Mid Term Evaluation Report
for the 
Program Implementation 
in Morogoro, Dodoma and Manyara Regions
P.O. Box 10011
Dar es Salaam, Tanzania
Tel: +255 22 2774986,
stassctz@gmail.com
Process Consultants
and Facilitators
Associates
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TABLE OF CONTENTS 
TABLE OF CONTENTS....................................................................................................................................... I
LIST OF TABLES ............................................................................................................................................. IV
LIST OF FIGURES............................................................................................................................................. V
LIST OF ACRONYMS AND ABBREVIATIONS ..................................................................................................... VI
ACKNOWLEDGEMENTS ................................................................................................................................ VIII
EXECUTIVE SUMMARY.................................................................................................................................... IX
1-0 INTRODUCTION .......................................................................................................................................1
1-1 CONTEXT.....................................................................................................................................................1
1-2 PROGRAM OBJECTIVE AND STRATEGY...............................................................................................................1
1-3 MID-TERM EVALUATION PURPOSE AND SCOPE OF WORK......................................................................................2
1-4 REPORT LAYOUT...........................................................................................................................................2
2-0 METHODOLOGY AND DESIGN ..................................................................................................................3
2-1 METHODOLOGY.............................................................................................................................................3
2-2 EVALUATION DESIGN......................................................................................................................................4
2-2.1 Sampling Procedure............................................................................................................................. 4
2-2.2 Data Collection tools and Enumeration................................................................................................... 5
2-2.3 Implementation process........................................................................................................................ 5
2-2.4 Data Analysis ...................................................................................................................................... 6
2-3 ETHICAL CONSIDERATIONS..............................................................................................................................7
2-4 STAKEHOLDERS DISSEMINATION ......................................................................................................................7
2-5 INHERENT LIMITATIONS...................................................................................................................................8
3-0 MID TERM EVALUATION FINDINGS ...........................................................................................................9
3-1 ASSESSMENT OF PROGRESS TOWARD ACHIEVEMENT OF RESULTS .........................................................................9
3-3 INCREASED GOVERNMENT BUDGET ALLOCATION FOR NUTRITION INTERVENTIONS ...................................................11
3-3.1 National Level.................................................................................................................................... 11
3-3.2 District Nutrition Planning and Budgeting.............................................................................................. 12
3-4 INCREASED CONSUMPTION OF NUTRITIOUS FOOD AT HOUSEHOLD LEVEL...............................................................14
3-4.1 Agriculture and Nutrition Linkages ....................................................................................................... 14
3-4.2 Gardening and Small Livestock Keeping .............................................................................................. 15
3-4.3 Children Dietary Diversification............................................................................................................ 16
3-4.4 Women Dietary Diversity...................................................................................................................... 18
3-4.5 Food Quantities and Quality ................................................................................................................. 18
3-4.6 Iodization of Household Salt ................................................................................................................. 19
3-5 KNOWLEDGE, ATTITUDES, GENDER NORMS AND SOCIAL SUPPORT .......................................................................21
3-5.1 Nutrition Education and Communication Interventions ........................................................................... 21
3-5.2 Infant and Young Feeding Practices .................................................................................................... 23
3-5.2.1 Early Initiation of Breastfeeding ..................................................................................................................... 23
3-5.2.2 Exclusive Breastfeeding .............................................................................................................................. 24
3-5.2.4 Complementary Feeding ............................................................................................................................. 24
3-5.3 Hand Washing and Hygiene Practices ................................................................................................. 26
3-5.4 Mosquito Nets for Malaria Prevention................................................................................................... 27
3-5.4.1 Ownership of Mosquito Nets ........................................................................................................................ 27
3-5.4.2 Uses of Mosquito Nets ................................................................................................................................. 28
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3-5.5 Male Engagement in Maternal and Child Care ...................................................................................... 28
3-5.6 Women Empowerment towards Maternal and Child Care....................................................................... 29
3-6 QUALITY OF MATERNAL AND CHILD HEALTH NUTRITION SERVICES........................................................................30
3-6.1 Maternal and Child Health and Nutrition Education................................................................................ 30
3-6.1.1 District Nutrition Team Facilitators (DNTFs)................................................................................................... 31
3-6.1.2 Health Facilities and Health Facility Workers .................................................................................................. 31
3-6.1.3 Extension Workers ........................................................................................................................................... 32
3-6.1.4 Community Leaders ......................................................................................................................................... 32
3-6.1.5 Community Health workers (CHWs) and Home Based Care (HBCs) ...............................................................33
3-6.1.6 Formation of Peer Support Groups..................................................................................................................... 34
3-6.2 Child Nutrition Services ...................................................................................................................... 35
3-6.3 Vitamin A Supplementation ................................................................................................................. 36
3-6.4 Deworming........................................................................................................................................ 37
3-6.5 Nutrition Status of Under Five Years Children ....................................................................................... 37
3-6.5.1 Child Weight at Birth ................................................................................................................................... 37
3-6.5.2 Anthropometric Measures............................................................................................................................. 38
3-6.6 Utilization Maternal Nutritional Services................................................................................................ 39
3-6.6.1 Antenatal Care ............................................................................................................................................ 39
3-6.6.2 Antenatal Care Visits.................................................................................................................................... 39
3-6.6.3 Coverage of ANC........................................................................................................................................ 40
3-6.7 Prevention of Maternal Anemia............................................................................................................ 41
3-6.7.1 Provision Iron Tablets in Health Facilities ....................................................................................................... 41
3-6.7.2 Use of Iron Tablets by Pregnant Women at Community level............................................................................42
3-6.7.3 Use of Malaria Drugs for Prevention ............................................................................................................. 42
3-6.7.4 Prevalence of Anemia among Women .......................................................................................................... 42
3-6.8 Maternal Nutritional Status .................................................................................................................. 43
3-6.9 Access to Maternal and Child Nutritional Services ................................................................................. 44
3-7 INSTITUTIONAL CAPACITY BUILDING ................................................................................................................45
3-7.1 Institutional Strengthening of TFNC and COUNSENUTH ....................................................................... 45
3-7.1.1 Tanzania Foods and Nutrition Center ............................................................................................................... 45
3-7-1.2 COUNSENUTH.......................................................................................................................................... 46
3-7.2 CSO Sub Grantees ............................................................................................................................ 47
3-7.3 Strengthening the National SUN Secretariat ......................................................................................... 48
3-7.4 Districts Multi-sectoral Steering Committees ......................................................................................... 48
3-7.5 Supportive Supervision....................................................................................................................... 49
3-8 OPERATIONAL RESEARCH AND MONITORING AND EVALUATION.............................................................................50
3-8.1 Operational Research......................................................................................................................... 50
3-8.2 Monitoring and Evaluation System....................................................................................................... 51
3-8.2.1 Monitoring and Review Capacity ................................................................................................................... 51
3-8.2.2 Data Collection and Quality Assurance ............................................................................................................. 51
8-2.3 Reporting Framework ........................................................................................................................ 52
8-2.4 Feedback and Learning ..................................................................................................................... 52
4-0 PROGRAM MANAGEMENT......................................................................................................................53
4-1 INSTITUTIONAL ARRANGEMENTS.....................................................................................................................53
4-1.1 Management Personnel...................................................................................................................... 53
4-1.2 Integrated Management Structure........................................................................................................ 54
4-1.3 Sub-Grantees Performance Management............................................................................................. 55
4-3 PARTNERSHIP BUILDING AND COORDINATION....................................................................................................55
4-3.1 Colaboration with the Government...................................................................................................... 55
4-3.2 Partnerships with Other FtF Partners ................................................................................................... 55
4-3.3 Networking with other CSOs ............................................................................................................... 56
4-4 GENDER MAINSTREAMING.............................................................................................................................56
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5-0 LESSONS LEARNT................................................................................................................................. 58
6-0 CONCLUSION ........................................................................................................................................59
7-0 RECCOMMENDATIONS...........................................................................................................................61
ANNEXES .................................................................................................... ERROR! BOOKMARK NOT DEFINED.
LIST OF REFFERENCES ..................................................................................................................................72
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LIST OF TABLES
 
Table 1: Mean number of foods groups consumed by women of reproductive age (15 - 49) by region
Table 2: Presence of iodized salt in households, MTE for MBNP 2014
Table 3: Number and percent of children age 0-5 months who were exclusively breast-fed by region
Table 4: Percent of breast-fed children 6 - 23 months who received 4 meals per day by region
Table 5: Percent of breast-fed children 6 - 8 months who received 2 or more meals per day by region
Table 6: Percent of breast-fed children 9-23 months who received 3 or more meals per day by region
Table 7: Percent of women 15-49 years who wash hands by soap and Region
Table 8: Number and percent of CHWs and HBCs recruited by MBNP in ZOI
Table 9: Number of children provided with nutrition services per year by region
Table 10: Number of Children Provided with Vitamin A through Health Facilities
Table 11: Nutritional status of children under five years of age by sex, region and overall
Table 12: Number and percent of pregnant women who took iron tablets per recommended days
Table 13: Number and percent of anemic women of reproductive age 15-49 years by region
Table 14: Number and percent of BMI for women of reproductive age 15-49 years by region
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LIST OF FIGURES 
Figure 1: Number of beneficiaries with home gardens or small livestock 
Figure 2: Percent of people trained in gardening and small livestock keeping
Figure 3: Percent of children 6-23 months of age receiving Minimum Acceptable Diet per region
Figure 4: Percent of under 5 years children by food group consumed
Figure 5: Percent of women reproductive age 15-49 by food group consumed
Figure 6: Number of care groups trained on maternal anemia and IYCN
Figure 7: Initiation of breastfeeding
Figure 8: Percent of infants under 6 months who were fed with a bottle with a nipple
Figure 9: Percent of household ownership of ITNs
Figure 10: Percent of men who escorted their wives in any ANC visit at least once
Figure 11: Percent of household decision making by wives and husbands 
Figure 12: To what extent could you make personal decisions?
Figure 13: Number of people trained in child health and nutrition through USG-supported programs
Figure 14: Number of oriented community leaders against targets 
Figure 15: Number of Peer Support Group formed per year
Figure 16: Number of members of PSGs formed per year
Figure 17: Number of children provided with nutrition services per year
Figure 18: Number of children under 5 years who received vitamin A supplementation in the last six 
months by year
Figure 19: Percent of children who took pills for intestinal worms in the last six months by region
Figure 20: Number of women reproductive age reached by USG-supported programs per year
Figure 21: Percent of ANC visit by women of reproductive age during their last pregnancy
Figure 22: Months of first ANC visit
Figure 23: Percent of pregnant women who received iron tablets by number of days
Figure 24: Percent of women who took iron supplements during last and previous pregnancies 
Figure 25: Nutrition status for women of reproductive age 15-19 years 
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LIST OF ACRONYMS AND ABBREVIATIONS 
BMI -- Body Mass Index
CDOs -- Community Development Officers
CHWs -- Community Health Workers
CoP -- Chief of Party
CSOs -- Civil Society Organizations
DDI -- Deputy Director Implementation
DDIS -- Deputy Director Institutional Strengthening
DED -- District Executive Director 
DMO -- District Medical Officer
DMNuSC -- District Multi-sectoral Nutrition Steering Committee
DNTF -- District Nutrition Technical Facilitators
DNuO -- District Nutrition Officer
DPGN -- Donor Partners Group on Nutrition
FtF -- Feed the Future
GHI -- Global Health Initiative
GOT -- Government of Tanzania
HBCPs -- Home Based Care Providers
HKI -- Helen Keller International
IDI -- In Depth Interview
IFA -- Iron Folic Acid
IPT -- Intermittent Presumptive Treatment
IR -- Intermediate Result
ITNs -- Insecticide Treated Nets
IYCF -- Infant and Young Child Feeding 
LGA -- Local Government Authority
LLITN -- Long Lasting Insecticide Treated Net
MAD -- Minimum Acceptable Diet
MAFC -- Ministry of Agriculture, Food Security and Cooperatives
MBNP -- Mwanzo Bora Nutrition Program
M&E -- Monitoring and Evaluation
MOHSW -- Ministry of Health and Social Welfare
MFF -- Minimum Feeding Frequency
MTE -- Mid Term Evaluation
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MTEF -- Medium Term Expenditure Framework 
MUAC -- Middle Upper Arm Circumference
PIs -- Performance Indicators
PMO -- Prime Minister’s Office
PMORALG -- Prime Minister’s Office-Regional Administration and Local 
Government
PMTCT -- Prevention of Mother To Child Transmission
PSG -- Peer Support Group
RMNuSC -- Regional Multi-sectoral Nutrition Steering Committee
RNuO -- Regional Nutrition Officer
SBCC -- Social and Behavior Change Communication
SSQ -- Semi Structured Questionnaire 
Sub IRs -- Sub Intermediate Results
SUN -- Scaling Up Nutrition
TAFSIP -- Tanzania Agriculture and Food Security Investment Plan
TDHS -- Tanzania Demographic and Health Survey
TFNC -- Tanzania Food and Nutrition Center
TMG -- The Manoff Group
UNICEF -- United Nations Children Emergency Fund
USAID -- United States Agency for International Development
VEO -- Village Executive Officer
WEO -- Ward Executive Officer
WFP -- World Food Programme
WHO -- World Health Organization
 
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ACKNOWLEDGEMENTS
ST Associates – Process Consultants & Facilitators team that conducted the Mid-Term Evaluation 
would like to express its deep appreciation for the guidance and accessibility provided by the 
Africare/Mwanzo Bora Nutrition Program (MBNP) senior management and staff, to various relevant 
stakeholders who were involved in MBNP implementation. These included but were not limited to the 
central and local Government departments, consortium members, implementing partners, civil society 
organizations (CSOs) grantees, Community Health Workers (CHWs), village leaders and members of 
eligible households. 
Specifically, our special thanks go to Africare/MBNP Chief of Party, Mr. Brian Grants; the MBNP Deputy 
Directors (Dr. Vedasto Rutachokozibwa & Mr. Winstone Bohela); and the Agriculture Specialist, Mr. 
Alex Nalitolela who provided us with technical feedback right from the design stage, the review of our 
evaluation instruments, and responses to some of our evaluation questions as key informers, to 
providing comments and observations on the report debrief as well as the draft report. 
Special thanks also go to the MBNP Monitoring and Evaluation Specialist (M&E) Mr. Isaelly Nagunwa, 
and program staff in the regions, without whose unwavering supporting, it would not have been 
possible to conduct and complete this evaluation exercise successfully. They were instrumental in 
providing the program overview, reviewing and harmonization of the program’s secondary data, and in 
following up with the logistics required in locating the targeted respondents at district and community 
level. District Nutrition Officers (DNuOs) and CSO grantees at district level in locating the CHWs and 
Health Facility Workers (HFWs) included in this evaluation field exercise.
Our sincere thanks also go to all the stakeholders listed in Annex 2, led by CHWs in the three districts 
covered during this evaluation exercise for their valuable time and support. Many thanks also go to the 
Peer Support Group (PSG) members and head of eligible households who participated in the 
consultations.
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EXECUTIVE SUMMARY
Background 
This mid-term evaluation (MTE) was conducted for three months from October 6th 2014 and was 
designed to provide information that demonstrates the progress made by the implementation of the 
Mwanzo Bora Nutrition Program (MNBP), a five-year Program that became effective in September 
2011. A consortium of four organizations led by Africare implements the Mwanzo Bora Nutrition 
Program. Other members of the consortium are COUNSENUTH, Deloitte and Manoff. In the regions, 
the program works in partnership with relevant regional and district government institutions and the 
private sector composed of Civil Society Organizations (CSOs). MBNP was approved with a total 
budget of USD $30 million by USAID Feed the Future (FtF) and Global Health Initiative (GHI) vides 
Program Agreement No. AID-621-A-11-00001. 
The overall goal of the program is to improve the nutritional status of children and pregnant and 
lactating women in Tanzania, with specific focus on reducing maternal anemia and childhood stunting 
by at least 20% in Dodoma, Manyara and Morogoro regions. The program uses a community based 
approach to which Nutrition Social Behavioral Change Communication (SBCC) has been a key strategy 
utilized to achieve this capacity enhancement and transformation objective, while placing an emphasis 
on the first 1,000 days of the child’s life. Furthermore, the program aims to strengthen a referral and 
counter–referral service system whereby ward and community level nutrition and agriculture programs 
are linked to facility based health. 
Design and Methodology
MTE was designed in a way that addresses fundamental questions to determine whether or not the 
intended results have been achieved. To arrive at the answers to the evaluation questions, the 
evaluator employed a mixture of gender responsive methods, which entailed both quantitative and 
qualitative data collection techniques. In order to collect relevant information that could respond to the 
purpose of the evaluation, the evaluator also used triangulation of data generated from these various 
methods. The methods used included: i) Review of project documents and relevant policies; ii) Key 
informant interviews with MBNP staff, consortium members, Government personnel and other partners 
at the national and local governments; iii) Focus group discussions (FGDs) with mainly Peer support 
group (PSGs) members; iv) Surveys of beneficiaries at the household level; v) Stakeholder analysis; 
and vi) Observations at service delivery and technology sites. 
For the household surveys, the Team used a three-stage sampling procedure to select districts, villages 
and a sample of 165 households from three out of the 10 districts in which MBNP started 
implementation in 2011 before expanding to now cover 20 districts. The elgible households, which 
primarily constitute households with women of reproductive age (15-49 years) who are breastfeeding, 
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mothers of children under five years of age, pregnant and/or caretakers of children under five years of 
age were randomly selected in each village. 
Key Findings
The prevalence rate of child stunting (height-for-age) among children under-five years of age in the 
10 Districts where the project started implementation in 2011 is 40%. The national data (2010 TDHS)1
indicate 42% national prevalence rate of child stunting. Though it is not verified if this is a statistically 
significant reduction, any improvement in the prevalence of child stunting is programmatic important. 
The regional assessment on prevalence of child stunting showed 44.2% in Morogoro Region, 38.2% in 
Dodoma Region and 36.1% in Manyara Region, respectively.
The prevalence rate of anemia among women of reproductive age 15-49 years in the program area 
was 37%. According to the 2010 TDHS result, anemia prevalence in the nation is 40%. This 
performance of MBNP could be attributed to a number of successfully implemented interventions that 
focused awareness creation on the importance of iron supplementation on pregnant women, coupled 
with improvement of drugs ordering and supply chain to reduce stock outs as well as uptake of iron 
supplements during pregnancy and the post-partum period. 
Increase Government allocation for nutrition interventions
All 10 districts in the program area have included nutrition essential actions and budgets in their annual 
plans; and, largely supported the effort towards the increased budget allocations for nutrition 
interventions at national and district level. However, planned actions were not entirely incorporated and 
budgeted for in every sector plan; and even with an increase in budget allocation, there are still very 
few resources readily available for implementing nutrition activities.
Increase consumption of nutritious foods at the household level
A total of 51% of breastfed children age 6-23 months, received a Minimum Acceptable Diet (MAD) in 
the 24 hours preceding the survey. The assessment of MAD in 2010 TDHS shows 32%. Furthermore, 
the analysis in terms of the major foods classes consumed in the day or night preceding the interview 
revealed that 88% consumed foods made from grains, 64% ate vegetables, 40% were fed with protein￾rich foods: legumes and nuts, 31% ate meat, fish or poultry; and 35% fruits. Other foods such as milk 
and other milk products including yogurts were consumed by 19% of children and only 2% of children 
ate eggs. The use of infant formula and fortified baby foods was minimal.
Women of reproductive age in the program zone of influence (ZOI) consumed a diversified diet at a 
mean value of 4.1 food groups. The 2010 TDHS finding is a 3.6 mean value of consumed food groups. 
All (100%) women respondents ate foods made of roots and tubers (which complement cereals as a 
source of energy) and about 53% consumed protein-rich foods such as legumes in the day and night 
 
1 TDHS –Tanzania Demographic Health Survey
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preceding the interview. 38% consumed meat/fish/poultry/eggs that are a good source of iron. Milk 
and milk products including yogurt was consumed by a small proportion 15% of women; and a few (3%) 
women ate eggs. This performance may be attributed to the created awareness on complementary 
feeding and SBCC education promotion by the program. 
Access to diversified foods particularly vegetables is seasonal and limited due to low household 
adoption of small livestock keeping and low household income. Peer Support Group (PSG) members 
reported this during FGDs as well as Community Health Workers (CHWs) and Health Facility Workers 
(HFWs) during the in-depth interviews. 
Improved Knowledge, Attitudes, Gender Norms and Social Support
SBCC Kits were reported to be very effective, especially the use of virtual facilitated radio 
communication channel to promote facts on child and maternal nutrition. This was reported during the 
FGDs in 75% (15 out of 20) of the visited villages. 
The number of male PSG members has decreased by 2%, from about 41% in 2012/13 to 39% in 
2013/14 (MBNP Annual Reports). With the recognition of the important role to be played by men in 
impacting nutritional outcomes, this ratio presents a challenge. Moreover, the analysis of the gender 
responsiveness in matters of family nutrition, i.e., the willingness of men to actively carry out nutrition 
tasks assigned to them as members of the PSG that would have benefited to the program has neither 
been reported by the program nor assessed by this MTE as it was beyond the scope. 
Nearly all (99%) children are breastfed for some period of time. Further, the assessment revealed that 
28% of children under 24 months of age were breastfed six times or more during the night (between 
sunset and sunrise), and 72% were breastfed six times or more during the daylight, which meets 
WHO/UNICEF recommendations for optimal breastfeeding. 
 
71% of infants under 6 months were exclusively breastfed in a day preceding the survey. The national 
data (2010 TDHS) indicate that 50% of infants are exclusively breastfed. The Minimum Feeding 
Frequency (MFF) of breastfed infants 6-8 months was 87%; and the MFF of children 9-23 months was 
about 77% indicating that these two groups of children had received the recommended daily MFF in the 
24 hours preceding the evaluation.
 
A total of 91.6% of the caretakers of children aged 0-59 month reported use of soap in washing their 
hands at least once within 24 hours preceding the survey. However, only 38% of the caretakers are 
awareness of the tippy tap hand wash technology and the household adoption remains low. 
Improve quality of maternal and child health nutrition services
MBNP has to a large extent achieved its set target of training health professionals and non-health 
professionals on maternal and child health care and nutrition. Trained profesionals provided 
indispensable services in health facilities and communities, which included promotion of exclusive 
breast-feeding for children 0-6 months and complementary feeding for children 6 - 23 months, among 
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others. The services were reported to have positively influenced program performance as 
demonstrated on improved knowledge and change in breastfeeding and complementary feeding 
practices. 
More than a half (53%) of pregnant women made their first ANC visit during the first trimester of 
pregnancy. 87% of interviewed women of reproductive age reported to have received ANC services 
from skilled providers (such as nurses and midwives) at the health facility, while the remaining received 
from non-medical professionals, such as CHWs and traditional birth attendants (TBAs). 80% of women 
are reported to have received ANC from a skilled provider in the 2010 TDHS. 
86% of participating women aged 15-49 years reported that they took iron supplements during their last 
pregnancy and the post-partum period. Out of these, more than a half (55%) used iron tablets for 90 or 
more days. According to 2010 TDHS, iron supplementation by women aged 15-49 years is only 4%. 
Access to Vitamin A supplementation by children of age 6-59 months has improved. The analysis
showed that 94% of children aged 6-59 months were given vitamin A supplements in the six months 
before the survey. A total of 61% of children aged 6-59 months were given vitamin A supplements, 
reported 2010 TDHS. In addition to the Government campaigns, which are conducted six monthly, 
these results could be attributed to the education and SBBC promotion that is done by trained 
personnel from MBNP in health facilities and communities. 
84% of women of reproductive age from 15-19 years took antimalarial drugs during their last 
pregnancy. These drugs were provided during the Ante Natal Care (ANC) visit, which is suggesting 
that Intermittent Preventive Treatment (IPTp) use of Sulfadoxine Pyrimethamine (SP), is integrated into 
routine antenatal care. 
83% of children age 12-59 months received deworming medication in the six months before the survey. 
These findings may suggest a decrease in stock outs and improvement in the quality of services 
provided by HFWs during ANC visits. 
Strengthen Institutional Capacity of Government and a national NGO 
There has been a significant improvement in the strengthening of operational and technical institutional 
capacity of Tanzania Food and Nutrition Center (TFNC). All six (6) targeted improvements identified 
during their capacity assessment including lack of clarity on the mandate for the TFNC, its placing in 
the Government of Tanzania (GoT) structure and effective organization structure; lack of permanent 
Managing Director, and lack of a strategic plan for the Centre were implemented with good progress. 
These include the institutionalization of the TFNC Board of Directors (BoD) and the approval of a 
Comprehensive Strategic plan in November 2014. However, there are still administrative bottlenecks 
that slowed efficiency in the coordination of the implemented nutrition interventions, and limited 
technical capacity necessary to improve and scale up SBCC programming countrywide.
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The ability of COUNSEUTH to mobilize and manage finances has been enhanced, as well as key
organizational and operational systems have been improved. The organization has a strategic plan 
and an institituonal capacity building plan that was informed by the outcome of the Capacity Needs 
Assessment study conducted by in 2012. The finalization of this strategic plan is expected to facilitate 
consistency implementation of its mission. 
The National Nutrition Coordination Secretariat at the Prime Minister’s Office has been supported to 
develop a Draft Nutrition Coordination Plan, which has been submitted for approval. 
District Nutrition Multi-Sectorial Steering Committees (DMNSCs) in all 10 District Councils have been 
established. Nonetheless, most of these established DMNSCs were not conducting quarterly meetings 
as per policy requirement. 
Program effectiveness
MBNP has been effective in strengthening the operational and technical capacity of the Government 
and CSOs to deliver quality nutrition education and communication and strengthening the delivery of 
integrated community-based nutrition services and social behavior-changing education. The program 
was also found effective in facilitating and/or promoting various services across and within the service 
delivery chain, including support for orientation sessions, training for knowledge and skills development, 
and equipment to improve operational capacity and competitiveness. The governance procedures 
revealed that they are well within the approved program design, and represent an effective framework 
for MBNP management and implementation.
Progress toward achievement of intended results 
The evaluation team found substantive evidence of progress in almost all the sub intermediate result 
areas of MBNP. The findings indicated that other Sub IRs have made the most progress; while the 
ones related to increasing consumption of nutritious food at household level have lagged behind. The 
willingness of households to consume nutritious food was evident but the means to access these food 
items remains a problem. MBNP has accelerated the implementation of the earmarked interventions 
under this Sub IR and it is on a good track to achieving its objectives by end date.
Recommendations
The following are the proposed recommendations for the program to consider: 
1. MBNP should continue to work in collaboration with Prime Ministers Office (PMO) and TFNC to 
enhance the role of DMNSC’s in nutrition planning and budgeting at the Council level. 
2. The program should accelerate home gardening and small livestock keeping and promote 
other livelihood activities as a measure to improve access diversified nutritious food items at 
the household level.
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3. The program should implement the recommendations made by BBC Media Action following the 
assessment of SBCC Kit. 
4. Since PSGs are the main vehicle for reaching household members, mobilization activities 
should consciously reinforce involvement male and other marginalized population groups. 
And, ensure regular access to nutrition and SBCC education through all formed PSGs. 
5. MBNP need to conduct a gender analysis study to generate evidence information on gender 
outcomes that are attributed to the program implementation, document lessons learned as well 
as to identify gender gaps to inform gender planning and budgeting.
6. The program should strengthen its efforts to raise the awareness and promote education on 
the importance of dietary diversification, food fortification and use of iodized salt as well as 
hand washing as an important hygiene practice through its SBBC program; and continue 
collaboration on food fortification including salt iodization. 
7. Proposed areas for investment on improving utilization of maternal and child health and 
nutrition services will be those with high potential to develop capacity of public and private 
institutions and personnel to deliver quality maternal and child health education and counseling 
services. 
8. Improve community-to-facility linkages and referral system by putting in place a feedback 
mechanism to track the number of referrals and measure the efficiency of the referral 
mechanism. 
9. The program should continue conducting refresher training to the existing health facility 
workers, CHWs/HBCs, local government leaders and other extension workers as well as 
checking for attrition.
10. The program should support the village leaders in becoming more committed and supportive of 
the CHWs/HBCs by creating/increasing their awareness and engaging them appropriately. 
This can be achieved by providing orientation and engaging them with program specific roles, 
such as insuring that nutrition is a permanent agenda in village Council meetings as well as 
Village Assemblies. 
11. Support DNTFs by ensuring that all they do for the program is part of their annual plans, which 
makes them accountable to the department heads through the provision of updates and 
feedback about the program. This will facilitate integration of the program and most 
importantly, nutrition will become an issue of concern in each sector, as well as strengthening 
the role of DNTFs beyond delivery of trainings organized by the program.
12. MBNP should continue to support TFNC to iron out existing administrative bottlenecks and 
strengthen SBCC programming capacity so that all achieved milestones can benefit the 
organization and nation as a whole. 
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13. MBNP should continue to support the effective functioning of COUNSENUTH’s governance 
structures of the organization as the delay is likely to attract new changes in the Institutional 
Capacity Needs over the period of the graduation plan, which deters realization of program 
results. 
14. The current absence of the effective stakeholders' coordination has resulted in poor 
accountability and participation of stakeholders, which poses a threat on the continuity and 
sustainability of MBNP support. The program should work closely with Council Directors to 
increase their commitment in organizing committee meetings on a quarterly basis. 
1
1-0 INTRODUCTION 
1-1 Context 
Africare Tanzania with funding from USAID Feed the Future (FtF) and Global Health Initiative (GHI) is 
leading the implementation of a flagship nutrition project called Mwanzo Bora Nutrition Program 
(MBNP) under Tanzania’s Feed the Future (FtF) program. The goal of this project is to improve the 
nutritional status of women and children in Tanzania. Specifically, MBNP objectives are (i) to reduce 
the prevalence of low height for age, or stunting among children less than five years of age by 20%, 
and (ii) to reduce maternal anemia among pregnant and lactating women by 20% in three regions of 
Dodoma, Manyara, and Morogoro in Tanzania Mainland.
Despite many years of investment in health, nutrition and agricultural programming and the 
establishment creation of the Tanzania Food and Nutrition Centre (TFNC), Tanzania continues to face 
many challenges with alarming rates of anemia and chronic under- nutrition. Child nutrition has been 
one of the key concerns of national medical intervention as malnutrition2 in all forms is one of the major 
contributing factors in maternal and child mortality. 
The country currently faces unique opportunity to significantly improve nutrition coordination, targeting, 
beneficiary coverage and service delivery mechanisms as many of the existing national nutrition 
programs are in the process of redesigning and restructuring. The country’s leadership has 
demonstrated political will to deliver on nutrition through President Kikwete’s commitment in September 
2011 to be part of the global Scaling-Up Nutrition (SUN) Initiative, and by the Prime Minister 
establishing a High Level Steering Committee on Nutrition (HLSC) under the PMO to oversee 
implementation of National Nutrition Strategy (NNS). The National Nutrition Strategy and its 
Implementation Plan have been developed, and all districts have been directed by the Central 
Government to include nutrition on their development plans and budgets. This leadership creates the 
platform for addressing nutrition as a priority in Tanzania. 
MBNP is directly supporting the implementation of the Government of Tanzania’s National Nutrition 
Strategy (NNS), and the Tanzania Agriculture and Food Security Investment Plan (TAFSIP). MBNP is 
engaging and building the capacity of Councils’ Health Management Teams (CHMTs) and existing 
human resources including the new cadre of nutrition officers, health, agriculture extension and 
community development officers to provide the basic nutrition services that will reduce childhood 
stunting and maternal anemia. Additionally, MBNP engages with and builds the capacity of local 
Tanzanian Civil Society Organizations (CSOs) working in the target regions. 
 
