workers
 Training material
 Administrative
personnel
 Transportation
 Computers
 Computer skills
 Local government
support (District,
ward and village
government leaders)
 Available budget
(timely)
 Baseline survey on
sample areas
 "Built-in" evaluation
scheme
 Referral system
 Reporting scheme
PROCESSES
 Baseline study on Knowledge,
Attitude and Practice to
mothers with children aged 624 months and health care
providers
 Sensitization seminars at
different levels( National,
Regional, District, Ward and
Village levels)
 Development of training
materials and job aids
 Conduct stakeholders meeting
 Training of train of trainers
and community peer
counselors
 Development of Support
equipment and logistics for
counseling of pregnant and
lactating mothers
 Support Materials
Development for trainers,
counselors and mothers/ report
production and publications,
Production and Dissemination
of IEC materials – no fund
 Communication tools
developed
 Supporting and supervising
countries, trainers, and
counsellors
OUTPUTS
 Baseline study on Knowledge,
Attitude and Practice conducted
 Sensitization seminars at National,
Regional, District, Ward and Village
levels conducted
 Training materials and job aids
developed
 Stakeholders meeting conducted
 District trainers trained
 Community health workers and peer
counselors trained
 Support equipment for counseling of
pregnant and lactating mothers
developed
 Support Materials for trainers,
counselors and mothers developed
(Trainers guide, trainee book,
counseling flip chart, record keeping
work book, IEC materials –
brochures on maternal nutrition /
exclusive breastfeeding /
complementary feeding / expressing
breastmilk )
 Reports and publications developed
 IEC materials disseminated
 Communication tools developed
 Supportive supervision to countries,
trainers, and counsellors conducted
OUTCOMES
 Community systems for supporting infant and young
child feeding strengthened
 Health status of infants and young children improved
(reduced child mortality and morbidity)
 Nutritional status of infants and young children
improved (reduced stunting, wasting and
underweight)
 Infant and young child feeding practices improved
(timely initiation of breastfeeding; use of colostrum;
nonuse of prelacteal feeds; increased number of
exclusively breastfed infants 0 - 6 months; timely
introduction of complementary food; increased
median duration of breastfeeding; improved dietary
diversity score during complementary feeding)
 Improved maternal nutritional care and support
(improved dietary diversity score among pregnant and
lactating women; increased feeding frequency among
pregnant and lactating women; increased resting time
among pregnant and lactating women; increased
uptake of iron and folic acid supplements among
pregnant and lactating women; increased utilization
of vitamin A supplements, malaria prophylaxis drugs,
deworming drugs and insecticide treated bed nets
among eligible women)
 Improved nutritional status of pregnant and lactating
women (reduced prevalence of anemia among
pregnant and lactating women; reduced prevalence of
Low Birth Weight babies; reduced prevalence of
malnourished non pregnant women of reproductive
age basing on Body Mass Index) Reduced maternal
mortality
 Increased involvement of community in infant and
young child feeding activities
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2.1.2 A Dynamic Model for the project
The dynamic model graphically represents how the project it is supposed to work on problems, what are
the expected results and what else can happen (confounding factors) basing on the HIPPOPOC table. It
discloses linkages among the various activities and allows for the identification of crucial and vulnerable
points in the implementation plan. The dynamic model therefore illustrates how the project acts, hence it
makes useful tool for coordinating management, monitoring and evaluation system.
Figure 1. The project dynamic model
(Developed by the authors)
2.1.3 Planned activities
The following are the planned activities for the project since its inception in 2011 to 2013.
1. Conducting a baseline study on Knowledge, Attitude and Practice to mothers with children aged
6-24 months and health care providers
2. Conducting sensitization seminars at different levels( National, Regional, District, Ward and
Village levels)
3. Development of training materials and job aids
4. Conducting stakeholders and steering committee meeting
5. Training of train of trainers and community peer counselors
6. Development of Support equipment and logistics for counseling of pregnant and lactating
mothers
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7. Support Materials Development for trainers, counselors and mothers/ report production and
publications, Production and Dissemination of IEC materials
8. Communication tools development
9. Supporting and supervising countries, trainers, and counsellors
2.1.4 Progress made
During the period under review (January 2011 – August 2013) the project team in collaboration with
district resource persons and Council Health Management Team in Ruangwa district have accomplished a
number of tasks. Among the successful implemented activities is the baseline study on infant and young
child feeding knowledge, attitude and practices; sensitization seminars for leaders at national, regional,
district, ward and village levels; and development of training materials and job aids. Other
accomplishments include conducting stakeholders and project steering committee meetings; training of
district level resource persons; training of community health workers cum peer counselors; development
of support equipment for counseling of pregnant and lactating mothers; and production and
dissemination of readers materials.
2.2.1 Baseline study
This study was undertaken to characterize the knowledge, attitudes and practices of mothers of children
aged 6 – 24 months in Ruangwa district as regards to various recommended infant feeding practices and
issues. In addition, the study was intended to characterize knowledge and practices of health service
providers in promoting, protecting and supporting optimal infant feeding practices in their community;
and establish baseline nutritional status of children aged less than 2 years in the study area.
9
Figure 2: Documentation of infant feeding knowledge, attitudes and practices using key informants
The finding of the study shows that the majority of health service providers had inadequate knowledge
about infant feeding in the context of HIV and AIDS. Majority of HIV negative had inadequate
knowledge about recommended infant feeding practices. Further results shows prevailing social attitude
against the use of colostrum to feed the baby; significant positive attitude towards early complementation;
and negative attitude towards exclusive breastfeeding. As regards to practices of supporting, promoting
and protecting optimal infant feeding practices it was discovered that some of health care workers provides
water or glucose to newborn babies. Suboptimal breastfeeding practices such as giving newborn babies
prelacteal feeds; low prevalence of exclusive breastfeeding for six months; early cessation of breastfeeding
before 24 months; and giving children complementary foods that are nutritionally unbalanced do exists.
The frequency of feeding of complementary foods are low while most women prefer to add salt into the
baby food in lieu of adding foods that improve the nutrient and energy density of complementary foods.
The levels of malnutrition among children aged 6-24 months were unacceptably high. For instance, the
prevalence of stunting among HIV exposed and non-exposed children were 32 percent and 43 percent
respectively; the prevalence of wasting were 13 percent and 15 percent for HIV exposed and non-exposed
children respectively; whereas that of underweight among HIV exposed children were 23 percent and
among non-exposed children were 31 percent (Figure 2).
