The below resources are considered useful for implementing partners. Where available, tools are also provided in Swahili.
Overview of stunting reduction toolkit
This document provides an overview of the purpose and contents of the toolkit.
This document provides a complete list of acronyms that you'll find in the toolkit resources.
Collaborating with the government
Before the ASTUTE programme began, many nonprofit nutrition programmes were run parallel to, but separately from, government activities. As a result, programme implementers often failed to communicate regularly and integrate their work plans with government efforts. Furthermore, interventions often ended after donor-funded programming did. To tackle this challenge, UK Aid sponsored the ASTUTE nutrition project which was deliberately co-created with the government and aligned with its Multi-Sectoral Nutrition Action Plan. This document makes recommendations about how to engage the government in activities whose purpose is to reduce stunting in children and to improve women's diets through integrated nutrition activities.
Collaborating effectively with the government
In Tanzania, district-level governance happens through Local Government Authorities (LGAs). These entities were created by Government of Tanzania to decentralise government power. When implemented properly, decentralisation involves more people at the local level in the planning and implementation of development programmes. In this brief, you will 1) learn why it is important to engage Civil Society Organisations (CSOs) in nutrition and the district level, 2) identify key approaches used, 3) describe challenges and solutions to engaging CSOs, and 4) become familiar with additional CSO nutrition tools.
How evidence transformed the design of SBC strategies in Tanzania
Social and Behaviour Change (SBC) programmes are most successful when they marry a thorough understanding of local context with a knowledge of the epidemiology of poor health as well as state-of-the-art programmes that have improved nutrition both inside and outside of Tanzania. This brief describes the evidence-based approach ASTUTE used to design its programmes.
TO UPLOAD: How evidence transformed the design of SBC strategies in Tanzania
This document—developed at the inception of the ASTUTE programme—outlines ASTUTE’s overall strategies at the national, regional, LGA, and community levels to make it innovative, unique, and effective. This document includes a short description of the tools presented in this kit, designed to improve the uptake of behaviours known to reduce stunting and improve maternal nutrition.
ASTUTE's approach to SBC
This toolkit includes a number of resources that when used properly will improve health behaviours known to positively impact maternal and child nutrition. As part of ASTUTE, Community Health Workers (CHWs) conduct home visits using a proven strategy known as negotiating for behaviour change. Details of this strategy can be found in the USAID-funded manual Make Me a Change Agent (included here for easy reference; see lesson 3 of the manual). One reason for ASTUTE’s success is a focus on small, do-able actions (SDAs). SDAs are behaviours that CHWs (and CSO volunteers) promote and that household members can easily try because the practices themselves are not complex. When considered collectively, SDAs add up to large changes in health behaviours and outcomes.
This is a USAID-funded manual for front-line health workers that provides training curricula for many SBC activities, including negotiated behaviour change. Make Me a Change Agent manuals are also available for agriculture and WASH. Lesson 3 contains information about negotiated behaviour change.
Make Me a Change Agent
Personalised Support Groups for Action
A number of implementing partners - including the Government, international NGOs, and CSOs - use support groups regularly. However, when done poorly, they are often simply vehicles for sharing messages. In Tanzania, support groups may fail to respond to the needs of the community and are not tailored to group members. They are often used to tell group members what they “have to do,” and don’t commit support group members to adopting healthy practices. As part of the ASTUTE project, PANITA worked with 50 CSOs to strengthen their capacity in the management of support groups. In Geita region and elsewhere, PANITA piloted the use of Personalised Support Groups for Action. This document outlines the steps to conducting personalised support groups for action—including “teach back” and commitment.
This is a step-by-step outline for conducting personalised groups for action.
This short, ready-to-use training module shows how to conduct training for personalised support groups for action. The module is for on-the-job training of CSO staff.
Here you will find a tool developed by Development Media International (DMI) that provides guidelines on developing a mass media campaign:
Here you will find a sample of radio spots DMI created for ASTUTE. Radio spots are aired over two-week time periods across much of northwestern Tanzania and the Southern Highlands. They are played on average 10 times a day.
You will also find a sample of TV spots DMI developed to reach ASTUTE’s target population, which increasingly uses TV as a form of entertainment and news.