2
 Malnutrition in this context means under-nutrition – protein energy malnutrition and micronutrients 
under-nutrition.
1
1-2 Program Objective and Strategy 
The overall goal of the program is to improve the nutritional status of children and pregnant and 
lactating women in Tanzania. This overall goal will be attained through achievement of two outcomes: 
(i) Strengthened capacity of government and indigenous NGOs to deliver quality education on nutrition 
and communication; and (ii) Strengthened delivery of community-based nutrition services and social 
behavior-changing education resulting in a model that can swiftly be scaled-up to reduce childhood 
stunting and maternal anemia. Achievement of these outcomes would entail specifically attaining the 
following objectives:
i. Reduce the prevalence of low height for age or stunting among children less than five years of 
age by 20% in three regions of Dodoma, Manyara and Morogoro.
ii. Reduce maternal anemia among pregnant and lactating by 20% in three regions of Dodoma, 
Manyara and Morogoro.
iii. Support the Government of Tanzania (GoT) and local Tanzania Non-Governmental 
Organizations (NGOs) and CSO’s to improve nutritional outcomes in targeted regions with a 
strong focus on scaling up community level interventions.
iv. Raise and expand awareness about under-nutrition in the country and strengthen institutional 
capacity to respond to issues related to malnutrition.
v. Provide targeted assistance to further strengthen the technical, administrative and financial 
capacity of the Tanzania Food and Nutrition Centre (TFNC), the Centre for Counseling for 
Nutrition and Health (COUNSENUTH) and Civil Society Organizations (CSOs) to implement 
the NNS.
Nutrition SBCC is a key strategy to achieve this capacity enhancement and transformation objective, 
while placing an emphasis on the first 1,000 days of life. Furthermore, the program aims to strengthen 
a referral and counter–referral service system whereby ward and community level nutrition and 
agriculture programs are linked to facility based health. 
MBNP is a partnership initiative in which Africare prime. Africare as a prime partner is responsible for 
managing the overall program implementation and deliverables. Key short-term technical partners 
include Deloitte and The Manoff Group (TMG). Deloitte provide significant institutional strengthening 
support to TFNC and COUNSENUTH to ensure that by the end of the program, these local indigenous 
partners have strong operational foundations. TMG provide SBCC technical and strategic advice to 
ensure that their ability to lead, manage and sustain nutrition implementation and innovations has been 
reinforced. Africare is working closely with COUNSENUTH to enhance their institutional capacity to 
become a premiere nutrition technical assistance organization in nutrition SBCC approaches in 
Tanzania, with the capacity to implement large-scale programs and manage funding from multiple 
donors. 
2
MNBP team of implementing partners is also endowed with several strategic lead national collaborating 
partners, TFNC and LGAs whose participation maximizes the program potential to leverage existing 
structures and resources and capitalize on established networks. 
1-3 Mid-Term Evaluation Purpose and Scope of Work 
Under the FtF initiative, USAID has placed a strong emphasis on monitoring and evaluation as well as 
evidence-based programming. This is evident by the existence of detailed result frameworks and a 
comprehensive indicator handbook for use by all programs to ensure consistency in the comprehension 
of the indicators and collection of data.
MBNP has designed a monitoring and evaluation system that feeds into the FtF system. Monitoring, 
evaluation and learning, aims at collecting present information about program implementation to enable 
erudition and enlighten the program on changes taking place in the target communities whether 
intended or unintended. With this kind of information, the program is able to measure positive changes 
including making the program more responsive to the needs of its beneficiaries in order to align itself 
accordingly and thereby obtain a lasting impact on the reduction of anemia and stunting.
The purpose of this MTE is to provide an independent opinion on the progress made during the first 
three years (2011-2014) in the implementation of the MNBP in terms of processes and whether or not it 
is on track towards achieving the intended impact. This information would assist Africare in determining 
whether a change in strategic emphasis of MBNP is worthwhile. Therefore, based on the 
implementation of MBNP, Africare is interested in learning more about what works and what does not 
and why, in terms of strengthening the capacity of government and indigenous NGOs to deliver quality 
nutrition education and communication, and the delivery of community-based nutrition services and 
social behavior-changing education resulting in a model that can quickly be scaled-up to reduce child 
stunting and maternal anemia. 
1-4 Report Layout 
The draft MTE Report is structured in 7 Chapters and 4 Annexes. Chapter 1, provides the introduction 
to the MTE; Chapter 2 elaborates the methodology and Chapter 3 presents the key evaluation findings. 
In Chapter 4, the assessment of program management is given, and Chapter 5 provides lessons learnt. 
In Chapter 6, a conclusion from the study is presented and in Chapter 7, recommendations for 
improvement of the program implementation are discussed.
Annex 1 provides a list of studied villages and Annex 2 presents a list of people met. Annex 3 gives a 
set of data collection tools and Annex 4 presents a copy of Ethical clearance certificate. 
3
2-0 METHODOLOGY AND DESIGN 
This Chapter provides an overview of the methodology and design of MTE with special focus on the 
methodology, design, ethical considerations, stakeholder’s dissemination and inherent study limitations. 
2-1 Methodology 
In line with the Scope of Work (SOW), the methodology used to conduct MTE entailed reviewing the 
extent to which the project has so far contributed to achieving the overall goal. An independent team of 
consultants from ST Associates conducted the evaluation. The team collected data and information on 
progress for the assessment of the performance of MBNP in the field. In order to arrive at the answers 
to the evaluation questions, the evaluation approach was based on using varied methods and 
triangulation of data to ensure that the findings fully respond to the purpose of the evaluation. The 
methods included the following:
Document Reviews of not only selected documents listed in the SOW but also materials assembled by 
other reviewers (particularly of the performance monitoring plan baseline data), targets and
performance reports (which was useful in the building on of baseline conditions to assess progress as 
reported by MBNP since its inception in September 2011 to September 30th 2014;
Conduct Key Informant Interviews with MBNP activity senior managers and staff, program consortium 
members and partners that operate nationally, or in other specific areas in MBNP project regions, 
districts and communities;
Focus Group Discussions (FGDs), mainly with Peer support groups (PSGs) members; 
Conducted Survey of implementing actors covering not only the women of reproductive age (15-49
years), the ultimate recipients of the nutritional services but also intermediate beneficiaries such as 
Community Health Workers (CHWs) and Home Based Care Providers (HBCs), health facility workers 
and CSOs, which are implementing the program at the district level. It is important to note that gender 
was integrated within the survey questionnaires;
Stakeholder Analysis was used to determine the effectiveness of partnerships and collaborations 
forged with not only other USAID supported FtF implementing partners in the country but also other 
areas of focus in the implementation of various MBNP interventions; 
Observation at service delivery and technology sites such as the demonstration sites/plots, household 
gardening, small livestock keeping, and hand washing practice using tippy taps (‘kibuyu chirizi’), 
respectively. 
4
Anemia Testing: Anemia testing was performed using a widely used system that rapidly measures 
Hemoglobin (Hb) concentration from a drop of blood obtained from by finger, HemoCue photometer 
(Hb 201+). This rapid testing allows results to be reported to the respondent immediately following the 
testing procedure. 
Anthropometric measures were taken for children under five years of age and women of reproductive 
age of 15-49 years. Anthropometry measurement of a person’s height (length) and weight were taken 
to assess the nutritional status of a study population. 
Iodization of salt used in households was tested using a “rapid iodine test kit” 
2-2 Evaluation Design 
2-2.1 Sampling Procedure 
MTE adopted a three stage sampling frame to identify study districts, villages, eligible households and 
other respondents.
Sampled Districts: three districts were randomly selected out of the 10 covered by MBNP since year 1 
of its implementation in 2011. Sampled districts were Mvomero District Council (Morogoro Region), 
Kongwa District Council (Dodoma Region), and Babati District Council (Manyara Region). The sample 
size was determined using a representative sample of the proportions of a large population.
Sampled Villages: Sampled villages for MTE compose of 8% of the total number of villages in the 10 
program districts, which amounted to a total of 20 randomly selected villages for MTE data collection. 
Sampling frame comprised of all villages in selected districts where MBNP activity implementation has 
taken place for three years. A Systematic Random Sampling (SRS) method was used. A list of 
sampled villages in each district is presented in Annex 1. 
Selection of Households for the study: The primary respondents constituted households with women of 
reproductive age (15-49 years) who were breastfeeding, mothers of children under five years of age, 
pregnant and/or caretakers of children under five years of age. The selection of the eligible households 
was random village based. Eligible household in this MTE refers to women of reproductive age (15-49) 
years who were pregnant or breastfeeding mothers of under five years children, as well as, all men who 
were taking care of those eligible women in each of the selected households. Firstly, a list of eligible 
households in each hamlet in the village was established; thereafter SRS method was applied to select 
eight households per village. The evaluation therefore successfully administered questionnaires in 165 
households, which is 108.5% of the initially planned 152 households.
Respondents: In addition to the household level respondents, all other respondents were to be 
purposefully and subjectively selected from key stakeholder groups and individuals based on 
5
involvement with the program at all levels: community, district, regional and national. A total of 147 
individuals participated in discussions and shared their perceptions on the progress of the program; 
whether it has made it or if it is on track towards achieving the intended impact. A detailed list of people 
met from all levels is given in Annex 2.
2-2.2 Data Collection tools and Enumeration
Secondary data were collected through in-depth documentary review; and primary data were collected 
using developed data collection tools. These tools were developed in consultation with stakeholders, 
pre-tested and translated into Kiswahili from the English Language for user-friendliness before actual 
fieldwork. Tools that were adopted for MTE include 15 modules household questionnaires, which were 
designed to collect data from eligible households, in-depth interview guide (IDI) with key informants 
and guide for moderating focus group discussions (FGDs). Final set of data collection tools is attached 
in Annex 3. 
Enumerators formed an integral part of the collection and quality of data collected. A total of 11 (4 
male and 7 female) trained nurses, nutritionists and evaluation experts were recruited, received 
theoretical and practical training on human research, and successfully engaged with the field data 
collection exercise. 
 
2-2.3 Implementation process 
The team employed a mixed-approach that entailed both quantitative and qualitative methods in order 
to collect relevant information. The MTE assessed all aspects of project design, implementation, and 
reporting. The evaluation process included desk studies, briefings of evaluators, training of 
enumerators, stakeholder’s review of data collection tools, and pre-testing of tools. Also, field visits to 
implementing regions, districts and villages, facility and household survey, program review, and 
debriefings. Focus group discussions were conducted to elicit information on perceptions of program 
effects, with the emerging findings complementing the quantitative data gathered through household 
surveys. 
A household survey of eligible household members was conducted in order to get insights into benefits 
from MBNP as well as key constraints faced by beneficiaries. This was done via administration of 
household questionnaires.
The evaluation team assessed progress toward targets to determine the likelihood of which 
intermediate results have been achieved. The evaluation team used established baseline conditions by 
Tanzania Demographic Household Survey, 2010 (2010 TDHS) for assessing progress achieved toward 
the set IRs and Sub-IRs. The status of each parameter per result (in line with the evaluation questions) 
was assessed i.e. what MBNP’s intervention contributed to, any challenges, the achievement level and 
an explanation where results were not achieved as planned. Methods for collecting and analyzing data 
6
from fieldwork were consolidated to develop the Team’s conclusions and recommendations, and acted 
as a solid basis for subsequent MBNP actions pursuant to the evaluation. 
2-2.4 Data Analysis 
All completed quantitative questionnaires were sorted, batched and checked manually for accuracy 
before embarking in data entry and processing using CSPro software. Thereafter, verification was 
done and data exported to SPSS for cleaning to check for outliers and human errors before carrying out 
the required analysis. Data analysis to generate the answers to specific evaluation questions as 
stipulated in the SOW entailed several approaches that included the following:
a) Analysis in SPSS to generate summary tables on the various variables being tracked by 
MBNP, as well as key questions included in MTE questionnaires;
b) Performed content analysis of data gathered from both IDI and FGDs;
c) Used ‘triangulation’ of data from all the different sources to answer each evaluation question. 
The ‘triangulation’ process in and of itself was also used to get findings which entailed the 
results analysis based on the project’s performance monitoring plan (PMP);
d) Use of midterm evaluation findings to confirm or refute progress gleaned from MBNP progress 
reports or documents; and
e) Use of secondary data to reconfirm and establish contextual analysis within each Sub-IR, 
emerging issues relating to the program with main focus on the design, implementation, results 
and lessons learned.
The evaluation team specifically analyzed the level of progress towards achieving the annual targets, 
and MBNP’s overall objective as well as examined the performance of the targets set by the program 
under every Sub-IRs and FtF planned results using pre-defined program PMP and FANTA-23
indicators, respectively. The other key elements of the evaluation such as crosscutting issues, and 
management issues were also critically assessed in relation to their impact on program performance. 
As a result of this holistic approach, the Team provided recommendations for reprogramming and 
monitoring around MBNP’s main objectives.
MTE findings generated have been used to shed more light on the program effectiveness, partnerships 
and management, with specific focus on:
• Effectiveness: Performance vis-à-vis the reality on the ground/ performance targets 
• Partnerships: Stakeholder analysis, connectedness, and adequacy 
• Management: Structure and staff composition, its adequacy in delivering activities as envisioned in 
its annual work plan. 
 
3 FANTA-2 website: www.fanta-2.org
7
2-3 Ethical Considerations
The study team obtained informed consent from respondents and if minor, from their parents/guardians 
on study procedures, i.e., household questionnaires, anthropometry and anemia testing. Enumerators 
carefully explained procedures for ‘Protecting Human Research Participants’ to respondents, so as to 
ensure that they understand benefits and risks of participating in each procedure. There was no 
coercion or undue influence to recruit household members to participate in this study and it was made 
clear during the informed consent that refusal to participate in any of the study procedure will not affect 
their ability to access any nutrition or health services. It was not mandatory for respondents to answer 
the entire questionnaires and they free to skip to the next question if desired - this was also clearly 
explained to them during the informed consent and they were reminded throughout the survey.
There were minimal risks associated with anemia testing
 
. Finger prick was done (rather venipuncture) 
to collect very small amount of blood sample analysis of the level of hemoglobin (Hb) materials used 
were immediately disposed in accordance with the standards for the disposal of biohazard waste. 
Minor discomforts at the time of finger prick subsided immediately. The finger was disinfected with 
alcohol wipes before the procedure and the site of finger pricking was covered with a piece of cotton 
wool immediately after the procedure to minimize chances of infection. Finger prick for anemia testing 
was conducted with no serious consequences. Respondents identified to be severely stunted or 
severely under-nourished were referred to a local health facility through CHWs to receive necessary 
assistance. There were no risks with taking anthropometric measures.
MTE did not collect any type of sensitive information that may impose social risks such as shame or 
tarnishing reputation within a household or the community. Reasonable precautions were taken to 
protect privacy and confidentiality of respondents. The HH questionnaires used for this study were 
similar to the DHS questionnaires (some of the adopted modules are standard), which are regularly 
used by the NBS at the national level in Tanzania. The Ethical Clearance Certificate was obtained from 
the MOHSW through NIMR (see Annex 4). 
2-4 Stakeholders Dissemination
MTE findings will be presented in a stakeholder’s workshop for validation and dissemination purposes. 
Generated information on nutritional status in the program ZOI could be used to improve not only 
implementation in three target regions (Morogoro, Dodoma and Manyara); but also policy decisions and 
planning and programming in the program and elsewhere. The envisaged stakeholders dissemination 
workshop, intends to provide an opportunity for sharing lessons learnt, possibilities for replication and 
potential for scale-up of good practices to benefit more people in Tanzania and beyond. 
8
Invitation to stakeholder’s dissemination workshop will include key sectors and ministries in the 
implementation of NNS, program implementing LGAs, CSOs, research institutions, representative of 
USAID supported FtF initiatives, development partners, and MBNP staff. 
2-5 Inherent Limitations 
The evaluation team believes that the findings of this report are appropriate based on the evidence 
gained through the above MTE design and methodology. However, the team would like to 
acknowledge the following data limitation. Some of the data collected were based on recall, thus they 
should be treated as estimations of the real situations.
Effects and/or results achieved may not have solely been contributed by MBNP because the SBCC 
strategy is for the first time being implemented in the country with limited research to avail evidence￾based information for comparing and tracking progress in this regard. 
9
3-0 MID-TERM EVALUATION FINDINGS 
3-1 Assessment of Progress towards Achievement of Results 
This section presents the findings of MTE with respect to the question: “What is the progress made in 
the implementation of the MBNP in terms of processes; and is it on track towards achieving the 
intended impact?” The observations and conclusions in this section were based on analysis of the 
project self-reported data, (supported by information drawn during the household survey from the three 
sampled districts) and stakeholder consultations at national and sub-national levels. The presentation 
of findings on the progress made toward achieving program results is organized around the 
intermediate results of the program, which are discussed below.
The overall goal of the program is improved nutritional status of children and pregnant and 
lactating women in Tanzania’ with specific focus on reducing the prevalence of maternal anemia (as 
measured by blood hemoglobin concentration) and childhood stunting (low height for age) among 
children under-five years of age by at least 20% in Morogoro, Dodoma and Manyara by August 2016. 
This goal will be attained through achievement of two principle objectives: 
MBNP as one of the USAID Tanzania FtF programs, is implementing five Sub Result Areas (Sub-IRs) 
out of eight in the FtF results framework (MBNP revised PMP, August 2014) in order to achieve the 
overall program goal. These are: - 
Sub –IR 3.1: Increased GOT budget allocations for nutrition interventions at national and district level;
Sub –IR 5.1: Increased consumption of nutritious foods by women and children at the household level;
Sub –IR 6.1: Improved knowledge, attitudes, gender norms and social support for
Sub–IR7.1: Improved quality of maternal and child nutrition services at the health facility and 
community; and
specific maternal and 
child nutrition practices;
Sub–IR8.1: Strengthened institutional capacity of TFNC, COUNSENUTH, PMO, District Nutrition Multi￾Sectoral Committees and CSOs.
In addition, the Performance Management Plan (PMP) of the program defines eight (8) performance 
indicators (PIs) for measuring project results (i.e., outcomes and outputs) which are linked to the Sub￾1. Strengthened 
capacity of 
Government and 
indigenous CSOs to 
deliver quality nutrition 
education and 
communication. 
2. Strengthened delivery 
of community-based nutrition 
services and social behavior￾changing education resulting in 
a model that can quickly be 
scaled-up to reduce child 
stunting and maternal anemia.
10
IRs. These PIs have been used to quantify and qualify the assessment of findings on progress so far 
made in the program implementation. 
a. Number of districts with plans and budgets that include at least three Essential Nutrition 
Actions
b. Number of people trained on home vegetable gardening and keeping of small livestock 
c. Number of people reached through community awareness supported by MBNP
d. Number of children under five who received Vitamin A from USG-supported programs
e. Number of children under five reached by USG-supported nutrition programs
f. Number of people trained in child health and nutrition through USG-supported programs
g. Enhanced human and institutional capacity development for increased sustainable nutrition 
program implementation for COUNSENUTH
h. Number of women of reproductive age receiving services from and reached by USG-supported 
health facilities and nutrition messages and programs
It is good to note that in the absence of baseline data on program indicators, MTE findings on the 
performance and outcome measuring indicators were compared to the 2010 TDHS results. 
11
3-3 Increased Government Budget Allocation for Nutrition Interventions
This section provides the assessment of Sub IR 3.1, which was designed to support the increase in 
Government of Tanzania (GOT) budget allocations for nutrition interventions at national and district 
level. The successful implementation of this Sub-IR would contribute to the FtF effort to increase 
investment in agriculture and nutrition related activities. Program activities under this Sub-IR area were 
designed to ensure that district plans and budgets factored in at least three essential nutrition actions. 
This entailed support in planning and budgeting processes, and stakeholders review of the 
implementation at the national and district levels.
3-3.1 National Level 
The activities under this intervention were focused on supporting GOT’s efforts to increase its level of 
investment in nutrition in line with the President’s commitment to have Tanzania as an early riser in the 
Scaling Up Nutrition (SUN) Initiative. The program since year 2011/12 has supported consolidation of 
gains from the National Nutrition Strategy (NNS) by creating awareness and commitment of the high 
level government structures on the need to increase investment in nutrition. 
MBNP also supported focal persons in key ministries to take up their coordination and technical 
responsibilities. Twenty-five nutrition focal persons (18 males and 7 females) from nine lead ministries4
and the Planning Commission tasked with the implementation of the NNS received training. This 
training was officiated by the Nutrition Secretariat in the Prime Minister’s Office. Other nutrition 
implementing partners including World Health Organization (WHO), United Nations Children Fund 
(UNICEF) and Hellen Keller International (HKI) also participated. Each of the nine ministries developed 
a nutrition action plan. 
MBNP successfully contributed in ensuring integration of nutrition activities into agricultural programs 
within the context of the Agriculture-Nutrition linkages through its active participation in the review of 
National Food Security Policy, for the Ministry of Agriculture, Food Security and Cooperatives. During 
the Joint Implementation Review (JIR) of the Food and Nutritional Security component of ASDP (the 7th
Agriculture Sector Development Program), MBNP recommended a program focus on production, 
marketing, preservation and consumption of nutrition and energy dense foods (crop and livestock 
source). 
These efforts have positively contributed to the intended results, which have been confirmed in Public 
Expenditure Review (PER) report of January 2014. The report indicated that annual budget allocation 
for the nutrition sector significantly increased during the three years especially after scaling-up efforts 
through NNS and strengthening of the Government nutrition agenda in FY2011/12. According to the 
 