10
Figure 3: Prevalence of malnutrition among children 6- 24 months
Basing on the findings of the study it was recommended to design and implement SBCC strategy with the
aim of promoting, protecting and supporting appropriate care practices for infants and young children
and strengthening nutrition counselling services by using community health workers and peer counselors.
2.2.2 Sensitization seminars
Prior to the implementation of the project efforts were made to introduce and familiarize leaders at
various levels with this important intervention. This was done by means of conducting sensitization
meetings first with the 25 members of the National Consultative Group on Infant and Young Child
Feeding. Another group which was sensitized includes 8 members of the Regional Health Management
Team in Lindi region where Ruangwa district is located. The meeting was also conducted at the district
level whereby 14 Council Health Management Team members from Ruangwa district were also sensitized.
In order to fortify the linkage between health facilities the need was recognized to sensitize local
government leaders at ward level. Therefore, leaders from five wards in Ruangwa district were also
sensitized.
However, following the initiation of peer counseling activities at the village level the need was recognized
and 50 Village Executive Officers were sensitized so that to win their support. The involvement of Village
Executive Officers was necessitated by the fact that they are key stakeholders who could provide a helping
hand to trained peer counselors who conduct interpersonal communication and home-to-home
counselling services in the communities.
11
2.2.3 Development of training materials and job aids
Following the finalization of baseline survey, the team of experts under the coordination of TFNC
developed the Training Toolkit for infant and young child feeding at the community level. A working
session was conducted at Njuweni Hotel in Kibaha from 24th– 29th September 2012 were the materials
were edited and drafts were produced. The activity was performed by TFNC staff, medical doctor from
Amana Hospital, PMTCT unit and UNICEF. The Training Toolkit was developed by suing available
information from various resource materials such as the National Strategy on Infant and Young Child
Feeding and Community Infant and Young Child Feeding Training Pack developed by UNICEF among
others. The Toolkit is comprised of four books namely the Trainers Guide; Participant Manual; Flip
Chart; and Community Health Worker Record Keeping Workbook.
In addition, the toolkit contains four types of brochures that can be used by the clients such as pregnant
and lactating women as well as child caretakers. The brochures titles are: Maternal Nutrition (for
nutritional care of pregnant and lactating women); How to Breastfeed a Child Aged 0 – 6 Months;
Complementary Feeding (6 – 24 months); and How to Express Breastmilk and Cup Feeding a Child.
Figure 4: Four resource materials for training toolkit
12
The Training Toolkit was developed stage by stage to perfection. The first drafts were presented to the
stakeholders namely the National Consultative Group on Infant and Young Child Nutrition to solicit
their inputs. Members of the groups are the Ministry of Health and social Welfare – particularly the
Reproductive and Child Health Section and the National Programme on Prevention of Mother – To –
Child Transmission of HIV and AIDS; development partners (such as UNICEF and WHO); local and
international Non-Governmental Organizations (such as Centre for Counseling on Nutrition and Health
Care, Elizabeth Glaser Pediatric AIDS Foundation) and TFNC which is the secretariat. The draft toolkit
was used to train Council Trainers and the first batch of Community Health Workers in December 2012.
These training sessions were used to pretest the toolkit. The experience of the first training session was
used to refine and finalize the toolkit. The final resource materials were approved by the Ministry of
Health and Social Welfare to be used in the country and were signed by the Permanent Secretary and the
Chief Medical Officer.
2.2.4 Stakeholders and project steering committee meeting
During the period under review 4 meetings were organized to engage the stakeholders in the project.
These include project Technical Working Group meeting under the chairman ship of the Tanzania
Commission for AIDS; the Ministry of Health and social Welfare – particularly the Reproductive and
Child Health Section and the National Programme on Prevention of Mother – To – Child Transmission
of HIV and AIDS; Centre for Counseling on Nutrition and Health Care and TFNC. Other meetings
involved the National Consultative Group on Infant and Young Child Nutrition.
2.2.5 Training of trainers
Among the core aim of the project managed is to build the capacity of frontline workers at the council
level. The project also intended to develop a team of expert trainers on infant feeding in Ruangwa district
and a team of village level frontline workers who can work on improving the knowledge, changing attitude
and practices on infant feeding in the context of HIV. In December 2012 the first training session was
organized in Ruangwa district with the objective of developing a team of district level trainers and resource
persons on infant and young child feeding in the context of HIV and AIDS. A total of 20 district officers
from various sectors such as health, community development, agriculture, water were trained. In total, the
final output of the training was that 19 district level resource persons1.
2.2.6 Training of community health workers cum peer counselors
In December 2013 the trained district resource persons were used to train 18 community health workers
in Ruangwa district under IBFAN support. The trained community health care providers were drawn
from three wards. In addition, the project team managed to train 163 community health workers from all
1
One trainee was unable to finish the training because of illness.
13
90 villages in Ruangwa district with support from EGPAF in March 2013. The second training session
under INFAN support was undertaken in July 2013 in Ruangwa district whereby a total of 39 community
health workers from 39 villages were trained. Therefore, all 90 villages of Ruangwa district were covered
with these training sessions and in total the number of trained community health workers in Ruangwa
district was 220. It is anticipated that the village level frontline promoters of infant feeding will contribute
to the implementation of the social and behavior change communication strategy by disseminating
appropriate behaviour change communication messages and interventions that are relevant to the
beneficiaries.
Figure 5.Community health workers cum peer counselors in a training session
2.2.7 Development of support materials for counseling
Under IBFAN support the project managed to produce 230 bags to be used by community health workers
cum peer counsellors and district level resource persons. The bags are used to keep resource and reader
materials that are used by the said frontline workers in their quest to support infant and young child
feeding in their communities. Supportive communications materials such as take-home brochures for
mothers and families and job aids for community workers which encourage the adoption of positive
behaviours were printed under the support of UNICEF and EGPAF.
14
2.2.8 Development of checklist for supportive supervision
The tools for supportive supervision at the district and community level were developed in June 2013. The
said tool is in a form of checklist. As of now it is still shared by other stakeholders so as to make it perfect.
In addition, efforts are made to harmonise this checklist with other / similar tools used by other nutrition
relevant actions at community level in Tanzania. Thereafter, the checklist will be shared with all
