Grant Request: 350000 USD

1. Problem Statement

Tanzania has a population of about 43 million people who live in 30 administrative regions. Child malnutrition rates vary widely across the country, with high food-producing regions such as Iringa actually recording some of the highest rates of stunting. Children younger than 5 are 17 percent of the population and nearly half of all Tanzanians are under the age of 14. Women of reproductive age (defined as ages 15-49) comprise 22 percent of the population. The prevalence of stunting in children under 5 is 42 percent— which adds up to more than 3 million children. The prevalence of anemia among women aged 15-49 is 40 percent.

Although the national prevalence of stunting is 42 percent, 14 of the 30 regions have a rate higher than this, and in four regions (Dodoma, Iringa, Rukwa, and Lindi), the rate exceeds 50 percent. More than half of Tanzania’s regions have had either no change or an increase in stunting between official surveys. The majority of stunted children live in rural areas particularly in the targeted selected district of Iringa Municipality and Kilolo are highly affected by the situation if not supported in this intervention. Anemia affects more than half of schoolchildren. High rates of anemia among women of reproductive age are common in Iringa region particularly at Iringa Municipality and Kilolo district where there are high levels of childhood stunting. Tanzania is on track to meet the MDG 1 underweight indicator, but an increased focus on reducing stunting is needed to meet the country’s own target for 2015.

According to the World Bank, micronutrient deficiencies cost Tanzania the equivalent of 2.65 percent of its GDP each year—a negative economic impact of $500 million. The 2010 Demographic Health Survey (DHS) showed that some of the regions with the highest stunting rates were also among the country’s most agriculturally productive, underlining the point that improving farming productivity alone will not necessarily reduce levels of childhood stunting. Tanzania has a population of about 45 million people who live in 30 administrative regions. Child malnutrition rates vary widely across the country, with high food-producing regions such as Iringa actually recording some of the highest rates of stunting. Children younger than 5 are 17 percent of the population and nearly half of all Tanzanians are under the age of 14. Women of reproductive age (defined as ages 15-49) comprise 22 percent of the population. The prevalence of stunting (defined as a height more than two standard deviations below other children of the same age) in children under 5 is 42 percent— which adds up to more than 3 million children. The prevalence of anemia among women aged 15-49 is 40 percent.

Although the national prevalence of stunting is 42 percent, 14 of the 30 regions have a rate higher than this, and in four regions (Dodoma, Iringa, Rukwa, and Lindi), the rate exceeds 50 percent. More than half of Iringa districts have had either no change or an increase in stunting between official surveys. The majority of stunted children live in rural areas (2.5 million) rather than urban areas (700,000).

Anemia affects more than half of schoolchildren. High rates of anemia among women of reproductive age are common at Iringa Municipality and Kilolo districts where there are high levels of childhood stunting. Iringa is on track to meet the MDG 1 underweight indicator, but an increased focus on reducing stunting is needed to meet the country’s own target for 2015.

However, poverty and under-nutrition form a vicious cycle where poverty limits access to an adequate and balanced diet, while malnutrition reduces physical strength and cognitive abilities, resulting in reduced productivity and low earning capabilities. Malnutrition has an inter-generational cycle of causation and impact. Studies have shown that inadequate nutrition between conception and age two leads to serious cognitive delays among school-age children (Grantham McGregor, S., Cheung, Y.B., Cueta, S., Glewwe, P., Richter, L., Strupp, B., Developmental potential in the first five years for children in developing countries. Lancet, v. 369, 2007). Children under two years of age are the most prone to stunting and damage to physical and mental development is almost irreversible thereafter (Sustainable Nutrition Security in Tanzania: A Leadership Agenda for Action; Coalition for Sustainable Nutrition Security in Tanzania; May 2010). Stunting in this age group is largely attributed to sub-optimal breastfeeding and complementary feeding practices (UNICEF, Progress for Children, 2010). Improving nutritional status of under-twos therefore represents the most critical opportunity to break this cycle.

The Children Care Development Organization conducted survey during the year 2013 -2014 reviewed that some of the districts in Iringa region with the highest stunting rates were also among the region’s most agriculturally productive, underlining the point that improving farming productivity alone will not necessarily reduce levels of childhood stunting.

