Improving nutrition in Tanzania
Tanzania has made notable progress in improving nutrition in the past 25 years, with significant reduction in the prevalence of stunting, wasting and being underweight among children under five. The prevalence of chronic malnutrition (stunting) among children under five fell from 50% in 1992 to 34% in 2015, and the prevalence of acute malnutrition (wasting) decreased from 8% in 1992 to 4.5%. Despite this excellent progress, levels of malnutrition remain unacceptable.
This UNICEF-funded Public Expenditure Review (PER), is looking at the volume, composition and processes around public expenditure on nutrition-related activities in Mainland Tanzania and Zanzibar, for the years 2013/14 – 2015/16. It is particularly notable for being only the second PER in the nutrition sector ever conducted globally (following on from that conducted in Tanzania in 2014). This PER will update the findings and conclusions of the 2014 PER, and review progress since. It will also expand the analysis to include Zanzibar.
Tanzania has made good nutrition a priority, by building institutional capacity and coordination at all levels. The Government recognises that the effective supply and coordination of finance is vital for the nutrition effort. Accordingly, this PER has been commissioned to assess public expenditures on nutrition and, as far as possible, to evaluate results against targets in national strategy documents. Amongst other goals, its findings are expected to identify shortcomings in budgetary processes for nutrition and to better direct future budgetary support.
The financing of nutrition in the public sector is complex. It is challenging because nutrition is not a sector in the formal sense, and thus the identification of nutrition-related expenditures across multiple sectors is called for. Activities are financed by the Government of Tanzania at both central and subnational levels, as well as by the donor community. Nutrition-relevant activity is carried out in many ministries, departments and agencies, and budget classifications do not always enable ready identification of nutrition interventions.
Our approach is addresses five main thematic analytical areas:
(1) Policy and institutional framework: The PER provides an overview of the current institutional and policy framework for nutrition, including existing strategic documents, frameworks and sector plans. Judgements of technical and allocative efficiency will be based upon the policy goals and priorities of the nutrition sector.
(2) Level and composition of nutrition sector expenditure in mainland Tanzania and Zanzibar: The analysis of trends in nominal and real nutrition budgets will consider execution rates, nutrition allocations and expenditures per capita (against sector benchmarks), breakdowns by economic and functional classifications, and the share of spending by level of government and by funding source.
(3) Budget process and performance: including an analysis of the nutrition budget preparation process at central and local levels, as well as a review of budget execution and control, and how budget performance is monitored in relation to nutrition.
(4) An analysis of efficiency and equity of nutrition spending.
(5) A set of politically feasible recommendations for improving the fiscal space for, and the strategic prioritisation and value for money of, nutrition expenditures.
The PER will provide an evidence base and set of policy recommendations that are expected to lead to improvements in sector expenditure, as well as addressing institutional impediments, in order to achieve effective, targeted allocation of resources for improved nutrition outcomes.