stakeholders so as to solicit their inputs before being presented to the National Consultative Group on
Infant and Young Child Nutrition for endorsement. Once endorsed by that body the checklist will be
used nationwide by all stakeholders to provide technical support on matters related to infant and young
child feeding at community level.
2.2.9 Development of tools for monitoring and evaluation
A log frame, tool for guiding project management, monitoring and evaluation was developed in June
2013. The tool was developed by adopting the IBFAN proposed framework for monitoring the progress of
the project. It contain national overall development objective that the project is expected to contribute to;
immediate Objective which is the effect expected to be achieved as the result of the project delivering the
planned outputs; and outputs which are the "deliverables" the tangible results that the project
management team guarantee to deliver. Other items are the activities that have to be undertaken by the
project to produce the outputs, and inputs which are the resources that the project consumes in the
course of undertaking the activities. Various indicators that can be verified as well as means of verification
have been shown together with assumptions or necessities that creates enabling environment for achieving
the project goals2.
The log frame is shared by other stakeholders and will go through the process of harmonisation with other
tools used to monitor and evaluate community nutrition interventions in Tanzania. The tool will be
shared with all stakeholders and fine-tuned before being endorsed by the National Consultative Group on
Infant and Young Child Nutrition for nationwide use.
2.3 Key Achievements
Despite various hurdles in so far the implementation of this project has been so far very successful in
many fronts. The following are the major achievements realized:
2.3.1 Development and launching of training materials
The process of developing training materials has been both challenging and successful. The four types of
resource materials and their accompanying reader materials have been endorsed by the Ministry of Health
2
See annex 2
15
and Social Welfare and were launched by Honorable Salma Kikwete, the wife to the President of the
United Republic of Tanzania during the commemorations of the World Breastfeeding Week in August 7,
2013.
Figure 7: Training materials were launched by Honorable Salma Kikwete, the wife to the President of the
United Republic of Tanzania.
2.3.2 Building capacities of community members
The training activity major accomplishment was an output of a total of 220 community volunteers who
were drawn from all 90 villages of Ruangwa district. The capacity of those trained community volunteers
in managing maternal and young child nutrition has been really strengthened. At an outcome level, the
training was very successful in terms of improving the knowledge levels of community volunteers on
matters related to maternal nutrition, infant and young child nutrition and prevention of mother to child
transmission of HIV. This is manifested by the fact that during the pre-training assessment, the number of
participants who provided wrong answers to the assessment questions was higher than that of those who
provided correct answers. This is elucidated by the line of wrong answers which is over and above that of
correct answers as seen in the pre assessment results chart 3. In contrary, the number of participants who
provided wrong answers to the post training assessment questions was lower than that of those who
provided correct answers4. Since all villages in the district were represented this entails that EGPAF
strengthened the districts’ capacity to manage maternal and young child nutrition. As an impact, the
training is anticipated to deliver social and behavior change among community members in issues related
3
4
See Annex 11
See Annex 11
16
to maternal and young child nutrition, hence contributing to the improvements in terms of nutritional
status, morbidity and mortality rates.
2.3.3 Dissemination of correct information to communities
A total of 4000 reader materials on infant and young child nutrition were disseminated to community
members through the trained community health workers cum lay counselors. Through the training
sessions, a total of 220 participant’s manuals and 220 counseling flip charts were disseminated to all
villages in the district. The counseling flip charts are used by village health workers to counsel men and
women on maternal nutrition, infant and young child nutrition and prevention of mother to child
nutrition. These materials are anticipated to fill in information gaps and help to cultivate positive
behaviours among community members.
Figure 8. Community health workers cum peer counselors practicing communication skills in the
villages
2.3.4 Acceptance of the initiative by stakeholders
The decision to extend infant and young child feeding counseling and support services to the community
level was well accepted by various stakeholders. In so far UNICEF has printed the training toolkit for use
in its focal districts. In addition, the World Food Programme have shown interest to follow the same
process of conducting baseline KAP study, developing district level trainers and training of lay counselor
in three districts of central Tanzania. Also EGPAF has not only assisted the project to train more
community health workers in Ruangwa but also funded a working session to refine the training toolkits
17
and harmonization of the draft supportive supervision checklist and log frame. Moreover, EGPAF has
shown interest to replicate the Ruangwa experience in various districts where they are implementing other
activities. Many stakeholders including the Ministry of Health and Social Welfare are looking forward to
see community infant and young child feeding activities are scaled up to cover more regions and bring
positive social and behaviour change for betterment of maternal and child welfare.
2.3.5 Extending interpersonal communication and counseling to communities
Among the planed interventions on this project was to build capacities of community health workers cum
lay counselors so that to enable them provide counseling services to pregnant and lactating women at their
dwelling places through home visits. In so far, available data shows about 41 community health workers
cum lay counselors who have been trained in December 2012 and March 2013 are actively engaged in
provision of counseling services to clients in the villages. According to available data from January 2013 to
June 2013 they have listed a total of 733 pregnant women; 989 children aged 0-6 months and 1642
children aged 7 – 24 months. Among the listed clients the trained community health workers cum lay
counselors have conducted home visits and counseled a total of 711 listed pregnant women; 855 parents
of the listed children aged 0-6 months and 1233 parents of children aged 7 – 24 months5.
2.3.6 Barriers of optimal breastfeeding and complementation identified
The baseline survey and interviews with community health workers cum lay counselors have enabled the
project team to identify a number of social cultural norms and values that hinder optimal breastfeeding
and child complementation. For instance the major barrier to exclusive breastfeeding is the ritual of giving
a new born baby some semi solid foods locally known as “totoli” during the 40th day of his life. This is the
day when the new born baby is brought outside the house for the first time. The relatives including
members of the extended family gather in the house and as the child is brought outside everyone is
supposed to feed the baby a little amount of totoli. In addition, children under complementary feeding are
given undiversified diet with limited animal protein, fruits and vegetables. These findings have shaded
some light on areas of message targeting during the designing of social and behaviour change