4
 Prime Minister’s Office (PMO), Ministry of Community Development, Gender and Children (MCDGC), Ministry of Industry and Trade (MIT), 
Ministry of Livestock and Fisheries Development (MLFD), Ministry of Health and Social Welfare (MOHSW), Ministry of Agriculture, Fisheries 
and Cooperatives (MAFC), President’s Office for Planning Commission (POPC), Ministry of Finance (MOF), Ministry of Education and 
Vocational Training (MOEVT) and Ministry of Water (MOW).
12
PER report, over a three-year period the budget allocation grew at a rate of 31% per annum, with a big 
jump between 2010/11 and 2011/12 (55%), while increase between 2011/12 and 2012/13 was 21% per 
annum. The GOT and Development Partners (DPs) efforts and commitment to improve the nutrition 
status in the country were apparent through this increase in the budget allocation. 
However, the PER reported that the national aggregate data did not include the Local Government 
Authority (LGA) data due to difficulties in collecting nutrition specific budget and expenditure from 
districts/councils. The national nutrition sector total budget was determined on the basis of data 
collected at a national level through public and private sector organizations that are involved in nutrition 
programs and interventions. Therefore, the national data excluded the majority of LGAs data, because 
they could not be captured at a national level.
3-3.2 District Nutrition Planning and Budgeting
The activities under this intervention program focused on building institutional capacity through 
strengthening the institutions responsible for nutrition with a focus on LGAs, civil society organizations 
and district council level nutrition focal points.
MBNP actively participated in the development and operationalization of the Guideline for Councils for 
the Preparation of Plan and Budget for Nutrition, Prime Minster’s Office, Second Edition, 2012. The 
guideline provides a package of nutrition activities for the district level stakeholders from different 
development sectors to plan and budget for essential nutrition actions. 
In this context, MBNP collaborated with TFNC to conducted training sessions to enhance capacity of 
districts to identify and set a price for nutrition activities to be included in annual plans and budget 
through Medium Term Expenditure Frameworks (MTEFs). A total of 130 individuals of which 79 
(60.8%) were male and 51 (39.2%) female were trained, including staff responsible for planning and 
budgeting in key sectors and various departments. 
As a result of these trainings, most districts planned and budgeted for the recruitment of District 
Nutrition Officers (DNuOs) who responsible for would coordinating the implementation of nutrition 
activities. By the time of this MTE, all districts in the program ZOI had DNuOs in place. The 
assessment of MTEFs also showed other nutrition activities to include promotion of optimal 
breastfeeding of infants during the first six months of life; complementary feeding from six months of 
age with continued breastfeeding to 24 months and beyond; nutritional care of sick and malnourished 
children; nutrition for pregnant and lactating women; Prevention of vitamin A deficiency in women and 
children; adequate intake of iron and folic acid and prevention and control of anemia for pregnant 
women and children; and adequate intake of iodine at the household level. MBNP support continued 
through a collaborative arrangement with Helen Keller International (HKI) to orient LGAs on the 
updated Council’s Nutrition Budgeting and Planning Guideline during which the emphasis was placed 
on allocation of adequate funds for addressing maternal anemia and stunting. 
13
An indicator on number of districts with plans and budgets that include at least three essential 
nutrition actions tracks MBNP performance under this Sub IR 3.1. Overall the assessment indicates 
that the program has made significant achievements. By the time of this MTE, all ten (100%) District 
Councils adopted Guidelines for preparation of plan and budgets to a large extent and have 
successfully included at least three essential nutrition actions in MTEFs as targeted. In addition, 
Districts Nutrition Officers (DNuOs) have been appointed as per NNS to coordinate stakeholder’s 
efforts. 
Despite achieved performance, MTE revealed that the total nutrition budget allocation for nutrition has 
remained low. In some instances, the allocation remains on paper because even the allocated funds 
were not actually provided for implementation of identified nutrition interventions. Resource allocation 
was mainly ad- hoc and often times targeted those activities that were driven from the Central 
Government such as support of Vitamin A supplementation and deworming campaigns. 
With an exception of districts in Manyara region, nutrition budget data from other districts for the past 
three years could not be obtained. The analysis of availed nutrition budget data showed fluctuating 
patterns among the District Councils in the Region from one year to the other. A similar observation 
was made by the Nutritional Sector Budget Expenditure review (Final Report, January 2014). It was 
reported that Councils are currently allocating funds for nutrition activities but nutrition budget data 
showed fluctuating patterns among the Councils as well as within each Council from one year to the 
other. Similarly, for some of the Councils, sets of budget data for the complete three years could not be 
obtained except from only six out of 14 visited councils were assessed. Other specific observations 
include the following: 
a. The assessment team faced a challenge in tracking the budget items due to the absence of a 
specific budget line item for nutrition. Nutrition activities are budgeted under different lines 
depending on the ministry. The program will have to continue working with the district teams to 
ensure that in subsequent years, there is clarity in the line items budgeted for nutrition for easy 
tracking.
b. NNS has ensured demarcation of interventions that are mandated for other sectors, such as 
health, water, agriculture and education. Guidelines for Councils for preparation of a nutrition 
plan and budget stipulates what each sector can do to improve nutrition and avoid duplication. 
However, patterns of budget allocation showed that the councils were not consistent in 
identifying and prioritizing multi-sectoral nutrition interventions in their respective sectors.
c. NNS emphasize the importance of the participation and involvement of stakeholders, and it has 
clearly stated their role in its implementation. Council plans and budgets that were assessed 
by the evaluation team did not reflect activities and resources from existing nutrition partners in 
the council. MBNP have to continue supporting Councils budget meetings; while promoting an 
actively participation of other development partners and CSOs. 
d. Only District Planning Officers, who are responsible for the coordination of planning and 
budgeting processes in district councils were informed, other staff even the DNuOs did not 
seem to be aware of the allocated budget for nutrition.
14
3-4 Increased Consumption of Nutritious Food at Household Level 
The interventions under this result area (Sub –IR 5.1) were designed to enable the community 
members particularly women and children to continuously access diversified and quality foods through 
promotion of agriculture and nutrition linkages, as well as investments in nutrition-friendly agriculture 
programs (horticulture, small livestock) and food preservation and processing. This entailed increasing 
community and household production of staple and quality food such as fruits, green and yellow 
vegetables, and animal proteins through the adoption of household gardening, fish and small livestock 
keeping such as poultry and rabbits. Activities will also engage smallholder farmers learn food 
preservation and processing techniques. 
3-4.1 Agriculture and Nutrition Linkages
The extent to which interventions have contributed to increased consumption of nutritious food by 
women and children at household level, were tracked by monitoring the number of beneficiaries with 
home gardens or small livestock as a proxy for access to nutritious foods and income. Overall 
sub IR 5.1 was implemented with improved 
progress annually and at the time of MTE the 
program had reached a total of 82,200 
beneficiaries (MBNP Annual Report, October 
2013-September 2014) as it is depicted in 
Figure 1. This is an increase of 137% from the 
annual target of 34,650. These include people
who adopted vegetable gardening aiming to 
increase the diversity of household diet 
through production and consumption of 
nutritious vegetables and the keeping of small 
livestock for domestic consumption to enhance 
consumption of iron rich source of diet. 
The implementation of planned program activities attained the intended achievements. Following the 
provision of education on food accessibility and diet diversification, demonstration plots comprising 
horticultural crops and small livestock are continuously being established. Community groups in 135, 
(25% more than 126 targeted) were mobilized to establish and manage integrated demonstration plots 
at ward level. The regional assessment indicated that Morogoro region managed to establish 25% (45 
instead of the planned 36) more demonstration plots than the planned target; while the other two 
regions Manyara and Dodoma reached all (100%) targeted. 
Community groups were mobilized to establish and manage integrated demonstration plots. The 
program CSOs grantees in all 10 districts and district extension workers were oriented to conduct Field 
Demonstration Days (FDDs) at each plot. The purpose of conducting FDDs was to improve food 
preparation techniques at household level in order to ensure that beneficiaries get quality-diversified 
15
meals and complementary foods. By the time of MTE, a total of 7,420 (1,297 males and 6,123 
females) members of Peer Support Groups (PSGs) indicated to have had attended at least one field 
demonstration day. People who attended the demonstration days were oriented on how to prepare 
diversified complementary meals and vegetables without depleting their nutrients. Moreover, 
beneficiaries also received a practical training on: (i) basic food preservation techniques, and (ii)
vegetables production ad small livestock keeping in their own households. CHWs and HBCPs were 
also trained together with PSG members.
In addition to the above-mentioned trainings, MBNP in collaboration with ‘Pamoja Tuwalee’ project 
delivered skills training on income generation activities (IGAs) to a total of 1,200 PSG members. The 
establishment of Savings and Internal Lending Cooperatives (SILC) was also part of this training. The 
later was aimed at enabling beneficiaries to increase household income and access to nutritious foods 
through money saving and borrowing, and investing in gardening and small livestock keeping in a more 
enterprising manner. 
3-4.2 Gardening and Small Livestock Keeping 
Figure 2 provides analysis of MTE field data, which also confirms the positive performance as about 
61% respondents in all three regions reported to have received training on gardening, which was 
delivered by MBNP. 
When asked whether or not the household has established a home garden as a result of the training 
received, about a third said yes, while the other two thirds were yet to adopt home gardening. With 
regard to the type of produce in the adopted home gardens, MTE data indicated that 52% have grown 
Chinese cabbage, followed by 48% Sweet potato leaves (“Matembele”), 27% Amaranths, 24% 
Pumpkin leaves, Tomatoes 24%, and the least 5% have grown carrots, while 7% have grown other 
vegetables and fruits such as “mnavu” (local greenish vegetable) and pawpaw fruits. Further, the 
program supplied a variety of seeds for initiation of demonstration plots, and PSG members were to 
organize themselves to manage and utilize the produce to enable households obtain food, income and 
seed for replanting as well as to support the scaling up of home gardening. The management was 
16
poorly done, leaving most demonstration plots unproductive and most PSG members with no supply of 
seed for scaling up. 
At household level, the assessment showed that the majority (79.7%) was keeping poultry, followed by 
15.9% who keep goats and the remaining 4.3% have started to raise rabbits. MBNP support has 
positively influenced intensive poultry keeping from the traditionally practiced open grazing in the 
program villages. Zero grazing not only reduces the chance for chicken to be stolen by people and/or 
hawks, but also minimize chances for the chicken to destroy gardens within the house compound and 
neighbors. The program introduced and supplied high breed of Rabbits, which quickly reproduce, easy 
to maintain and rich in iron. Those PSGs, which managed to allocate an appropriate, were supported 
by the program to construct improved cage and supplied with two rabbits (male and female). This 
intervention had been recently introduced; as a result very limited community groups (PSGs) had 
adapted rabbits keeping by the time of the survey. 
Importantly, PSG members indicated willingness to adopt home gardening but reported lack of access 
to inputs and seasonal water supply to be a challenge. All 55 (100%) CHWs/HBCs met and the 
program staff confirmed this. In this realization, MBNP introduced “sack gardens” a simply and 
affordable investment that require less amount of water to grow vegetables. Sac gardens use 
wastewater from the home kitchen to ensure regular supply of nutritious vegetables for a household. 
CHWs and HBPCs met during the MTE field data collection, reported an increased trend in the 
adoption of this home gardening technology. MTE team members also found sack gardens in some of 
the visited households. Further, district staff and health facility workers (HFWs) interviewed 
commended this technique. Nonetheless, the obtained data could not support the analysis of the 
magnitude of production that could be apportioned for consumption and sales so as to generate 
income. This may require a specific study. 
3-4.3 Children Dietary Diversification 
Data collection tools for dietary diversification for children and women were developed by MBNP and 
adopted by the consultant. The statistical analysis has been done using the WHO IYCF operation 
guidance document, and WHO document: Indicators for assessing IYCF practices, Part 2, 
Measurement as reference. Minimum dietary diversity for children measures the proportion of 
children 6-23 months of age who received a minimum acceptable diet (MAD), apart from breast 
milk. MAD indicator measures both the minimum feeding frequency and minimum dietary diversity as 
appropriate for various age groups. If a child meets the minimum feeding frequency (MFF) and 
minimum dietary diversity for their age and breast-feeding status, then they are considered to receive a 
MAD5
 
