دانلود رایگان ترجمه مقاله برنامه ریزی و بودجه برنامه های تغذیه ای در تانزانیا (نشریه Ijhpm 2015)

برنامه ریزی و بودجه بندی برای برنامه های تغذیه ای در تانزانیا: درس هایی از برنامه ملی مکمل ویتامین A

Planning and Budgeting for Nutrition Programs in Tanzania: Lessons Learned From the National Vitamin A Supplementation Program

Abstract

Background: Micronutrient deficiency in Tanzania is a significant public health problem, with vitamin A deficiency (VAD) affecting 34% of children aged 6 to 59 months. Since 2007, development partners have worked closely to advocate for the inclusion of twice-yearly vitamin A supplementation and deworming (VASD) activities with budgets at the subnational level, where funding and implementation occur. As part of the advocacy work, a VASD planning and budgeting tool (PBT) was developed and is used by district officials to justify allocation of funds. Helen Keller International (HKI) and the Tanzania Food and Nutrition Centre (TFNC) conduct reviews of VASD funds and health budgets annually in all districts to monitor the impact of advocacy efforts. This paper presents the findings of the fiscal year (FY) 2010 district budget annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in FY 2010? (2) how many funds were allocated specifically to twice-yearly VASD activities in FY 2010? and (3) how have VASD funding allocations changed over time?

Methods: Budgets from all 133 districts in Tanzania were accessed, reviewed and documented to identify line item funds allocated for VASD and other nutrition activities in FY 2010. Retrospective data from prior annual reviews for VASD were used to track trends in funding. The data were collected using specific data forms and then transcribed into an excel spreadsheet for analysis.

Results: The total funds allocated in Tanzania’s districts in FY 2010 amounted to US$1.4 million of which 92% were for VASD. Allocations for VASD increased from US$0.387 million to US$1.3 million between FY 2005 and FY 2010. Twelve different nutrition activities were identified in budgets across the 133 districts. Despite the increased trend, the percentage of districts allocating sufficient funds to implement VAS (as defined by cost per child) was just 21%.

Discussion: District-driven VAS funding in Tanzania continues to be allocated by districts consistently, although adequacy of funding is a concern. However, regular administrative data point to fairly high and consistent coverage rates for VAS across the country (over 80% over the last 10 years). Although this analysis may have omitted some nutrition-specific funding not identified in district budget data, it represents a reliable reflection of the nutrition funding landscape in FY 2010. For this year, total district nutrition allocations add up to only 2% of the amount needed to implement nutrition services at scale according to Tanzania’s National Nutrition Strategy Implementation Plan.

Conclusion: VASD advocacy and planning support at the district level has succeeded in ensuring district allocations for the program. To promote sustainable implementation of other nutrition interventions in Tanzania, more funds must be allocated and guidance must be accompanied by tools that enable planning and budgeting at the district level.

Methods

Data Collection It is recognised that according to the Lancet series,4 nutritionspecific activities are defined as interventions that address the immediate causes of malnutrition related to food intake, care practice, and disease. For the purpose of this review, these activities were defined as any fortification, supplementation, dietary/nutrition counselling or education activities, the treatment of malnutrition, and finally any other activities where the words ‘nutrition’ or ‘food’ were indicated.

Two trained VASD nutritionists were oriented on the methods for this review and then reviewed the CCHPs over the course of 2 weeks in October 2011. Two official final copies of all CCHPs from mainland Tanzania exist: one is stored in the offices of the Prime Minister Office Regional Administrative and Local Government (PMO-RALG) in Dodoma, Tanzania and the second is with the Ministry of Health and Social Welfare (MoHSW) in Dar es Salaam, Tanzania. As is done annually, permission to review one copy of the official CCHP from all districts (n=133) was obtained by the PMORALG office and copies were reviewed in situ at one of the two locations. Budget allocations were reviewed line by line and all identified activities and their allocated budget were recorded on a standardized data collection form. Visits were made to both offices since a complete set of CCHPs from each district was not found in either location alone. The CCHPs for each district reviewed were from FY 2010. Data from prior reviews (annually since FY 2005) were used for comparison and trend data. CCHP documents from all 133 mainland Tanzania districts were found and reviewed.

Data collected on integrated larger programs with nutrition subcomponents were not included in this analysis, unless there was a specific line item for a nutrition subcomponent, since it was not possible to determine the specific funding amount for nutrition. For example, although home-based care and prevention of mother to child transmission (PMTCT) programs have known but not quantifiable nutrition subcomponents, they were not included in this analysis.