The State of the World's Children 1998: Focus on Nutrition

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Panel 11

Rewriting Elias's story in Mbeya

Photo: As one way to improve child nutrition and maternal health, the HANDS project has brought safe water and sani tation to thousands of people. Women and their children in Tanzania.

My name is Elias. I am two-and-a-half years old and I live on the outskirts of Mbeya with my mother, father, two older brothers and an older sister.

We are poor and our house has no toilet. My mother gets up early to fetch water from the river since our house has no tap. Then she goes to her farm plot, leaving me with my sister, Sophia, who is seven. Sophia collects firewood and does other chores for my mother, so she doesn't have much time to spend with me.

When my mother returns from her plot, she cooks a meal, usually maize porridge. Last year my mother grew enough maize, but this year she had to sell some to get money to buy other things. Now she says she doesn't know what we will eat when our maize stock runs out.

When I was younger, my mother breastfed me. Since she stopped, I have often been ill with fevers and diarrhoea. When I last had a fever, the nurse at the dispensary said it was probably malaria. My mother bought medicine but I didn't get better. Now I feel very ill and I don't have much energy.

- From a drama staged by HANDS' community organizers

Elias's story is a cautionary tale of how poor sanitation, the cessation of breastfeeding, disease and poverty converge all too often in malnutrition or even death for young children. The Health and Nutrition District Support (HANDS) project is helping people in Mbeya, a large urban centre in south-west Tanzania, rewrite this tale with a healthier, happier ending for their children. Launched by the Tanzanian Gov ern ment in 1992 with support from the United Kingdom Overseas Devel op ment Admin is tration, HANDS' success has been impressive.

Moderate malnutrition in children fell to 22 per cent in 1995 from 33 per cent in 1992, and severe malnutrition dropped to 0.4 per cent from 3.3 per cent in areas where HANDS operates. In contrast, malnutrition increased by 7 percentage points among children under five in Mbeya as a whole.

In the same period, in HANDS' areas, the percentage of pregnant women with anaemia declined from 37 per cent to 33 per cent, and the incidence of low birthweight was also reduced. Ninety-nine per cent of children between the ages of one and five were fully vaccinated, up from 86 per cent. The proportion of households with access to safe water increased from 60 to 96 per cent, and those with pit latrines from 75 to 92 per cent. In all, about 125,000 people benefited directly and indirectly.

An important strategy of HANDS lies in careful targeting: The project focuses on areas with the highest levels of child malnutrition and infectious diseases, lowest levels of domestic sanitation and most limited access to health facilities. Equally important, the community has been intimately involved, from planning through implementation and management, with evaluation. The poor identified their priorities and became partners with government staff in implementing a range of health-enhancing development activities.

Donor support has been critical in providing training, essential equipment and transport. An investment was also made in council and community development funds, enabling the council to improve health services and access to safe water, upgrade sanitation and promote household hygiene in targeted areas.

Revitalized maternal and child health services in the community now are responsible for child vaccination, antenatal and post-natal care, family planning, diarrhoeal disease control, treatments for common childhood illnesses and growth promotion activities. Health and nutrition education activities are stronger and focus on children's vul nera bility during the period when complementary foods are being introduced, on the nutritional needs of pregnant women and on home-based oral rehydration therapy. Outreach services now support households with malnourished children, and community-based day-care centres have improved the well-being of young children.

Four new water schemes serve over 50,000 people, and three health centres were upgraded, now reaching 80,000 people. Af fordable latrines and basic hygiene are promoted, and innovative work is being done on low-cost public toilets.

Thanks to seminars, formal training and drama sessions run by Tanzanian women lawyers, the rights of women and children are higher on the public agenda. A subsequent survey found that fathers are making greater contributions to child welfare.

The HANDS project is now in a second phase: Tanzanians have replaced international staff, and project management lies with local council committees. The commitment and participation of local government staff and community members indicate that the project is sustainable.

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