1. Description of Organization                                                                              

The Children Care Development Organization (CCDO) is a non-governmental Organization registered officially in Tanzania on 13^th April, 2010 with legal registration No.ooNGO/00003818 made under the Non-Governmental Act, 2002 made under section 12 (2) of Act No.24 of 2004. CCDO Works to serve children through healthcare and food nutrition education particularly in poor marginalized rural areas where women pregnancy and widows are at high risk. Reducing pregnancy women poverty through practical ICT solutions is our major components including the issues of increasing women’s awareness on health governance in Tanzania for their healthier improvement and sustainability since our CCDO mission is to strengthen local community competency to the promotion of children and women health care education and development to deprived members of the societies through food nutrition and horticultural small gardens establishment for their poverty alleviation.

Currently, we established horticulture garden along Nduli village within Iringa Municipality where we have 6 acres of land based on agricultural food security in which we train our women on food nutrition, nutrition counseling, balanced deity diversion, how to grow a farm of vegetable garden through practical demonstration. In this project we connected pipe water for vegetable garden irrigation as our strategy is to impart new knowledge to our pregnancy women and lactating mothers. Every Saturday of each week per month we have a classroom on food nutrition and counseling activities.                       

CCDO achievement includes;

1)      We established 6 acres of land for our women agricultural food security farm at Nduli village that contribute towards improved nutrition of pregnant and lactating women and children under 2 years through nutrition sensitive agriculture along Iringa Municipality and Kilolo.

2)      We have identified 70 pregnancy women dropped out of schools particularly who are helpless and needy nutrition education, income generating activities, education and support.

3)      We managed to construct our own CCDO children and women center along Mkimbizi village at Iringa Municipality.

4)      We have mobilized 50 computers5 sewing machines for our women income generating activities.

5)      We have mobilized 67 women for microfinance groups where each group is made up with 5 soft loans borrowers.      

6)      We have offered soft revolving loans to our 150 women groups joined at CCDO VICOBA

7)      We have formed 640 women groups for agricultural small business activities and loans provisions.

8)      We trained 15000 girls and women on good governance

9)      We trained 20 local wards leaders on ICT and good governance practices

10)  Wee trained Iringa Districts Councilors on good governance and women empowerment programs.           

11)  We have established CCDO Day Care Center and vocational training center.

12)  We have developed a good networking with Local Government Authorities and health centers working in Iringa.

13)  We have mobilized vitamin A supplements from Vitamin Angels in America and distributed to Ngome Government Health Center.

The CCDO head offices if located at Mkimbizi area within Iringa Municipality of Iringa region in Tanzania. This is National NGO mandated to operate in Tanzania Mainland that the aforesaid organization in accordance with our governing Constitution. Our areas covered are Iringa and Njombe regions only.

Our target audiences are children and mothers, early pregnant girls/women, school drop girls, and people living with HIV/AIDS while our experience is to impact MDG 4 by reducing neonatal and infant mortality in selected blocks of Iringa and Njombe regions through improving infant and young child feeding practices among the poorest and most marginalized populations in these districts will improve both children’s and mothers’ nutrition and productivity.

The CCDO has wide experience and positive image to our local and international development donors due to our committed staffs and volunteers we work with them. CCDO has 5 full-time staffs who area professional in health sector, health nutrition, counseling, community and sensitization, HIV prevention strategies and health policy analysis, media, and communication management and project management governance. We have 2 part-time workers and 3 volunteers. All volunteers are assigned to work with our staffs as a team work.

Our past CCDO experience is to create behavioral communication change to our community women members through, food nutrition and balanced diet knowledge transfer, promotion and identification of lactating women living with HIV/AIDS. We have been advocating for health policy improvement, care and counseling pregnant women living with HIV/AIDS through health care education and horticulture income generating activities.

Our current programming experience in nutrition services and service behavior is based on our creative and innovative program that works to improve the health and nutrition condition of less-privileged women of Mkimbizi, Nduli, Kilolo, and Makete villages through raising their awareness and supporting them with health services, to give support on sanitation and pure drinking water, to reduce infant mortality rate from 80 per 1000 live births to 50 per 1000 live births, to reduce maternal mortality rate from 4.50 to 2.80 per 1000 live births, to provide health & nutrition education to the community people for prevention of AIDS, STD and HIV, to raise nutritional level of pregnant women awareness through health programs, to give support on sanitation and pure drinking water, to provide nutritious food to children, to develop the health status of the women and children and make them aware socially to live with dignity and honor since in most of our rural areas of Iringa villages do not have health care facilities. That’s why malnutrition is one of the common identified problems among women and children in the selected project area that CCDO has already services, but we are lacking an existing partner for our reciprocal exchange information, experience and knowledge transfer.

