In Tanzania, millions of people lack access to essential health services. Every year, many people suffer financial catastrophe due to out-of-pocket healthcare expenditures. Seventy per cent of all deaths globally are a result of non-communicable diseases. Out of its population of 65 million people, 58 million people (88% of the population) lack access to safe water, and 49 million people (74%) lack access to a safe toilet. People living under these circumstances, particularly women and girls, spend a significant amount of time traveling long distances to collect water. Many adolescent deaths that occur annually could be prevented. YAWE harnesses its longstanding work and lived experience with communities to optimise health and well-being and allow young people and children to reach their full potential.

Strengthening Health Systems

We strengthen community health systems by providing training, materials and supplies, and community health worker supervision. We support and work with community health workers, and health service providers at the health facility level to cascade health and nutrition action at the community level. We enhance community case management and strengthen community monitoring and referral mechanisms. We help reduce the burden of illness at the community level. We achieve this by promoting positive health, hygiene and nutrition behaviours and practices through behaviour change communication and community engagement. We collaborate with other civil society organisations to promote transparency and accountability for governmental and non-governmental health and nutrition services and programmes.

We improve access to and uptake of facility- and community-based health and nutrition services, by addressing gender, social, cultural and financial barriers to their use. Our targeted investments in healthcare infrastructure and equipment in government and facilities improve the quality of care.

We strive to enable adolescents to navigate a positive pathway from childhood through to adulthood, by reducing risk, promoting resilience and broadening their opportunities. This is a channel for addressing underlying drivers of poor health. It includes reducing the risks of violence, harmful attitudes, norms, behaviours and practices that contribute to gender inequality and infringe upon adolescents’ rights. Maintaining good sexual and reproductive health is essential for overall well-being and quality of life. It involves understanding and practising safe and consensual sexual behaviours, accessing healthcare services when needed, and making informed decisions about contraception and family planning.

At YAWE, we are committed to providing accurate information, resources, and support to empower young people in all aspects of sexual and reproductive health. Promoting safer sexual health behaviours, seeking information on birth control methods, STI prevention, fertility awareness, or sexual wellness, we strive to be a trusted source of knowledge and guidance. Our mission is to promote open and respectful conversations about sexual health, reduce the stigma surrounding reproductive issues, and advocate for comprehensive healthcare services that meet the diverse needs of individuals and communities.

Designed for young men, Program H encourages critical reflection about rigid norms related to manhood and encourages the transformation of stereotypical roles associated with gender. We have adopted the Program HM curriculum and approach and our staff members are trained and certified as trainers to engage with young men showing more gender-equitable attitudes and determined critical factors in helping boys and young men adopt similar attitudes and behaviours. This is an evidence-based group education activity involving role-playing and discussion of important issues to help change attitudes, adjust coping mechanisms, and introduce healthier ways to deal with conflict. We combine with youth-led campaigns to encourage supportive peer groups, engage young people, and reinforce specific social changes in a community.

Adaptations

Although adapted across many settings, schools have long been a central implementation setting for Program H as well as Program M, providing supportive structural environments through which the approach can be scaled up institutionally. We train teachers and community health workers on the Program H and Program M methodologies.

Intergration of Mental Health

Mental health encompasses our emotional, psychological, and social well-being. It affects how we think, feel, and act, influencing how we handle stress, relate to others, and make choices. Mental health is crucial at every stage of life, from childhood and adolescence through adulthood. Good mental health allows us to realize our full potential, cope with the stresses of life, work productively, and contribute meaningfully to our communities. It is essential to recognize that mental health is not just the absence of mental illness but also includes factors like resilience, self-esteem, and the ability to enjoy life. Unfortunately, mental health issues are common and can affect anyone, regardless of age, gender, background, or economic status. These issues can manifest in various forms, such as anxiety disorders, depression, substance abuse, and more severe conditions like schizophrenia.

