Multi-sectoral Action Teams Help District Officers Implement - - PowerPoint PPT Presentation

Multi-sectoral “Action Teams” Help District Officers Implement Nutrition Policies and Strengthen Coordination Across Sectors for Nutrition in Tanzania

Rosemary Kayanda Research Coordinator, IMA World Health August 2019

Tanzania Food and Nutrition Centre

Funding for this research was provided by UK aid from the UK government through the Department of International Development (DFID) Lead: IMA World Health, Tanzania Collaborating Partners: Tanzania Food and Nutrition Centre, Dar es Salaam and Cornell University, United States Co-authors: Gina C Klemm, Aidan Kazoba, Luitfrid P Nnally, Juliet McCann, and Katherine L Dickin

Acknowledgements

Tanzania Food and Nutrition Centre Cornell University Division of Nutritional Sciences

Background and Objectives

Multi- Sectoral Nutrition

Health (Nutrition) Social Welfare Agriculture Community Dev. Education WASH (Water and sanitation)

• Multi-sectoral nutrition (MSN) policies

are important for reducing stunting

• Tanzania has excellent MSN policy but

factors affecting implementation are not well-known

• Knowledge gap exists in how to translate

policies at the implementation level

• Study Objective: Explore “Action Teams”

and mentoring as low cost strategies to support local coordination across sectors for nutrition

United Republic of Tanzania (2016): National Multi-sectoral Nutrition Action Plan (NMNAP), 2016-2021

Sampling

• Conducted in 5 regions with high childhood

stunting rates, >30% (MoH, 2018)

• Presence of “ASTUTE” program—aimed to

strengthen community-based maternal, infant and child health programs to prevent stunting

• In each region, the Regional Nutrition Officer

was recruited to mentor a multi-sectoral team

• Regional Nutrition Officers chose 1 district to

pilot the “Action Team” approach, with variation in accessibility and officer experience

Regions in Tanzania, n=20

Study Setting

• In the 5 districts, District Nutrition Officers had

limited availability and were over-committed, some working as full-time clinicians

• Collaboration across sectors was challenging

given the coordination required to get all stakeholders involved

• Districts had MSN Steering Committees but

they weren’t meeting regularly—when they did, other sectors had little to report

• Nutrition not considered a multi-sectoral issue;

need to change mindsets and mobilize stakeholders

Strengthening MSN Capacity and Collaboration

National Multi- sectoral Nutritional (MSN) Action Plan

POLICY

National MSN Steering Committee

COORDINATION

Regional Nutrition Officer Regional MSN Steering Committee Health Sector Head: Regional Medical Officer District MSN Steering Committee

IMPLEMENTATION

Health Sector Head: District Medical Officer Heads of other Sectors: Agriculture, Education, Community Development, etc. Agricultural, Education, & Community Development Officers District Nutrition Officer

MSN ACTION TEAM Regional Nutrition Officers supported District Nutrition Officers to create an MSN Action Team of 3-4 officers from other sectors

Implementation Process

month 0 month 3-4 month 4-5 month 10-13 month 14-15

Mentoring workshop conducted MSN Action Teams created MSN goals and activities planned Activity proposal developed by action teams MSN activities implemented in communities

Midstream of study, we identified lack of funding in

• ther sector’s budgets as a

major barrier for implementation of actions

Research Methods

• Held quarterly support calls with Regional

Nutrition Officers to address emergent challenges, including lack of funding

• Interviewed participants 3-4 times over 15

months using a semi-structured interview guide to capture barriers and facilitators to MSN planning and collaboration

• Transcribed interviews with 29 regional

and district officers; analyzed transcripts thematically

• Action Teams formed and met regularly in 4 of 5 sites
• Most teams included officers from Health, Agriculture,

Community Development, and Education Sectors

• Motivated, social conscience officers who were well-connected

in communities were critical for membership

• Mentoring happened, most Regional Officers were supportive
• Connecting teams to sector leaders provided credibility
• Delays due to workload, transfer of officers, and lack of funding

Nutrition Officers created Action Teams despite “silo mentality”

• 1. Increased priority

for nutrition

• 2. Improved budgeting

for nutrition

• 3. Developed capacity

at community level

Action Teams planned & implemented nutrition actions in a multi-sectoral way

Advocacy Budgeting Implementation

“Ever since the Regional Nutrition Officer started coming, nutrition is now being seen as an activity in this

• department. Before it was not even

known if there are nutrition activities to focus on.”

• Community Development Officer

Action Teams planned and implemented nutrition actions in a multi-sectoral way

• 1. Increased

priority for nutrition

Action Teams planned and implemented nutrition actions in a multi-sectoral way

• 2. Improved

budgeting for nutrition

“Previously nutrition wasn’t budgeted

• for. We’ve been able to advocate to

government officials and emphasize funds be set aside for nutrition. It’s common to have leaders budget for nutrition but never release the funds. We’re now working on a strategy to improve this issue.”

• District Nutrition Officer

Action Teams planned and implemented nutrition actions in a multi-sectoral way

• 3. Developed

capacity at community level

• One team established multi-sectoral

nutrition committees at the level below the district to cascade implementation to local levels.

• Structured way for district officers

to build capacity of implementation staff and better understand local challenges

• Started with 5 committees; has

since scaled-up to 21.

Dissemination and Sustainability

• We disseminated preliminary findings and

recommendations in the 4 research sites that completed study activities

• Dissemination meetings included Regional

Nutrition Officers, Action Team members, and key regional and district leaders

• Attendees were very enthusiastic and

generated ideas for how to sustain and scale-up study approaches

Recommendations

• Have Action Team members sign a “nutrition

compact” to acknowledge their role

• Create a vehicle share for the Action Team to

implement several multi-sectoral actions per trip

• Use current policy to fund Action Team activities

(e.g. 1,000 TSH per child)

• Share strategies—Teams were motivated to try

new activities after learning what others did

• Scale-up—Initial Action Team members to serve

as mentors for others interested in the approach

Thank You

Artwork by David Kyungu, Matatizo Media Productions

• A mutual, supportive, learning relationship where

someone with more experience passes on knowledge and skills, and opens doors to otherwise

• ut of reach opportunities
• Strengthens mentee knowledge and ability to

communicate and network with stakeholders to better meet professional goals

• Encourages mentees to ask important questions,

promote greater self-awareness, and make more informed decisions

• Helps leaders gain a greater understanding of the

challenges facing implementers and helps them to

• vercome barriers

Mentoring:

MSN Action Team:

• An organized and active group comprised of

stakeholders from key nutrition-sensitive sectors

• Supports the implementation, sustainability, and

scale-up of effective interventions and activities in communities

• Is guided by and actively engages with policy

recommendations, sector leaders, and community members

• Implemented a supportive supervision tool to use in schools

and health facilities that was nutrition-sensitive

• Held a workshop on importance of school feeding program

and a plan to establish school gardens

• Trained Primary Health Teachers, Community Health Workers

and Extension Officers on MSN strategy to reduce stunting

• Developed and advertised promotional materials for Vitamin

A supplementation campaign

Examples of other activities implemented by Action Teams