1. Project Description

The proposed CCDO idea is due to the high prevalence of chronic malnutrition at Kilolo and Iringa Municipality of Iringa region of Tanzania where the project will be implemented and with head offices at Kihesa- Mkimbizi area within Iringa Municipality since our objectives are to improve nutritional status of children, pregnant and lactating women, and to increase access and deliver quality lifesaving management of severe and moderate acute malnutrition for 60 percent of children under five and pregnant and lactating women, and to provide access to integrated services to prevent under nutrition for at least 30 percent of girls and boys aged 059 months, pregnant and lactating women and other vulnerable groups, including increasing institutional capacity to conduct nutritional assessments and analysis in order to respond to nutritional emergencies in a timely manner. Under the initiative the CCDO is aligning efforts towards first 1000 most critical days, from pregnancy until a child turns 2 years old to address child stunting. The proposed project will thus address the factors that influence and contribute to high levels of child stunting including: (a) lack of diversified cropping systems in project areas, (b) poor diet diversity and quality for pregnant and lactating women and children under 2 years (c) poor infant and young child feeding (inadequate and inappropriate complimentary feeding) and (d) low capacity to enhance the nutritional (protein, micronutrient, energy) value of food and lack of value addition technologies to preserve food in a nutritious manner. The proposed project will thus focus on the introduction of improved nutrient dense crop varieties and crop management practices, dietary diversification and promotion of nutrient dense crops (legumes, fruits and vegetables), food preservation, and integration of nutrition interventions on infant and young child feeding and nutrition education and behavior change communication to achieving the MGD 1 and 4.

The target numbers of community members who will be reached are 19000 children under 5 years, 12500 pregnancy women, and   20000 lactating women. All these are project beneficiaries

CCDO funding will be used to address the immediate lifesaving and quality nutrition care needs of targeted communities in the geographic area of Iringa Municipality and Kilolo district and Iringa region in Tanzania. The justification of the proposed project needs is based on the evidence and CCDO’s knowledge, expertise, and experience of the geographic areas, previous and current programming, needs assessment reports conducted by cluster and other agencies. In all, CCDO will position itself inline with the findings and recommendation of the cluster need analysis and response plan, the general strategic objectives and cluster specific objectives and output. To achieve this objective, CCDO will work towards the following expected results; Deliver and increase access to quality and effective community and facility based therapeutic and supplementary nutrition services among children under five and pregnant, lactating women in target areas, increase coverage of the targeted population for under nutrition prevention through micronutrient supplementation, dissemination of key nutrition and ccdo messages, increase institutional capacity to conduct nutritional assessments and design/implement a full range of nutrition interventions including building capacity for nutritional emergency response and preparedness.

The project will implement a behavioral communication change (BCC) strategy to encourage mothers and caregivers of children under two years of age to follow optimal Mwanzo Bora Nutrition Program practice. The focus will be on: 1) early initiation of breastfeeding within one hour of birth; 2) exclusive breastfeeding for the first six months; and 3) timely, adequate and appropriate introduction of complementary feeding at six months of age. The project will work at various levels among households, communities, health care providers and policy influencers. The maximum duration allowable by the grant of five years will be availed so as to reach the ambitious target numbers and provide time to demonstrate purpose level achievement. Using positive deviance analysis, CCDO will identify cases where mothers or caregivers have been successful in overcoming obstacles and use these to offer practical solutions to others. The findings will guide the development of the BCC strategy and related communication and training materials. The strategy will be geared to create awareness on the advantages of following the correct CCDO practices and to help solve the problems women face in doing so, so that increase in knowledge can be translated into behavior change. The project will reach out to “audiences” at four levels.

Level 1, Households: The primary audience will be mothers in the third trimester of pregnancy and with infants up to two years of age. Secondary audiences at this level include fathers, mothers-in-law and sisters-in law, adolescent girls and other caregivers in the family such as the elderly.