The good news is that mental health conditions are treatable, and many people recover completely or live well with their conditions with appropriate treatment and support. Seeking help early can make a significant difference in recovery and overall quality of life. At YAWE, we aim to provide resources, information, and support to promote mental well-being, reduce stigma, and encourage conversations about mental health. Our efforts extend beyond physical health to encompass mental resilience, as we offer psychosocial and psychological support that stems from culturally sensitive, sustainable, and evidence-based techniques. Together, we can foster a community that values and prioritizes mental health for everyone.

Children, adolescents, and women bear the triple burden of malnutrition: undernutrition, micronutrient deficiencies, and overweight and obesity. Tanzania is making progress in reducing the prevalence of stunting among children under five and reducing the rate of anaemia in women of reproductive age; however, more action is needed to accelerate progress to reach the SDGs targets. Nearly one-third of children under 5 are stunted, and micronutrient deficiencies remain a public health concern. Overweight and obesity are an emerging problem, especially among adolescent girls and women. The children and adolescents of today will soon become adults in large numbers. Healthy, well-nourished children and adolescents—able to learn, grow, and reach their potential—will enable Tanzania to turn its rapid population growth into a demographic dividend as they engage in the economy of the future and participate meaningfully in society. We address undernutrition by fostering positive nutrition behaviours and practices. These include infant and young child feeding, reducing micronutrient deficiencies through food-based approaches and micronutrient supplementation, and enhancing early identification, treatment and monitoring of stunted, wasted and low birth weight children.

We focus on reducing the likelihood of intergenerational transmission of undernutrition. We improve pre-conceptual health and the nutritional status of adolescent girls, strengthen the health system to better integrate nutrition into ante-natal and postnatal care, and ensure the care and treatment of small and sick babies. We reduce the burden of overweight and obesity by improving access to and use of a diverse array of nutritious foods, encouraging a healthy lifestyle and fostering positive nutrition behaviours and practices. YAWE is committed to addressing the triple burden of malnutrition by strengthening health, education, food, and social protection systems at all levels, with the goal of improving behaviours, increasing access to quality services and promote optimal nutrition, growth, and development practices. YAWE reinforces a multisectoral approach, empowers communities and women, and promotes male involvement. YAWE focuses on maternal and child feeding practices, water, sanitation, early childhood development, and healthcare-seeking behaviours.

Inequities in access to and control of assets have severe consequences for women’s ability to provide food, care, and health and sanitation services to themselves, their husbands, and their children, especially their female children. Women with less influence or power within the household and community will be unable to guarantee fair food distribution within the household. These women will also have less ability to visit health clinics when their infants and children are sick and to spend time interacting with their infants and other children. Any reduction in gender asymmetries benefits the entire family. Substantial evidence demonstrates that more equal access to and control over assets raises agricultural output, increases investment in child education, improves visits to health facilities for infants, raises household food security, and accelerates child growth and development. It also offers important economic payoffs for the entire society. Women’s contribution to food production, food preparation, and child care are critical underpinnings for the social and economic development of communities, yet efforts in this direction are hampered by malnutrition. Furthermore, malnutrition in women contributes significantly to growing rates of maternal deaths and is directly related to faltering nutritional status and growth retardation in children.

Maternal malnutrition has been linked to low birth weight, which in turn results in high infant morbidity and mortality rates, adding to healthcare costs and undermining the human resource potential for an economy. It is also now clear that fetal malnutrition harms health status in later life, and predisposes one to increased incidence of non-communicable diseases. In addition, malnutrition in mothers jeopardizes the quality of caregiving they can offer their children by reducing the meaningful mother-child interaction that is necessary for proper growth. Limiting access to nutritious foods and nutrition education among other issues have debilitating impacts on women and girls’ nutritional status and contribute to poorer health. This threatens women, girls and people of diverse gender identities’ overall well-being and opportunities across their lifetimes, and for the generations that follow. To date, some efforts have been made to “integrate” or “mainstream” gender into nutrition programs, but wide gender disparities persist because these efforts have not addressed the root causes of the problem. It is insufficient, and many times harmful, to seek to improve individual women and girls’ situations without addressing the discriminatory gender norms and unequal power imbalances between women and men that contribute to gender inequality and malnutrition.

