Improving nutrition in Tanzania: experiences from food markets
In Tanzania, more than 40 per cent of children suffer from stunting, a sign that they are chronically malnourished. While improving households’ access to foods rich in micronutrients and nutrition seems the obvious solution, policymakers face difficult choices. First, food alone is not the only cause of undernutrition. Second, while recent trends show that more households are buying food from markets, how can policy ensure foods are rich in the micronutrients lacking in many Tanzanians’ diets (especially Iron and Vitamin A) and that they reach low income populations?
Drawing on several years of research on nutrition, markets and business, IDS recently convened a workshop in Tanzania for individuals working on a variety of initiatives which use markets to increase people’s access to nutritious foods. Some people were working on developing new, nutritious products using locally produced foods, others were engaged with large scale fortification, others on working with small millers to fortify the maize that they sell. Participants actively working on market based programmes to improve nutrition has the opportunity to compare the strengths and weaknesses of four ongoing initiatives in the country, covering different markets and a diverse range of policy approaches. The workshop report synthesises lessons from projects in Tanzania, and sets out priorities for better market-based approaches and for reaching vulnerable populations.
Nutrition interventions need to work with small businesses
In 1995 Tanzania made it a legal requirement to add iodine to salt during production (to combat iodine deficiencies that can lead to brain damage in children). However there were not enough local inspectors to cover the thousands of small salt producers and to test whether all salt was being iodised.
A breakthrough came when staff in the Ministry of Health and Social Welfare discovered that some salt makers had modified hand-held spraying pumps and were using them to iodize salt in small batches. This was an improvement on the conventional technology, which only worked for very large quantities of salt. Rather than policing the salt makers and trying to put them out of business, Ministry staff offered trainings about the importance of iodine for public health, provided more spray pumps to producers and taught them how to use the pumps effectively.
The result has been that many more Tanzanians – especially poor people– receive iodine through salt. Tanzania has seen impressive declines in goitre, with rates in the most-affected areas falling from 65% in the 1980s to 24% in 1999.
The challenge using markets to deliver nutritious foods
Different markets have very different structures. Wheat flour (used in common urban foods like bread and chapatis) is produced by just three large manufacturers in the country; in contrast, maize flour (used to make ugali one of the staples of the diet) is produced by tens of thousands of very small millers scattered across towns and villages. Tanzania’s national fortification programme faces very different challenges when working with large and small businesses.
Key lessons for policy on food markets and nutrition
The workshop allowed participants to compare the experiences of different programmes and approaches in Tanzania and to identify shared gaps and priorities for policy:
- More effective processes and structures for enforcement. In Government, agencies simply do not have enough staff to monitor (or even identify) the thousands of small food businesses. Participants discussed motivating small businesses through training and better efficiency, and how businesses could monitor each others’ activities through associations.
- Building public trust in micronutrient fortification. Particularly in rural areas, residents are suspicious of the fortified powders introduced by products, and some people incorrectly believe they are a form of birth control. Meanwhile, shopkeepers do not know the difference between fortified and unfortified flours or oils. Workshop participants wanted prominent people in government to publically support fortified foods. They wanted to learn from other countries’ experiences funding large-scale nutrition awareness programmes.
- Better coordination for market-based programmes. Changing the way markets function required actions by governments, businesses and development actors alike. But there were few guidelines on how to ensure all actors played their roles and were held accountable. For example, development projects tended to be primarily accountable either for improving the performance of businesses and markets or for demonstrating improvements in nutrition. Addressing both in a single project was a challenge.
What next for markets and nutrition in Tanzania?
Workshop participants will be looking for ways to channel these lessons into ongoing efforts to strengthen nutrition policies in Tanzania. Meanwhile, IDS is investigating innovative policy responses through our ongoing research. Based on the workshop, we have identified at least three important questions needed to develop better policies:
- What policy approaches are effective for working with small enterprises and informal markets?
- Given that a lack of institutional capacity so often inhibits the effectiveness of interventions, how can policies and programmes specifically anticipate low capacity? What approaches are effective where capacity is low?
- Food markets are complex systems in which no one actor can determine outcomes individually, and where uncertainty is high how should policymakers approach working in these complex food systems?
What other questions need to be answered in order to improve our approaches to nutrition, food and markets? Please share your ideas in the comments below!