Positive Deviance/Hearth (PDH) is an assets-based strategy for improving nutrition and related behaviours. It requires community mobilisation and includes 1) identifying positive deviants (at-risk, poverty-stricken families) whose children are well-nourished 2) learning from them 3) encouraging parents of underweight children to adopt the same practices using hearth sessions, and 4) following up with families in their homes to make sure that they are able to maintain the positive deviant practices they learned about during hearth sessions. This document shares lessons learnt and recommendations for the government and others who implement PDH.
PDH for stunting reduction
CHWs and home visits
This document is a job description for CHW supervisors. In initial trainings for CHWs and their supervisors, these roles and responsibilities should be spelled out first so that supervisors understand how their day-to-day activities align with their overall roles and responsibilities.
This document summarizes CHWs’ roles and responsibilities. In initial trainings for CHWs, these roles and responsibilities should be spelled out first so that CHWs understand how their day-to-day activities align with Management their overall roles and responsibilities.
This document is a checklist CHW supervisors can use to ensure that CHWs are implementing high quality home visits.
Strengthening government capacity
District Nutrition Officers (DNuOs) are a key component of the Government of Tanzania’s efforts to improve nutrition. In addition to DNuOs, ASTUTE’s organisational structure also includes CHW supervisors who are able to more efficiently supervise CHWs, given their larger numbers. Under ASTUTE, DNuOs meet monthly with all CHW supervisors and in turn, CHW supervisors meet on a monthly basis with CHWs. This document contains guidance for the DNuO on what he or she should discuss with CHW supervisors during the meeting including classroom-based and community-based skills building in negotiation.
Monthly meetings are the primary means of strengthening CHW capacity in behaviour change. This document contains guidance for the CHW supervisor on what he or she should discuss with CHWs during their meetings, including classroom and community-based skills building in negotiation. The guidance includes topics that must be discussed every month as well as subjects that can be discussed less frequently.
CSOs and personalised support groups for action
This document summarizes roles and responsibilities for CSO volunteers. In initial trainings for CSO volunteers, these roles and responsibilities should be spelled out first so that volunteers understand how their day-to-day activities align with overall roles and responsibilities.
This checklist is for CSO staff and is to be used when they observe CSOs while conducting personalized support groups for action. There is a checklist for the support groups as a whole as well as checklists for nutrition, early childhood development, WASH, and the health of the mother.
This document lists operations research presentations, publications, manuals, and other documents Cornell University produced under the ASTUTE project. It also lists presentations and publications produced as part of a joint collaboration between ASTUTE and Brigham Young University. Many of these papers and presentations used ASTUTE’s baseline and mid-line data.
Operations research to improve programmes
This document describes the operations research designed and conducted by Cornell University, in collaboration with IMA World Health and the Tanzania Food and Nutrition Centre (TFNC), to strengthen ASTUTE intervention efforts through exploration of attitudes and conditions around infant and young child feeding (IYCF) behaviours and local capacity to deliver quality and effective interventions.
Operations research update
Fixed obligation grants for government accountability
Fixed obligation grants (FOGs) are used to support specific development activities where both the grant donor and recipient understand the costs required to meet certain deliverables and carry out specific activities. IMA provides FOGs to regional and district government to enable the government to plan its nutrition activities and practise allocating these funds. Using FOGs promotes ownership and buy-in from the government at all levels and increases the likelihood that the government will own and sustain stunting reduction activities following the project’s end. This document describes strategies ASTUTE has used to successfully implement FOGs, as well as lessons learnt and recommendations.
This template provides an easy-to-follow approach to monitor FOGs, by milestone. It also allows for comment on progress for each deliverable.
This is an easy-to-use form that LGA government authorities use to report on their activities on a regular basis. This report replaces the need for lengthy narratives and increases the chance that LGAs will complete the forms in a timely fashion.
This document contains guidance on how to write a field-based success story as part of a communications package.
This document provides an example of what a FOG agreement might look like:
Example FOG agreement
This document provides 1) a rationale for more fully including the disabled in nutrition programmes 2) a summary of what Tanzanian law says about working with disabled populations 3) guidance for programme implementers, and 4) links to additional resources.
Accounting for disabilities in stunting programmes