communication interventions.
2.4 Challenges
2.4.1 Selection of community health workers cum peer counselors
Among the major challenge observed was that of receiving a significant number of participants who were
actually not village health workers. This challenge was noted mostly during the first batch of trainees on
December 2012. That’s why among the 90 villages which sent trainees during the training sessions of
December 2012 and March 2013 only 41 villages had given data of clients counseled in their homes for
the period of January to June 2013. Following on this challenge showed that some of Village Government
Leaders were not aware of the selection criteria for participation of the training. This necessitated the
coordinators of the training to redesign the invitation information to the village leaders to enroll the right
people. In addition, this necessitated conduction of sensitization seminars to Village Executive Officers in
June 2013 so as to inform them about the project and what is expected from them. Nevertheless, prior to
5
See annex 3
18
the beginning of training sessions those participants who were identified to be non-eligible were returned
to the village and the village leaders were able to replace them with the intended beneficiaries.
2.4.2 Incentive for community health workers cum peer counselors
The trained community health workers cum peer counselors are providing home to home counseling
service on voluntary basis. Although about two community health workers cum peer counselors have been
trained in each village, the typical villages are too big to be covered on foot. Because of the need to keep
active the trained community health workers cum peer counselors the project team and district officers
have recognized that motivating the volunteers is crucial.
2.4.3 Social and behaviour change communication strategy
Causes of sub-optimal child feeding practices in Ruangwa are deeply rooted on social cultural norms and
structural barriers. Tackling these barriers requires designing and implementation of a social and
behaviour change communication strategy. Expertise and empirical evidence required for developing and
implement SBCC strategy is available. However, actualizing this endeavor is constrained by financial
resources.
2.5 Lessoned learned
The intervention of building capacities of frontline workers and volunteers at community level was well
accepted by various stakeholders and communities. Also, the available human resource at TFNC is well
capable of implementing project activities professionally. Involvement of leaders at all level is paramount
not only for familiarizing them with the project design, objectives and its link to national developmental
targets but also to gain their support. This was manifested by eagerness of Village Executive Officers to
support and make follow up of community health workers cum peer counselors in their villages in the
execution of their duties. Also, the involvement of national level leadership and nutrition champions such
as Honorable Salma Kikwete who is the wife of the incumbent president of Tanzania; the Minister of
Health and Social Welfare; the Chief Medical Officer of the Government among others has helped to
spread correct information about infant feeding and community support. The initiative can be easily
copied and replicated in many communities with little technical support from central level. The district or
council officials can be capacitated and take over the management and coordination of similar
interventions in areas under their jurisdiction. In addition, although the community infant feeding
initiative can be coordinated by the health sector, the involvement of other sectors such as community
development, agriculture and education within the implementing district could not be overemphasized.
That’s why the team of community infant feeding resource persons in Ruangwa district is comprised by
members from various departments reflecting the multi-sectoral nature of nutrition issues.
2.6 Opportunities
There is existence of a number of opportunities that can be taped to scale up and strengthen the
implementation of similar intervention in Tanzania. Among the available opportunities is the presence of
19
many stakeholders implementing nutrition activities in the country. These include the public sector,
private sector, civil society organizations and development partners such as UN agencies, multi-lateral and
bilateral organizations(The United Republic of Tanzania, 2011). Another opportunity is the presence of
the Tanzania Food and Nutrition Centre (TFNC) which is the implementing institution fully mandated to
coordinate and oversee nutrition activities in the country. Its mandate includes nutrition policy
formulation, planning and initiation of nutrition programmes, advocacy, capacity development,
harmonization, coordination, research, monitoring and evaluation of nutrition services in the country.
The center is well established with experienced nutrition experts. Yet the project may gain more strength
from institutions of higher education and training for the sectors of health, agriculture, community
development and education.
Currently there is adequate political commitment to support nutrition. This is evidenced by the inclusion
of nutrition indicator in the national strategy for growth and reduction of poverty and other
developmental programmes. The political commitment was also reiterated during the launching of the
National Nutrition Strategy by his honorable Mizengo Peter Pinda, the Prime Minister of the United
Republic of Tanzania in 2011 and was reinvigorated further by the President himself in June 2013 when
he called for more action to fight malnutrition in Tanzania.
20
Figure 9. President of the United Republic of Tanzania, Excellency Jakaya Kikwete during the event of
inauguration of the presidential call for action on nutrition in Dar es salaam, 16 June 2013
2.7 Recommendations
The project team recommends to stakeholders to think of and devise some incentive schemes for
community health workers cum peer counselors. Among the proposed incentives include providing them
with low cost transport facilities such as bicycles; T-shirts with infant feeding messages; and conducting
one day retreat meetings with active community health workers cum peer counselors at least once after
every six months. Presentation of certificates to active community health workers cum peer counselors
during public events such as World Breastfeeding Week commemorations can as well serve the purpose.
Other non-monetary forms of incentives can also be adopted.
21
There is a dire need of designing and implementation of a social and behaviour change communication
strategy so as to tackle the root causes of sub-optimal child feeding practices. The focus SBCC strategy is
the primary target group such as women and secondary target including family members, community
members and community leaders and health service providers. Channels of communication for SBCC
message delivery will include individual and group counseling, religious sermons, sporting events,
traditional media such as folklore dances and songs, formal sessions through health services and mass
media.
22
BIBLIOGRAPHY
Barker, D. P. (1998). Mothers, Babies and Diseases in Later Life. London: UK: Churchil Livingstone.
IZiNCG, I. Z. (2004). Assessment of the Risk of Zinc Deficiency in Populations and Options for its Control. Food
and Nutrition Bulletin 25: , S95 - 204.
Ministry of Health and Social Welfare. (2009). Ministry of Health and SociNational Scale up Plan for the
Prevention of Mother-to-Child Transmission of HIV and Paediatric Care and Treatment 2009 - 20013 .
Ministry of Health and Social Welfare. (2009). National Scale up Plan for the Prevention of Mother-to-Child Dar
es Salam:
Ministry of Health and Social Welfare. (2009). National Scale up Plan for the Prevention of Mother-toChiTanzania: National PMTCT Programme.