The project will create a special cadre of community based nutrition workers who will function as Peer Educators (PEs). The PEs will receive a small honorarium and will be responsible for reaching out to households to raise awareness, develop skills and help relevant family members to solve issues in improving nutritional status of 1000 days to pregnancy and lactating women Along Iringa Municipality and Kilolo District. Honoraria are preferred over performance based payments as: 1) the latter are complex to monitor and manage – and often create contention among the service providers; and 2) they tend to skew services to being more supply-driven to programme assumptions of priorities rather than being responsive to mothers’ expressed and actual needs. The PEs will also act as a resource cadre for improving nutritional status of 1000 days to pregnancy and lactating women Along Iringa Municipality and Kilolo District related issues to other field level functionaries, especially the ASHAs (Auxiliary Nurse Midwives), Accredited Social Health Activist (ASHA), and the CCDO Rural Change Agent Workers (CRCAW)

Each pair of PEs, working in tandem, will cover about six villages, serving a population of about 18000. Village selection will be based on three main criteria: 1) primarily targeting the unreached sectors of the target blocks (populated by the poorest, scheduled castes and poor religious communities); 2) clustering in existing sub-centre catchment areas to encourage linkages with the lowest levels of the government health system (level 2, below); and 3) geographical proximity to each other to facilitate PEs’ logistics and reduce travel time. The village coverage is estimated to provide a critical mass to demonstrate a working model at scale that can be scaled further by existing systems in the neighbouring blocks and subsequently rolled out across other districts in the region. Within the target villages the project employs a saturation strategy.                                                                                                                

PEs’ selection will be based on referral by village lactating women members, endorsement from all sections of the community to ensure acceptance, and guided by positive deviance analysis. They will initially attend a centrally organised one-week training by the partners’ technical staff and Cluster Coordinators (see below) who have been trained as trainers. Their first task will be to identify existing groups, such as self-help groups, savings groups and other community based groups that may be used as mother support groups. Where they do not exist, PEs will form groups specially based on: 1) Women in the last trimester of pregnancy and mothers of children less than 6 months of age; 2) Mothers and caregivers of children between 6-12 months; and 3) Mothers or caregivers of children between 1-2 years of age. As the baby grows, the mothers will move from one group to another.

The PE pairs will meet each group at least once a month. The ASHAs (Auxiliary Nurse Midwives), Accredited Social Health Activist (ASHA), and the CCDO Rural Change Agent Workers (CRCAW) of the village will be oriented to the procedure and their assistance sought to mobilize women’s attendance. The PEs will use appropriately designed and pre-tested session plans and training materials. The meetings will also serve as a mother-to-mother problem-solving platform. Women will be encouraged to express the constraints or reservations they face in improving nutritional status of 1000 days to pregnancy and lactating women along Iringa Municipality and Kilolo District project recommendations. The PEs will follow-up unresolved issues and women who need in-depth counseling through IPC (Inter-personal Communication) sessions during home visits (management by exception). Fathers, mothers-in-law, sisters-in law, adolescent girls and other caregivers will be included as important decision makers in the family regarding the child’s diet.

For every 12 villages, the project will appoint a Cluster Coordinator (CC) to train and mentor the PEs, and help solve problems the PEs may face. Each CCDO staff will train a core number of CCs as trainers of PEs. The CCs will organise monthly meetings for post-training follow-up and continuous education, as well as for peer-to-peer learning and disbursement of the honorarium.

For mid and mass-media communication, CCDO will leverage the efforts of existing projects and community radio’s (Radio Ebony FM, Radio Country FM, Radio Overcomers FM, Radio Kibra FM, Nuru Radio FM and Iringa Municipal Television, and incorporate specially designed radio spots on improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities. PEs’ selection will be based on referral by village lactating mothers members, endorsement from all sections of the community to ensure acceptance, and guided by positive deviance analysis. They will initially attend centrally organised one-week training by the partners’ technical staff and Cluster Coordinators who have been trained as trainers. Their first task will be to identify existing groups, such as self-help groups, savings groups and other community based groups that may be used as mother support groups. Where they do not exist, PEs will form groups specially based on: 1) Women in the last trimester of pregnancy and mothers of children less than 6 months of age; 2) Mothers and caregivers of children between 6-12 months; and 3) Mothers or caregivers of children between 1-2 years of age. As the baby grows, the mothers will move from one group to another.

Level 2, Community-based service providers: The project will work through both formal and informal community based functionaries. Although ANMs and ASHAs are unable to give nutrition counseling the attention it deserves, it is essential that they be involved as they have access to and the confidence of the community. Traditional birth attendants (TBAs) also mould community thinking and action, which is important as, despite government’s promotion of institutional deliveries, a high percentage of deliveries continue to occur at home (over two thirds in Itinga Municipality and Kilolo districts and 40 percent in Iringa region. (Accelerating Maternal and Child Survival. The “High Focus District” Approach. Ministry of Health & Family Welfare, Government of Tanzania).