5 Proportion of children 6–23 months of age who receive foods from 4 or more food groups. Consumption of any amount of food from each food 
group is sufficient to “count”, i.e., there is no minimum quantity, except if an item is only used as a condiment.
. According to the results presented in Figure 3, out of 63-breastfed children age 6-23 months, 
about 50.8% were given foods from four or more food groups in the 24 hours preceding the survey, and 
49.2% were fed the minimum number of times in the previous 24 hours. 
17
This MAD results show an increase by 19% when compared with the findings of the 2010 TDHS, which 
showed that 32% of 6-23 months of age children received foods from 4 or more food groups. This 
performance could be attributed to the awareness created and educational activities by the program on 
complementary feeding. Nonetheless, regional analysis showed that the proportion of children who 
received MAD in Manyara region (61.1%) was higher than in the remaining two regions of Morogoro 
(47.8%) and Dodoma (45.5%).
Furthermore, the analysis of children under five years of age by type of foods consumed in the day or 
night preceding the interview (Figure 4) reveals that 88% consumed foods made from grains, 64% ate 
vegetables and 35% fruits. 
The children are also fed protein-rich foods: legumes and nuts (40%) and 31% are meat, fish, and 
poultry. Other foods such as milk and other milk products including yogurts were consumed by 19% of 
children and only 2% of children ate eggs. The use of infant formula and fortified baby foods was 
observed to be minimal in the program ZOI. The regional analysis of food groups consumed by 
18
children under 5 years per region shows a similar pattern. The majority of children were fed with 
cereals, roots and plantains; while very few ate eggs. More (41%) children in Manyara region 
consumed milk and milk products as compared to Dodoma (12%) and Morogoro (9%).
3-4.4 Women Dietary Diversity
Dietary diversity is a key dimension of a high quality diet with adequate micronutrients content; and 
thus, important in ensuring the health and nutrition of both women and children. Women of 
reproductive age are at risk for multiple deficiencies, which can jeopardize their health and ability to 
care for their children and participate in income generating activities. 
Tools to collect information for assessing the dietary diversification for women was adopted from MBNP 
and data collection process adhere to FtF M&E guidance series Volume 8: Population-based survey 
instrument for the FtF zone of influence indicators. Women dietary diversity is measured through an 
indicator on mean number of food groups consumed by women of reproductive age. According to 
TDHS, this indicator aims to measure the micronutrient adequacy of the diet and reports the mean 
number of food groups consumed in the previous day by women of reproductive age (15-49 years). 
Nine food groups are used to calculate this indicator, thus the higher the mean the better. Table 1
shows that women in the program ZOI consume 4.1 food groups, which is an improvement from the 
2010 TDHS mean value 
(3.61). The deviation between 
the three program 
implementing regions is not 
significant. 
3-4.5 Food Quantities and Quality
MTE assessed the type of foods consumed by mothers of children aged below five years (who are also 
women on reproductive age 15-49) during the day and night preceding the interview. The quantity and 
quality of food that pregnant and lactating mothers consume influences their health and that of their 
children. The analysis in Figure 5 shows that all (100%) women respondents ate foods made of roots 
and tubers (which complement cereals as a source of energy) in the day and night preceding the 
interview, more than 2010 TDHS results (32 percent). About 53% of women consumed protein-rich 
foods such as legumes, showing an increase of 15% from results of the 2010 TDHS (37%) and a total 
of 38% consumed meat/fish/ shellfish/poultry/eggs that is a good source of iron. These findings 
indicated improvement from the 2010 TDHS results (35 percent). Milk and milk products including 
yogurt was consumed by a small proportion of women (15%). Generally very few (3%) women ate 
eggs. 
Figure 5 also indicate that the percentage of women reporting to consume Vitamin A-rich fruits and 
vegetables is low at 17%, and results from the 2010 TDHS reported very high use (62 percent of 
Table 1: Mean number of foods groups consumed by women of reproductive age 
(15 - 49) by region
Morogoro Dodoma Manyara Total
Mean Mean Mean Mean
4.4 3.7 4 4.1
19
women). Similar results were found by MTE in regional results, in Morogoro 24%, Dodoma 13% and 
Manyara 11% ate vegetables and fruits rich in Vitamin A. On the other hand, milk and milk products 
were more consumed by women of reproductive age in Manyara Region (33%) as compared to 
Dodoma Region (13%) and Morogoro Region (5%). Only 2% of women in the ZOI ate any organ meat, 
despite their importance as rich source of vitamin A. 
These findings revealed the need to provide more income generating knowledge and skills 
development support to PSGs with the objective of increasing household income and in return 
improving food diversification. 
3-4.6 Iodization of Household Salt 
The fortification of salt with iodine is the most common method of preventing iodine deficiency. Iodine 
deficiency has serious effects on body growth and mental development. According to the WHO, a 
country’s salt iodization program is considered to be on a good track (i.e. poised to attain the goal of 
eliminating iodine deficiency), when 90% of the households are using iodized salt. In Tanzania the 
compound used for fortification of salt is potassium iodate (KIO3). Fortified salt that contains 15 parts 
of iodine per million parts of salt (15 ppm) is considered adequate for the prevention of iodine deficiency 
(ICCIDD, UNICEF, and WHO, 2001). 
The analysis of tested salt for iodine 99.4% of visited households using the ‘iodine rapid test kit’ in 
Table 2 shows that about 53.9% of households were using salt that is adequately iodized (15+ ppm), 
and 15.8% are using salt that is inadequately iodized (<15 ppm), thus indicating that 69.7% of the 
households are using salt that has some iodine. The availability of iodized salt shows a decrease of 
12.3% when compared with the findings of the 2010 TDHS (82%). These MTE results are more 
comparable to the findings of TDHS of 2004-2005, which showed that 73% of households were using 
iodized salt. 
20
Use of adequately iodized salt is correlated with local availability of salt. MTE results show that in 
Dodoma Region, households are more likely not to use adequately iodized salt (13.7%) compared with 
less available local production, Morogoro and Manyara (30.6% and 24.8%, respectively). Further 
observation done by the MTE team suggests that most of the tested salt manufacture in Dar es 
Salaam, Tanzania lacked iodine; but salt that is manufactured in Lindi region in Tanzania and the 
imported salt from Kenya contains the recommended levels of iodine. The availability of locally 
produced salt and limited awareness of people on the effects of iodine deficiency in body growth and 
mental development might have contributed to these results. 
Iodine deficiency has adverse effects on all population groups, but women of reproductive age are often 
the worst affected. For example, iodine deficiency is related to adverse pregnancy outcomes including 
abortion, fetal brain damage, congenital malformation, stillbirth, and prenatal death. For this reason, 
use of iodized salt by women of reproductive age receives emphasis. On one hand, MBNP should 
create the community awareness on the effects of using local salt, which has not been fortified with 
iodine; and on the other hand, share these findings with TFNC a national structure with food fortification 
mandate for further enforcement actions. 
21
3-5 Knowledge, Attitudes, Gender Norms and Social Support 
The interventions under this result area (Sub –IR 6.1) were designed to improve the knowledge, 
attitudes, gender norms and social support for specific maternal and child nutrition practices through 
the scaling up of social and behavior change to improve infant and young child feeding practices. This 
includes exclusive breastfeeding, complementary feeding, hand washing and the importance of 
micronutrient supplementation for prevention of micronutrient deficiencies. This objective would have 
been achieved through targeted nutrition outreach and behavior change activities that focus on the 
pregnant and lactating mothers and children under-five years of age. 
3-5.1 Nutrition Education and Communication Interventions 
The activity implementation under this objective has resulted into significant achievements. The 
program developed and operationalized nutrition education and communication program, which led on 
behavior changes among the majority of women as targeted. This has in return improved nutritional 
status of children and women as presented in the previous section 3.4 of this report. 
The Tanzania National Nutrition SBCC Strategy, 2013-2018 that was developed with the program 
support, include SBCC framework to support the linkage between agriculture and nutrition 
programming. The framework that indicates key household actions cycle from discussion on gardening 
and livestock keeping through increased household access, to diversified nutritious foods and benefit 
sharing has been compiled in form of SBCC kits. A total of 2,366, which is 79% of the targeted 3,000 
have been procured and disseminated in 2,045 program-implementing villages. SBCC kits are 
multimedia, containing print and audio communication materials. MTE team witnessed the use of 
SBCC kits by CHWs and HBCs during PSG meetings to promote nutrition social and behavior change 
in all visited communities. The usefulness of SBCC Kit was also confirmed in facilitated focus group 
discussions (FGDs) being a way that PSG members became aware and gained knowledge on nutrition 
aspects on children, pregnant and lactating women, specifically referred to as “SIKU 1000” 
FGD participants further unanimously mentioned radio to be the most preferred media 
communication channel over the print as effective in creating people’s awareness and stimulating 
dialogue regardless of the high illiteracy rate and low levels of education amongst among household 
members. Further, the program also estimate (MBNP, 2nd Year Annual Report) that a 3-day radio 
campaign to launch “SIKU 1000” had successfully reached about 2,663,153 people with information on 
key nutrition behaviors and facts about SIKU 1000 of a human life. These findings were also reported 
by other National surveys on development communication and beneficiary impact assessment 
studies done on media communication channels. 
Likewise, MBNP had intensively promoted nutrition education with an objective of influencing behavior 
change on exclusive breastfeeding for children under six months and appropriate complementary 
feeding practices from 6 to 23 months has been developed and disseminated. Behavior change 
messages and appropriate job aids to inform and support health workers, extension workers and other 
22
key audience groups regarding the importance of consuming foods rich in iron and taking iron 
supplements during pregnancy are in place. Sensitization activities were held since the inception of the 
program. For example “Maziwa SMS text message campaign” that provided information on 
breastfeeding in which about 55,510 nutrition messages were sent out to a total of 7,930 subscribers. 
Use of community theatre art groups to sensitize 
community on essential nutrition actions is positive. 
By the end of September 2014, about 116 
community theatre groups with an approximate total 
of 2,220 (of which 34.9% are male and 65.1% 
female) artists have been mobilized to promote 
community awareness and education on Maternal 
and Child nutrition, with a specific focus on the 
importance of “SIKU 1000”. MTE team met and 
consulted with community theatre art group 
members (in the photo) during field data collection 
exercise in Peko Misegese village, Mvomero district 
in Morogoro region. These theatre art 
performances were reported to be useful in the 
promotion of nutrition messages at the community 
and also at the national level during the breastfeeding week celebrations, Vitamin A campaigns and 
field demonstrations days. 
The promotion of education and behavior change, particularly focusing on infant and young child 
feeding (IYCF), maternal nutrition, as well as water supply sanitation and hygiene has been 
implemented as planned. Information, Education and Communication (IEC) and Behavior Change 
Communication (BCC) materials have 
been repackaged, reproduced and 
disseminated to health facilities, 
CHWs, and PSG members. 
The later have also received training 
on maternal anemia and IYCF. Figure 
6 shows that in Morogoro region the 
training had reached more (124%) 
PSG members 1033 out of 836 as 
targeted, and similarly in Manyara 
(126%) that is 729 against the targeted 
579 people. 
The extent to which interventions have contributed to improved knowledge, attitudes, gender norms 
23
and social Support for specific Maternal and Child Nutrition practices are measured through an 
indicator of “number of people reached through community awareness supported by MBNP”. 
The indicator measures people reached through radio programs, performances by dance and drama 
groups, SMS campaigns and demonstration days. The cumulative estimation of the Sub –IR 6.1 
performance on people reached through community awareness supported activities by the program 
since its onset has not been included. The data provided an overall skewed performance as it raises a 
red flag because of the implementation gaps in 2011/12 and 2012/13 as indicated in MBNP, Annual 
Reports; and the over achievement in 2013/14. According to the Annual Report, October 2014, the 
number of people reached by the program has increased by 322.7 times between 2nd and 4th quarters 
from 216 to 67,900 people, respectively. Another limitation was posed by the lack of data on people 
reached through electronic media channels. The reported figure covers people who were directly 
reached by program activities. This unrealistic performance may be attributed to either under targeting, 
or data quality issues. This requires further investigation, which is beyond the scope of this MTE. 
3-5.2 Infant and Young Feeding Practices 
The assessment of people’s specific knowledge and practice (KAP) on specific nutrition behaviors and 
gender norms towards maternal and child nutrition indicated positive change as a result of program 
interventions. Recommended feeding practices, which were also promoted by MBNP, include early 
initiation of breastfeeding, exclusive breastfeeding during the first six months of life, continued 
breastfeeding up to two years of age and beyond, timely introduction of complementary feeding at age 
six months, and frequent feeding of solid/semisolid foods. The indicators, which measure the quality of 
infant and young child feeding practices, are also included.
3-5.2.1 Early Initiation of Breastfeeding 
It is recommended that children be fed colostrum immediately after birth and continue to be exclusively 
breastfed even if the regular breast milk has not yet let down. The first liquid to come from the breast, 
known as colostrum, is produced in the first few days after delivery and provides antibodies for natural 
immunity to the infant. Figure 7 shows a variation in the initiation of breastfeeding within one hour of 
birth by region. Initiation of breastfeeding within one-hour was higher (91.7%), in Manyara region, 
which is comparable with the results of the 2010 TDHS (92.9 percent). In Morogoro and Dodoma 
regions, a total of 79.6% and 73.9% respectively, were breastfed within one hour after birth. These 
findings show an increase from 2010 TDHS results of 66.3% percent and 42.8% in Morogoro and 
Dodoma regions, respectively. Further, the assessment revealed that less than a half of all eligible 
women in all three-program regions had their milk flowing the first time they put their infants to the 
breast. 
24
3-5.2.2 Exclusive Breastfeeding 
UNICEF and WHO recommend that children be exclusively breastfed (no other liquid, solid food, or 
plain water) during the first six months of life (World Health Assembly, 2001). Introducing breast milk 
substitutes to infants before six months can contribute to breastfeeding failure. Substitutes, such as 
formula, other kinds of milk, and porridge, are often watered down and provide too few calories. 
The indicator that is used to measure this is “the proportion of infants 0-5 months of age who 
received breast milk only”. Table 3 shows that in the program ZOI, exclusive breastfeeding for the 
first six months is 
widely practiced, 
about 71% of 51 
infants under six
months were 
exclusively 
breastfed in a day 
preceding the survey. This is an improvement compared to the prevalence shown by the 2010 TDHS, 
which was 50%. It is important for an infant to breastfeed frequently as this improves milk production. 
The analysis showed that all 132 (100%) out of 249 children under age of six months were breastfed 24 
hours preceding the survey. 
According to the WHO and UNICEF recommendations for optimal breastfeeding, children under age six
months need to be breastfed at least six times during the 24 hours. Findings from this assessment 
revealed that during the night (between sunset and sunrise) 28% of children under age of five were 
breastfed six times or more; during the daylight about 72% were breastfed six times or more which 
meets WHO and UNICEF recommendations for optimal breastfeeding. 
Use of a bottle with a nipple: The 
regulations regarding breast milk 
substitutes in Tanzania discourage the use 
of bottles with nipples. The use of a bottle 
with a nipple, regardless of the contents 
(breast milk, formula, or any other liquid), 
requires hygienic handling to avoid 
contamination that may cause infection to 
the infant. The survey data (Figure 8) 
shows that 4.6% (12 out of 249), which is 
almost similar to findings in 2010 TDHS 
where 5% of infants under six months are fed with a bottle with a nipple. In Manyara region no infant 
was fed with a bottle with nipple. 
3-5.2.4 Complementary Feeding 
After six months, a child requires adequate complementary foods for normal growth. Lack of 
appropriate complementation may lead to malnutrition and frequent illnesses, which may lead to death. 
25
The analysis of collected information showed that complementary feeding starts early in the program 
area. About 25% of children below six months of age were given complementary foods. 
It is recommended that complementary foods (solid or semisolid foods fed to infants in addition to 
breast milk) should start being fed immediately after the age of 6 months. This is because, at this age, 
breast milk alone is no longer sufficient to maintain the child’s optimal growth. The amounts of feeds 
are increased gradually from 6 to 23 months, which is the period of transition to eating the family diet. 
The analysis of collected data on types of foods consumed in the 24 hours preceding the survey by 
breastfeeding children under age 5 revealed that all (100%) of the breastfed children age 6-23 months 
received solid or semi-solid complementary foods in addition to the breast milk.
MTE assessed “the percentage of children age 6-23 months living with their mothers, who are 
fed four meals or more per day” according to IYCF feeding practices based upon number of food 
groups and times they are fed during the day or night preceding the survey. MTE finding on this 
indicator is depicted in 
Table 4, showing less 
than a half (44%) ate 
four or more meals as 
recommended in the 24 
hours preceding the 
survey, and the other 56% were fed the minimum times per day in the previous 24 hours. The regional 
analysis indicated that the proportion of breastfeeding children age 6- 23 months who are given a 
variety of foods at least four times daily is more in Manyara Region (68%), followed by Morogoro 
Region (36%) and lastly, Dodoma Region with only a quarter of children eating recommended meal 
frequencies.
Minimum Feeding Frequency (MFF) for breastfed children was also assessed. MFF is considered to 
be two or more feedings per day of solid, semi-solid or soft food groups other than breast milk in the 
case of infants 6-8 months, and at least three times per day in the case of children 9-23 months. A total 
of 15 children age between 6-8 months were met during the MTE data collection. The assessment of 
MFF for infants 6-8 months (Table 5) shows that the majority (87%) of children age 6-8 months do 
receive meals as per 
recommended MFF; while 
only a few proportion (13%) 
ate only once per day in the 
24 hours preceding the 
survey. 
Table 4: Percent of breast fed children 6 - 23 months who received 4 meals per day by region
Meal frequency Morogoro Dodoma Manyara Total
% % % % 
1 6 13 0 6
2 18 33 14 21
3 39 29 18 29
4+ 36 25 68 44
Table 5: Percent of breast fed children 6 - 8 months who received 2 or more meals 
per day by region
Meal 
frequency Morogoro Dodoma Manyara Total
% % % % 
1 13 50 0 13
2+ 88 50 100 87
26
The assessment in Table 6 reveals that out of 70 children aged between 9-23 months, 77% received 
meals as per 
recommended 
frequency in the 24 
hours preceding the 
MTE and the other 
(23%) ate once or 
twice per day. According to the regional assessment, the majority (91%) of children age between 9-23 
years in Manyara Region ate three or more meals (the recommended frequency), followed by Morogoro 
Region (84%) and lastly Dodoma Region (55%). Stakeholders met including CHWs, HBCPs, HFWs, 
members of DNTF suggested the need for a more intensive promotion of education and SBCC on IYCF 
to accelerate changes in nutritional behavior and practice in the community. 
3-5.3 Hand Washing and Hygiene Practices 
The program introduced the use of tippy tap technology at some demonstration plot sites and promoted 
hand wash as a good hygiene and sanitation practices. According to the annual program reports, a 
total of 150 tippy taps were established near 
demonstration plots (in the photo), with 
Morogoro region establishing 24 (67%) more 
units. However, the adoption of tippy taps at 
the household level has been slow. The 
assessment indicated that about 38% out of 
the 179 respondents were aware of the hand 
washing method; while the majority (62%) 
remained unaware. For those who were 
aware confirmed the program to be a source of 
their information. The regional data showed a 
similar pattern of findings, where less than a 
quarter of people in all three regions seemed 
familiar with tippy taps. Hygiene practices 
including the community adoption and use of 
tippy taps need to be intensively promoted 
through the program supported community 
awareness activities. 
Further, assessment of the hand washing practice by breastfeeding women revealed that most 
understand the importance and have used soap to what their hands at least once within 24 hours 
preceding the survey. MTE findings showed 98% in Manyara Region, followed by 96.7% in Dodoma 
Region and 82.6% in Morogoro region. Generally, the analysis of responses indicated that a majority 
(90.7%) of household members does wash their hands with after going to the latrine, and about 5% 
Table 6: Percent of breast fed children 9-23 months who received 3 or more meals per day by 
region
Meal frequency Morogoro Dodoma Manyara Total
% % % %
1 4 9 0 4
2 12 36 9 19
3+ 84 55 91 77
27
reported to use soap anytime they use their hands to do something. Regional statistics (Table 7) 
revealed the same pattern. The majority between (85-95%) of the breastfeeding women in the three 
regions washed their hands with soap after using the latrine. The importance of promoting hand 
washing was also emphasized by HFWs met, especially due to the scarcity of water and lack of latrines 
in some areas. 
Table 7:Percent of women 15-49 years who wash hands by soap and Region
Reason for hand wash Morogoro Dodoma Manyara
% % %
After going to the latrine 85.7 93.2 93.6
After washing baby's bottom/changing diaper 17.9 15.3 12.8
Before preparing food 44.6 33.9 38.3
Before eating 42.9 30.5 36.2
Before feeding/breastfeeding baby 30.4 16.9 23.4
Any time 5.4 5.1 4.3
Other 14.3 20.3 23.4
3-5.4 Mosquito Nets for Malaria Prevention 
Ordinary untreated mosquito nets provide limited physical barrier between mosquito and man and 
protection as they may still bite through the net or get inside the net following improper use. Mosquito 
nets treated with insecticides provide better and effective protection by keeping away mosquitoes as 
well as killing them. An insecticide-treated mosquito net also kills or keeps away other nuisance insects 
such as cockroaches, bedbugs, houseflies, fleas, etc. 
The use of insecticide-treated mosquito nets (ITNs) is a primary health intervention designed to reduce 
malaria transmission in Tanzania. Distribution of long-lasting insecticide nets (LLINs) to children under 
5 in Mainland started in late 2008 with a pilot project that was expanded region by region in May 2009. 
By the time of data collection for the MTE in November 2014, all regions including Morogoro, Dodoma 
and Manyara had experienced the distribution of LLINs to all children under 5 through health facilities. 
It is anticipated that widespread use of ITNs will reduce mosquito density and biting intensity. The MTE 
assessed the household possession and use of ITNs and LLINs by household members. 
3-5.4.1 Ownership of Mosquito Nets
The majority (73.3%) of the visited 
households own at least one mosquito net. 
This MTE finding is a bit less than 75% 
result in 2010 TDHS. Of these 17.6% 
have at least one mosquito net, 23% own 
two nets and 32.7% have three or more 
ITNs. This has limited improvement in 
household ownership of mosquito nets can 
be attributed to the discontinued 
28
distribution by the Government during the current year, the MTE team were informed by HFWs and 
district medical staff met. 
In the program regions (Figure 9), ownership of ITNs/LLINs is more than 80% in Manyara region, 
followed by 72.7% in Morogoro, and 66.7% in Dodoma. The increase in ITN/LLINs ownership between 
2010 TDHS survey and 2014 MTE is significant in Manyara (from 73 percent to 82.2%).
ITNs/LLINs are factory-treated net that do not require any further treatment, or a net that has been
soaked with insecticide within the past 12 months. The analysis of responses revealed that 28% of the 
households had soaked or dipped their nets in a mosquito repellant over the last 12 months, which is 
below the WHO recommended practice. ITNs have to be retreated every 6 to 12 months, or even 
more frequently if the nets were washed. 
3-5.4.2 Uses of Mosquito Nets
MTE asked respondents about the use of mosquito nets by household members the night before the 
day of data collection. The question was as follows: “Did anyone sleep under these mosquito nets 
(ITN) last night?” The analysis of responses on whether or not anyone in household had slept under 
ITN/LLIN a night proceedings the survey revealed about 60%. These MTE findings show an increase 
from the 2010 TDHS results (56%). Findings from regional data indicated more (75.6%) ITNs/LLINs 
use in in Manyara region, followed by 60.6% in Morogoro and then 46.3% in Dodoma.
3-5.5 Male Engagement in Maternal and Child Care
Sensitization efforts focusing on building constructive engagement of men in household nutrition and 
care related behaviors have been implemented. When asked a question: “Did you go with your wife in 
any of the ANC visit?” About two third (67%) of 
men interviewed said yes, while the remaining 
33.1% answered no, they did not escort their 
wives (Figure 10). Regional data shows that 
less (16.2%) men in Manyara go to ANC visit 
with their wives, while in Morogoro more 
(29.2%) are willing to attend ANC with their 
wives during pregnancy. 
During household visits, the assessment of 
men’s knowledge on care was done by asking 
the following question: “When a child is experiencing diarrhea, is she/he given less than usual to drink, 
about the same amount, or more than usual?” The analysis of responses showed that less than a half 
(43.6%) men had a correct knowledge, the other 26.4% said about the same amount and 3.6% lacked 
knowledge. The later said children should drink less than the usual amount of water when having 
diarrhea. The above findings call for a need of MBNP to strengthen male participation in maternal and 
child nutrition education activities. 
29
3-5.6 Women Empowerment towards Maternal and Child Care
The MTE used a household decision-making questionnaire to collected information on characteristics 
specific to women’s empowerment through household activities and work. MTE respondents 
expressed their attitudes towards specific household decisions, such as who makes decisions about 
purchase of inputs for agriculture production, minor household expenditure, what and how much food to 
be consumed by women and for children. Figure 11 provides the analysis of responses, which 
indicated that the majority (72.6%) of women would mainly make decisions with regard to what food 
and how much to eat; 70.7% on what food be consumed by herself and children; and 41.5% on minor 
household purchases. More (53.7%) men decide on issues like what inputs for agricultural production 
to buy; when and how much crops to be taken to the market (53%), and livestock to be sold (44.7%).
Further, the analysis showed that in about a half (51.3%) of household’s make joint decisions on 
whether or not to use family planning to space or limit birth; and to an extent (34.1%) of couples make 
joint decision on what kind of tasks do on a particular day. Rarely, someone else makes household 
decisions. 
When women respondents were asked a 
question, “to what extent do you feel you 
can make your own personal decisions?” 
The assessment of responses (Figure 12)
showed that at least 38.8% of women 
could to a great extent make specific 
household decisions; about 26% were able 
to make decisions to some extent. The 
remaining 8.4% would not make any 
decision at all. 
30
3-6 Quality of Maternal and Child Health Nutrition Services 
The interventions under this Sub –IR 7.1 were designed to improve the quality of Maternal and Child 
Health (MCH) nutrition services at health facility and community levels. The delivery of maternal and 
child nutrition services would be achieved through the strengthening of existing maternal health 
platforms that link facilities to communities and improve knowledge and attitudes of women on the 
importance of taking iron supplements during pregnancy as well as increasing consumption of iron-rich 
foods.
This would entail activities targeting nutrition outreach and behavior change that target pregnant and 
lactating mothers and children under-five years of age. It was also expected that improved knowledge 
and other capacities to provide nutrition education and SBCC programs would lead to positive attitude 
among practitioners that will in return facilitate change in behavior and practice of women and men 
towards maternal and child nutrition with a particularly emphasis on the first thousand days (SIKU 
1000). Improved health of the mothers will lead to better nutritional outcomes for children as well. 
The implementation of program activities made significant achievements. These are discussed below 
in three main sections: (i) Maternal and child nutrition education; (ii) Child nutrition services; and (iii) 
Maternal nutrition services.
3-6.1 Maternal and Child Health and Nutrition Education 
Behavior change messages and appropriate job aids were developed to inform and support health 
workers, agriculture extension workers and other key audience groups regarding the importance of 
consuming foods rich in iron and taking iron supplements during pregnancy. Increasing access to and 
awareness on the importance of iron rich foods and iron supplements was promoted with the goal of 
reducing the prevalence of maternal anemia and improve the nutritional status of reproductive aged 
women. Since its onset the program has 
invested in delivery of train program to 
various actors with an objective of 
improving knowledge on maternal and child 
nutrition, with a particular focus on the 
improvement of service delivery. The 
extent to which planned interventions have 
contributed to the increased maternal and 
child nutrition education was tracked by 
monitoring the “number of people trained 
in child health and nutrition through 
USG-supported programs”. Overall 
cumulative sub IR 7.1 performance met the 
31
target as depicted in Figure 13. The performance was noted on the increased number of all trained 
individuals (health and non-health professionals) in year one and year three that reached 101% and 
154% of the target, respectively. However, in year two (2012/13), the target was met by 90% only 
(MBNP Annual Reports). These include District Nutrition Team Facilitators (DNTFs), Health Facility 
Workers (HFWs), and non-health professionals including the extension workers, community leaders, 
CHWs and HBCs as well as community members. 
3-6.1.1 District Nutrition Team Facilitators (DNTFs) 
A team of District Nutrition Facilitators (DNTFs) has been established to support the scaling-up and 
cascading of nutrition activities in all 10 districts. DNTFs provide technical support and training in their 
area of jurisdiction. DNTFs comprise of about eight district staff from key sectors, making a total of 80 
trained personnel. These eight individuals have successfully attended a four-day training using MBNP 
developed curriculum to enhance their technical knowledge on maternal and child nutrition, counseling 
and facilitation skills, as well as maternal anemia and childhood stunting. In addition, the training also 
focused on program set up, roles and responsibilities of key nutrition actors and the information 
management. 
MTE conducted interviews with nine (9) randomly selected DNTF members (DNuOs, DRCHCOs, 
District Community Development Officers (DCDOs) or District Agriculture Development Officers 
(DADOs)/District Livestock Development Officers (DLDOs)). All (100%) have informed the MTE team 
that the four-day training was useful. The assessment also revealed that DNTFs have effectively 
collaborated with the program and CSOs in facilitating all organized trainings. However, they have 
requested for a follow up training on how to conduct supportive supervision on the implemented 
nutrition activities. 
3-6.1.2 Health Facilities and Health Facility Workers
A total of 826 out of 841 (98.2%) health facilities benefited from the capacity building activities delivered 
by MBNP. The program focused on building the capacity to promote nutrition education and improve 
the delivery (in terms of quantity and quality) of nutrition services to pregnant mothers and children. 
MTE team found the Health Facilities addressing maternal anemia and childhood stunting through the 
provision of curative and preventive services that are targeting pregnant women, infants and children. 
Approximately 5,718 HFWs, medical doctors and nurse midwifery have been trained. The program 
successfully trained about eight (8) individuals in each District Hospital, four (4) in Health Centers and 
two (2) people in Dispensaries. The training was an eye opener. The consultation with trained HFWs 
also revealed that this was the first time to understand the importance of “SIKU 1000” in the life. 
According to HFWs met, the training was very useful and it covered the following topics:
a. Maternal nutrition particularly focusing on counseling and communication to clients, evidence￾based interventions to control maternal anemia, IFA supplementation, consumption of iron rich 
foods, iron enhancers and inhibitors, malaria control and de-worming, and importance of male 
involvement; and
b. Child nutrition with focus on childhood stunting, its critical pathways and interventions; caring 
32
for and feeding a sick child, preventive care to reduce child infections, Vitamin A 
supplementation for under five years olds, de-worming, complementary breastfeeding, optimal 
breastfeeding, breastfeeding issues and good management, myths, misconceptions, beliefs 
and family influences on this regard. 
Further, MBNP in collaboration with Regional and District Pharmacists and Vaccination Officers 
delivered training and coaching on quantification and ordering of essential safe motherhood supplies 
such as IFA, SP and de-worming drugs to a total of 80 HFWs (of which 23.7% were males and 76.3% 
female). The analysis of responses from the Health Facilities In-Charges met indicated the training was 
useful, and has resulted into the reduction of stock outs. 
3-6.1.3 Extension Workers
Extension Officers at ward level were oriented in the provision of supportive supervision of nutrition 
sensitive practices and introduced to the Care Group Model that has been set up at the community as a 
means to mobilize and engage with the beneficiaries. The analysis of information from Regional 
Program offices showed that about a half (49.5%) of the targeted 1,534 Extension Workers the have 
been trained over the three years period. Given the important role that Extension Workers are 
expected to play in the promotion of agriculture-nutrition linkages, MBNP has to ensure that planned 
targets for the training of Extension Workers are achieved. 
MTE also found out that there is limited MBNP support to Extension Worker’s agriculture-nutrition 
linkages. Only 2 or 10% out of 20 villages visited during MTE, reported to have received advice on 
how to start and maintain home gardening and small livestock keeping. The majority seems to lack 
willingness and motivation to participate in MBNP programs, and this was confirmed by CHWs during 
consultations. MBNP will have to collaborate with Councils in ensuring that exiting Extension Officers 
at ward and village levels effectively participate in the promotion of nutrition agenda and become 
accountable. 
3-6.1.4 Community Leaders 
In collaboration with CSOs and DNTFs, MBNP oriented ward and village leaders including Councillors, 
Ward Executive Officers (WEOs), Village Executive Officers (VEOs) and Villages chairpersons. The 
orientation focused on the magnitude and effects of maternal anaemia and childhood stunting, 
programs interventions as well as their expected role and responsibilities in promoting community 
nutrition education and behavioural change.
A total of 1,729 leaders have been 
oriented in the three regions over the 
last three years as shown in Figure 14. 
The regional comparison of regional 
performance indicates that in Dodoma 
Region only 22% (369 out of 1,674) 
leaders have been so far oriented, 
33
which is less than the planned target. In Morogoro and Manyara regions the performance has 
surpassed the target by 43% and 5%, respectively. These findings clearly indicate a need for 
orientation of more community leaders in Dodoma region to support community mobilization. During 
FGDs, community members and CHWs reported that the usefulness of these leaders on y mobilizing 
community members to participate on PSG meetings which are organized with an objective of 
promoting nutrition education and positive change on related social behavioural. 
3-6.1.5 Community Health workers (CHWs) and Home Based Care (HBCs) 
The program has recruited a total of 2,283 CHWs and HBCs during the three years, who are in charge 
with the roll out of SBCC Kit. There are at least two trained CHWs and one HBC provider in each 
program village. CHWs and HBCs were appreciated for promoting community nutrition awareness, 
basis maternal and child nutrition education and SBC communication at community level through 
mobilization of Parent Support Groups (PSGs). CHWs/HBCs promoted the linkage between 
communities and clinical services. 
The regional assessment of targets against achievements (Table 8) revealed that the recruitment and 
training target in Morogoro were fully met, while targets set for Manyara were met by 94%. In Dodoma 
region, analysis showed a performance of 70.6% (2422 out of targeted 3430). 
Source: MBNP Annual reports
The analysis of responses from the interview that was conducted with 55 CHWs/HBCs (45% male and 
55% female) indicated that the training received has equipped them with the understanding nutrition 
education and SBCC kit and skills to implement their expected roles and responsibilities. A total of 
78% of the 55 interviewed CHWs/HBCs could mention key services they should deliver, which included 
the formation of PSGs, organizing meetings and using SBCC kits to promote basic nutrition facts and 
linking community members to health facilities to access clinical services. During MTE data collection 
some of the CSOs reported to experience increasing CHWs/HBCs dropout, however the magnitude 
was not established. The program may wish to establish the magnitude and implement a replacement 
plan.
Table 8:Number and percent of CHWs and HBCs recruited by MBNP in ZOI
Type of Actor Region Target Achievement
Number %
CHWs
Morogoro 626 805 129
Dodoma 1,296 553 43
Manyara 326 307 94
Morogoro 313 315 100.6
HBC providers Dodoma 648 229 35
Manyara 221 213 96
34
3-6.1.6 Formation of Peer Support Groups
With the support of MBNP, CHWs/HBCs collaborated with CSOs and DNuOs to mobilize SIKU 1000
parents into Peer Support Groups (PSGs). PSGs mainly comprise of twelve (12) SIKU 1000 parents 
who would together learn and share experiences regarding pregnancy and childcare practices, and 
support one another in adopting good pro-nutrition practices and behaviours (Figure 15). The program 
has supported the formation of 
3,336 PSGs with about 40,037
members. Regional assessment 
indicated the performance of 132% 
(17,619 members of PSGs against 
the target of 13,320) in Morogoro
Region; followed by 193% (8749 
against targeted 4522) in Manyara 
Region and managed to recruit 
29% of 46,656 PSG targeted 
(MBNP Regional Office data, 
November 2014). The program 
team in Dodoma Region has to pay 
attention to the causes of the 
reported lower achievement rate. 
According to the program records (Figure 16), the number of PSG members has increased significantly 
from zero in year 2011/12 to over 23,000 in the third year. Of these 33,667 PSG members, 60.5% were 
female and 39.5% were male. These results indicated that there are fewer men PSG members, as 
according to the Care Group Model that 
has been adopted each PSG would 
comprise of 12 members (6 men and 6 
women). The objective was to enable 
holding sex specific as well as mixed group
discussions on key behaviors, norms, 
cultural practices and other crosscutting 
gender issues. 
MTE commends the use of this model 
because it ensures the establishment of 
informal local networks. During the FGDs, 
members of PSGs expressed satisfaction 
with regard to the shared knowledge and learning on care for pregnancy, infants and children of age 
under 59 months. Education on “SIKU 1000” was highly appreciated by PSG members and also 
CHWs/HBCs during the conducted FGD sessions. 
Moreover, the assessment revealed that SBCC Kit has very effective tools not only on awareness 
creation but also on stimulating community dialogue and influencing behavioural change. As indicated 
35
in the previous section on this report, community members have increased knowledge on maternal and 
child nutrition; and households have adopted breastfeeding and complementary feeding practices as a 
result of the program effort. MTE carried an assessment of the effectiveness of communication 
channels in the SBBC Kits during the FGDs. The analysis of responses from 15 conducted FGDs 
showed that radio was the most effective channel, followed by the face-to-face. Prints such as leaflets 
and brochures seem to be the least preferred. 
3-6.2 Child Nutrition Services 
Trained health and non-health proffesionals provided nutrition services aiming at prevention of 
malnutrition and mitigation of poor nutrition outcomes to children and pregnant women. Some of the 
indispensable services provided at health facilities and community levels included provision of behavior 
change communication education package, promotion of exclusive breastfeeding for children 0-6 
months and complementary feeding for children 6 - 23 months and promotion of children attendance to 
immunization services at health 
facilities. An indicator, “number of 
children under five years reached by 
USG-supported nutrition services”,
measures provision of nutrition 
services for under-five years children. 
The adequate nutrition is essential for 
normal growth and development of a 
child. Figure 17 provide the findings 
of the program performance against 
target that revealed improvement in
numbers of children reached with 
nutrition services at 92% in 2012/13 
and 137% in 2013/14 surpassing the 
target. 
These include behavior change communication activities, home or community gardens, micronutrient 
fortification or supplementation, anemia reduction packages, growth monitoring and promotion and 
management of acute malnutrition. Similar results were obtained in the regional level assessments 
(Table 9) with increased of number of children reached annually.
Table 9: Number of children provided with nutrition services per year by region
Year Region
Morogoro Dodoma Manyara
2011/12 43,515 41,032 8,070
2012/13 226,727 196,285 57,383
2013/14 397,292 544,553 331,360
Source: MBNP Annual report, October 2013/14
36
3-6.3 Vitamin A Supplementation
Vitamin A is an essential micronutrient for the immune system that plays an important role in 
maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye 
damage. VAD has the potential of increasing the severity of infections, such as measles and diarrhea 
in children, as well as perpetuate slow recovery from illness. Periodic dosing (usually every six months) 
of vitamin A supplements is one method of ensuring that children at risk do not develop VAD. 
The program performance on Vitamin A supplementation to children under-five years is measured 
using an indicator, “number of children under five years of age who received Vitamin A 
supplementation from USG-supported programs”. Analysis of the collected information from the 
household on children aged 6-59 months who received vitamin A supplementation in the last six 
months by region shows about 94% of 189 children age 6-59 months were given vitamin A 
supplements in the six months before the survey, which is a notable improvement as compared to 2010 
TDHS result (61%). The regional assessment revealed a similar trend in the program performance. All 
(100%) of children studied in Morogoro, 93% in Manyara and 85.5% in Dodoma region received 
Vitamin A supplementation in the last six 
months. These results can be attributed 
to the capacity building interventions 
delivered by the program. Health facility 
records on this same indicator confirmed a 
significant increase of the number of 
children under-five years that received 
vitamin A supplementation from 2011/12 
through 2013/14. Figure 18 presents MTE 
results on the analysis of the achievements 
against targets, which revealed that the 
performance in year 2013/14 has 
surpassed the target by 20%. However, in 
year 2012/13 the program achieved 76.3% 
(out of the targeted 270,000) of the 
planned target. The later low performance was associated with poor infrastructure and low health 
facility attendance rate especially in pastoralist communities. Similarly, the assessment of vitamin A 
supplementation by the under five years from the health facility data by regions (Table 10) indicated an 
annual increase in all three regions. These findings could be attributed to the program effort to promote 
linkage between the community and health facilities and demand for vitamin A supplementation to 
children. 
Table 10: Number of Children Provided with Vitamin A through Health Facilities
Region Year 1 Year 2 Year 3
Dodoma 33,840 99,129 497,989
Manyara 1,727 28,445 281,675
Morogoro 43,145 78,447 339,806
Source: MBNP Annual report, October 2013/14
37
3-6.4 Deworming 
Certain types of intestinal parasites can cause anemia. Periodic deworming for organisms like 
helminthes and schistosomes (bilharzia) can improve children’s micronutrient status. MTE collected 
information from the household on children who have taken pills for intestinal worms in the last six
months. The assessment of responses showed that the majority (83%) of children age 6-59 months 
received deworming medication in the six months before the survey, which are more than 2010 TDHS 
results (50%). The regional 
statistics in Figure 19 indicates 
that Morogoro and Manyara 
regions have the highest 
proportions of children who 
receive deworming medication 
(88.3% and 86%), respectively. 
This achievement might be 
associated with increased 
community awareness and 
availability of deworming 
medication in health facilities 
resulted from MBNP interventions. 
3-6.5 Nutrition Status of Under Five Years Children
In assessing child health and survival it is important to include infant birth weight at birth and track 
child’s growth by assessing nutrition status using anthropometric measurements. These two important 
areas were assessed by MTE on 237 children of which, 47.4% were male and 52.3% female. 
Analytical results are discussed below.
3-6.5.1 Child Weight at Birth
A child’s birth weight is an important determinant of infant and child health and mortality, while a birth 
weight of less than 2.5 kilograms is considered low. For all births during the five-year period preceding 
the survey, mothers were asked to produce child’s health card. If the mother or both parents were not 
able to present a card, she was asked to recall the specific child’s size at birth. Although such 
information is subjective, it was useful proxy for the weight of the child in kilograms. The findings 
indicated that the majority (84.8%) of children under five year were weighed at birth, indicating that 
most deliveries occur at a health facility. The other 13.5% were not weighed, and parents of the 
remaining 1.7% children did not either know the birth weight or failed to present a health card. 
Among births with known birth weight, only 3% (7 out of 237) were classified as having low birth weight 
(weighed less than 2.5 kg at birth). According to the respondent’s own assessment of her infant’s size 
(kg from recall), at least 3.8% (9 out of 237) infants were smaller than average. The majority (93.2%) of 
38
infants were classified as average or larger than average. 
3-6.5.2 Anthropometric Measures
MTE took anthropometric measures (height and weight) to facilitate the assessment of nutritional status 
of all children under-five years of age. Data was collected to calculate three indices: weight-for-age, 
height-for-age, and weight-for-height. For this MTE, indicators of the nutritional status of children were 
calculated using new growth standards published by the World Health Organization (WHO). These 
new growth standards were generated using data collected in the WHO Multicenter Growth Reference 
Study (WHO, 2006).
Standardized anthropometric Z-scores from anthropometric data that was collected from 237 children 
during MTE on: weight-for-age (WAZ), height/length-for-age (HAZ) and weight-for-length/height (WHZ) 
indices were computed as illustrated in Table 11. An indicator “prevalence of stunted children 
under five years of age”, which measures the nutritional status of children under five years of age was 
tracked. 
The assessment of stunting (height-for-age) in the program area revealed that 40% of children under￾five years are stunted, and the 2010 TDHS6 findings indicated 42%. Though it is not verified as to 
whether or not this is a statistically significant reduction, any improvement in the prevalence of child
stunting is important to MBNP. This may show that the project is in the process of reducing overall 
rates of stunting in target areas through its investment in nutrition education and SBCC program, 
promotion of food diversification as well as community adoption of agriculture-nutrition technologies and 
supplementation. The regional assessment on prevalence of child stunting showed 44.2% in 
Morogoro Region, 38.2% in Dodoma Region and 36.1% in Manyara Region, respectively.
Table 11: Nutritional status of children under five years of age by sex, region and overall1
Category Underweight Stunting Wasting
Sex Yes No Yes No Yes No
 Male 14 (12.5) 98 (87.5) 44 (39.3) 68 (60.7) 11 (9.8) 101 (90.2)
 Female 27 (22.0) 96 (78.1) 50 (40.7) 73 (59.4) 8 (6.5) 115 (93.5)
Region
Morogoro 13 (13.7) 82 (86.3) 42 (44.2) 53 (55.8) 5 (5.3) 90 (94.7)
Dodoma 18 (26.5) 50 (73.5) 26 (38.2) 42 (61.8) 10 (14.7) 58 (85.3)
Manyara 10 (13.9) 62 (86.1) 26 (36.1) 46 (63.9) 4 (5.6) 68 (94.4)
Overall 41 (17.5) 194 (82.6) 94 (40.0) 141 (60.0) 19 (8.1) 216 (91.9)
1Percents are shown in brackets in each cell
Further analysis of the indicator, prevalence of wasting for children under-five years of age, shows that 
the overall prevalence was 7.9% in the program area, while the result of 2010 TDHS was lower (5%). 
According to the regional analysis, the prevalence of wasting was 5.6% in Manyara Region, 5.3% in 
Morogoro Region and high 14.7% in Dodoma region, respectively. Additionally, the prevalence of the 
underweight of children who were under-five years of age in the ZOI was 17.5%. Child nutritional 
status was also stratified by sex. The findings in Table 11 revealed the underweight prevalence of 
22% and 12.5% in female and male children, respectively. 
 