An effective response requires that gender equality and the empowerment of women and girls become the central foundation upon which multi-sectoral responses to nutrition are built. Traditional power holders and influencers must be engaged in this process. They are important gender champions. Mobilized as agents of change, working together with women and girls and people of diverse gender identities, they can use their positions of power to shape systems to create a more equitable world for all. Localized, transformational change that is profound and resilient is vital to deep and lasting impact. This demands radical breakthroughs in paradigms, beliefs and behaviour at various levels. We need to think differently so that we can do it differently.

At YAWE, we mainstream gender aspects into our nutrition program adopting a gender-transformative framework for nutrition (GTFN) which is an evidence-based conceptual model that expands the potential of nutrition programs to tackle gender inequalities. The Framework leverages existing literature and theoretical frameworks by applying systems thinking to critically examine the multi-sectoral drivers of malnutrition while placing empowerment and gender equality at its centre. This re-framing helps us understand how gender norms, institutions, and power relations are disempowering women and girls and causing unequal access to food, health and nutrition services, education, agricultural resources, markets, and technologies. In doing so, the Framework uncovers entry points and facilitates solutions that can address the full social complexity of malnutrition. The approaches that flow from this starting point can synchronously build resilience to unanticipated shocks that undermine pathways to improved nutrition and gender equality.

YAWE has learned a great deal about what works in an operational sense to improve the nutrition status of newborns, infants, and children. Until recently, less attention has been devoted to finding operationally effective interventions to improve the nutrition status of adolescent girls and pregnant women. Improving the nutritional status of girls and women hinges on applying the success stories seen so far and improving existing programs to strengthen their potential for success. Micronutrient deficiencies afflicting girls and women can be addressed through balanced and long-term supplementation to build up stores for meeting acute deficiency needs. Gender-sensitive nutrition education is also needed to sustain good dietary practices. It is within the mandate of YAWE to develop a better nutrition intervention toolkit to address the special needs of girls, adolescent females, and pregnant women. These programs need not be expensive; iron supplementation programs for expectant mothers and iodine fortification of salt have worked well in many situations. Iron supplementation could also be used for girls and women of reproductive age as a preventative approach before pregnancy. To accelerate this development, the community needs to build on the experiences of the network of experts and practitioners who work with adolescents in all dimensions of welfare—not necessarily in nutrition—to develop not only effective nutrition interventions, but also feasible delivery mechanisms.

Improvements in the nutrition status of girls, adolescent females, and women make it more likely that the cultural constraints facing women will be relaxed as the advantages of investing in their human capital become apparent. Better-nourished girls are more likely to stay in school and to learn more. They will miss fewer days due to illness and be more attentive when in class. They will grow up to become more productive economically and more aware of the various livelihood options. They will become more empowered to make decisions in all spheres of activity, including parenting. They will have greater control over their sexuality-related choices— crucial for controlling family size and preventing HIV/AIDS. In addition, future generations—male and female—will benefit from such a human capital investment via improvements in nutrition status transmitted throughout the life cycle. Good nutrition in infancy is a necessary condition for the development of human capital. The possession of human capital facilitates access to other types of capital—physical (such as farm equipment), natural (such as land and water rights), financial (such as microfinance services), and social (such as access to community associations). The possession of human capital is crucial for economic development and sustained human development. Incorporating nutrition components into policies and programs to improve women’s status will increase the likelihood that such efforts will reap benefits not only in the medium term but also for the next generation. Increasing the gender-sensitive nutrition content of public policy that seeks to improve the status of women will make such improvements more sustainable.