The project will organise refresher sessions for the front line workers on improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities, orient them to the project goals and methods and their roles, and encouraged them to partner with the PEs in mobilizing the community members for group meetings. Attending these PE-led sessions on improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities in their villages, with home visits to women in need, will provide them hands-on exposure to the correct CCDO messages and skills for group facilitation and IPC. The PE will act as their mentor to ensure knowledge and skills transfer. It is envisaged that by the end of the project, participating ASHAs and AWWs will be able to hold group and one-on-one counseling sessions on improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities on their own. The PEs will also hold group-counseling sessions as a regular part of the Village Health and Nutrition Days (VHNDs), including healthy baby shows to promote CCDO messages and celebration of the annual breastfeeding week. As all three front-line workers are present during the monthly VHNDs, this will be a good learning exercise. As well as reaching a substantial number of mothers, VHNDs being government mandated platforms, will contribute to sustainability.

Religious leaders and village elders are often present at time of birth, or are called in immediately following. Their opinion is highly respected and adopted by family members. The PEs will discuss the importance of early initiation with these opinion makers to share with the family when they visit women in pregnancy or who deliver at home. will also hold group-counseling sessions as a regular part of the Village Health and Nutrition Days (VHNDs), including healthy baby shows to promote CCDO messages and celebration of the annual breastfeeding week. As all three front-line workers are present during the monthly VHNDs, this will be a good learning exercise. As well as reaching a substantial number of mothers, VHNDs being government mandated platforms, will contribute to sustainability.

Level 3, Facility-based service providers: With the introduction of the Children Care Development Organization programme - a maternity benefit scheme that offers women financial incentives to opt for institutional deliveries - institutional deliveries are increasing in Iringa. Thus, facility-based health providers are increasingly important in supporting early initiation of breastfeeding.

Medical officers and specialists are often too busy with clinical and curative tasks to spend time with women to counsel on breastfeeding. This task can be taken over by the nurse-aides that are placed at the health facilities and serve in labour rooms under the Iringa Medical Consultation Clinic and Maternal Hospital Partnership Initiative in Iringa. CCs will train nurse-aides in the science behind early initiation, motivate them to help and encourage women to initiate breastfeeding within an hour of birth, and help them (especially first time mothers) to ensure correct attachment of the baby to the breast, which facilitates initiation. Many medical officers and health facility supervisors do not actively promote early initiation due to traditional social or commercial pressures from manufacturers of infant milk substitutes who offer “gifts” to practitioners to prescribe their products. As technical leaders on maternal child health issues, these officers will be re-oriented to the improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities guidelines and their role in promoting this healthy behavior, and encouraged to be project trainers for nursing staff and nurse-aides at their health facilities.

Level 4, Policy influencers: The project will consult with the Tanzania Medical Association, Federation of Obstetricians and Gynaecologists of Iringa Association of Paediatricians to encourage their support for the project strategy and elicit their professional advocacy for optimal of improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities practices and specialist counseling in infant and child nutrition. This outreach will be managed through such means as pre-conference Continuing Medical Education items, conference sessions, newsletters, articles and editorials in journals. District level associations of ANMs, AWWs and ASHAs will be tapped into to reinforce the frontline workers’ support and facilitate wider communication of messages. CCDO will organize an end of project national conference on findings from the project for practitioners, policy promoters and donors.

The project will advocate to the Government of Tanzania’s health department and the two district administrations to issue formal guidance to all delivery facilities, both public and private sector, about improving nutritional status of 1000 days to pregnancy and lactating women Iringa communities and the role of the facility in encouraging early and exclusive breastfeeding, while discouraging bottle feeding and artificial milk substitutes. Measures like not stocking or displaying such products in the facility pharmacy will give the right message to mothers and caregivers. Simple practices like keeping the newborn with the mother instead of in the baby nursery, and reassigning staff from the baby nursery to provide CCDO counseling, will help in early uptake of breastfeeding.