6 TDHS –Tanzania Demographic Health Survey
39
3-6.6 Utilization Maternal Nutritional Services 
Overall cumulative weight of the performance on improved utilization of nutritional services for women 
of reproductive age under the program was measured by an indicator on, “number of women of 
reproductive age reached by USG-supported nutrition programs”. This would include the number 
of women of reproductive age (15-49) who receive micronutrients, anemia reduction packages, and 
other nutrition services from health facilities, and those reached by behavioral change communication 
activities from USG-supported programs. According to MBNP records from the first and second year 
(Figure 20), the performance was 72% and 137%, respectively. The good performance in 2013/14 
could be attributed to the continued promotion of nutrition education and SBCC and the improved 
nutrition services provision in health facilities. 
The utilization of maternal nutritional services was also assessed through number of antenatal care 
(ANC) visit and coverage, use of iron supplements, use of anti-malaria drugs and the prevalence of 
anemia. The key findings are presented below in this section. 
3-6.6.1 Antenatal Care 
Early and regular checkups by trained medical providers are very important in assessing the physical 
status of women during pregnancy. Antenatal care can be most effective in avoiding adverse 
pregnancy outcomes when it is sought early in the pregnancy and continues through to delivery. This 
assessment allows intervention to occur in a timely manner if any problems are detected. The program 
has trained HFWs and CHWs/HBCs to provide quality nutrition services such as promotion of early 
booking for Antenatal Care (ANC) for pregnant women and utilization of antenatal and post-natal care 
services. The 2014 MTE obtained information on number of ANC visits, months of pregnancy on the 
first ANC visit and coverage. 
3-6.6.2 Antenatal Care Visits 
WHO recommends that a pregnant woman without complications should have at least four ANC visits 
to provide sufficient care. It is possible during these visits to detect reproductive health risk factors. In 
40
the event of any complication, more frequent visits are advisable and admission to a hospital may 
become necessary. About 67% of 
women whose last birth occurred in the 
five years before the MTE made four or 
more ANC visit (Figure 21) as per 
WHO recommendation. This is higher 
from the recorded 53% in 2010 TDHS 
by 14%. Women in Manyara region 
(18.8%) were less likely to make four or 
more ANC visits than 25.7% women in 
Morogoro region and 21.2% Dodoma 
region, respectively 
Women respondents were asked a 
question, “How many months pregnant 
were you when you first received antenatal care for the last pregnancy?” The assessment of responses 
on the stage of pregnancy at the first visit is presented in Figure 22. More than a half (53.1%) of 
pregnant women made their first ANC visit during the first trimester, while the national data as per 2010 
TDHS indicate only 15%.
3-6.6.3 Coverage of ANC 
The majority (87.1%) of interviewed women received ANC from a skilled provider (nurses and 
midwives) at the health facility, the other (12.7%) receive some kind of antenatal care from people who 
are not medical professionals, such as CHWs and traditional birth attendants (TBAs). Women, who 
received ANC from a skilled provider in the program regions, were slightly more than 80% that was 
reported in the 2010 TDHS. The regional analysis indicated that more (87.1%) pregnant women 
accessed ANC services from health facilities, while the remaining 12.9% obtained ANC services from 
relatives, CHWs/HBCs and other community members. 
41
3-6.7 Prevention of Maternal Anemia 
The training of HFWs and CHWs/ HBCPs has strong emphasis on promoting the use of Iron Folic Acid 
(IFA) tablets for the prevention of maternal anemia and consumption of iron rich foods to women of 
reproductive age. Nutritional deficiencies like anemia are often exacerbated during pregnancy because
of the additional nutrient demands associated with fetal growth. Iron status can be improved by 
providing iron supplements to food consumed by women along with improved diets and control of 
parasites and malaria. Iron supplementation is necessary for pregnant women because their needs are 
usually too high to be met solely by food intake. For pregnant women, daily iron tables are 
recommended throughout the pregnancy period (MOHSW, 1997). The program interventions focused 
on the provision of iron tablets and anti-malaria drugs in health facilities and promoted the use by 
pregnant women at the community levels. 
3-6.7.1 Provision Iron Tablets in Health Facilities
The performance of interventions towards improvement of maternal anemia in health facilities is 
measured using the indicator, “number of pregnant women who received a full 90-day supply of 
iron tablets from a heath facility”. MTE assessed number of women who took iron tablets during the 
last pregnancy and the post￾partum period. The statistical 
analysis of collected data revealed 
that 85.5% (152 out of 179) of 
women age 15-49 years used iron 
tablets during their last pregnancy, 
while the remaining 14.5% did not. 
When asked a question, “for how 
many days did you take iron 
tablets during the last pregnancy?” 
The analysis of responses (Figure 
23) indicated that more than a half 
(55%) used iron tablets for 90 or 
more days during the last 
pregnancy and the post-partum period. According to the national data in 2010 TDHS, the use of 4% of 
iron supplementation by pregnant women was 4%. The improvement in the utilization of iron 
supplementation might have resulted from the promotion of the intake of iron tablets by MBNP as a 
strategy to reduce prevalence of maternal anemia. The regional assessment indicated that the 
percentage of women who took iron supplements for 90 or more days per region (Table 12) is higher 
(58%) in Dodoma region, followed by 54.2% in Morogoro region and 52.4% in Manyara region, 
respectively. 
42
3-6.7.2 Use of Iron Tablets by Pregnant Women at Community level
Maternal nutrition services were to be improved through strengthening of existing maternal health 
platforms, which link facilities and communities with interventions aiming to attitudes and practices of 
pregnant women on the importance of iron supplements in addition to increased consumption of iron￾rich food. MTE collected and analyzed 
information, which showed that 85.5% (123 out 
of 145) of the interviewed women took iron 
supplements during their last pregnancy that is 
more than (25.5%) who reported to take iron 
tablets during the previous pregnancy (Figure 
24). 
The analysis further revealed that 8.3% of 
those who reported to use iron tablets during 
their last pregnancy had to discontinue at a 
certain point in time because of either the 
associated side effects, or lack of access due 
to stock outs in health facilities or due long distance to reach a nearby health facility. Moreover, that 
assessment indicated that more (70.2%) pregnant women were advised by a health workers on the 
importance of using iron supplements as a preventive measure, 14.5% because they were diagnosed 
with anemia, and the remaining 15.3% because they were convinced by a relative or a friend. 
During the FGDs, the program was said to be the main source of information and knowledge on the 
importance of iron supplementation during pregnancy. The majority (74.5%) mentioned SBCC kits as 
an information source. The above results confirm on the effectiveness of the program community
3-6.7.3 Use of Malaria Drugs for Prevention
Malaria is a major public health concern for all Tanzanians, especially for pregnant women and children 
under-five years. The disease is a leading cause of morbidity and mortality among outpatient and 
inpatient admissions. It accounts for up to 40% of all outpatient attendance (MOHSW, 2006). Many 
regions of the country report malaria transmission throughout the year. As a protective measure, it is 
recommended that all pregnant women in the country receive at least two doses of IPT with SP during 
the second and third trimesters of pregnancy. 
MTE statistics indicated that the majority (84.4%) of women reproductive age 15-19 years took 
antimalarial tablets, which were received during the ANC visits. In addition, a high proportion (96.1%) 
of women consumed SP drugs during their last pregnancy, while the remaining 3.9% reported to have 
used chloroquine or other types of anti malaria drugs. Regional statistics revealed that less (26.0%) 
number of women in Manyara Region took SP as compared to Dodoma and Morogoro Regions (32.5% 
and 37.7%), respectively.
3-6.7.4 Prevalence of Anemia among Women 
Anemia is defined as a reduction in the normal number of red blood cells or a decrease in the 
43
concentration of Hb in the blood. Hb level below 7 g/dl for women whether pregnant or not is 
considered severe anemic status. MTE team used the HemoCue rapid testing methodology to obtain 
raw measured values of hemoglobin for assessing anemia prevalence among women reproductive age 
15-49. 
The overall findings from the analysis of collected samples from 175 women of reproductive age 15-49 
years revealed that the anemia prevalence in the program area is 37.1%, while the 2010 TDHS results 
indicated 40%. This performance could be attributed to a number of program implemented 
interventions that focused awareness creation on the importance of iron supplementation on pregnant 
women, coupled with improvement of drugs ordering and supply chain to reduce stock outs. In 
addition, the analysis also showed that more than half (55%) of the women of reproductive age used 
iron supplements for 90 or more days for during the last pregnancy and the post-partum period. Table 
13 presents the regional data on anemia prevalence as follows: 25.9% in Dodoma region, 27.1% in 
Manyara region, and 45% in Morogoro region, respectively.
Table 13: Number and percent of anemic women of reproductive age 15-49 years by region
Status
Region
Morogoro Dodoma Manyara
N (%) N (%) N (%)
Not Anemic >= 12g/dl 36 52.9 43 74.1 31 63.3
Anemic <12g/dl 32 47.1 15 25.9 18 36.7
Total 68 100 58 100 48 100
3-6.8 Maternal Nutritional Status 
The nutritional status of women was assessed by using two anthropometric indices - height and body 
mass index (BMI). To derive those indices, the MTE team took height and weight measurements of 
women aged 15-49 years. Women who gave birth within two months preceding the survey were 
excluded from the analysis. Short stature of a human being reflects previously poor socioeconomic 
conditions and inadequate nutrition during childhood and adolescence. In a woman, short stature is a 
risk factor for poor birth outcomes and obstetric complications. A woman is considered to be at risk if 
her height is below 145 cm ( 145 cm). The assessment of data collected revealed that the proportion 
of women with heights below 145cm was 4.2%. Regional statistics indicated that Morogoro Region has 
the highest (8.7%) proportion of women with heights below 145 cm, followed by 4.8% in Dodoma 
Region and, the lowest proportion (2%) was found in Manyara region. 
44
The analysis of collected data from 179 women 
of reproductive age (Figure 25) showed that 
about 7% are underweight, and a total of 38% 
are obese. BMI value below 18.5 indicates 
underweight or acute under-nutrition and a BMI 
of 25.0 or above indicates overweight or 
obesity. BMI is calculated by dividing the width 
in kilograms by the height in meters squared 
(kg/ ). Results (BMI values) are used to 
determine the percentage of women of 
reproductive age that is normal, underweight 
and overweight/obese. 
The assessment in the program regions (Table 14) indicated high proportion (16%) of overweight for 
women in Morogoro, with 11% in Dodoma and Manyara regions, respectively. Similarly the 
assessment of underweight women indicated that only 1% of women of reproductive age in Morogoro
region are underweight and about 3% in Dodoma and Manyara regions, respectively. 
3-6.9 Access to Maternal and Child Nutritional Services 
MTE collected information on the problems faced by women in obtaining nutritional health care for 
themselves aiming to assess barriers that women may be facing in seeking care. The assessment of 
responses from interviewed women age 15-49 showed reasons such as permission to visit clinic, lack 
of money for treatment, long distance to health facility, as well as lack of willingness to seek health 
care. Across the three program regions, women in Manyara Region were most (57%) likely to cite 
permission to go to the clinic, than women in Dodoma Region (17%) and in Morogoro Region (4.2%). 
This might be associated with the culture and the high male domination due to the patriarchal system in 
pastoralist communities.
45
3-7 Institutional Capacity Building 
The interventions under this Sub –IR 8.1 were designed to contribute into the improvement of policy 
and enabling environment for nutrition and agriculture in the country. This objective would be achieved 
by strengthening the institutions responsible for nutrition with a focus TFNC at the Central Government, 
and COUNSENUTH a civil society organization at the national level. In addition, MBNP has also 
invested support in enhancing the capacity of PMO–Nutritional Steering Commitee, and the Local 
Government Authorities (LGAs) through District Nutrition Multi-Sectoral Steering Commitees (DMSCs). 
3-7.1 Institutional Strengthening of TFNC and COUNSENUTH 
In collaboration Deloitte Tanzania (Deloitte Tz), the program delivered institutional capacity building 
program in line with the priority capacity needs using the Deloitte Organizational Capacity Assessment 
tool, while tracking the performance using an indicator, “Enhanced human and institutional capacity 
development for increased sustainable nutrition program implementation for TFNC and 
COUNSENUTH”. The two institutions received the capacity building support on target improvements, 
which were identified as a result of Institutional Capacity Building Need Assessment processes 
specifically conducted on each. 
3-7.1.1 Tanzania Foods and Nutrition Center
Tanzania Food and Nutrition Centre (TFNC) is the premier institution established by the Government of 
Tanzania through the Tanzania Food and Nutrition Act (1973) tasked with overseeing the 
implementation of nutrition activities under the Minister in the Ministry of Health and Social Welfare 
(MOHSW). TFNC is an autonomous institution governed by a Board of Directors and run by a 
Managing Director on a day-to-day basis. In 2011, TFNC was given an additional mandate to 
coordinate nutrition activities the country. 
MBNP through Deloitte Tz has successfully established a consistent framework for TFNC to analyse its 
own performance against its mission, mandate and identify operational activities that drive the 
performance as well as areas to be strengthened. As a result, a capacity building intervention plan was 
developed and agreed upon between TFNC and MBNP to focus on structural and systemic gaps, which 
included:
a. Governance due to the lack of a Board of Directors (BoD) and a permanent Managing Director; 
b. Clarity on the mandate for TFNC;
c. Absence of a strategic plan for providing a strategic framework in the implementation of the 
NNS and TFNC’s transformation to become a viable national nutrition coordination institution. 
MTE team found out that Institutional Capacity Buildind Assessement (ICBA) process was done in a 
participatory manner, which contributed to initial changes in the attitude of TFNC members of senior 
management and willingness to mitigate potential reasons for under institutional performance over the 
years, reported TFNC senior management during the consultation with MTE team. The assessment of 
the indicator having a capacity building plan that is informed by the outcome of the capacity needs 
assessment that was set to to measure performance and outcome of institutional capacity building 
46
support indicated that all (100%) of the six (6) improvements identified during the ICBA have been 
successfully addressed. TFNC has an approved comprehensive Strategic Plan since November 2014 
which focus on transfroming and equipping the institution to spearhead the implementation of the 
National Nutrition Strategy ( NNS). MTE assessment also revealed that TFNC’s organizational 
structure has been reviewed in line with its mandate, positioning and internal functions. The 
organizational structure was reviewed and the restructuring of three directorates -Policy and Planning, 
Finance and Human Resources and Administration took place. The GOT through the President’s 
Office-Public Service Management (PO-PSM) has approved an allocation to recruit 29 new staff as part 
of the restructuring process, and the recruitment process has been initiated. The budget for institutional 
strenthening and spearheading NNS implementation has been included in 2014/2015 MTEF. 
MBNP supported the development of accounts manual, resource mobilization strategy, skills gap study, 
and draft human resource manual. Alongside with the program support, FANTA implemented by FHI 
360, supported the review of the National Nutrition Policy of 1982. The policy review process involved 
lead MDAs (Planning, PMO, Government Policy Review Team under the PO-PSM). The draft National 
Nutrition Policy and Strategies were validated by the Multisector Nutrition Technical Team before it was 
submitted to the MOHSW in December, 15th 2014 for onward submission to the Cabinet Secretariat for 
approval. 
TFNC has been supported to clearly articulate direction and provide clarity on areas requiring 
stakeholder’s support. MTE commends the consultative nature of Strategic Planning process in 
enhancing TFNC’s visibility and the partner’s perception. Despite these achievements, non-remittances 
of committed resources remain a challenge. Morever, during the interview with TFNC management a 
need for support to improve financial management and procurement system was given emphasis. 
In addition, MBNP contributed to the enhanced TFNC’s technical capacity on Nutrition SBCC through a 
review and developing of the National SBCC strategy and the associated communication materials, i.e., 
SBCC kits for farmers and health workers. The program is currently supporting the implementation and 
coordination aspects of National Nutrition SBCC Strategy at the Central Government and LGA levels. 
At the Central Government, MBNP supported to establishment and the functioning of three (3) 
consultative working groups: SBCC, Anemia, and IYCF. MBNP has enhanced the capacity of TFNC to 
deliver technical nutrition education through participation in training activities and in the organized joint 
supervision visits. However, MTE revealed that TFNC has inadequate technical capacity on SBCC 
programming. This may require specific program consideration. 
3-7-1.2 COUNSENUTH
COUNSENUTH is a local Non-Governmental Organization (NGO) specializing in nutrition programming 
in the country. The organization constitutes one of MBNP consortium partners and also a beneficiary of 
the institutional strengthening support within the USAID context of building capacity of national 
institutions to implement development programs. 
MTE assessment revealed that COUNSENUTH has been supported to conduct Institutional Capacity 
Assessment in year 2012, which has been resulted into an Institutional Capacity Building and 
47
Graduation Plan 2012–2016. The assessment of the progress in implementation of institutional 
capacity building plan that was informed by the outcomes of ICBA indicated outcomes in organizational 
systems strengthening and improvements in technical capacity. 
MBNP also supported the strengthening of revision key organizational systems (financial, human 
resources and procurement). Staff received on-the-job training and mentoring support to enhance their 
management skills, control and compliance. MBNP also supported the improvement of the 
administration and management processes by strengthening the management information system 
(MIS) through the installation of a new server, filing system, procurement system, reporting mechanism 
and website. COUNSENUTH will use the website for marketing and fundraising purposes and sharing 
of technical information resources with nutrition stakeholders. Despite of the improvements, the 
assessment indicated that COUNSENUTH system to monitor the organizational transformation and 
strengthening institutional is weak. COUNSENUTH should ensure effective integration of the 
institutional capacity building plan into the organizational Strategic Plan to facilitate tracking and 
performance measuring, as this was not evident. 
The technical capacity of COUNSENUTH to implement nutrition programs has been enhanced. MBNP 
through its partner The Manoff Group has built the organization’s capacity to implement nutrition SBCC 
interventions. The MTE assessment of progress on institutional technical capacity improvement 
revealed that COUNSENUTH have recruited an adequate number of trained nutritionists. The senior 
management staff, represent MBNP in nutrition meetings and participate in the three National 
Consultative Working Groups: SBCC, Anemia, and IYCF at TFNC. 
Despite the progress, COUNSENUTH like many other NGOs in the country was found to still depend 
heavily on donor support to execute its mission. The program supported the costing of priority income 
generating activities (IGAs) for the organization, and the documentation Resource Mobilization 
Strategy. The organization should hasty with the approval and implementation of this Strategy as it 
presents possibilities for COUNSENUTH to growth it’s financial and asset base. MBNP should 
continue to support as planned while paying attention to the arising institutional capacity needs of 
COUNSENUTH, as there are likely to change over the period of the graduation plan. 
3-7.2 CSO Sub Grantees 
In efforts to build the capacity of local organizations, the program has recruited and entered into an 
agreement with CSOs to facilitate the implementation of community level nutrition activities in all 10 
districts. These CSOs were trained on their contractual responsibilities; orientated on the program 
areas of focus; and supported to develop action plans and budgets, aligned with MBNP work plan and 
targets. This training also outlined the MBNP model of engagement with community members, i.e., 
care group model, demonstration plots, demonstration days as well as referral and counter-referrals 
between communities and health facilities. Promotion of maternal and child health nutrition education 
and SBCC by CHWs/HBCs through SBCC Kits was given a particular emphasis. 
48
In collaboration with the Regional Nutrition Officers (RNuOs) in the three regions, MBNP delivered the 
training of CSOs. According to the interviewed RNuOs, the participation to the CSO trainings created 
their awareness and a better understanding of their role in supporting the program districts as regional 
partners. The assessment also found out that the program had observed protocols and procedures for 
proper introduction of these CSO sub grantees to the relevant LGAs; and in return, CSOs received 
necessary collaborative. 
The interview with the senior management of CSOs noted the willingness to execute signed 
agreements. However, staff turn over was noted to be a challenge. CSO leaders cited low motivation 
as a reason for this. For example, lack of provision for salary increase throughout the program 
implementation years. CSO staff that was interviewed also complained of poor salary. As a result, 
CSOs employ junior staff (fresh from school) with very little to no experience. 
3-7.3 Strengthening the National Scale-Up Nutrition (SUN) Secretariat 
The Prime Minister’s Office was tasked to establish a High Level Steering Committee for Nutrition 
(HLSC) that will oversee implementation of National Nutrition Strategy; since in September 2011 when 
the GOT ratified and committed to be part of the global Scaling Up Nutrition (SUN) Initiative. 
MBNP provided technical input to the Secretariat through its active participation and development of 
operational National Guidelines specific for each National Technical Thematic Working Group: SBCC, 
anemia, and IYCF. With an exception of the National Guidelines for IYFC, which awaits dissemination, 
the program has successfully supported the development and dissemination of National SBCC and the 
National Anemia Guidelines. The program continues to collaborate with SUN Secretariat in order to 
ensure effective coordination towards improved nutrition policy and regulatory framework. A draft 
Nutrition Coordination Plan was developed in consultation with key national stakeholders and submitted 
to the Government for approval. Its approval by the Prime Minister will enhance the capacity to 
coordination nutrition stakeholders’ support in the country. 
 
