نوآوری و کوچک شدن فضای سیاسی و تعهد سیاسی
Abstract
1- Introduction
2- Data and methods
3- Results
4- Discussion and conclusions
References
Abstract
In the past 15 years, Tanzania has made considerable progress in the fight against child undernutrition. This paper analyses in what respects an enabling environment for nutrition action in Tanzania has emerged. It critically investigates the nature of government political commitment and assesses the breadth and depth of a range of public policies, initiatives and actions within and across nutrition-specific and nutrition-sensitive sectors, and at the national, sub-national and community levels. It finds that Tanzania has undertaken substantial policy innovation and institutional development, carrying significant promise to accelerate nutrition improvements, provided they are accompanied by stronger domestic investments, and greater political space enabling communities to hold the government to account for its performance combating malnutrition.
Introduction
During the past 15 years, Tanzania has made considerable progress in the fight against child undernutrition. Stunting levels for children under five years of age have seen gradual declines, from nationwide averages of 48 per cent in 1999, to 44 per cent in 2005, and to 34 per cent in 2015 (Government of Tanzania, 2016). A recent re-analysis of the Demographic and Health Survey data suggests that official figures are underreporting the achievements, finding stunting levels to have declined to 30 per cent in 2015 (Headey et al., 2019). This downward trend is replicated among neighbouring countries' under-five stunting rates, with Malawi, Kenya and Uganda exhibiting similar reductions. For example, between 2003 and 2014, Kenya's under-five stunting rate declined from 36 per cent to 26 per cent (Government of Kenya, 2015). Faster declines over a similar period were noted in South East Asia, where Nepal experienced a reduction in stunting level of 21 per cent between 2001 and 2016 (Government of Nepal et al., 2017) and Cambodia a decline of 18 per cent over a 14 year period (Government of Cambodia et al., 2015). These figures have contributed to the overall global reduction in stunting, with levels falling by more than 10 per cent, from 33 per cent in 2000 to 22 per cent in 2017 (UNICEF et al., 2018). Several studies have sought to explain the reduction of stunting in Tanzania by exploring the drivers of improved nutritional status, with notable attention given to the positive role of better access to general health interventions, wealth gains and strengthened education of mothers (Masanja et al., 2008; Semali et al., 2015). Using a decomposition analysis to quantify the empirical drivers of positive change in underfives’ height-for-age, Headey et al. (2019) find dramatic increases in infants’ birth size to be the most significant factor, attributed to, in order of significance, improved maternal health monitoring, malaria prevention, HIV infection testing and improved water and sanitation facilities. However, overall, relatively little has been reported on the role of the enabling environment for nutrition action in Tanzania. This paper hence seeks to investigate the ways in which changes in the enabling environment may have underpinned the contributions of determinant factors towards declining stunting rates. Gillespie et al. (2013, p. 553) define enabling environments as the ‘political and policy processes that build and sustain momentum for the effective implementation of actions that reduce undernutrition’. Drawing upon this definition, we examine the role that the Government of Tanzania has played. The study thus adds to a portfolio of country case studies documenting the mechanisms by which nutrition has improved over the past 15 years in several countries as part of the Stories of Change in Nutrition project (Gillespie and Van den Bold, 2017; Harris et al., 2017; Kampman et al., 2017; Nisbett et al., 2017).