Ministry of Health and Social Welfare. (2012). Tanzania National Strategy on Infant and Young Child Nutrition.
Dar es salaam: Tanzania Food and Nutrition Centre.
National Bureau of Statistics Tanzania and ICF Macro. (2011). Tanzania Demographic and Health Survey 2010.
Dar es salaam, Tanzania: NBS and ICF Macro.
PAHO. (2003). Guiding Principles for Complementary Feeding of the Breastfed Child. Twenty-third St. N.W.,
Washington, D.C. 20037: Guiding Principles for Complementary Feeding of the Breastfed Child.
TwentyPan African Health Organization, World Health Organization, Division of Health Promotion and
Protection, Fooand and Nutrition Program.
Pierre et. al. (2000). Patrick Kolsteren, Marie-Paule De Wael, Francis Bye. Comprehensive Participatory Planning
and Evaluation. Nationalestraat 155, 2000 Antwerp Belgium: 20Nutrition Unit Tropical Medicine.
TACAIDS et. al.,, ZAC, NBS, OCGS and ICF Macro. (2013). HIV/AIDS and Malaria Indicator Survey 2011 - 12. Dares-Salaam: Tanzania.
TFNC. (2012). Analysis of Knowledge, Attitudes and Practices of Infant Feeding in the Context of HIV and AIDS in
Ruangwa District. Dar es salaam, Tanzania: Tanzania Food and Nutrition Centre.
TFNC. (2002). Evaluation of IDD control program. Dar es salaam, Tanzania: Tanzania Food and Nutrition Centre.
The United Republic of Tanzania. (2011). National Nutrition Strategy July 2011/12 – June2015/16. Dar es salaam,
Tanzania: Ministry of Health and Social Welfare.
UNICEF and WHO. (2001). Development of Global Strategy on Infant and Young Child Feeding. Development of
GlobaBudapest, Hungary: Report on WHO/UNICEF Consultation for WHO European Region.
URT. (2011). National Nutrition Strategy July 2011/12 - June 2015/16. Dar es salaam,: Tanzania, Ministry of
Health and Social Welfare.
23
URT. (2011). URT. (2011). National Implementation Guidelines on Infant National Implementation Guidelines on
Infant and Young Child Feeding. National Implementation Guidelines oDar-es-Salaam, Tanzania:
URT. (2011). National Implementation GuidelinTanzania Food and Nutrition Centre, Ministry of Health and Social
Welfare .
WHO. (1995). Physical Status: the Use and Interpretation of Anthropometry. Geneva: World Health Organization.
WHO,. (2002). Summary of Guiding Principles for Complementary Feeding of the Breastfed Child. Geneva,
Switzerland: HO. (2002). Summary of Guiding Principles for Global Consultation on Complementary Feeding
2001. ISBN 92 4 15461 X.
24
ANNEXES
Annex 2: Physical implantation of capacity development project - Tanzania: June 2012 - July 2013……..24
Main Activity
Sensitization at
different level
(National,
Regional, District
and Community
level)
Conduct working
session to
develop training
package
Sub activities
Planned
Conduct Sensitization
meeting with Regional
Health Management Team
Expected Results
Conduct Sensitization
meeting with community
leaders and other influential
people
Working session was done
by implementing
institutions and other
partners working on Infant
feeding to develop training
package
Editing of training package
done by team of infant
feeding trainers
Sensitization Meeting
conducted
Sensitization Meeting
conducted
Training packages was
developed: Trainers Guide;
Participant Manual; Flip
Chart; Record Keeping
Workbook; Brochures
Edited packages was
produced
Status of
Implementation
The meetings were
conducted as
planned.
100% achievement
The meeting was
conducted as
planned.
100% achievement
All necessary draft
were prepared
100% achieved
The documents were
printed by UNICEF
support to be used in
their focal districts
100% achievement
Training at
different levels
Conduct training of
trainers at district level
Training of trainers done 20
district trainers trained
Conduct transfer training
to village health workers
Transfer training was done
to 220 village health workers
Observation
/Challenges
The training was
conducted as
planned.
100% achievement
Two training sessions
with IBFAN support
and one session with
EGPAF support
conducted
100% achievement
Training
tool
kit
finalized with EGPAF
support, endorsed by
the ministry of health
and social welfare and
launched by the wife to
the President of the
nation
One participant cold
not finish the training
due to illness
25
Development of
support materials
for counseling
Produce support materials
for community health
workers cum peer
counsellors and district
level resource persons.
230 bags for community
health workers cum peer
counsellors and district level
resource persons produced.
Develop tools for
supportive
supervision at the
district and
community level
Development of checklist
for supportive supervision
Checklist developed
Development of
tools for
monitoring and
evaluation
Develop a log frame for
guiding project
management, monitoring
and evaluation
Log frame developed
Bags were developed
and distributed to 39
community health
workers cum peer
counsellors and 10
Trainers
The draft checklist is
shared and refined by
stakeholders before
endorsement.
60% Achievement
The draft log frame is
shared and refined by
stakeholders before
endorsement.
60% Achievement
Materials developed
with IBFAN support.
Drafting was done with
IBFAN support.
EGPAF is supporting
refining of the draft
checklist and
endorsement process.
Drafting was done with
IBFAN support.
EGPAF is supporting
refining of the draft
checklist and
endorsement process.
26
Annex 2. List of Participants Trained from 2012 – 2013
N
o
Name
Gender
Village
Work
Phone number
1.
2.
3.
4.
5.
6.
7.
Tabu M. Chande
MohaMaledi H. Likate
Rashidi A. Majeje
Mbaraka Juma
Abdalah S. Ngonde
Abubakari I. Malolela
Madaraka M. Gwaja
Female
Male
Male
Male
Male
Male
Male
Dodoma
Namakuku
Mitope
Nandenje
Nanjaru
Nachikalala
Nandandara
Peasant
Peasant
Village Health Worker
Peasant
Village Health Worker
Peasant
Village Health Worker
0687 533 615
0687 648 310
0682 648 690
8. Paulo Thomasi
9. Issa Nanjuja
10. Josephina Paulo
Male
Male
Female
Michenga (B)
Ng’unvwa
Malolo
11. Kassimu Matauna
12. Saidi M. Mtauka
13. Adamu S. Mbila
Male
Male
Male
Nambilanje
Mkaranga
Nahanga
Female
Female
Male
Female
Female
Male
Female
Male
Male
Male
Female
Female
Nahanga
Mchenganyumba
Mbekenyera
Ngau
Chunyu
Mchichili
Likangala
Namkatila
Lichwachwa
Manokwe
Nanganga
Nachingwea
Peasant
Peasant
Member of AIDS
committee
Peasant
Peasant
Village
Government
Member
Village Health Worker
Peasant
Petty businessperson
Peasant
Peasant
Village Health Worker
Peasant
Peasant
Peasant
Peasant
Peasant
Pet businessperson
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Sofia S. Lossi
Amana MohaMaled Kalembo
Saidi M. Kobe
Hawa Ponera
Amina Selemani
MohaMaled O. Matuli
Zaituni H. Chitawala
MohaMaled R. Lijani
Seif S. Tuwesi
Rajabu H. Mkali
Mwanahamisi Mussa
Fatuma H. Mkokoya
0755888 332
0763
941229
/0688 913 924
0688281 146
0787727 701
0752 984 533
0757 965 130
0684 963 345
0685 871 330
0786 396 710
0685 528 628
0769 053 323
0716 140 988
0786 490 334
0762 832 119
0783 315 05
0713 455 726
27
26.
27.
28.
29.
30.
31.
32.
Asia Issa Chuma
Hamza Fredrick
Ilujidina Mpwapwa
MohaMaled O. Mwambe
Mahamudu Chindema
Paulo John
Asha MohaMed
Female
Male
Female
Male
Male
Male
Female
Mbekenyera
Mpumbe
Nangumbu
Nandanga
Narungombe
Ipingo
Mmawa
Village Health Worker
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
33.
34.
35.
36.
37.
38.
39.
40.
Rabuna Selemani
Amina Mwitu
Huruma Amiri
Issa A Chitukutu
Ziada Omari
Leticia Kalembo
Subira Rashidi
Nurudini Dadi
Female
Female
Female
Male
Female
Female
Female
Male
Peasant
Village Health Worker
Peasant
Peasant
Peasant
Village Health Worker
Housewife
Peasant
Male
Male
Male
Machang’anja
Matambalele
Mbangala
Muyu (Chibula)
Namikulo
Mtimbo
Chikwale
Chienjele
Njawale)
Chienjele
Mtambale Kusini
Nangumba A
Male
Female
Female
Male
Female
Female
Male
Female
M
Female
Male
Male
Male
Male
Male
Namilema
Chimbila B
Nachinyimba
Chilangalile
Mmakia
Chibula
Mpara
Namahema (A)
Lipande
Naunambe
Mihewe
Nandagala B
Kipindimbi
Mandarawe
Nkowe
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
41. Issa Ng’wandu
42. Nurudini Chiputa