3-7.4 Districts Multi-sectoral Steering Committees
The National Nutrition Strategy (NNS) outlined the need for district level coordination of nutrition 
activities, and the GOT passed a circular that instructs all districts in the country to establish Nutrition 
Multi-Sectoral Steering Committees (NMSCs). MBNP have supported the establishment of DMNSCs in 
all 10-district councils in the program ZOI under the coordination of Council Directors with the majority 
of its members are district heads of departments and sectors. In addition, the program trained DMNSC 
members on their roles and has allocated resources to support quarterly stakeholder coordination 
meetings. MTE assessment findings showed that these established DMSCs are not conducting the 
required quarterly meetings. All visited Districts would only recall a DMNSC meetings organized by 
MBNP to review 2013/2014 implementation and plan 2014/2015 activities and budgets. Selected 
DNTF members and District Nutrition Officers (DNuOs) met confirmed on the same. MTE consultations 
with DNuOs revealed that inadequate funding for committees operation was a reason for failure to 
implement this policy directive. 
49
Uncoordinated stakeholder’s nutrition support and implementation services threaten the continuity and 
sustainability of MBNP support. The program should liaise with Council Directors on potential 
measures for making use of allocated resources and promoting commitment to organize DMNSC’s 
meetings on quarterly basis. 
3-7.5 Supportive Supervision 
MBNP technical teams conduct supportive supervision and on-the-job coaching with the purpose of
supporting nutrition implementation efforts, particularly scaling up of nutrition education and SBCC in 
community using SBCC kits. The 
photo on the left was taken in 
Dodoma region in 2013 during the 
MBNP supervision visit held with 
PSG members. The supervision 
support by the program targeted 
all trained professionals and non￾professionals, and community 
members through PSGs. 
Organized supportive supervision 
visits aim to provide continued capacity building and learning opportunity. These visits also serve as a 
quality improvement measure to ensure consistency of SBCC approach across all program 
components. DNuOs and DNTFs were coached on their technical nutrition responsibilities. 
The assessment indicated that the program co-opted subject matter specialists to participate on 
supervision missions for provision of feedback and advice for enhancing the quality of services. For 
example, experienced Pharmacists and Frontline Health Workers were invited to support the mapping 
and provide technical support on logistics management for Safe Motherhood commodities with 
emphasis on IFA. During consultations, TFNC leaders also informed the MTE team of their 
participation in organized visits, which were found to be useful. MTE assessment revealed that there is 
no set of national nutrition specific supportive supervision guidelines in the field. It is recommended 
that MBNP facilitate the harmonization of existing tools into National Supervision Guidelines.
50
3-8 Operational Research and Monitoring and Evaluation 
MBNP interventions target national institutions tasked with the responsibility of overseeing the 
implementation of nutrition-related activities; regional level institutions are targeted to ensure the 
national policies and strategies have a direct bearing on the activities taking place at the grassroots 
level. These activities lead to individual and community behaviors that improve nutrition status of every 
member in the household, particularly the most vulnerable: pregnant and lactating women, infants and 
young children.
By design, MBNP would conduct operational research on institutional barriers aiming to equip CSOs 
and sector entities with the analytical skills to articulate the needs for reform in the nutrition sector. 
The monitoring and evaluation (M&E) of the implemented activities would be conducted in accordance 
to the indicators, which accumulates results and outcomes from program interventions. M&E reports 
are to offer learning opportunities, facilitate the identification and correction of any deviations, and to 
inform future plans. 
3-8.1 Operational Research 
The successful implementation of operational research would have resulted in stimulating the 
stakeholder’s participation and investment in nutrition. The program has procured the services of BBC 
Media Action to deliver two-day training on Strategic Health Communication to program staff in the ZOI 
from TFNC, COUNSENUTH, and selected council representatives. The training was vital in improving 
the knowledge on the importance of evidence data at different stages of Social and Behavioral Change 
Communication (SBCC) interventions; various types of research such formative audience research, 
process research, summative research; media planning and audience segmentation; as well as the use 
of innovative methods to monitor and evaluate SBCC programs. The assessment of this training 
showed that it was very timely and important in ensuring the existence of local capacity to design and 
carry out SBCC campaigns. The program should put more attention on the use of acquired knowledge 
and skills from operational research so as to avail information, which will guide SBCC programming and 
nutrition reform in the country.
Moreover, BBC Media Action launched a formative research on radio program with the purpose of 
assessing the qualitative impact of ‘SIKU 1000’ campaign among target audiences in Morogoro, 
Manyara and Dodoma regions as well as in Zanzibar. Findings of this formative research highlighted a 
number of radio stations, which are more preferred by listeners in each program region. Example
include: Abood FM and Ulanga FM in Morogoro and Dodoma regions, respectively; and Radio Free 
Africa (RFA) in Manyara region. The results obtained provide useful evidence in making decisions and 
guiding SBCC interventions. 
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3-8.2 Monitoring and Evaluation System
M&E framework for MBNP involves on-going monitoring of program activities in the implementation of 
community and health facilities in the program districts, annual reviews, mid-term evaluation and 
terminal evaluation. The design of the M&E system was found to facilitate smooth collection and 
processing of program information at the different levels and intervals of its implementation. Annual 
reviews were conducted and resulted into three Annual Progress Reports, which furnished the MTE 
with secondary information on performance of program implementation, and challenging experienced. 
MBNP was using an M&E system that feeds into the broader FtF and GOT M&E frameworks. The 
system has also aligned its project level results framework into the USAID Tanzania Results 
Framework. The program M&E framework complied to the Africare M&E framework of June 2009, 
which put emphasis on the routine process of data collection and measurement of progress toward 
program goals; and the Performance Monitoring Plan (PMP) to tracked the progress of implementing 
five intermediate results (listed in Section 3-2 of this report), which formed the basis of MTE 
assessment. 
3-8.2.1 Monitoring and Review Capacity 
MBNP has a designated full-time M&E Specialist to appropriately monitor progress and engage in 
development and/or improvement of the system. The M&E Specialist works to ensure that program 
results are monitored at all levels and contributes to their reporting systems. Further, the program has 
employed M&E officers at regional level to assist the M&E Specialists and build the capacity of 
community and health facility actors. The program has put in place a regular participatory monitoring 
function that takes into account supportive supervision to the work of CSOs and CHWs/HBCs as well 
as quarterly stakeholders review meetings. 
3-8.2.2 Data Collection and Quality Assurance
The Program provided an orientation to all actors from the nation through community level 
(CHWs/HBCs, HFWs, CSOs and Districts council staff, and regional program office staff) on how to use 
pre-designed tools to collect community nutrition data. 
The disseminated data collection tools were not user friendly. According to community level actors who 
were consulted, the tools were difficult to interpret and failed to collect comprehensive data. Further 
analysis revealed that those tools were not pre-tested. The Program noted this weakness and by the 
time of MTE data collection, the program had pre-tested revised data collection tools and the printing 
process was underway. The majority (89%) CHWs/HBCs met confirmed to participate on the pre￾testing exercise. 
Community data are collected by CHWs and HFWs, and then submitted to the respective CSOs sub 
grantee for compilation and submission to the Program Regional Office through M&E officers. The 
Program Regional Office assesses data completeness before submitting to the M&E Specialist at the 
Program Headquarters in Dar es Salaam for preliminary analysis and reporting. 
52
In order to fulfill their responsibility, CSOs through their M&E officers use telephone calls and SMSs to 
collect data from all HFs every monthly as it has been practically impossible for a CSO to make 
physical visits. MTE team found this to be an innovative approach as it ensures data availability for 
program use; however, the approach poses a question on the reliability and quality of data. In efforts to 
ensure that reliable data is collected, MBNP consider to collect HF data from the DMO office. This will 
ensure that the program have access to official data. MTE team is suggesting to the program to 
conduct data verification and frequent consistency checks for improved data quality, which suggest the
need for the program to provide an orientation of actors on how to fill in new data collection forms and 
to collect verified information. In addition, the program will have to promote the importance of timely 
collection and availability at the DMO office so as not to delay the program reporting process. 
8-2.3 Reporting Framework 
The program has standard reporting requirements, which adds into the baseline and other 
survey/assessment work undertaken to contribute to the larger M&E framework. Progress reports are 
generated at all levels. 
The assessment noted that CHWs/HBCs at the village level produce reports and submit to the 
respective district CSO grantee on monthly basis. Unfortunately, copies of CHWs/HBCs reports were 
not submitted to the Village Government Office, leaving Village leaders less informed. Village leaders 
met had also confirmed to have no access to CHWs/HBCs reports. This information is necessary for 
Village Government to have so as to remain aware of the progress and promote community 
mobilization support services. 
Reporting of progress made towards achieving expected results is done at the program level quarterly 
and annually. All reports produced from the program onset were presented. The reported information 
was found to adequately present the performance against planned outputs. However, there is a room 
for improving the comprehensiveness by integrating the qualitative aspects of the implementation 
process and program outcomes. 
8-2.4 Feedback and Learning 
The methodologies adopted to ensure full participation of program beneficiaries in organized program 
activities were found to be useful in improving community nutrition education and social behavior 
change. MTE assessment revealed that program reports were not disseminated to the regional and 
district stakeholders. MBNP should consider the use of existing statutory platforms, i.e., Village 
Assembly, Ward Development Committee (WDCs), DMNSCs and District Consultative Committee 
(DCC) as well as Regional Consultative Committee (RCC) to share on program objectives, 
implementation experience and lessons learned. This way MBNP will reach more leaders and cultivate 
political commitment in supporting the program goal on reduction of maternal anemia and child stunting, 
thus nutrition sector policy. 
53
4-0 PROGRAM MANAGEMENT 
This section of the report provides an assessment of the project management with regard to the 
institutional arrangements, parthenship building and coordination as well as gender and sustainability 
aspects. These support systems are critical to achieving intended results. 
4-1 Institutional Arrangements 
Under this section MTE assessment of the personnel and integrated management structure is 
presented. 
4-1.1 Management Personnel
Africare provided overall administrative, managerial and technical direction to this program. The 
program recruited key personnel to oversee implementation of its activities including the Chief of Party 
(CoP), Deputy Director for Institutional Strengthening (DDIS), Deputy Chief of Party and Deputy 
Director for Implementation (DCoP/DDI) and Monitoring, Evaluation (M&E) Specialist, as well as the 
Director of Finance and Finance and Administration staff.
Three Regional Offices have been established, furnished and staffed to oversee implementation of 
program activities in each of the program implemented regions. A regional office has a Regional 
Coordinator, Monitoring and Evaluation officer and a Nutrition Officer, Finance and Administration 
Officer and support staff (other administrative staffs that support the efficient running of those offices). 
As mentioned earlier, the program is working closely with the district teams and the government 
machinery to implement its activities as well as entrench sustainability within its interventions.
The assessment of staff retainship showed that the program had experience frequent changes of senior 
leadership staff. Firstly, the first COP resigned in July 2012, followed by DDI who resigned during the 
third quarter of the program year two (2012/13), as well as M&E Specialist and the Communication 
Officer—both left at the beginning of 2013/14. Nevertheless, these staff gaps did not result into 
noticeable ineffectiveness or inefficiency in program implementation. In responding to this situation, 
Africare seconded its own Senior Country Director to act as COP, who also spearheaded the 
recruitment process from which staff gaps were replaced within the shortest time possible but the 
recruitment of the Communication Officer position is underway. MTE team met with MBNP senior 
management staffs that are committed and willing to manage the programs work toward achieving the 
expected results and nutrition outcomes. 
54
4-1.2 Integrated Management Structure
The program management structure was found to be an appropriate and relevant. The functional units 
within the management structure provided the necessary expertise to achieve the planned Intermediate 
Results (IRs) as well as the competency to address the inherent SBCC approach underlying the 
program strategy.
In the case of COUNSENUTH for example, functional sub systems (such as those relating to 
operations and grant management) were found to have been well established and operational. 
COUNSENUTH was more actively engaged as both recipients of capacity development and a lead 
national NGO partner with its capacity progressively developed into becoming a strong national 
institution, capable of planning, implementing and evaluating nutrition programs. With further Technical 
Assistance (TA) from the consortium technical partners the organization has a potential to assume 
more program management responsibilities “as needed” in the remaining years of the program. 
The Manoff Group led the technical direction for the SBCC strategy development and development of 
the SBCC Communication and Education package in collaboration with COUNSEUTH and TFNC was 
reported by stakeholders to be effective and in line with NNS. Manoff will continue assisting the 
program to develop SBCC household survey questionnaire to measure nutrition behavior change. 
By the time of this MTE, the newly deployed RNuO and DNuOs hadn’t received SBCC and nutrition 
technical training, which is vital in ensuring a feasible model for the scale-up of the SBCC package and 
prioritized nutrition interventions in respective LGAs. The program has contracted BBC Media Action to 
provide Short-Term Technical Assistance (STTA) targeting SBCC capacity development of designated 
actors at the national and district level structures. BBC Media Action has successfully carried an 
assessment on the impact of Mwanzo Bora SBCC 1000 Days (Parent) Kit. It is expected that the 
program will use the findings from this study to streamline the materials in the Kit and retain those that 
have stronger impact on behavior change. Similarly, MBNP should use the findings to improve the 
SBCC programming capacity that was found low at all levels. 
Deloitte Tanzania was a key locally based technical partner, providing the high level of effort of targeted 
technical assistance needed to strengthen institutional and management capacity for TFNC 
COUNSENUTH and CSOs. The assessment indicated that Deloitte/Tanzania has successfully 
provided the targeted TA on sub-grants management, financial management & auditing, performance 
mapping and HR capacity development. It is good to note that the previously discussion achievements 
by TFNC and COUNSENUTH (in section 3-7 of this report) have resulted from the TA provided by 
Deloitte/Tanzania. Despite the recorded improvements, the continued TA by Deloitte/Tanzania should 
now be directed to enhancing the capacity of both TFNC and COUNSENUTH for institutionalization and 
management of developed systems to maximize the operational and technical performances. 
55
4-1.3 Sub-Grantees Performance Management 
Africare has an effective system set up for the management of CSO sub -grantees. CSOs were 
selected using pre-defined criteria and signed 12 months’ commitments ‘performance contract’ with 
agreed performance indicators in line with the delivery of SBCC strategy. The performance contracts 
for CSOs have clearly stipulated that payments are made quarterly depending on the level of 
performance for each of the agreed indicator and this is contingent upon achievement of performance 
milestones by 80% or more. Sub-grantees were required to report monthly on activities, and quarterly 
on progress of program activity implementation and performance under each result. The assessment 
also revealed that CSO grantees were providing both fiscal and operational results as well as 
submitting their expenditure statements and financial needs requests. 
4-3 Partnership Building and Coordination
This section provides the assessessment of the program collaboration with the Government, 
Partnerships with Other FtF Partners and networking with other CSOs.
4-3.1 Colaboration with the Government
Council Directors (CDs) and District Medical Officers (DMOs) in all visited Districts were aware of the 
trainings and activities implemented by the program. The program has established the DNTFs in all 10 
District Councils, which are charged with the delivery of stakehlder orientation and trainings aiming to 
create community awareness of program objective and improve capacity to implement SBCC and other 
essential nutrition activities in the district. The assessment showed that this collaborative arrangement 
has enabled the program to hasten the implementation of planned interventions from the ward through 
village levels. 
At the Central Government, the program has been working in a close collaboration with PMO-NS, 
TFNC and NBS aiming to enhance the coordination of NNS and scale up the implementation of SBCC 
strategy, among other things.
Despite the council staffs, senior leaders such as Regional Administrative Secretaries (RAS) and 
political leaders seemed to have limited awareness and poorly participated in program activities. As 
previously mentioned (section 8-2.4 of this report), sharing of program information through stakeholders 
and decision-making forums has a potential of further accelerating the commitment of senior leaders 
and politicians to support the nutrition agenda. 
4-3.2 Partnerships with Other FtF Partners
MBNP made deliberate efforts to facilitate optimal synergy and establish mutually beneficial 
partnerships that would contribute to the accomplishment of its goals. The program ensured 
56
implementation of interventions was coordinated and synchronized to maximize opportunities for 
leveraging resources for complimentary activities especially with ongoing USG supported FtF efforts 
that were focused on improving agriculture and nutrition linkages. In this regard, MBNP worked closely 
with other Nafaka and Tuboreshe Chakula projects. The program has initiated potential partnership 
with Global Service Corps (GSC) for purposes of using GSC’s rapid multiplication approach for
increasing the adoption of keyhole gardens for home vegetable production in order to promote the 
consumption of nutritious foods (dietary diversification) at the household level. 
4-3.3 Networking with other CSOs
MBNP has been delivering its community focused program objectives using CSO sub-grantees in each 
district. Apart from CSO sub grantees, MTE team did not find a working relationship of any form with 
other existing CSOs, either Community Based or Faith Based Organizations in Zone of Influence (ZOI). 
MTE team encourages formation and/or strengthening networking with existing types of CSOs even at 
ward and village levels. This nature of networking is expected to broaden the promotion of nutrition 
education and advocacy, hence widening adoption of positive nutrition behaviors.
The program should consider conducting meetings that bring together civil society institutions working 
on agriculture and nutrition related issues in communities to identify potential areas and agree on 
modalities for collaboration. Inviting more CSOs to participate in the scaling up of nutrition education 
and SBCC package is not only in line with the program’s objective of building capacity of local CSOs, 
but it is also expected to curb the gap of inadequate coverage of CHWs/HBCs. 
4-4 Gender Mainstreaming
Gender issues have informed the design of MBNP. The program recognizes the different roles women 
and men played, particularly in the agriculture sector that accounts for more than 85% of the labor. The 
finding of the gender assessment done by MTE team indicated that while MBNP did not provide for or 
recruit a dedicated gender focal person among its management staff, the program implementation duly 
emphasized gender as a critical amalgamating issue. The analysis of gender integration showed that 
MBNP implementation strategy has also recognized the major role played by women in household, 
including roles such as provision of labor input in the production processes.
The composition of PSGs that are the main community structures through which household members 
have been reached with MBNP supported SBCC activities, considered the participation of both men 
and women as critical to the achievement of community level objectives of the program. Nevertheless, 
participation of men in PSGs remained a bit low (less 40%) as compared to over 60% women 
members.
According to CHWs, most men expect tangible benefits and fail to recognize the value of nutrition 
education that is provided for free and that it a catalyst for intergeneration behavior change. MBNP 
has to promote the need for male participation on PSG so that they become active partners and 
57
nutritional SBC agents. 
The appointment of CHWs and HBCs by Village Leaders emphasized on the identification both men 
and women in all villages. As a result, there were 55% female and 45% male CHWs/HBCs recruited to 
the program. The increased number of male CHWs/HBCs may become a good model for attracting 
more male participation in SBCC interventions. Recruitment of men and women facilitators (DNTFs), 
CSOs sub grantees and regional program office staff considered gender as a key criterion for 
recruitment. 
Gender mainstreaming is a key strategy in the implementation of MBNP. There is a Gender 
Mainstreaming Strategy that clearly stipulated how the program integrates gender into its plans and 
activities implementation. The gender mainstreaming strategy has deliberated on ensuring gender 
equality through participation of both men and women as active as partners in the prevention of 
maternal anemia and childhood stunting, and insuring positive nutrition outcomes in the community. 
Strategies for women empowerment were outlined and male participation has been given deserved 
emphasis. The strategy recognized the significant ownership over productive resources and power on 
the expenditure of household income men have due to social-constructions of gender and patriarchal 
system that is widely practiced. In this regard; therefore, having the majority of men engage with the 
promotion of nutrition education and SBCC packages is pivotal to the success of program objectives. 
M&E system also provided for performance and process indicators at output and activity levels 
respectively, which collect and track gender disaggregated performance data. Gender disaggregated 
information forms an integral part of the reported information. Nonetheless, in some cases reported 
information was not disaggregated by gender leading to an information gap that hinders the 
assessment of gender quality improvement. 
58
5-0 LESSONS LEARNT 
There were a number of lessons learned that MTE team presents as key learning points to guide future 
MBNP implementation. These include the following:
1. MBNP activities directed at the strengthening and development of operational systems through 
the approach of addressing gaps and bringing various actors/stakeholders along nutrition 
discussions together have immense potential for creating a sustainable environment toward 
reaching the program goal and objectives. An example of where this has been successful is in 
the use of CSO sub guarantees, a cost effective strategy as these institutions work very closely 
with the people and have a good understanding of the nutrition related socio-culture practices as 
well as community norms;
2. Awareness and promotion of quality nutrition education and SBCC to a wider community is an 
effective public health or preventive approach in addressing pregnancy anemia and childhood 
stunting in a long term;
3. The design and implementation of interventions for the nutrition education and social behavior 
change was deliberately considering high illiteracy rate of community members. 
4. CHWs/HBCs volunteering poses a challenge because they are also required to produce and earn 
for their families. 
59
6-0 CONCLUSION
Whether or not the program has achieved its goals can be assessed through the effectiveness of the 
program activity implementation, the efficiency with which they were implemented, the overall 
performance level, and possibilities for the sustainability of the program’s outcomes/impact in the areas 
of concern. 
Generally speaking, there has been a reduction in the prevalence of maternal anemia as well as a more 
effective response towards reduction of childhood stunting in the target areas of the program. This is 
evident through an increase in consumption of nutritious foods by women of reproductive age 15-49 
years and under five-year children at the household level. While program interventions for this aspect 
received better responses in specific regions, it could be safe to confirm that with continued program 
support the program targets and intended outcomes are likely to be achieved by the end of the program 
period. 
There has been a large effort towards the increased budget allocations for nutrition interventions at 
national and district level such that more is allocated to the planning aspect of the program as intended. 
However, even with an increase in budget allocation, there are still very little resources supplied or 
readily available for use thus hindering efficiency and even effectiveness in some cases. 
A very important factor to be considered as well is that of sustainability and to the extent that this has 
been nurtured. It has been observed that some of the households have continued to utilize the 
recommended measures made familiar to them by the program such as including properly prepared 
vegetables in household diet (dietary diversification), IYCF practices, use of iron supplements, hand 
washing with soap as frequently as possible, which shows that some intervention programs would have 
a long lasting impact. 
Perhaps, one of the most important aspects in question is behavior change with emphasis on improved 
knowledge, attitudes, gender norms and social support for specific maternal and child nutrition 
practices. SBCC has proven to be an excellent strategy as it is usually at the grassroots level and 
aimed towards achieving many of the other targets. However, this strategy required time to generate 
outcomes and impacts as behavior change only becomes apparent after constant dialogue and 
repetition of the implemented practices. Thus an accurate representation cannot be attained yet. 
Although women of reproductive age seem keen to make use of nutritional services as well as health 
facilities, the number and quality of resources within the facilities is remarkably low. In addition, women 
are not getting the support needed from other members of the household such as their husbands to 
make informed choices and have control over use of resources available. There is still limited access 
and utilization of maternal and child health services such as education and nutrition counseling, intake 
of iron supplements. Thus, intended use of nutrition education and resources by women of 
reproductive age is not adequately met as per the standard of the program. 
60
There has been a significant improvement in the strengthening of Institutional Capacity of Government 
institutions (central and local) as well as CSOs. However, in addition to inadequate technical capacity, 
there is still evident bureaucratic failures and slow decision making which hinders efficiency in the 
coordination and implementation of nutrition interventions called for by NNS. Moreover, there is still a 
need for institutions to operationalize tools available so as to further achieve targets set. 
Programming capacity for SBCC is inadequate. Technical assistance is required to enhance capacity 
of actors in the program. There is also still limited operational research information and documented 
lessons learnt from SBCC implementation to even better inform decision-making and programming. 
Additionally, although the M&E system has been effective for the most part, there seems to a problem 
in tracking the impact of electronic media channels used such as the radio as well as the qualitative 
aspect of change in gender dynamics. Thus the level of effectiveness in this regard is either 
immeasurable or unclear. 
These observations inspire thought into the root causes of hindrance of absolute success of the 
program as well as strategies of ensuring that planned targets by the program could be fully met in the 
future. A close examination of each target is required so as to acquire justifications and thereafter, 
meaningful implementable recommendations so as to further improve the extent to which the program 
will achieve the intended outcomes.
61
7-0 RECCOMMENDATIONS
The following are the MTE teams’ recommendations based on the findings from the assessment of 
program documents and consultations with stakeholders. These recommendations are presented as 
implementable actions for MBNP consideration in enhancing the performance under its Sub-IRs and 
management for the remaining program period. 
Sub-IR 3-1:Increased investment in agriculture and nutrition related activities
Despite of the increase in the budget allocation at the national level (PER report, January 2014), 
nutrition budget allocations at the district level remains low. It is recommended that the program: 
1. Works in collaboration with PMO-NSC and TFNC to strengthen the stakeholder’s coordination 
and build the capacity of DMSCs for developing nutrition strategic plans and the subsequent 
annual costed plans. 
2. Disseminate its objectives and lessons from implementation through regular meetings, i.e. 
DNMSCs, Council (Financial Committee and Full Council) meetings, District Consultative 
Committees (DCCs) as well as Regional Consultative Committees (RCCs).
3. Works closely with Council Directors to increase their commitment and organize DMSC 
meetings for effective stakeholders' coordination on quarterly basis. 
Sub –IR 5-1: Increased consumption of nutritious foods by Women and Children at the 
household 
Demonstration plots and demonstrations days that involve a practical hands-on learning approach and 
use of demonstration materials, whose costs are above their capacity to procure and use have been 
key in facilitating knowledge transfer to households. The evaluation team has determined that these 
inputs have been critical in influencing the behavior of some farmers but the capacity to procure these 
inputs has hindered efforts for increased household adoption. With awareness that USAID/MBNP 
policy does not permit the provision of free materials/inputs it is recommended that: 
1. MBNP to subsidize demonstration inputs especially high costs like seeds (crop and livestock), 
housing materials, while ensuring community access to inputs from demo plots for scaling up. 
 
2. The program accelerates the provision of entrepreneurship education to increase productivity 
as well as income generating and savings (SILC and SACCOS), which could potentially
enhance people livelihood and income. 
3. MBNP may consider active engagement of extension workers who are also government 
employees at the ward level (with specialization on crop production, livestock keeping, 
community development, primary health) to provide regular technical/sector specific input at 
community level. Currently, the role of these extension workers to the program is not clearly 
defined, and they never received any training or orientation on SBCC and nutrition-agriculture 
linkage.
62
Sub –IR 6-1: Improved nutrition related behaviors
Some of the households were found to access certain foods but continued with a common practice, did 
not eat a diversified diet. There are about 25% of children under six months old who are not exclusively 
breast-fed, were given complementary food. Change in behavior requires continuous education and 
dialogue that is built on evidence-based information. It is recommended that:
1. MBNP actively document and dissemination lessons on IYCF practices and dietary 
diversification aiming to encourage more households to adopt effective ways for processing 
and preparation of diversified and nutritional diet with a specific focus on exclusive breast￾feeding, complementary feeding as well as feeding during pregnancy. 
SBCC Kits were widely disseminated and used in raising community awareness and promoting nutrition 
education for children and education on behavior change towards pregnant and lactating women 
through PSG meetings under the coordination of CHWs/HBCs and the importance of ‘SIKU 1000’ in 
life of a child. The multimedia communication nature of the Kit was mostly appreciated, with radio 
and community theatre communication channels most preferred. It is recommended that:
1. MBNP enforce the mobilization and organization of PSG meetings at the hamlet (Kitongoji) 
level by CHWs/HBCs. 
2. Consider mapping of existing CHWs/HBCs and organize gap replacement, refresher training 
and a cost-effective incentive package as high turn over rates were reported on this cadre. 
3. Implement the recommendations of BBC Action Media that are likely to be raised from the 
commissioned study on the “Assessment of the Mwanzo Bora SBCC Kit” that is currently 
ongoing. 
Iodization of salt: The commonly used salt in the program area is locally manufactured, because 
residents find it more appetizing and affordable. Nevertheless, most of this salt was found to contain 
zero or very little iodine content. It is recommended that:
1. MBNP strengthen its efforts in the awareness raising and promotion of education on the 
importance of iodine in the human body through its SBCC program. And, liaise with TFNC for 
further awareness and enforcement actions on salt iodization to all licensed salt manufacturers 
and exporters in the country. 
Hand washing: The program had promoted hand washing as an important hygiene practice through 
supporting establishment of tippy taps along demonstration plots, while expecting households to adopt 
the use of this technology. Unfortunately, the adaptation rate and hand washing behavior at the 
household level has remained low. It is recommended that:
1. The program continue to promote hand washing as an important hygiene practice with 
emphasis on the use of tippy taps as well as support for household installation. 
Sub-IR 7-1: Improved Utilization of Maternal and Child Health and Nutrition Services
Intake of iron tablets for up to 90 days or more during pregnancy as recommended is still low. The 
reasons for this include periodic stock outs of iron tablets in health facilities, and the low acceptability by 
63
the community due to lack of awareness and education on the importance of iron on a human body. It 
is recommended for the program to: 
1. Put more emphasis on continuous education (orientation and refresher trainings) for behavior 
change at the facility and community levels, targeting professionals and non-professionals with 
special focus on the delivery of SBCC program as well as addressing technical capacities such 
as nutrition planning, quantification and supply chain management of drugs and commodities 
from MSD through community entities and quality of services. 
While the MTE noted an increased number of pregnant women who make early ANC visit (during the 
first trimester) as per WHO recommendation, there is also a larger proportion that do not. It is 
recommended that MBNP: 
1. Strengthen the community to heath facility referral and feedback systems, with a specific focus 
on early ANC visit. Community education could effectively be promoted through PSG meetings, 
village assemblies, and health facilities.
 