The CCDO will reach our targeted population through designing lactating education / IEC campaigns. Lactating Education IEC materials will use gender sensitive peer education methodologies with particular focus on participatory approaches such as drama, role plays and community education talks to create awareness of Mwanzo Bora Nutrition Program. Existing structures such as women and men’s church groups, ante-natal clinics, traditional birth attendants, sports clubs will be used as entry points to lactating mother’s education. Lactating mothers groups will be formed in the targeted population in this project.

Our project plan for sustainability: The project will promote a range of strategies to ensure that nutrition counseling remains a focus in the target districts. Through earning recognition as specialist nutrition counselors in their communities, the PEs will be motivated to sustain their services beyond the end of the project. While incentivised through the project with a small honorarium, CCDO will encourage the Local Governments to take on and fund these trained hands, similarly to the recommendation of the Mwanzo Bora Nutrition Program on how to tackle Tanzanian malnutrition problem, where recruitment of stand-alone nutrition counselors at the village level will be proposed.

Another recommendation from the retreat was for the government to take on a second CCDO recommendation, whose main focus would be on home visits to counsel mothers and young women about dietary recommendations during pregnancy, lactation, infancy, childhood. Iringa Local Governments could thus be the first region to adopt the recommendations of the retreat and the follow-up meeting of the Prime Minister’s Nutrition Council through this project.

For levels 2, 3 and 4, the focus of the project is to create sustainable capacity among the respective audiences. For example, if the ASHAs learn and practice the skills of group and interpersonal counseling, it is likely that they will retain these skills beyond the project period. Also VHNDs (Village Health and Nutrition Day) are a government priority and group counseling sessions by front line workers form an integral part of the VHND guidelines. Sustainability also refers to retention of behavior change in the target populations. Once the children, pregnancy and lactating women in the community feel the benefits of mother support groups and peer learning, it is likely that knowledge sharing and mutual problem solving through these processes will continue even without external support.

The project will work at a level of critical mass in two districts (Iringa Municipal Council and Kilolo District Council). The project will coordinate closely with other major health and nutrition programs currently rolling out in Iringa, such as the Mwanzo Bora Nutrition Program supported programs, so as to scale up the successful elements of the project model through the state. The project will similarly coordinate with the district administration. The project will create a body of demonstrated evidence and data by the mid term to support the case to the government’s district health societies for project components to be built into the annual district action plans (DAPs) and become eligible for public budget allocation. This will help scale up the activity across the district and sustain funding after project support ends.                                                               

1. Implementation Plan                                                                              

Building on more than five years of programming experience in Iringa region, CCDO will continue to strengthen the accessible, equitable, and enduring health and nutrition care delivery structure it has helped to develop in the proposed project areas. This proposed project will be run through these vital healthcare facilities and linked with intensified community component. CCDO nutrition coordinator will be responsible for ensuring the technical implementation of the project in timeline for activities with national and international standards.

CCDO plan is to address the factors that influence and contribute to high levels of child stunting by deploying well trained trainers of trainees, rural change agents and our recruited qualified staffs including our volunteers from the selected project areas. CCDO will implement the project in collaboration with Iringa Municipal and Kilolo District Councils; we will employ a system where all stakeholders participate in all cycles of project management including project implementation. Community leaders / representatives and government partners will play a major role in implementing project activities. Moreover, CCDO will pursue an integrated strategy whereby the links between nutrition, health, food security, and water and sanitation activities are strengthened to allow programs to have more synergies. CCDO will work closely with the existing health lead agency to integrate the nutrition and primary health care activities and the CCDO food security staff, work closely with the nutrition team and the existing lead mothers for improving nutritional status of 1000 days to pregnancy and lactating women promotion will be revitalized and trained to maximize the project inputs. The following nutrition components that will be implemented in this program will include outpatients therapeutic program (OTP) in all health facilities, health delivery points, lactating mothers, micronutrients supplementation for children, pregnancy and lactating women, growth monitoring and promotion, nutrition education and improving nutritional status of 1000 days to pregnancy and lactating women promotion in all target communities, training of community and facility based health and nutrition health workers. CCDO plan will thus focus on the introduction of improved nutrient dense crop varieties and crop management practices, dietary diversification and promotion of nutrient dense crops (legumes, fruits and vegetables), food preservation, and integration of nutrition interventions on infant and young child feeding and nutrition education and behavior change communication to achieving the MGD 1 and 4. Among the fruits and vegetables which will be introduced are tropical fruits i.e. papaya, mango, pineapple, guava, banana, indigenous fruits such as orange, temperate fruits, peaches, apples, pears, avocado, tree tomato. Vegetables that will be introduced to them include exotic vegetables i.e. tomato, onions, carrots, cabbages, Chinese, peas, mchicha, cucumber, water melon, string less beans, sunflower, oyster mushroom and indigenous tropical vegetables such as Night shades, pumpkin leaves, sweet potato leaves, cassava leaves and local mushrooms.