43. Ally B. Nchila
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
Juma Mshamu
Halima Chitanda
Farida Chimbunga
Seleman Kambanga
Fitina Hamisi
Halima Mtaabaya
Shabani A. Ngao
Hasanati B. Mchenga
Athmani Abdala
Mayasa B. Mkonga
Saadati Ally
Kishenina A. Kulimangondo
Godfrey Chitanda
Omari Bakari Kumpali
Hamisi I. chupa
Peasant
Peasant
0788 150 160
0783 731 448
0713 286 827
0718 222 256
0687 959 691
0712 111 686
0656699293
0783711402
0688 558 188
0788 197 906
064 960 034
0717 106 030
0684 961 291
068805591
0659808959
0786 397 905
0686 777 090
0686 651 595
0782 449 736
0682722316
0783 587 980
0788 157 840
0784 119 154
0786 754 758
0683 058 535
28
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
Abdallah M. Mkokotole
Sadamu a. Mika
Jabiri O. Mnonda
Saidi Rashidi
Tabu R. Nachinuku
Ester Simon
Asha MohaMaled
Amina Musa Ngololo
Asumini Omari
Stefania Isdory
Hassani R. Tumaini
Godfrey R. Maduga
Bakari S. Linyangwi
Mateso A. Liengo
Salima H. Chikawa
Devota Natanieli Mngowe
Rehema I. Maganga
Kais Abdallah
Abdallah Nakuhwa
Getruda K. Chitumbi
Seif M. anafi
Ismail S. Chiputa
81. Omari Juma Kubanga
82. Sigistus V. Nnunduma
83. Jalina H. Mpende
Male
Male
Male
Male
Male
Female
Female
Female
Female
Female
Male
Male
Male
Male
Female
Female
Female
Male
Male
Female
Male
Male
Mtondo
Chigungwa
K/Hewa Ruang
Mmawa
Likunja
Nandagala B.
Mandawa Chini
MkutingoMale
Chikoko
Chinokole
Chikundi
Namahema A
Nandagala A
Makanjiro
Namahema B.
Michenga A
Luchelegwa
Nangurugai
Mbecha
Mibure
Ruangwa
Liuguru
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Peasant
Male
Male
Female
Chimbila A.
Mtakuja
Nandagala A
Peasant
Peasant
Peasant
0786 440 883
0717 229 899
0684 292 619
0687 647 657
0688 274 003
0684 963 345
0783 266 673
0682 548 807
0656 219 362
0713 227 320
0684 876 756
0688 529 690
0687 902 828
0652 505 251
0783 014 104
0688 412 799
0785 847 458
0688 893 947
29
No
Name
Gender
Village
Work
Phone number
1.
2.
3.
4.
5.
6.
7.
Sesilia E. Chitanda
Leokadia Raphael
MohaMaled B. Mtawala
Farida Hamidu
Shaibu M. Chiumbo
Joseph T. Ngondo
Zeituni I. Limbwenda
Female
Female
Male
Female
Male
Male
Female
Mibure
Mtakuja
Namienje
Mchangani
Nahanga
Mbekenyera
Mpumbe
0687 940 570
0653 180 178
0717 142 452
0654 458 055
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Fatuma F. chilumba
Esha J. Lipy
Hidaya N. Mpokya
Awesa R. Mbwele
Esha A. Chilemba
Hadija A. Mandikite
Salima S. Chikawe
Hadija A. Lichoki
Sophia M. Chingwande
Amina A. Igala
Zakia A. Millanzi
Luti I. Ng’mbo
Haji Mitumba
Bakari M. Ahamadi
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Nkowe
Chinokole
Chingumbwa
Mbekenyera
Lipande
Namkatila
Njawale
Matambarale
Mchichili
Mamienje
Nanjaru
Kipindimbi
Matambarale
Nachinyimba
22.
Sudi Rajabu Libaba
Male
Chikoko
23.
24.
25.
26.
27.
28.
29.
Hamisi M. Bilauri
Ally M. Mpingo
Shabani S. Paul
Rehema B. Namwimbe
Otilia Aidani Mchopa
Swalihina R. Kunongwa
Fatuma B. Kumpika
Male
Male
Male
Female
Female
Male
Female
Mmawa
Mnacho
Mbangara
Mihewe
Nandanga
Mchenganyumba
Mtondo
30.
31.
Tariki M. Chilumba
Siglinde Nguli
Male
Female
Luchelegwa
Lichwachwa
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Insecticide treated net
distributer
Vulnerable
Children
Support (PACT-TZ)
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village
Volunteer
0765 050 969
0782 067 814
0782 290 099
0766 946 299
0788 157 275
0719 621 360
0788 157 275
0789 023 108
0788 219 335
0766 586 163
0682 404 353
0688 661 323
0789 085 644
0719 629 908
0782 956 414
0786 503 040
0756 550 281
30
32.
Mwanahija M. Kaponda
Female
Nambilanje
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
Zaituni R. Mkorogo
Tausi Ndaka
Obelini Joseph
Hassan H. Sheuna
Maua Rashidi
Binasa S. Kaimba
Agnes V. Kambona
Hamisi Mahamudu Bonge
Seif A. Miate
Saidi J. Mateka
Zaituni S. Nyagali
Said I. Ngulanjwe
Juma H. Makota
Afra Thomasi
Selina W. Malibiche
Female
Female
Male
Male
Female
Female
Female
Male
Male
Male
Female
Male
Male
Female
Female
Nandenje
Ipingo
Chimbila “B”
Nanganga
Mbecha
Nachikalala
Manokwe
Namkuzo
Chibula
Namichiga
Mbuyuni
Chunyu
Namkonjela
Michenga (B)
Michenga (A)
48.
49.
50.
Regia Cristian Mbinga
Mwajuma Y. Lukanga
Pili A. Ubavu
Female
Female
Female
Chimbila (A)
Namkonjela
Likangara
51.
Mwanajuma S. Lolela
Female
Dodoma
52.
Fatuma M. Mtopilia
Female
K/hewa
53.
Hilda B. Kambona
Female
Chilangalile
54.
Sofia B. ChaMaleta
Female
Chikwale
55.
56.
Fatuma I. Nangolondo
Beltila S.Magani
Female
Female
Namichiga
Ngimbwa
57.
58.
Sumini M. Mwambe
Eliagia K. Mwambe
Female
Female
Nangumbu (B)
Malolo
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village Health Worker
0763 479 789
0787 016 283
0659 656 284
0783 960 675
0687 959 209
0686 904676
0754 816 927
0659 768 951
0685 117 305
0687 884 692
0684 831 161
0657 582 584
0685 528 510
0783 547 785
0682 696 627
0784 570 625
0789 864 611
31
59.
60.
61.
62.
Farida H. Mnally
Somoe Mpwapwa
Awesa M. Anthony
Biasha S. Libaba
Female
Female
Female
Female
Nangumbu (A)
MkutingoMale
Namahema
Mitope
63.
Athumani Hamis
Male
Nachingwea
64.
Fatu S. Kalembo
Female
Liuguru
65.
66.
Raphael P. Malibiche
Said M. Livago
Male
Male
Mtimbo
Namkonjela
67.
Juma M. Namtonda
Male
Mandawachini
68.
Lusia L. Nnamba
Female
Namakuku
69.
Jalahi S. Likando
Male
Machang’anja
70.
Flaviana Clemence
Female
Chienjele
71.
Rehema M. Ngopo
Female
Nandandala
72.
73.
Ramadhani Nguruwe
Tabu M. Chitomwa
Male
Female
Likunja
Mandarawe
74.
Somoe M. Mtopwa
Female
Namilema
75.
76.
Donata J. Mpunga
Binasa K. Mkangula
Female
Female
Mpara
Nangulunga
77.
78.
79.
Halima S. Maenjela
Safina A. Ajuae
Rose T. Kambona
Female
Female
Female
Mkaranga
Muhudu
Makanjiro
80.
Saidi H. Namulya
Male
Naunambe
Village Health Worker
Village Health Worker
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village Health Worker
Village Health Worker
Village
Volunteer
(Mtunze Mtoto Initiative)
Village
Volunteer
(Mtunze Mtoto Initiative)
0784 537 157
0787 744 612
0787 928 729
0686287523
0717264024
0786758668
0784778960
0717 264 024
0766 026 955
0786 898 439
0654 456 672
32
No
Name
Gender
Village
Work
81.
82.
83.
84.
85.
86.
87.
Pili H. Matikwili
Zuwena M. Chapanga
Saidi S.Mpangwa
Fatuma S.Halfani
Yungu I. Liunga
Mwanaidi S. Maukito
Edina Packisens
Female
Female
Male
Female
Male
Female
Female
Chingumbwa
Namkema
Liuguru
Kilimahewa
Nachingwea
Mchichili
Nandagala
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
Asha Mpindo
Zainabu A. Matanga
Sauda O. Mapua
Hadija Mgo’mbo
Amina Chembe
Fatuma Ndonya
Moses G. Chiunga
Rehema S. Nachinguru
Helena Maluma
Husna S. Ng’itu
Maura P. Kambona
Female
Female
Female
Female
Female
Female
Male
Female
Female
Female
Female
Namikulo
Chikwale
Makanjiro
Chikoko
Chilangalile
Nbekenyera
Michenga
Nangurumbai
Nangumbu
Luchelegwa
Namahema
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Phone number
0784 088 366
0657 750 755
0685 528 465
0784 532 863
0688 294 968
0683 375 303
0714 595 257
0682 581 716
0659 378 301
0786 744 236
0786 762 332
0657 965 914
0786 001 171
33
No
Name
Gender
Village
Work
Phone number
1.
2.
3.
4.
5.
6.
7.
Ahmad Namitela
Sharifa Namkwile
Awatu Mchelema
Sophia Bande
Fabiola Antoni
Selemani Imbwile
Fatuma M. Chingano
Male
Female
Female
Female
Female
Male
Female
Mkutingome
Naunambe
Likangara
Chibula
Chinokole
Malolo
Nahanga
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
0682 898 392
0783 742 145
0682 361 677
0753 097 792
0687 903 529
0688 630 517
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Akika M. Njoro
Ahmadi A. Mtilanje
Zuwena O. Mbinga
Adina M. Maengo
Esha S. Mtendandi
Nurdini Pilingu
Pili S. Ntale
Mwanajuma M. Mwalimu
Adija S. Kabwa
Fatuma J. Ungele
Fadhili F. Mnunduma
Female
Male
Female
Female
Female
Male
Female
Female
Female
Female
Female
Chunyu
Kitandi
Mchangani
Narungombe
Machanganja
Mtakuja
Likunja
Lipande
Nambilanje
Mbangara
Chmbila A
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
Village Health Worker
0716 836 681
0782 520 112
0682 916 704
0718 850 589
0757 062 055
0686 505 155
0786 001 171
34
No
Name
Designation
Village
Ward / Address
Mobile phone
1
Joseph A. Mkwakwata