Sub-IR 8.1: Improved Enabling Policy Environment for both Agriculture and Nutrition
DNTF teams are made up of Council staff from key nutrition sectors, which are supposed to actively 
support districts in the coordination and management of nutrition plans. However, some council staffs 
including Council Directors were having limited knowledge about MBNP objectives and main 
interventions. It is recommended that: 
1. MBNP should encourage DNTFs to promote and create awareness about the program’s work 
in Council Departments through active feedback about their involvement with the program. 
This in their respective departments and the District Council as a whole, as this is important in 
creating learning and facilitating integration of nutrition priorities in the Council’s Development 
Plan. 
2. MBNP should continue to support TFNC to iron out existing administrative bottlenecks and 
strengthen SBCC programming capacity so that all achieved milestones can benefit the 
organization and nation as a whole. 
3. MBNP should continue to support the effective functioning of COUNSENUTH’s governance 
structures of the organization as the delay is likely to attract new changes in the Institutional 
Capacity Needs over the period of the graduation plan, which deters realization of program 
results. 
The program is not well known, thus there is limited commitment of senior government officials and 
politicians at the regional and district levels. 
1. Lobbying is required so that MBNP is accepted as an important participant in existing decision￾making and consultative structures at the regional and district levels, the Regional Consultative 
Committee (RCC) and the District Consultative Committee (DCC), respectively. Use these 
meetings as an opportunity to create awareness, promote nutrition agenda and provide support 
(technical and operational) in areas which need further strengthening. 
Monitoring, Evaluation and Learning 
64
Monitoring and Evaluation system supported data collection and reporting for upward accountability. 
Program experiences and lessons are not adequately shared with stakeholders at district level. It is 
recommended that:
1. The program disseminate information on implementation progress, challenges and lessons to 
district stakeholders using coordination forums so as to raise awareness and encourage 
stakeholders to use the information in decision-making, planning and budgeting processes. 
The M&E system for the program has put emphasis on data quality assurance; however, there is a 
room for improvement. The program could consider the following recommendations for improvement:
1. Build the capacity of actors at all levels and organize refresher trainings on use of too for data 
collection, data verification and checks for consistency, and integrated reporting.
2. Liaise with District Medical Officers (DMOs) for the facility data to be officially collected from his 
office, instead of using CSOs staff that use telephone calls and SMS to collecting it from every 
health facility. This mode of work posed a question on the reliability of the reported data. 
3. Encourage CHWs to share copies of reports with Village Executive Officers (VEOs). This will 
serve as initial point of verification and also provoke the commitment of leaders to support 
program interventions, particularly with community mobilization. 
The successful implementation of operational research is expected to stimulate stakeholders’ 
participation and investment in nutrition, and provide greater incentives for community members 
(women, men and children). Nonetheless, low stakeholders capacity in designing and carrying out 
SBCC campaigns was revealed regardless of program supported technical capacity enhancement 
through Manoff Group initially and currently BBC Media Action provide technical assistance. It is 
recommended that:
1. MBNP procure the services of the Short Term Technical Assistant (STTA) to improve 
stakeholder’s capacity to conduct operational research, monitor and carry out internal 
assessment of the SBCC package. This should include ability to track the impact of electronic 
communication channels used to disseminate SBCC messages such as radio. 
The learning strategy of the program is not clearly spelt out and feedback mechanisms are 
inadequately used to inform on the performance of actors in the implementation process and 
responsibility of structures on key sectors of central and local governments. It is recommended that:
1. MBNP clearly define its learning strategy (with actions and associated performance indicators) 
that will guide documentation of lessons learnt and good practices, the packaging and 
dissemination to the different audience. 
2. Revamp the feedback mechanism to enable actors and stakeholders to share information, 
provide and receive feedback on the program performance direct from the public and targeted 
communities and vice versa. This is expected to enhance stakeholder’s participation in the 
delivery of community-based nutrition services and social behavior-changing education leading 
to reduce childhood stunting and maternal anemia.
65
Program Management
There is limited number of CSOs participating in the delivery of NNS. The strategic partnership with 
existing CSOs at ward and village levels (in line with the expanded program objective to build capacity 
of local CSOs) would have enabled broader promotion of nutrition education and advocacy on planned 
interventions, help to fill the gap of inadequate coverage of CHWs/HBCs, and also attract more 
resources to implement essential nutrition actions. It is therefore recommended that: 
1. The program work in collaboration with DMNSCs to organize meetings with CSOs working on 
agriculture and nutrition related issues with a purpose of creating their awareness on the 
essential package for nutrition planning and budgeting, and agree on potential areas for 
collaboration. Consideration needs also to be put into the work modalities and relationship 
with CSO sub-grantees. 
CSO sub-grantees have showed high commitments to implement and deliver as per contractual 
agreements. However, these CSO grantees experience high staff turnover that have resulted into 
inadequate technical and managerial capacities. It is recommended that the program: 
1. Conduct performance assess on the qualification of CSO grantees prior to annual contract 
renewal, and organize refresher trainings to improve the quality of operational and technical 
competencies.
MBNP has a gender strategy, and its implementation duly emphasizes gender as a critical 
amalgamating issue. Gender is mainstreamed into the project design, activity implementation, and 
M&E system. However, the mainstreaming focuses more in quantitative aspects leaving the gaps in 
qualitative gender considerations. It is therefore recommended that the program: 
1. Conduct a gender analysis study to assess the qualitative aspects of gender responsiveness, 
and use the findings of this study to inform gender planning and budgeting.
66
ANNEXES
67
ANNEX 1: LIST OF STUDIED VILLAGES 
S/No. Region District Ward Village No. per 
District
1 Morogoro Mvomero Diongoya Lusanga
8 
2 Morogoro Mvomero Kanga Kanga
3 Morogoro Mvomero Hembeti Msufuni
4 Morogoro Mvomero Mvomero Mgudeni
5 Morogoro Mvomero Mlali Manza
6 Morogoro Mvomero Mlali Peko Misegese
7 Morogoro Mvomero Mgeta Kibaoni
8 Morogoro Mvomero Nyandira Nyandira
1 Dodoma Kongwa Kongwa Kongwa
7 
2 Dodoma Kongwa Chamkoroma Chamkoroma
3 Dodoma Kongwa Chamkoroma Tubungwe Juu
4 Dodoma Kongwa Iduo Iduo
5 Dodoma Kongwa Sagara Ibwaga
6 Dodoma Kongwa Mtanana Mtanana A&B
7 Dodoma Kongwa Hogoroa Hogoro
1 Manyara Babati Mawemairo Mawemairo
5 
2 Manyara Babati Mamire Mamire
3 Manyara Babati Endakiso Endakiso
4 Manyara Babati Dareda Dareda Kati
5 Manayara Babati Bermi Bermi
Total 20
68
ANNEX 2: LIST OF PEOPLE MET 
S/No. Name Organization Designation
Dodoma region
1. Prisca Msong’o MBNP Regional Coordinator
2. Mary Bonaventure MBNP Regional Nutritionist
3. Elias MBNP Regional M&E officer
4. Herieh Carin Kongwa D.C District Nutrition Officer 
5. Leticia Shosho Kongwa D.C District Reproductive Health and 
Child Coordinator 
6. Justine Shirima Kongwa D.C Medical Officer
7. Amina Mustafsa Kngwa D.C Trained Nurse
8. Frank Uhwullo Kongwa D.C District Planning Officer
9. Hamza Mdoe Kongwa D.C Planning Officer/Economist
10. Ganja S. Kubeja Kongwa D.C Planning Officer/Statistician
11. Mr. Kimaro Kongwa D.C District Community Development 
Officer 
12. Stefen Mwandi Kongwa D.C Community Development Officer
13. Othman Bohari UMWEMA Executive Director
14. Hance Forogo UMWEMA M&E officer
15. Joshua Msaka Kongwa Home Based Care provider
16. Tumaini Dani Kongwa Home Based Care provider
17. Margareth Mgagi Kongwa Community Health Worker
18. Judith Nganga Kongwa Community Health Worker
19. Dr. George Karumuna Chamkoroma Health Facility In-Charge
20. Neema Maligana Chamkoroma Community Health Worker
21. Melabi Mbatiani Chamkoroma Community Health Worker
22. Peter Mtiyani Chamkoroma Community Health Worker
23. Abbasi R. Pazia Tubugwe Juu Community Health Worker
24. Peter Baton Husein Tubugwe Juu Community Health Worker
25. Paulina G. Lyakana Tubugwe Juu Community Health Worker
26. Abasi Mgenjo Iduo Community Health Worker
27. Paulina James Iduo Community Health Worker
28. Gisela Lusingo Iduo Ag. Health Facility In-Charge
29. Ejidi Lenjima Iduo Community Health Worker
30. Habiba salumu Iduo Home Based Care provider
31. Michael Ngalya Ibwaga Health Facility In-Charge
32. Magreth John Ibwaga Enrolled Nurse 
33. Jane Chidumika Ibwaga Community Health Worker
34. Luciana Lechima Ibwaga Community Health Worker
35. Elikano Kalaita Ibwaga Community Health Worker
36. Dr. Sembiche Mtanana Health Facility In-Charge 
37. Sofia Chisongela Mtanana Community Health Worker
38. Vaileth Katande Mtanana Community Health Worker
39. Flora Chalia Mtanana Community Health Worker
69
40. Elisha Muhimbano Hogoro Community Health Worker
41. Judith Ruhama Hogoro Community Health Worker
Manyara region
42. Prosper Msuya MBNP Regional Coordinator
43. MBNP Regional Nutritionist
44. MBNP Regional M&E officer
45. Mabula Msunga Regional Secretariat Regional Nutrition Officer
46. Bashan Kinyunyu Babati T.C Ag. District Nutrition 
Officer/DNTFs team 
47. Elizabeth Amnae Babati T.C District Reproductive Health and 
Child Coordinator 
48. Frank Mchuno Babati T.C Medical Officer/DNTFs team 
49. Hindu Mbwego CWCD Executive Director 
50. Glory Valerian CWCD Social worker
51. Adolf Kinale CWCD Nutritionist
52. Dominic Kweka Babati D.C Executive Director
53. Benito Kavenuke Babati D.C District Planning Office 
54. Stanley Msemo Babati D.C Asst. District Planning Office
55. Bernadetha Babati D.C District Nutrition Officer 
56. Nyella Babati D.C Asst. District Nutrition Officer 
57. Semkondo Mgalla FIDE Executive Director
58. Ibahim Shekhe FIDE M&E officer
59. Catherine Mathias FIDE Social worker 
60. Yasinta Silvan Mawemairo Home Based Care provider
61. Tatu Salim Mawemairo Community Health Worker
62. Minori Athmani Mawemairo Community Health Worker
63. Yahaya Issa Mamire Community Health Worker
64. Yohana Kaiza Mamire Home Based Care provider
65. Mwanahamisi Maige Mamire Community Health Worker
66. Hasan Nangai Endakiso Community Health Worker
67. Julita William Endakiso Community Health Worker
68. Regina Mraki Endakiso Home Based Care provider
69. Rose Bura Dareda Kati Home Based Care provider
70. Paskarina Jacob Dareda Kati Community Health Worker
71. Felista Sumaye Dareda Kati Community Health Worker
72. Loema Ninga Bermi Home Based Care provider
73. Veronica Christian Bermi Community Health Worker
74. Emmanuel Philipo Bermi Community Health Worker
75. Faustine Bathlomeo Bermi Community Health Worker
Morogoro region
76. Dr. Godfrey Mtey Regional Secretariat Regional Medical Officer
77. Florence J. Saka Regional Secretariat Regional Nutrition Officer
78. Amina Salehe MBNP Ag. Regional Coordinator
79. Ahnes Mahembe MBNP Regional Nutritionist
70
80. Deus Ngerangera MBNP Regional M&E officer
81. Yona Mark Morogoro D.C Council Director
82. Kasole Mango Morogoro D.C District Nutrition Officer
83. Agnes Haule Morogoro D.C District Nursing Officer 
84. Othman Bohari UMWEMA Executive Director
85. John Joseph UMWEMA M&E officer
86. Felista Michael UMWEMA Nutritionist
87. Tatu Hamis Pangawe Village Community Health Worker
88. Saidi Juma Pangawe Village Community Health Worker
89. Amos Jumanne Pangawe Village Health Facility In-Change 
90. Rehema Shaban Pangawe Village Village Executive Officer 
91. Ag. Mvomero D.C Council Director
92. Niyonzima Mvomero D.C District Nutrition Officer
93. Dr. Saweli Mtullu Tanga AIDS Working Group Executive Director
94. Mr. Bulugu Tanga AIDS Working Group Project Coordinator
95. Joyce P. Singili Tanga AIDS Working Group Social Worker
96. Eligius Kiwale Tanga AIDS Working Group M&E officer 
97. Hamis A. Msali Lusanga Community Health Worker
98. Mwanahamis Salum Lusanga Community Health Worker
99. Hamis Kitabu Lusanga Community Health Worker
100. Hatibu Haji Kanga Community Health Worker
101. Rehema J. Machange Kanga Community Health Worker
102. Ali juma Kanga Community Health Worker
103. Mwanahawa Rashidi Msufini Community Health Worker
104. Roger Maringa Msufini Home Based Care provider
105. Nakuva Elisante Msufini Community Health Worker
106. Mariam Chiduo Msufini Village Executive Officer
107. Yohana Luka Mgudeni Community Health Worker
108. Saidi Juma Mgudeni Community Health Worker
109. Bakari Mkumba Mgudeni Home Based Care provider
110. Selemani Alli Mgudeni Village Executive Officer 
111. Novast E. Mogella Manza Village Executive Officer 
112. Kibena Mahemu Manza Community Health Worker
113. Ally Simba Manza Community Health Worker
114. Sikitu Shomari Manza Home Based Care provider
115. Desideria Daudi Peko Misegese Community Health Worker
116. Issa Abdalah Peko Misegese Community Health Worker
117. Flora Amiri Peko Misegese Community Health Worker
118. Erasmi Kukoo Kibaoni Home Based Care provider
119. Beatrice Kibua Kibaoni Community Health Worker
120. Yolanda Mkwidu Nyandira Home Based Care provider
121. Bonifasi Ng’atigwa Nyandira Community Health Worker
122. Joyce Methodi Nyandira Community Health Worker
71
ANNEX 3: DATA COLLECTION TOOLS 
HOUSEHOLD IDENTIFICATION 
REGION
DISTRICT
VILLAGE 
NAME OF PRIMARY RESPONDENT (Code from roster in module 3):
Surname, First Name 
TYPE OF HOUSEHOLD
LAST VISIT
DATE SIKU
MWEZI
MWAKA
NAME OF ENUMERATOR: CODE OF ENUMERATOR:
OUTCOME OF INTERVIEW FINAL OUTCOME OF INTERVIEW 
NEXT VISIT DATE
TIME TOTAL NUMBER OF VISITS
HOUSEHOLD TYPE CODE: OUTCOME OF INTERVIEW CODE:
1 MALE ADULT ONLY 1 COMPLETED 4 REFUSED 
2 FEMALE ADULT ONLY 2 INCOMPLETE 5 COULD NOT LOCATE 
3 MALE AND FEMALE ADULT 3 ABSENT 
4 CHILD HEADED 
SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY
NAME NAME NAME NAME
REGIONS CODE: DISTRICT CODE:
Morogoro Mvomero Bahi
Dodoma Gairo Hanang
Manyara Kongwa Babati Uraban
SIGNATURE OF ENUMERATOR DATE:
SIGNATURE OF SUPERVISOR DATE:
3
INTERVIEW DETAILS - VISITS
CONFD
2 0 1 4
MODULE 1: HOUSEHOLD IDENTIFICATION COVER SHEET 
1
1 1
2
72
MODULE 2: INFORMED CONSENT
Informed Consent: Before beginning the interview, it is necessary to introduce the household to the survey 
and obtain their consent to participate. Make it clear to them that their participation in the survey is voluntary. 
Please read the following statement in the language of interview:
Thank you for the opportunity to speak with you. We are a research team from Mwanzo Bora Nutrition Program. 
We are conducting a survey to learn about food consumption, and nutrition of households in this area so that we 
can improve wellbeing of people in Tanzania. You have been randomly selected to participate in an interview. 
This means that your household was picked by chance from the list of all the households in your community. 
The interview includes questions on topics such as your family background, healthcare, food consumption and 
nutrition of women and children. We will ask these questions to the members in your household would be most 
knowledgeable to answer them. These questions in total will take approximately 1-2 hours to complete.
Your participation is entirely voluntary. Even if you refuse to participate, your decision will not affect your ability 
to benefit from other health or nutrition services. If you agree to participate, you can choose to stop at any time 
or to skip any questions you do not want to answer. If you agree to participate in the survey but don’t want to 
answer a question, just say, “I don’t want to answer that.” It won’t hurt my feelings. We will just move to the 
next question. Your answers will be completely confidential. We will collect your name and other information 
so that we can come back if we have more questions but we will not share information that identifies you with 
anyone else.
Do you have any questions about the study or what I have said? If in the future you have any questions 
regarding study and the interview, or concerns or complaints we welcome you to contact Mwanzo Bora 
Nutrition Program, by calling [+255 22 2666690 ] will leave one copy of this form for you so that you will 
have record of this contact information and about the study.
I ____________________________, the enumerator responsible for the interview taking place on 
__________________, 2014 certify that I have read the above statement to the respondents and they have 
consented to the interview. I pledge to conduct this interview as indicated on instructions and inform my 
supervisor of any problems encountered during the interview process.
Enumerator’s Signature Date
Respondent’s Signature or Thumb Print Date
If the household does not give consent to all of the data collection, stop the interview and inform your team 
leader. Team leaders will discuss the reason for this refusal and decide whether a partial data collection is 
possible for this household.
Consent form approved by…………….. on ……………………………..
73
MODULE 3: HOUSEHOLD ROSTER AND DEMOGRAPHICS
Household ID: Resopondent ID:
Sex
Male = 1
No.
Female = 2
(2) (3) (5) (6) (7)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
Enumerator: Ask these questions about all household members. Choose one or two respondents as the primary and secondary respondents. Ask the primary or secondary respondent, whoever is 
most knowledgeable about the age, completed education, and other characteristics of household members. Ask these questions about all household members. First list names of all members of 
this household, beginning with the respondent, including children and infants. Start with primary respondent; continue with the secondary respondent, if applicable, and other members in 
descending order of age. When a household woman is named, complete questions on her children living in the household before going on to the next adult. When finished, ask the person 
responding if this is truly all the people living in this household and if there is any missing children or infants
First, we would like to ask you about each member of your household starting with you
12= Form I
13= Form II
14= Form III
15= Form IV
16= FormV
17= Form VI
18= Training after secondary
 Education
19= University or equivalent
97= Other
98= Don't know
M3-07: Education leve
1= Head of Household
2= Husband
3= Wife
4= Co-Wife
5= Biological child
6= Adopted child
7= Step child
8= Grandchild
9= Son or Daughter-in -law
10= Sibling
11= Parent
12= Parent-in-law
13= Other related
14= Other unrelated
Grade of education 
completed by 
[NAME]?
Name of household member?
Slept in the net [NAME's]
Age
[NAME's]
Marital status
Read and 
write?
(For adults enter 
actual age, below 5 
years enter year and 
month)
[start with primary respondent, continue with the 
secondary respondent, if applicable, and other 
members in descending order of age]
(1) (4) Years Months (8)
1= Can read and write
2= Can sign name only 
3= Can read only 
4= Cannot read and write
5= N/A
M3-05: Marital status M3-06: Literacy
1= Married
2= Living together
3= Divorced
4= Separated
5= Widowed
6= Never married and Never lived
 together
7= No relationship
01= None
02= Nursery School
03= Standard 1
04= Standard 2
05= Standard 3
06= Standard 4
07= Standard 5
08= Standard 6
09= Standard 7
10= Standard 8
11= Training after primary
 education
CODES:
M3-02: Relationship to the head 
of household
Relation to the 
Head of 
Household
74
Enumerator: Ask of the person responsible for Household Food Preparation
Household ID Respondent ID: 
1 How many meals does your household usually have per day?
NEVER 1
2 SELDOM 2
OFTEN 3
ALWAYS 4
3 YES . . . . . . . . . . . . . . . . . . . . . 1
NO . . . . . . . . . . . . . . . . . . . . 2 5
4 RARELY (1-2 TIMES) ……………1
SOMETIMES (3-10 TIMES) 2
OFTEN (MORE THAN 10 TIMES)…. 3
5 YES ………………………… 1
NO ………………………. 2 7
RARELY (1-2 TIMES) ……………1
6 SOMETIMES (3-10 TIMES) 2
OFTEN (MORE THAN 10 10 TIMES)…. 3
7 YES …………………………. 1
NO …………………………. 2
RARELY (1-2 TIMES) 1
8 SOMETIMES (3-10 TIMES) 2
OFTEN (MORE THAN 10 TIMES)…. 3
→
→
In the past month (4 weeks/30 days) did you or any 
household member go a whole day and night without
eating anything at all because there was not enough food?
In the past month (4 weeks/30 days) was there ever no food to eat of 
any kind in your house because of lack of resources to get food?
How often in the last year did you have problems in Satisfying the 
food needs of the household?
How often did this happen in the past month (4 weeks/30 days)?
How often did this happen in the past [4 weeks/30 days]?
How often did this happen in the past month (4 weeks/30
days)?
 End of Module
MODULE 4: HOUSEHOLD HUNGER SCALE
(1 – 4 MEALS) More than 4 meals enter 4
QUESTION RESPONSE CODE SKIP TO
In the past month (4 weeks/30 days) did you or any household 
member go to sleep at night hungry because there was not enough 
food?
75
Enumerator: Ask of the person responsible for Household Food Preparation
Household ID: Respondent ID: 
CHILD’S ID CODE FROM THE HH ROSTER Age of the child in months
Q1 Date of birth of the child
Q2 Check from HH roaster
Q3 Age of the child in months
Now I would like to ask you about the types of foods that your child ate yesterday during the day and or at night
"1" If Yes
“0” If No
1
2 Vegetables
3 Fruits
4
5 Eggs Any eggs?
6 Pulses, legumes, nuts
7 Milk and milk products
8 Oil/fats
 End of Module
Day Month Year
Any fruits? (Embe, papaya, avocado, fenesi, 
stafeli, ndizi mbivu)
MODULE 5: INDIVIDUAL DIETARY DIVERSITY SCORE (IDDS) TOOL FOR CHILDREN
Meat, poultry, offal, Fish and 
seafood
[Read the list of foods. Write “1” (one) in the box on the right if any child under five years of age in the household ate the food in 
the question. Write “0” (zero) in the box on the right if no child under five year of age in the household ate the food]
Cereals; Roots and tubers, and 
plantains
Na. Food Group Examples of Foods List the Food Items Mentioned
Any vegetables? (mchicha, kisamvu, matembele, 
kabichi, carrot, mboga mboga za aina yoyote)
Any foods made from beans, peas, lentils, or nuts?
Any cheese, yogurt, milk or other milk products?
Any beef, pork, lamb, goat, rabbit wild game, 
chicken, duck, or other birds, liver, kidney, heart, 
intestines or other organ meats? Any fresh or 
dried fish or shellfish?
Any foods made with oil, fat, or butter, coconut 
stew?
Any: ugali, bread, rice noodles, biscuits, or any 
other foods made from millet, sorghum, maize, 
rice, wheat…etc? Any round/sweet potatoes, 
yams, manioc, cassava, cooked bananas/matoke 
or any other food made from roots or tubers, or 
76
Household ID: Respondent ID: 
Now I would like to ask you about the types of foods that a woman (age 15 – 49 years) ate yesterday during the day and at night
"1" If Yes
“0” If No
1
2
3
4 Any fruits and vegetables?
5
6 Any organ meat?
7 Eggs Any eggs?
8 Pulses, legumes, nuts
9 Milk and milk products Any cheese, yogurt, milk or other milk products?
10 Sugar Any sugar added?
11 1 YES
2 N0 →
3 Don't Know →
12 1
2 USAID/TAPP
3 Ministry of Agriculture
4 Other..........................
13 1 YES
2 N0
3 Don't Know
14 1 Carrots
2 Orange sweet potatoes
3 Amaranths 
4 Pumpkins
5 Rosella
If yes in question 11 above, who provided the training
If yes in question 13 above, what type of crops you have grown in your garden 
(tick as many as possible)
Have you or any other person in the household attended any training / 
seminar that taught how to develop and manage home gardens of essential 
nutritional agricultural crops? 15
Cereals, Roots and tubers, and 
plantains
Dark green leafy vegetables, including wild forms 
+ locally available vitamin A rich leaves such as 
amaranth, cassava leaves, spinach, matembele, 
majani ya kunde
Any: ugali, bread, rice noodles, biscuits, or any 
other foods made from millet, sorghum, maize, 
rice, wheat…etc? 
Any round/sweet potatoes, yams, manioc, 
cassava, cooked bananas/ matoke or any other 
food made from roots or tubers, or plantains?
Any vitamin A rich fruits and 
vegetables?
MODULE 6: DIETARY DIVERSITY FOR WOMEN OF 15-49 YEARS OF AGE 
No. Food Group Examples of Foods List the Food Items Mentioned
Enumerator: Apply to one woman of reproductive age (15-49 years) in the Household
[Read the list of foods. Write “1” (one) in the box on the right if a woman of 15-49 years of age in the household ate the food in the 
question. Write “0” (zero) in the box on the right if no woman of 15-49 year of age in the household ate the food]
Pumpkin, carrot, squash, or sweet potato that are 
orange inside + other locally available vitamin A 
rich vegetables
Ripe mango, apricot (fresh or dried), ripe papaya, 
dried peach, and 100% fruit juice made from 
these + other locally available vitamin A rich fruits
Any dark green leafy 
vegetables?
Liver, kidney, heart, intestines or other organ 
meats or blood-based foods
Any foods made from beans, peas, lentils, or nuts?
Meat, poultry, offal, Fish and 
seafood
Other vegetables (e.g. tomato, onion, eggplant) + 
other locally available vegetables
Other fruits, including wild fruits and 100% fruit 
juice made from these Any fruits? (embe, papaya, 
avocado, fenesi, stafeli, ndizi mbivu…)
Any beef, pork, lamb, goat, rabbit wild game, 
chicken, duck, or other birds, Any fresh or dried 
15
Do you have a garden that you have established and managed as a result of the 
training/seminar you attended?
Africare/Mwanzo Bora
77
6 Pawpaw fruit
7 Mnavu
8 Tomatoes
9 Sweet potato leaves
10 Other crops
15 1 YES
2 N0 →
3 Don't Know →
16 Do you raise any livestock rich in Vitamin A 1 YES
