2019 Tanzania: Evaluation of training program for nutrition officers

EXECUTIVE SUMMARY

Object of the Evaluation

This report is an endline evaluation of the In-service Training (IST) programme for Nutrition Officers (NuOs) in Tanzania. The IST follows the establishment of a Scheme of Service and Job Descriptions for a new cadre of nutritionists in 2009 by the Government of Tanzania (GoT) under the Ministry of Health Community Development Gender Elderly and Children (MoHCDGEC). Subsequently new graduates from institutions offering a basic degree in nutrition and related subjects were deployed as nutrition officers (NuOs) at the Regional and District levels. Their main role was to provide coordination, planning and budgeting, programme management, and monitoring and evaluation of nutrition services within their respective regions/ districts of operation. It was then realised that the newly graduated nutritionists lacked the requisite coordination and management capacities and skills to advocate for prioritization of nutrition activities and allocation of funds by Regional and District Council Management teams. Efforts were inevitably required to close this gap and the Prime Minister’s Office (PMO) made a call for efforts to train and empower the NuOs in post to enhance their expertise and performance. This was also intended to enhance the implementation of the National Nutrition Strategy. UNICEF responded by providing support in the development and implementation of the first national IST programme for regional and district nutrition officers (RNuOs and DNuOs) between 2012 and 2016.

Goal, objectives and expected outputs of the IST

The overall goal of the first IST for NUOs was to equip them with knowledge, skills, and capacity to manage and provide oversight for scaling-up nutrition activities at district, regional and national levels.

The specific objectives of the training were for the participants to be able to:

1. Articulate the nutrition situation in Tanzania/their geographical areas.
2. Integrate national nutrition strategy into district plans, budgeting and procurement.
3. Monitor the nutrition situation.
4. Mobilize resource, advocate and build capacity of nutrition frontline workers in their area of jurisdiction.

The expected outputs of the IST were three, namely: Output 1: Training programme for regional and district nutrition officers designed, and training packages developed; Output 2: Regional and district nutrition officers in all regions have completed the training course; and Output 3: Planning and budgeting guidelines and tools on nutrition rolled out to respective districts in all regions of Tanzania mainland for preparation of plans and budgets.

Structure and institutional organization of the the IST programme

The IST programme was implemented through a series of well researched steps for an effective IST programme consisting of: 1) a Training Needs Assessment (TNA); 2) development of theory-based IST Strategic Plan; 3) development of syllabus and training materials; 4) implementation of the training intervention; and 5) carrying out an end-line evaluation.

The TFNC was the main custodian of the IST programme and supported its development, roll-out in regions, quality assurance, mentoring and coaching. UNICEF provided technical advice in the design and delivery of the IST. Irish AID provided UNICEF a grant amounting to USD 874,811. SUA was contracted by UNICEF to conduct a TNA, develop a Training Strategy and Costed Implementation Plan 2013- 2017, prepare a Syllabus and Training Materials and deliver the (ToT). The government, through ministerial nutrition-related departments and Civil Society Organizations (CSOs) participated in the validation of the training curriculum and modules.

The roll-out of the training courses covered all the 25 regions of mainland Tanzania and 5 regions in Zanzibar. A zonal approach was used, comprised of five zones namely Lake zone, Southern zone (Lindi, Mtwara & Ruvuma), Eastern zone, (DSM, Pwani, Morogoro, Tanga & Zanzibar) Southern high lands (Iringa, Njombe, Mbeya, Rukwa & Katavi) Northern zone (Arusha, Manyara, Kilimanjaro), Central zone (Dodoma, Singida, Simiyu & Shinyanga).

Purpose and Scope of the Evaluation

UNICEF commissioned the end line evaluation which covered the period from mid2012 to 2016 and whose main purposes were firstly, to assess the contribution of the first IST programme in enhancing the capacity of NuOs to coordinate, plan and budget, manage programmes, monitor and evaluate the delivery of nutrition services and secondly, to assess the need for scaling-up IST activities among nutrition officers. The study was jointly conducted by two institutions, namely JIMAT Development Consultants of Zimbabwe and the Nutrition, Health and Sustainable Development Centre (NUDEC) of Tanzania.

Approach and Methodology

The evaluation approach was a cross-sectional study that used a mixed method design to collect both quantitative and qualitative data from March 2018 to June 2018 and adhered to the UNICEF-Adapted United Nations Evaluation Group (UNEG) Evaluation Reports Standards and key evaluation criteria of relevance, efficiency, effectiveness, impact and sustainability. A minimum sample size of 85 nutrition officers was estimated to be adequate at 95 percent confidence level and 5.8 percent precision while a combination of multi-stage, stratified random sampling and purposive sampling was utilised. The primary study population for the quantitative component comprised of 78 regional and district nutrition officers largely due to movement of some of the trainees from original duty stations which made it difficult for the evaluation team to locate them. The relocation was not systematically recorded by the health service. The sample size difference of 7 was not significant to change the findings and conclusions of the evaluation. The qualitative component included interviews with key informants comprised of policy makers, facilitators of Training of Trainers (ToT), the Trainers, supervisors/managers, United Nations Organizations; Donors, CSOs and Ward level nutrition related extension workers. Data entry, cleaning and analysis was conducted through use of Microsoft Excel and Census and Surveys Program (CSPRo) as well as the Statistical Package for Social Science (SPSS).