Registered Nurse
Ruangwa District Hospital
P.O.Box 49, Ruangwa
0786785202 &
0713059238
2
Violeth R. Byanjweli
Nutrition Officer
Ruangwa District
P.O.Box 51 Ruangwa
0652545813 &
0756937411
3
Amos R. Elias
Community Development Officer
Likunja Rwangwa
P.O.Box 51 Ruangwa
0754054597
4
Hoyfrasia Mapua
Enrolled Nurse
Nkowe Health Centre
P.O.Box 49 Ruangwa
0782090099 &
0655010011
5
Merina F. Kambona
Enrolled Nurse
Namichiga Dispensary
P.O.Box 49 Ruangwa
0787247754
6
Catherine E. Said
Agriculture Officer
Nachingwea Ward
P.O.Box 51 Ruangwa
0652359472
7
Mwajuma Salum
Community Development Officer
Nachingwea Ward
P.O.Box 51 Ruangwa
0717780785
8
Scholastica Mwageni
Community Development Officer
Makanjiro Ward
P.O.Box 51 Ruangwa
0752635807
9
Sabina Simon
Enrolled Nurse
Nkowe Health Centre
P.O.Box 49 Ruangwa
0787040162
10
Paskalina Mlowe
Registered Nurse
Ruangwa District Hospital
P.O.Box 49 Ruangwa
0716991337
11
Mikidadi E. Mbule
Clinical Officer
Ruangwa District Hospital
P.O.Box 49 Ruangwa
0785299258
12
Didace Iswalala
Registered Nurse
Mandawa Health Centre
P.O.Box 49 Ruangwa
0757607729
13
Joyce Mbalala
Enrolled Nurse
Luchelegwa Health Centre
P.O.Box 49 Ruangwa
0787668264
14
Afra Chilumba
Registered Nurse
Ruangwa District Hospital
P.O.Box 49 Ruangwa
0717776688
15
Saadiya Yusuph
Enrolled Nurse
Makanjiro Health Centre
P.O.Box 51 Ruangwa
0689306041
16
Ismail Naleja
Health Officer
Mandawa
P.O.Box 49 Ruangwa
0782625099
17
Alli A. Ntilla
Clinical Officer
Nkowe Health Centre
P.O.Box 49 Ruangwa
07872185…
18
Severina S. Moyo
Enrolled Nurse
Ruangwa District Hospital
P.O.Box 49 Ruangwa
0764510062
19
Uronu Evelyn
Senior Technician
Ruangwa District Council
P.O.Box 51 Ruangwa
0784226991
20
Bogia E. Mangaya
District Family Planning
Ruangwa District Council
P.O.Box 51 Ruangwa
0784580468
35
Name of participants of community health care providers training
No
1
Name
Christina Simon
Designation
Village Committee Member
Village
Likangara
Ward
Ruangwa
2
Tabia S. Chilungo
Village Committee Member
Nachingwea
Nachingwea
3
Mwashamba Mkengelemba
Community Health Care Provider
Dodoma
Nachingwea
4
Rehema Maulana
Community Health Care Provider
Dodoma
Nachingwea
5
Biasha Khalid
Community Health Care Provider
Nachinyimba
Mandarawe
6
Said S. Maunga
Community Health Care Provider
Nachinyimba
Mandarawe
7
Joyce E. Millanzi
Community Health Care Provider
Mandarawe
Mandarawe
8
9
10
Abdala S. Abdalla
Zaituni Rashid Mkorogo
Amina Bakari Makota
Community Health Care Provider
Community Health Care Provider
Community Health Care Provider
Lipande
Nandenje
Nachingwea
Ruangwa
Mandarawe
Nachingwea
11
Bakari M, Nambaka
Community Health Care Provider
Nachingwea
Nachingwea
12
Hassan Mkokoya
Community Health Care Provider
Likangara
Ruangwa
13
Abdalah Makota
Community Health Care Provider
Mchangani
Ruangwa
14
Chiku Mussa
Community Health Care Provider
Mchangani
Ruangwa
15
Madaraka Ng‟ombo
Community Health Care Provider
Mandarawe
Mandarawe
16
Khadija A. Mnwele
Community Health Care Provider
Kilimanihewa
Nachingwea
17
Rabuna B. Libaba
Enterpreneur
Kilimanihewa
Nachingwea
18
Zainabu M. Mbunga
Community Health Care Provider
Lipande
Ruangwa
Address
P.O. Box 51
Ruangwa
P.O. Box 173
Ruangwa
P.O. Box 19
Ruangwa
P.O. Box 19
Ruangwa
P.O. Box 51
Ruangwa
P.O. Box 51
Ruangwa
P.O. Box 51
Ruangwa
Mobile phone
0766753231
P.O. Box 173
Ruangwa
P.O. Box 72
Ruangwa
P.O. Box 51
Ruangwa
P.O. Box 82
Ruangwa
P.O.Box 51
Ruangwa
P.O. Box 51
Ruangwa
p.O. Box 51
Ruangwa
P.O. Box 51
Ruangwa
P.O. Box 51
Ruangwa
0689784484
0682667600
0717776566
0686300428
0718240840
0685528565
0664457256
0716159282
36
Annex 3. Target population reached with home visits and counseling services
Division
Ward
Vilage
Pregnant women
Total
1. RUANGWA
1.Ruangwa
2. Nachingwea
3. Mbekenyera
4. Namichiga
5.Matambarare
6.Chunyu
7.Narung’ombe
8. Makanjiro
9.Likunja
1.Mchangani
2.Likangara
3.Lipande
1.Nachingwea
2. Dodoma
3.Kilinani Hewa
1. Mbekenyera
2.Naunambe
3.Mkuti ngome
4. Chingumbwa
5. Namilema
6. Nusura
7. Mnamba
1.Namichiga
2.Namkonjera
3.Mbuyuni
1. Matambarare
2.Namkatila
3.Nandagara
4.Nantumba
1.Chunyu
2.Namikulo
3.Mihewe
1. Narung’ombe
2.Liuguru
3.Machang’anya
4. Chikwale
5. Nangurugai
1.Makanjiro
2.Chilangalile
3.Chikoko
4.Chinokole
5. Mbangara
1. Likunja
2.Mtimbo
3.Mpara
4.Mitope
5.Kitandi
Children 0 - 6 months
Total
counseled
Total
Children 7 - 24 months
Total counseled
Total
Total counseled
16
16
21
16
8
5
10
11
16
10
8
5
26
28
10
19
24
15
21
20
10
10
20
15
34
9
12
39
23
9
27
9
12
29
23
9
3
8
3
8
9
12
9
12
25
17
20
10
14
13
14
13
17
14
15
14
24
14
20
14
22
24
20
20
10
20
10
15
46
43
30
30
13
4
18
5
13
4
10
5
10
6
17
7
8
10
6
10
7
8
22
8
17
8
17
15
8
10
8
11
37
Division
Ward
Vilage
Pregnant women
Total
2.Mnacho
10.Nkowe
11.Chienjele
12.Mnacho /
Nandagala
13.Malolo
14.Nanganga
15. Luchelegwa
16. Chinongwe
17. Ngau
18.Mandarawe
1. Nkowe
2. Npinde
3.Mpara
4.Kipindimbi
5.Namiegu
1. Chienjele
2.Namakuku
3.Ng’imbwa
4.Njawale
5.Mibule
1.Nandagala
2.Namahema A
3. Namahema B
1.Namgumbu A
2.Malolo
3.Michenga A
4. Michenga B
4.Namgumbu B
5.Mtawilile
1.Nanganga
2.Mbecha
3.Mtakuja
4.Mchenga nyumba
1. Luchelegwa
2.Ipingo
3.Nandanga
1. Chinogwe A
2.Likwachu
3.Chinongwe B
4.Lutana
1.Chimbila A
2.Chimbila B
3.Manokwe
4.Ngau
Children 0 - 6 months
Total counseled
Total
Children 7 - 24 mo
Total counseled
Total
Total counseled
15
12
15
12
28
9
15
9
33
23
6
6
7
7
11
8
8
9
9
17
7
7
10
10
22
10
6
10
9
6
7
17
7
7
17
7
11
17
25
5
5
7
7
28
9
9
16
16
17
13
13
18
18
20
1. Mandarawe
7
7
25
20
23
2.Nachinyimba
24
15
21
15
21
3.Nandanje
6
14
24
38
Division
3.MANDAWA
Ward
19.Nambilanje
Vilage
Pregnant women
Children 0 - 6 months
Children 7 - 24 months
Total
Total
Total
Total counseled
Total counseled
Total counseled
1.Nambilanje
19
19
19
19
34
2.Mtondo
18
18
11
11
18
16
16
17
17
24
1.Chibula
5
5
6
6
16
2.Lichwachwa
2
2
4
4
5
5
12
5
12
8
6
8
6
11
12
3. Nanjaru
4. Mkaranga
20.Chibula
3.Muhuru
4.Namienje
21.Mandawa
1. Mchichili
0
0
3
3
9
2.Nahanga
10
10
15
15
63
3.Chikundi
Grand total
17
421
379
536
458
868
39
LIST OF PARTICIPANTS OF STEERING COMMITTEE ON CAPACITY DEVELOPMENT PROJECT ON INFANT AND YOUNG CHILD
FEEDING IN THE CONTEXT OF HIV AND AIDS 12 July 2013
Name
Luitfrid Nnally
Research Officer
Title
Organization
Tanzania food and nutrition Centre
Address
P.O.Box 977 Dar es salaam,
Mobile phone: +255754012883
E-mail: nluitfrid@gmail.com
P.O.Box 9083 Dar es salaam,
Mobile phone: +25571 314784
E-mail: pmuchuruza@yahoo.com
P.O.Box 76987 Dar es salaam,
Mobile phone: +255754 506985
E-mail: anulololi@tacaids.go.tz
P.O.Box 977 Dar es salaam,
Mobile phone: +255762595987
E-mail: lwogalfey@yahoo.co.uk
Pelagia Muchuruza
National PMTCT Community Coordinator
RCHS- PMTCT
Dr. Anoldia Muloli
Program Officer
TACAIDS
Freddy Lwoga
Research Officer
Tanzania food and nutrition Centre
Hamida Mbilikila
Research Officer
Tanzania food and nutrition Centre
P.O.Box 977 Dar es salaam,
Mobile phone: +255712700393
E-mail: hkatundu@yahoo.com
Winni Ntiro
Principal Accountant
Tanzania food and nutrition Centre
P.O.Box 977 Dar es salaam,
Mobile phone: +255754278872
E-mail: wntiro@yahoo.com
Sikitu Simon
Research Officer
Tanzania food and nutrition Centre
P.O.Box 977 Dar es salaam,
Mobile phone: +255754410148
E-mail: sikitu_simon@yahoo.com
Rehema Mzimbiri
Research Officer
Tanzania food and nutrition Centre
P.O.Box 977 Dar es salaam,
Mobile phone: +255754685860
E-mail: reyfd2000@yahoo.com
Deborah Charwe
Research Officer
Tanzania food and nutrition Centre
P.O.Box 977 Dar es salaam,
Mobile phone: +255713694719
E-mail: mischarwe@yahoo.com
Mary Kibona
Research Officer
Tanzania food and nutrition Centre
Grace Mushi
Accountant
Tanzania food and nutrition Centre
P.O.Box 977 Dar es salaam,
Mobile phone: +255713458525
E-mail: marykibona@yahoo.com
P.O.Box 977 Dar es salaam,
Mobile phone +255715278985
E- mail.
40
LOGFRAME FOR MONITORING AND EVALUATION OF COMMUNITY INFANT AND YOUNG CHILD FEEDING
INITIATIVE IN TANZANIA
Narrative Summary
Objectively Verifiable
Indicators - OVIs
Means of Verification
- MOVs
External Factors (Assumptions)