2 N0
3 Don't Know
17 Which livestock/fish do you raise? 1 Rabbits
2 Poultry
3 Fish
4 Other crops
18 Ask the respondent to provide you with tea spoon full of edible salt 0 PPM (No Iodine present) 1
Under 15 PPM 2
Test the salt for Iodine and observe the PPM (Parts Per Million) 15 PPM or more 3
4
Salt was not tested 6
18
18
In your training/seminar did you learn how to raise and manage 
animals/livestock/fish that are rich in vitamin A such as rabbits and poultry? 
No edible salt at home
78
MODULE 7: BREAST FEEDING PRACTICE
NO.
1
2
3
MALE…………………………………………………1
4 CHILD’S SEX FROM THE HH ROSTER
FEMALE…………………………………………… 2
5 Have you ever breastfeed (CHILD’S NAME)? YES………………………………………………… 1
NO……………………………………………………2 →
DON'T KNOW……………………………………… 8 →
6 How long after birth did you first put (CHILD’S NAME) to the breast?
HOURS………………………………………….
IF LESS THAN 1 HOUR, RECORD ‘00' HOUR and ‘00’ DAY DAYS…………………………………………
IF LESS THAN 24 HOURS, RECORD HOURS and ‘00’ DAY
OTHERWISE, RECORD DAYS and ‘00’ HOUR
7 YES………………………………………………… 1
NO……………………………………………………2
DON'T KNOW……………………………………… 8
8 YES………………………………………………… 1
NO……………………………………………………2 → 10
DON'T KNOW……………………………………… 8 → 10
(Mentioned=1, Not mentioned=2)
1 MILK (OTHER THAN BREAST MILK)………
9 What was (CHILD’S NAME) given to drink? Anything else? 2 PLAIN WATER………………………….
3 SUGAR OR GLUCOSE WATER…….
RECORD ALL LIQUIDS MENTIONED 4 GRIPE WATER……………………………
5 SUGAR-SALT-WATER SOLUTION…………
6 FRUIT JUICE………………………………
7 INFANT FORMULA………………….
8 TEA/INFUSIONS………………………
9 HONEY……………………………………..
10 OTHER (SPECIFY…………………….
………………………………………………………...………………….
10 Are you still breastfeeding (CHILD’S NAME)? YES………………………………………………… 1
NO…………………………………………………… 2 → 13
DON'T KNOW……………………………………… 8 → 13
11
NUMBER OF NIGHT TIME FEEDINGS
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER
12 NUMBER OF DAY TIMEFEEDINGS�
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER
13 YES………………………………………………… 1
NO……………………………………………………2
DON'T KNOW……………………………………… 8
HOUSEHOLD ID CODE FROM THE HH ROSTER COVER
1 2
How many times did you breastfeed yesterday during the daylight hours?
1
Enumerator: Ask Caregivers of each child under five years of age in Household. Enumerator should carry multiple copies of this Module and use with all children under five 
years of age in the Household
2
2
2
QUESTION RESPONSE CODE
END
INTERVIEW
How many times did you breastfeed last night between sunset and sunrise?
Did (CHILD’S NAME) drink anything from a bottle with a nipple yesterday or last 
night?
2
2
SKIP TO
2
1 2
1
1
1
CHILD’S ID CODE FROM THE HH ROSTER
MOTHER’S ID CODEFROM THE HH ROSTER
Was your milk flowing when you first put (CHILD’S NAME) to the breast?
Before your milk began flowing, was (CHILD’S NAME) given anything to drink 
other than breast milk?
1 2
1 2
1
1
79
MONTHS
14 For how many months did you breastfeed (CHILD’S NAME)?
if below 1 month enter "00" Still breastfeeding 97
15
MONTHS
Not started giving anything…97 → END
DON'T KNOW……… 98 → END
→ END
IF LESS THAN 1 MONTHS, RECORD ‘00' MONTH
16 1 Drinking water
2 Infant formulas (tinned)
3 Special food for children that is sold
4 Milk (other than breast milk)
5 Any other porridge
17 How many times did [NAME] eat solid and or soft foods yesterday during daytime
 and or at night? If more than 7 record 7
END OF MODULE
Now I would like to ask you about drinks and foods that [NAME] took yesterday 
during daytime or at night : You can tick more than one
INCLUDES : juice, cow's milk water, sugar water, solid foods or anything 
else
How old was (CHILD’S NAME) when s/he was first fed something other than 
breast milk?
NO.
1 HOUSEHOLD ID CODE FROM THE HH ROSTER COVER SHEET
2 RESPONDENT’S ID CODE FROM THE HH ROSTER
3 YES……………………………………………………
NO…………………………………………………… → 8
4 How many mosquito nets (ITN) does your household have? NUMBER OF NETS
5 ASK RESPONDENT TO SHOW YOU THE NET(S) OBSERVED……………………………………………
NOT OBSERVED………………………………………
6 YES……………………………………………………
NO……………………………………………
DON'T NO……………………………………………
7 Did anyone sleep under these mosquito nets (ITN) last night? YES……………………………………………………
NO……………………………………………
DON'T NO……………………………………………
8 YES……………………………………………………
NO……………………………………………
DON'T NO……………………………………………
MODULE 8: MALARIA PREVENTION
QUESTION RESPONSE CODE SKIP TO
Enumerator: Apply to one woman of reproductive age (15-49 years) in the Household or any other responsible person
Does your household have any mosquito nets (ITN) that can be 
used while sleeping?
1
2
END OF MODULE
At any time in the past 12 months, has anyone sprayed the interior 
walls of your dwelling against mosquitoes?
Since you got the mosquito nets (ITN), were they ever soaked or 
dipped in a liquid to repel mosquitoes or bugs?
8
8
1
2
1
2
8
2
1
2
1
80
NO.
1 HOUSEHOLD ID CODE FROM THE HH ROSTER COVER SHEET
2 RESPONDENT’S ID CODE FROM THE HH ROSTER
3 YES…………………………………………………
NO…………………………………………………… → 8
DON'T KNOW……………………………………… → 8
(Mentioned = 1, Not mentioned = 2)
4 Under what circumstances did you last use soap? 1 BATHING A CHILD 2
2 BATHING ONESELF 2
SPONTANEOUS RESPONSE. DO NOT READ ANSWERS ALOUD 3 AFTER USING LATRINE 2
4 AFTER CLEANING BABY’S BOTTOM 2
5 AFTER CLEANING LATRINE 2
6 AFTER RETURNING HOME 2
7 BEFORE PREPARING FOOD / COOKING 2
8 BEFORE FEEDING CHILDREN 2
9 2
10 CLEANING DISHES 2
11 DOING LAUNDRY 2
12 2
13 OTHER (SPECIFY) 2
5
BATHING A CHILD 
BATHING ONESELF 
AFTER USING LATRINE 
SPONTANEOUS RESPONSE. DO NOT READ ANSWERS ALOUD AFTER CLEANING BABY’S BOTTOM 
AFTER CLEANING LATRINE 
AFTER RETURNING HOME FROM OUTSIDE
BEFORE PREPARING FOOD / COOKING 
BEFORE FEEDING CHILDREN 
CIRCLE ALL THAT APPLY AND RECORD WHETHER IT WAS MENTIONED OR NOT
CLEANING DISHES 
DOING LAUNDRY 
OTHER (SPECIFY)
…………………………………………………..
Don't know
6 When do you wash your hands with soap/ash? (Mentioned=1, Not mentioned=2)
1 NEVER 2
SPONTANEOUS RESPONSE. DO NOT READ ANSWERS ALOUD 2 BEFORE FOOD PREPARATION 2
3 BEFORE FEEDING CHILDREN 2
CIRCLE ALL THAT APPLY AND RECORD WHETHER IT WAS MENTIONED OR NOT 4 AFTER DEFECATION 2
5 AFTER ATTENDING TO A CHILD 
WHO HAS DEFECATED 2
6 BEFORE OR AFTER EATING 2
7 OTHER (SPECIFY) 2
…………………………………………………..
1
WASHING CHILD’S HANDS BECAUSE THE 
LOOK OR FEEL DIRTY
98
1
1
1
1
1
1
1
1
98
1
1
1
1
1
MODULE 9: SELF-REPORTED HANDWASHING BEHAVIOR
QUESTION RESPONSE CODE SKIP TO
1
2
6
1
Have you used soap to wash your hands at least once since this
time yesterday?
WASHING MY HANDS BECAUSE THEY 
LOOK
1
1
1
2
3
4
8
96
11
12
Under what other circumstances did you use soap to wash your 
hands since this time yesterday?
5
WASHING CHILD’S HANDS BECAUSE THEY
 LOOK OR FEEL DIRTY 9
7 If the respondent mentions “washing my hands” OR “washing my 
children’s hands”, PROBE THEM TO SPECIFY WHY (was it because they 
were simply dirty or was a particular task performed?)
1
1
1
WASHING MY HANDS BECAUSE THEY
 LOOK OR FEEL DIRTY 
10
81
NO.
1 HOUSEHOLD ID CODE
2 RESPONDENT’S ID CODE FROM THE HH ROSTER
3 Have you been pregnant before? YES…………………………………………………
NO…………………………………………………
DON'T KNOW………………………………………
4 When was the last time you were pregnant? MONTHS AGO ………...…….
YEARS AGO ………...…….
5 Did the last pregnancy result in a live birth? YES ………...…….
NO ………...…….
6 YES ………...…….
NO ………...……. GO 8
HOME
7 HEALTH FACILITY
CHW 
DON'T KNOW
OTHER (SPECIFY)…………………
……………………………………….
YES
8 Why did you not seek antenatal care?
1 2
THE COSTS ARE TOO HIGH
POOR QUALITY OF HEALTH SERVICES
1 2
SHORTAGE OF MEDICINES
SHORTAGE OF FACILITIES
UNFRIENDLY PERSONNEL
INCOMPETENT PERSONNEL
CORRUPTION OF MEDICAL PERSONNEL
OTHER (SPECIFY
……………………………………….
9 MONTHS
DON'T KNOW
Where did you receive antenatal care for the last pregnancy? 
Anywhere else?
RECORD ALL MENTIONED AND SKIP 8
NO
THERE ARE SO MANY SICKNESSES NOWADAYS 
AND THEY OCCUR VERY OFTEN
1 2
1 2
1 2
1
END INTERVIEW
2
98
1
YES NO
HEALTH FACILITIES ARE VERY FAR AWAY FROM
MY HOME
2
Last time you were pregnant, did you see anyone for
antenatal care?
1
2
Enumerator: Apply to each women of reproductive age (15-49 years) in the Household. Enumerator should carry multiple copies of this Module and 
use with all women of reproductive age in the Household
QUESTION RESPONSE CODE SKIP TO
1
2 END INTERVIEW
1 2
1 2
LET RESPONDENT EXPLAIN WIHTOUT READING OUT THE OPTIONS 
AND RECORD ALL MENTIONED
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
How many months pregnant were you when you first received
antenatal care for the last pregnancy? 98
MODULE 10: WOMEN’S HEALTH SERVICES AND NUTRITIONAL BEHAVIOUR 
82
10 NUMBER OF TIMES
DON'T KNO………………………….
11 YES 1
NO 2 → 19
DON'T KNOW 8 → 19
12 Where did you get the iron syrup or iron/folate tablets? FROM ANC CLINIC……………………………….. 1
BOUGHT FROM PHARMACY……………………… 2
OTHER (SPECIFY)……………………………………8
13 Why did you take the iron/folate tablets? PREPARING FOR PREGNANCY…………………… 1
DIAGNOSED WITH ANEMIA……………………… 2
ADVICE FROM HEALTH PROVIDER…. 3
FAMILY MEMBER OR FRIEND……………………… 4
OTHER (SPECIFY)……………………………………8
……………………………………….
General public radio 1
14 SBCC radio 2
Mwanzo Bora related meeting 3
National Immunization campagne 4
Other Mention …………………. 8
15 During the whole pregnancy, how long did you take the iron syrup DAYS
or the iron/folate tablets? DON'T KNOW #
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS
DAILY……………………………………………… 1
2-6 TIMES A WEEK………………………………… 2
16 How often did you take the iron syrup or the iron/folate tablets? ONCE A WEEK……………………………. 3
LESS THAN ONCE A WEEK……………. 4
YES………………………………………………… 1
17 Did you ever stop taking the iron/folate tablets?? NO………………………………………………… 2 → 19
DON'T KNOW …………………………………… 8 → 19
18 What made you stop taking the iron/folate tablets? NO LONGER NEEDED/FELT BETTER………… 1
HAD SIDE EFFECTS………………………………… 2
RAN OUT AND COULD NOT GET… 3
OTHER (SPECIFY)………………………………….. 4
………………………………………………………….….
DON’T KNOW………………………………………8
19 During your last pregnancy, were you told that you were anemic? YES………………………………………………… 1
NO………………………………………………… 2
DON'T KNOW………………………………………8
20 YES………………………………………………… 1
NO………………………………………………… 2 → 23
DON'T KNOW………………………………………8 → 23
21 During the whole pregnancy, how long did you take the iron syrup DAYS
or the iron/folate tablets? DID NOT USE #
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS DON'T KNOW #
22 Why did you take the iron/folate tablets? PREPARING FOR PREGNANCY…………………… 1
DIAGNOSED WITH ANEMIA……………………… 2
ADVICE FROM HEALTH PROVIDER…. 3
FAMILY MEMBER OR FRIEND……………………… 4
OTHER (SPECIFY)……………………………………8
……………………………………….
How many times did you receive antenatal care during the last
pregnancy? 98
Prior to the last pregnancy, did you take any iron syrup or 
iron/folate tablets ?
What is tha main source of the information on the importance of 
using Vitamin Iron/ folic Acid tablets/syrup?
During your last pregnancy, did you take the iron syrup or the 
iron/folate tablets?
83
23 YES………………………………………………… 1
NO………………………………………………… 2 → End Module
DON'T KNOW………………………………………8 → End Module
(Mentioned=1, Not mentioned=2)
24 What drugs did you take? SP/FANSIDAR……………………………
CHLOROQUINE……………………
RECORD ALL MENTIONED OTHER (SPECIFY)…………………
……………………………………….
DON'T KNOW……………………………
25 SP/FANSIDAR…………………………………..
CHLOROQUINE………………………………..
OTHER (SPECIFY)…………………………………
2
1 2
During this pregnancy, did you take any drugs to keep you from 
getting malaria?
2
IF TYPE OF DRUG IS NOT DETERMINED, SHOW PICTURES OF TYPICAL 
ANTIMALARIAL DRUGS TO RESPONDENT
1 2
How many times did you take (NAME OF THE DRUG) during
the last pregnancy?
1
1
MODULE 11: VITAMIN A AND DEWORMING
NO. SKIP TO
1 HOUSEHOLD ID CODE
2 CAREGIVER’S ID CODE FROM THE HH ROSTER
3
MALE…………………………… 1
4 Child’s sex from the hh roster
FEMALE……………………………2
5 Under nomal circumstances children are required to be given Years
deworming tablets at what age? Months
DON'T KNOW 8
6 Has (CHILD’S NAME) taken any pill for intestinal worms in the last six months? YES……………………………… 1
NO……………………………… 2
DON'T KNOW 8
7 Under nomal circumstances children are required to be given Years
Vitamin A drops/ tablets at what age? Months
DON'T KNOW 8
8 Has (CHILD’S NAME) taken any Vitamin A in the last six months? YES……………………………… 1
NO……………………………… 2
DON'T KNOW 8
General public radio 1
9 SBCC radio 2
Mwanzo Bora related meeting 3
National Immunization campagne 4
Other Mention …………………. 8
END OF INTERVIEW
CHILD’S ID CODE FROM THE HH ROSTER
Enumerator: Ask of Caregivers of each child under five years in the Household. 
Enumerator should carry multiple copies of this Module and use with all children under five in the Household
QUESTION RESPONSE CODE
If yes in Q6 above, where mainly did you get the information on the 
importance of using Vitamin A?
84
MODULE 12: ANTHROPOMETRY FOR CHILDREN
NO.
1 HOUSEHOLD ID CODE FROM THE HH ROSTER COVER SHEET
2 CAREGIVER’S ID CODE FROM THE HH ROSTER
3 CHILD’S ID CODE FROM THE HH ROSTER
4 CONSENT GRANTED……………1
Your measurements will be kept confidential. Make sure to get a
signature or thumbprint…………………..
Will you allow (CHILD’S NAME) to be measured? REFUSED……………………… 2
5 What is (CHILD’S NAME)’s sex? MALE……………………………1
FEMALE…………………………2
6 I would like to ask you some question about
(CHILD’S NAME). In what month and year was
(CHILD’S NAME) born? (Pull from Roster)
7 How many months old is (CHILD’S NAME)?
RECORD AGE IN COMPLETED MONTHS MONTHS
YES………………………………… 1
8 CHECK P6. IS THE CHILD LESS THAN 60 MONTHS? NO………………………………… 2
DON'T KNOW………………………8
9
10 DOES CHILD HAVE EDEMA? YES………………………………… 1
NO………………………………… 2
DON'T KNOW………………………8
11 WEIGHT IN KILOGRAMS DON'T KNOW 99.8 . Kg
WEIGH (CHILD’S NAME)
12
MONTHS SHOULD BE MEASURED STANDING UP . Cm
DON'T KNOW 999.8
HEIGHT IN CENTIMETERS
MEASURE (CHILD’S NAME)
QUESTION RESPONSE CODED SKIP TO
Enumerator: Apply to each child aged 0 – 59 months in the Household.
Enumerator should carry multiple copies of this Module and use with all children aged 0-59 months in the Household
DAY MONTH YEAR
We would like to measure (CHILD’S NAME) weight and height. Your 
participation is voluntary and you may stop at any time. 
END
INTERVIEW
CHILDREN LESS THAN 24 MONTHS SHOULD BE MEASURED LYING DOWN; 
CHILDREN >= 24 MONTHS SHOULD BE MEASURED STANDING UP
What was the gestational age in months of the child's pregnancy i.e. How old in 
months was the pregnancy when the [NAME] was born?
13 VERY LARGE………………… 1
LARGER THAN AVERAGE…… 2
SMALLER THAN …………………… 3
AVERAGE………………… 4
VERY SMALL…………………. 5
DON'T KNOW………………………8
YES…………………………… 1
14 Was (CHILD’S NAME) weighed at birth? NO…………………………… 2
DON'T KNOW………………… 8
KG from Card 
15 How much did (CHILD’S NAME) weigh? . Kg
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE
KG from Recall
. Kg
DON'T KNOW
When (CHILD’S NAME) was born, was he/she very large, larger than average, 
average, smaller than average, or very small?
END
INTERVIEW
9.998
85
MODULE 13: ANTHROPOMETRY AND ANEMIA FOR WOMEN 
NO.
1 HOUSEHOLD ID CODE
2 WOMAN’S ID CODE FROM THE HH ROSTER
3 Are you pregnant? YES……………………………… 1
NO……………………………… 2
DON'T KNOW……………………8
YES……………………………… 1
4 Are you beastfeeding NO……………………………… 2
DON'T KNOW……………………8
5 YES……………………………… 1
Do you agree to be measured? NO……………………………… 2
6 Weight in kilograms 
Weigh <you> . Kg
7 Height in centimeters . Cm
Measure <you>
8 MUAC (if not pregnant or with birth in the preceeding two weeks) . Cm
9 Is woman less than 18 years? (pull from HH roster) YES……………………………… 1
NO……………………………… 2
10 Is woman < 18 (pull from HH roster) MARRIED………………………… 1
Never MARRIED………………… 2
If Age <18 and Never Married; Caregiver must give consent:
11
CONSENT GRANTED…………… 1
REFUSED………………………… 2
Signature/Thumbprint
Do you have any questions?
QUESTION RESPONSE CODE
You can say yes to the test for (NAME OF ADOLESCENT), or you can say no. It is up to you to 
decide.
END
INTERVIEW
The blood will be tested for anemia immediately, and the result will be told to you and (NAME 
OF ADOLESCENT) right away. The result will be kept strictly confidential and will not be shared 
with anyone other than members of our survey team.
SKIP TO
Enumerator: Apply to each women of reproductive age (15-49 years) in the Household. 
Enumerator should carry multiple copies of this Module and use with all women of reproductive age in the Household
We would like to weigh and measure YOU. Your participation is voluntary and you 
may stop at any time. Your measurements will be kept confidential.
As part of this survey, we are asking people all over the country to Take an anemia test. Anemia is 
a serious health problem that usually results from poor nutrition, infection, or chronic disease. This 
survey will assist the government to develop programs to prevent and treat anemia.
For the anemia testing, we will need a few drops of blood from a finger. The equipment used to 
take the blood is clean and completely safe. It has never been used before and will be thrown 
away after each test.
86
If the respondent is age >= 18 or married, consent should be obtained from the respondent:
12
CONSENT GRANTED…………… 1
REFUSED………………………… 2
Do you have any questions? Signature/Thumbprint
You can say yes to the test, or you can say no. It is up to you to decide.
Will you take the anemia test?
13 Record hemoglobin level here G/DL .
NOT PRESENT
REFUSED
OTHER 98.7
For the anemia testing, we will need a few drops of blood from a finger. The equipment used to 
take the blood is clean and completely safe. It has never been used before and will be thrown 
away after each test.
98.6
97.5
As part of this survey, we are asking people all over the country to take an anemia test. Anemia is 
a serious health problem that usually results from poor nutrition, infection, or chronic disease. This 
survey will assist the government or chronic disease. This survey will assist the government
END
INTERVIEW
The blood will be tested for anemia immediately, and the result will be told to you right away. 
The result will be kept strictly confidential and will not be shared with anyone other than 
members of our survey team.
87
No.
1
2
3 Name of the child
Code of the child
4 During the pregnance of this child, did her mother attended YES
NO → 6
DON’T KNOW → 6
5 YES
NO
6 Hospital/Health facility
Other ………………………………………
DON’T KNOW
7 More than usual
About the same
Less than usual
No drink at all
DON’T KNOW
1
2
8
When chilld is experincing diarrhea, is she/he given less 
than usual to drink, about the same amount, or more than 
usual to drink? 3
4
Did the (NAME's) delivery took place at the health facility? 1
2
8
1
 any clinic for investigation and advice? 2
8
Did you happen to go with her in any of the visits? 1
2
MAN'S CODE FROM THE ROSTER
Name of the child and code
MODULE 14: PARTICIPATION OF MEN
Ask one man in a family who is a father of under five years child
QUESTION RESPONSE GO
HOUSEHOLD ID
88
MODULE 15: DECISIONS AT THE HOUSEHOLD
1 Mainly male/husband 1 Not at all
2 Mainly women/wife 2 Small extent 
3 Husband and wife jointly 3 Medium extent 
4 Someone else in the household 4 To a great extent
5 Jointly with someone else in the household
6
UZALISHAJI WA KILIMO
What inputs to buy for agricultural production?
To sell livestock
Your own wage or salary employment?
Minor household expenditures?
What to do if you have a serious health problem?
How to protect yourself from violence?
Whether and how to express religious faith?
What kind of tasks you will do on a particular day?
What food and how much to purchase?
15
When, how much or who would take crops to the market
Whether or not to use family planning to space or limit birth?
What to do if your children have a serious health problem?
12
13 What food, how much, and how to consume food
for yourself?
14 What food, how much, and how to consume food
for children?
6
7
8
9
10
11
5
Jointly with someone else outside the 
h h ld S/N
1
2
3
Enumerator: The purpose of this module is to get additional information about decision making within households.
Ask for all categories of activities before asking If household does not 
engage in that particular activity, enter code for “Decision not made” 
and proceed to next activity.
 When decisions are made regarding the 
following aspects of household life, who is it 
that normally takes the decision?
To what extent do you feel you can 
make your
own personal decisions regarding 
these aspects of
household life if you want(ed) to?
89
ANNEX 4: ETHICAL CLEARANCE CERTIFICATE 
90
LIST OF REFFERENCES
1. ADRA DRC Jenga Jamaa Final Evaluation Eastern DRC MYAP FFP-A-00-08-00071-00 LOA:
July 1, 2008 to June 30, 2011.
2. Africare Tanzania - Monitoring and Evaluation Framework, June 2009.
3. AFRUCARE TANZANIA/COUNSENUTH – Improving Nutrition in Tanzania MWANZO BORA 
NUTRITION PROGRAM USAID-Tanzania 11-005-RFA, June 2013.
4. AMCA INTER-CONSULT Report – End of Project Evaluation for “Rolling Out Psychosocial 
Support Capacity Building Project”. February 2013.
5. Baseline Nutrition and Food Security Survey (BNFS), 2010
6. European Union, FAO, USAID, FANTA III, FHI – Introducing the Minimum Dietary Diversity – 
Women (MDD-W) Global Dietary Diversity Indicator for Women Washington, DC, July 15–16, 
2014.
7. FANTA III, USAID – BMI and BMI-for-Age Look-Up Tables for Children and Adolescents 5–18 
Years of Age and BMI Look-Up Tables for Non-Pregnant, Non-Lactating Adults ≥ 19 Years of 
Age, 
8.
January 2013. 
FANTA III, USAID - 
9. FAO - Evaluating the Impact of Capacity Building Activities in the field of Food Quality and 
Safety, by Hilbert van der Werf, a volunteer working at FAO in 2007.
Household Hunger Indicator Defined Measurement Guide, August 2011 – 
Terri Ballard, Jennifer Coates, Anne Swindle, Megan Ditcher.
10. FEED THE FUTURE – Feed the Future Indicators Handbook: Definition Sheet, October 3rd, 
2011.
11. FEED THE FUTURE – National Alliance Partnership Program -Tanzania Baseline Assessment 
Report, May 2014, BY Anne Naggayi, Country Director – Tanzania.
12. FEED THE FUTURE – Progress Report, Accelerating Progress to End Global to Hunger, 2014.
13. General Inventory of Agriculture Development Partner Activities in Zanzibar – Ag-DPs, July 
2014.
14. GTZ - Practitioner’s Guide: Nutrition Baseline Survey.
15. INDICATOR TITLE: 3.1.9.1-3 and 4.7-4 Prevalence of households with moderate or severe 
hunger (RiA). 
16. International Food Policy Research Institute (IFPRI), CONCERN Worldwide – Realigning 
Agriculture to Improve Nutrition RAIN Project. Impact Evaluation: Methods and Baseline 
Results, November 2011.
17. Inventory of Agriculture Development Partner Activities in Tanzania Mainland – Matrix on 
Activities implemented by Ag-DPs in Tanzania Mainland.
18. MEASURE Evaluation Manual Series, No. 7 – A Guide to Monitoring and Evaluation of 
Capacity-Building Interventions in the Health Sector in Developing Countries, March 2003.
19. MINISTRY OF FINANCE – Public Expenditure Review of the Nutrition Sector Final Report, 
January 2014. 
20. Ministry of Health and Social Welfare – Infant and Young Child Feeding, National Guidelines, 
July 2013
91
21. Ministry of Health and Social Welfare - National Nutrition Strategy JULY 2011/12, June 
2015/16.
22. Ministry of Health and Social Welfare – National Nutrition Strategy, July 2011/12 – June 
2015/16
23. Ministry of Health Tanzania – The Food and Nutrition Policy for Tanzania, July 1992.
24. Mwanzo Bora Nutrition – Baseline Survey Report, by: JL Consultants, December 2012.
25. Mwanzo Bora Nutrition Program - (MBNP) Agreement No.AID-621-A-11-00001– Quarterly 
Report, October, December 2013, Brian Grant, Chief of party, Africare Tanzania.
26. Mwanzo Bora Nutrition Program – About our SBCC Multimedia Kit.
27. Mwanzo Bora Nutrition Program - Article on MBNP in Morogoro - Friday, 26 July 2013.
28. Mwanzo Bora Nutrition Program - CEMDO-Mwanzo Bora Nutrition Program Staffs In Deferent 
Activities/Events, Friday, 10 January 2014.
29. Mwanzo Bora Nutrition Program (MBNP) – Agreement No.AID-621-A-11-00001 Quarterly 
Report January - March 2014, By Brian Grant, Chief of party, Africare Tanzania.
30. Mwanzo Bora Nutrition Program (MBNP) – Annual Report, October 2013 – September 2014, 
Agreement No.AID-621-A-11-00001, By Brian Grant, Chief of party, Africare Tanzania.
31. Mwanzo Bora Nutrition Program (MBNP) – Annual Report, Reporting Period: 1stSeptember 
2011 to 30th September 2012, by Sekai Chikowero Acting Chief of Party.
32. Mwanzo Bora Nutrition Program (MBNP) – Quarterly Report April – June 2014, Agreement 
No.AID-621-A-11-00001, By Brian Grant, Chief of party, Africare Tanzania.
33. Mwanzo Bora Nutrition Program (MBNP) – Year Two: Annual Report: October 1, 2012 to 
September 31, 2013, Submitted by: Brian Grant.
34. Nutrition Country Paper – The United Republic of Tanzania (Draft). CAADP Agriculture 
Nutrition Capacity Development Workshops, February 2013.
35. Progress of the Scaling up Nutrition Movement in Tanzania.
36. Section C - Description/Statement of Work MALI CVC PROJECT
37. SEE FEED CHANGE THE FUTURE – TANZANIA FY 2011 – 2015 Mult-Year Strategy.
38. Sharing Worlds strong together tunanguvu pamoja Annual report, 2013.
39. SPS LOCATION: Objective 3: Investing in People INITIATIVE AFFILIATION: FTF – IR 5: 
Increased resilience of vulnerable communities and households
40. Tanzania Agriculture And Food Security Investment Plan (TAFSIP) 2011 - 12 to 2020 – 21, 
Main Document 18th October 2011.
41. Tanzania Demographic and Health Survey 2010 - National Bureau of Statistics Dar es Salaam, 
Tanzania – ICF Macro Calverton, Maryland, USA April 2011.
42. Tanzania Food and Nutrition Centre - Report Summary to the Government of the United 
Republic of Tanzania, Institutional Capacity Assessment for the Tanzania Food and Nutrition 
Centre, November 2012.
43. UNICEF - Limited Program Review and Evaluation Assessment, UNICEF Post Tsunami 
Recovery Response, Evaluation Office 2008.
44. UNICEF Tanzania - Investing in nutrition for national growth and prosperity in Tanzania, 
Development Partners Group on Nutrition, February 2010.
45. USAID - Evaluation at USAID, November 2013 Update.
92
46. USAID, Mwanzo Bora, Feed Future – Understanding the core issues, Institutional Capacity 
Assessment for the Tanzania Food and Nutrition Centre.
47. USAID, UNICEF, World Food Organization – Indicators for assessing infant and young child 
feeling practices Part 1 Definitions.
48. USAID/Deliver Project Mid-Term Evaluation, March 2010.
49. USAID/TANZANIA FEED THE FUTURE Mwanzo Bora Nutrition Program - Performance 
Monitoring Plan (PMP) Revised, July 15, 2014.
50. USAID/UGANDA – Uganda Livelihoods and Enterprises for Agriculture Development (LEAD) – 
Mid-Term Evaluation Final Report, April 18th 2011. 
51. WORLD VISION - OCLUVELA Multi-Year Assistance Program Baseline Survey Report, 
Compiled by: Isidro Fote1, Brian Hilton2, and Denis Brown3 June 2009. Sponsored by USAID.