Table 1: Implementation Plan table

• PROJECT IMPLEMENTATION PLAN:
  

1. Organizational Capacity and Key Personnel                                                               
   

The Children Care Development Organization (CCDO) is a non-governmental Organization registered officially in Tanzania on 13^th April, 2010 with legal registration No.ooNGO/00003818 made under the Non-Governmental Act, 2002 made under section 12 (2) of Act No.24 of 2004. See the attached CCDO registration certificate.

The CCDO has a Bank Account at NMB Mkwawa Bank. This is our currency account. Account name: Children Care Development Organization (CCDO), and Account Number: 60510019932, Swift Code: NMIBTZTZ.

Children Care Development Organization (CCDO) is made up of six people who work full time at the organization, two part time staffs and three volunteers. The organization also have a linkage with different health care institutions, Sokoine Agricultural University, NGOs, FBOs, CBOs and government including other various groups which sometimes help the organization in designing and implementation of various project when it needs help. The database of various experts also helps the organization to get volunteer who could work at cheap fees while providing best knowledge or help which could be needed by the organization.

The structure of the organization is as follows:

                                             Board of Directors      

     Manager                

                                    Social Worker/Field Coordinator

Cooks/ Security personnel            Instructors               field Officers/Volunteers                                                   

                                    Clients: orphans and Caregivers

The CCDO will provide support to technical and management aspects of the project to ensure it is meeting its objectives, is of the highest quality and is in compliance with Mwanzo Bora Nutrition Program requirements. The CCDO will be responsible for overall planning, management, technical oversight and accountability of the project. CCDO management will develop monitoring and evaluation systems and protocols as per Mwanzo Bora Nutrition Program instructions. CCDO will provide directional and technical support through programme personnel such as the Director of Programmes, Senior Programme Officer for Nutrition Health, food security and Programme Officer for Community Health. As generating evidence will be an important project output, a Monitoring and Evaluation Advisor will be hired in this project. CCDO Finance Officer will oversee all grant management and financial accountability and reporting issues to the Project Donor.

CCDO will establish a three member Project Management Unit within this existing office of:

1)      Project Manager: Oversees and directs implementation; accounts for project performance; coordinates all community-level project resources, including implementing strategies, facilitates capacity building; monitoring and evaluation, drives advocacy initiatives at state level; reports to Mwanzo Bora Nutrition Program.

2)      Finance Manager: Establishes and maintains accounting systems and procedures to track and verify all project expenditures; identifies technical assistance and training needs related to accounting and compliance among all partners.

3)      Monitoring &Evaluation Manager: Ensures appropriateness, quality and timeliness of data collection and analysis for management and reporting; collaborates closely with the M&E Advisor.

4)      Communication and Advocacy Manager will design and develop the various communication materials and training aids, conduct training and refresher sessions for CCs, lactating mother’s committee members and government frontline workers, and provide on site technical support to CCs and PEs.

5)      Nutritionist Coordinator: supervising and controlling all related nutrition and counseling lactating mothers development programs, collates data from the field and prepare reports

The project will be implemented in the two districts of Iringa Town and Kilolo districts. CCDO will establish a Project Implementation Team at the community, cluster and district levels in their designated areas to reach up to 125,000 beneficiaries each. The roles and responsibilities of team members are:

1) Peer Educators: Deliver BCC; organize group meetings and home visits.

2) Cluster Coordinators: Train and provide supportive supervision to PEs, facilitate coordination between government frontline workers and PEs; build capacity building of PEs in project interventions.

3) Project Coordinators: Track project progress; liaise and advocate at block level; review reports with MIS Assistant.

4) Administration and Accounts Assistant: Manages project finances, logistics and administration.

5) Project Manager: Provides day-to-day management and technical oversight of the project in partner’s area; reports to Programme Manager; reviews monitoring data and provides technical and financial reports. The Project Implementation Team will be a new project structure at the district level to roll out project interventions. At the community level, two new cadres of PEs and CCs will be introduced as change agents to promote CCDO practices. Project team members will be re-integrated into partner programmes. The Project Implementation Team will be a new project structure at the district level to roll out project interventions. At the community level, two new cadres of PEs and CCs will be introduced as change agents to promote CCDO practices.