Survey
Supervision reports
TDHS


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)



Survey
Supervision reports
TDHS


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)



Survey
Supervision reports
TDHS


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)



Survey
Supervision reports
TDHS


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)
Development Objective
To empower all women to breastfeed their children exclusively for
6 months and continued breastfeeding with timely, safe and
adequately complementation for two years or beyond.
Immediate Objective NO 1:
Increase exclusive breastfeeding at 6 months by 60% by the end of
2013 in Project Implementing Areas in all countries
Outputs (Results)
1. Increased timely initiation of breastfeeding within 1
hour of birth
2. Increased exclusively breastfeeding
3. Increased infants fed on colostrum
4. Reduced prelacteal feeding
Immediate Objective NO 2:
Maintain the proportion of infants aged six to nine months who
are fed solid foods in addition to breast milk at >90%.
Outputs (Results)
1. Increased timely complementary feeding
2. Reduced bottle-feeding
3. Increased variety of complementary foods for children
6-24 months
4. Increased frequency of complementary feeding among
children 6-24 months
5. Increased consumption of iron rich foods among
children 6-24 months
6. Increased awareness on safe and appropriate infant
feeding practices among pregnant, lactating women and
i.
% of infants under six months who are exclusively
breastfed
ii.
% of children being put on the breast within 1 hour of
birth -Early Initiation of Breastfeeding
iii.
iv.
i.
% of infants who are fed on colostrum
ii.
iii.
iv.
% of infants exclusively breastfed to 6 months
% of infants who receive prelacteal feeds
% of women who initiate breastfeeding within 1 hour of
birth
% of infants fed on colostrum
% of infants received prelacteal feeds
i.
% children 6-9 months receiving complementary
food and continued breastfeeding
ii.
iii.
% of children bottle-feeding
iv.
% of children 6-24 months receiving minimum
frequency of foods of 4 times a day
% of children 6-24 months receiving food from all 5
groups of foods in a day
v.
% of children 6-24 months receiving at least one iron
rich food a day
vi.
% of mothers counseled practicing safe and
appropriate infant feeding practices.
i.
% of children who are receive complementary feeds
timely
ii.
iii.
% of bottle-fed children
iv.
% of children 6-24 who are fed complementary foods at
least 4 times in a day
v.
vi.
% of children 6-24 who consume iron rich foods
% of children 6-24 months receiving complementary
food from all 5 groups of food in a day
% of pregnant, lactating women and men counseled on
41
men.
Immediate Objective NO 3:
To increase the proportion of pregnant and lactating women who
practice healthy eating and timely attend antenatal and postnatal
clinic by 2013.
Outputs (Results)
1. Increased awareness on appropriate IYCN among
women and other members of the community.
2. Increased uptake of VCT services by pregnant and
lactating women.
3. Increased number of pregnant women timely attending
antenatal clinic
4. Increased number of lactating women attending
postnatal clinic
5. Increased awareness on healthy eating among pregnant,
lactating women and men.
Activities
1. Sensitization of decision makers and leaders at various
levels
2. Baseline survey to establish KAP on IYCN
3. Development of community based training package on
IYCN
4. Training of Trainers on IYCF at council level
5. Training of community health workers
6. Conduct home to home counseling on IYCF at
community level
7. Conducting supportive supervision on IYCF
8. Develop messages on behavior and social change
relevant for community
9. Disseminate behavior and social change communication
messages relevant for community
10. Quarterly planning and coordination meetings for the
Technical Working Group
11. Steering Committee planning meetings at national and
community level
12. End of project survey
safe and appropriate infant feeding practices.
i.
ii.
iii.
% of women advised on early antenatal booking.
iv.
% pregnant and lactating receiving infant feeding advice
according to set guidelines / standards.
v.
% of pregnant and lactating advised on increasing meal
frequency during pregnancy and lactation
i.
% of lactating women attending postnatal clinic



Survey
Supervision reports
TDHS


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)



Survey
Supervision reports
TDHS


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)








Sensitization report
Training package on IYCN
Report of baseline study
TOT Training report
Community health workers training report
Quarterly implementation reports
Supportive supervision report
Behavior and social change communication
materials developed (video; songs; leaflets;
brochures; comedies etc.)
Report on behavior and social change
communication dissemination events
(Radio& TV programmes; Traditional
media performances; campaigns etc.)
Minutes of quarterly planning and
coordination meetings for the Technical
Working Group
Minutes of Steering Committee planning
meetings at national and community level
Report of the end of project survey


Political commitment
Collaboration among partners
(Government; LGA; TFNC;
NGOs; communities etc.)
% HIV positive pregnant and lactating women advised to
undergo VCT at community level
% of women and other members of the community advised
on appropriate IYCN.
ii.
iii.
% of pregnant and lactating women undergone VCT.
iv.
v.
% lactating women attending postnatal clinic.
% of pregnant women timely attending antenatal clinic at
least 4 times during pregnancy.
% of pregnant, lactating women and men advised on healthy
eating.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
Decision makers sensitized.
Training package on IYCN developed (facilitator
guide, participants manual, job aids)
Decision makers and leaders sensitized
Baseline IYCN KAP study conducted
Number of trainers on IYCF trained
Number of community health workers trained
Number of households/primary targeted people
reached with home to home counseling on IYCF

Number of supportive supervision on IYCF
conducted
ix.
Type and number of behavior and social change
communication materials developed

x.
Number and type of behavior and social change
communication materials disseminated

xi.
Number of quarterly planning and coordination
meetings for the Technical Working Group
conducted

xii.
xiii.
Number of Steering Committee planning meetings at
national and community level conducted
End of project survey conducted
42