Previous donors, name of projects, amount of and contact person for reference

1. Monitoring and Evaluation Plan

An applicant should describe the monitoring and evaluation activities that will be implemented for each project activity. One of the main indicators of interest will be the number of eligible clients who received nutrition services segregated by age and sex. Number of Pregnant / lactating women who received nutrition services. The proposal should be clear on the following:

The project will track activities, output indicators and the three purpose level indicators through routine monitoring. An initial workshop will be held for all implementing stakeholders to develop a monitoring protocol (formats, frequency of reporting, data analysis tools, feedback channels to data generator etc.) as per Mwanzo Bora Nutrition Program format. A part time M&E Advisor will be hired to provide technical expertise and support to the implementing partners in designing the protocols and feedback mechanisms. The records maintained by the PEs on their activities and behaviours of mothers and other caregivers will form the basis of the monitoring data. The importance of compiling honest and clean data in recordkeeping, and understanding the link between activities, outputs and outcomes, as presented in the log frame, will be part of formal training for PEs. PEs’ records will be checked by CCs (Change Agents) for consistency and accuracy, with post-training mentoring provided. CCs will be required to back-check five percent of data as quality control. CCs will be responsible for collecting data from the community and facility level health providers on the mentoring they are receiving from the PEs. CCDO will record advocacy data when such achievements as a per project donor conditions on improving nutritional status of 1000 days to pregnancy and lactating women along Iringa Municipality and Kilolo District Project is released or a workshop by health professional associations is organized.

CCDO will have an MIS (Management Information System) assistant who will enter all the data into a data analysis programme designed centrally by the project team. CCDO programme managers will review this data before transmitting it online to the CCDO data base system and Mwanzo Bora Nutrition Program, where the MIS manager will collate and analyze to generate monthly reports, disaggregated by implementing partners and district. Feedback on progress will be shared in quarterly meetings for cross-learning among implementing partners.

Monitoring data on behaviours of women and caregivers on improving nutritional status of 1000 days to pregnancy and lactating women along Iringa Municipality and Kilolo District practices will be a “self assessment” of the PEs, and therefore has an inherent bias. Also, the source of the data will be only those women that PEs have reached out to. Thus, women, who have not yet been reached out to by the PEs, will not be part of the denominator. Thus, monitoring data trends, while good for programme management purposes, will not give the “real picture”. Coverage rates reflected in the monitoring data will need to be validated by an independent survey.

About 20,000 children under 2 years and 20,000 pregnant / lactating women from Kilolo district and Iringa Municipality will be reached in our proposed activities through our integrated system of traditional monitoring: data collection on inputs, outputs, and outcomes, and community based participatory monitoring mechanisms. Data on number of children and pregnant /lactating women will be collected and reported by sex and age wherever possible. Meetings will be facilitated in a participatory manner to ensure equal voice of all groups, including marginalized and vulnerable populations. Feedback will be both qualitative and quantitative and will include methods such as ranking and scoring matrices. Bi Weekly Reporting and Local Monitoring: CCDO's expatriate nutrition coordinator, in collaboration with other CCDO senior teams, will develop detailed performance monitoring and work plans to be used as key implementation guides by national staff at all CCDO target areas. These plans will form the basis of progress monitoring throughout the program period. Five major parameters will be assed in all monitoring activities including outputs, inputs, whether progress of activities are according to the objectives, decision making processes and context analysis. To clarify, progress towards achieving deliverables and quality of services rendered will be monitored by an expatriate nutrition coordinator via weekly meetings with all local staff, community volunteers and community workers in the CCDO field office at Kilolo and Iringa Municipality, as well as field visits. This is how our data will be verified for better quality. Local staff and community workers will report to the CCDO Nutrition Coordinator who will spend most of her time at Kilolo and Iringa Municipality and the coordination office twice a month to update on activities and address and resolve implementation challenges with the Program Manager based in Iringa Municipality. This is also a methodology that will be building local skills in support of CCDO sustainability and transition strategies.

Therefore, a Program Manager will be responsible for data collection and reporting to the program management and is the one who be responsible for reporting project data to the CCDO Nutrition Project.

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