Tanzania's Cash Plus Nutrition Program, with Jennifer Matafu of UNICEF

Last spring, our cohost, Dr. Tia Palermo, had the opportunity to travel to Tanzania and speak with Jennifer Matafu of UNICEF about a social protection intervention aimed to improve children's nutrition. In this episode, we dive deep into the value of programs such as UNICEF's Productive Social Safety Net (PSSN) and learn why models such as these could be critical in eradicating poverty.

Jennifer Matafu has extensive experience working in the social-economic development sector. At UNICEF Tanzania, where she has worked for 5 years, she is leading the policy dialogue, advocacy and programming related to social protection. Prior to that, she worked with the Embassy of Sweden/Swedish International Development Agency Sida in Tanzania for 20 years, where she managed programs in the areas of social protection, local governance, democratic governance, public sector reform programs, and land governance tenure and natural resource management. She has led and coordinated policy dialogue both at national and community levels.

Resources:
Tanzania: Joint Programme to Support Tanzania’s Productive Social Safety Net

Credits:
Host/Writer: Tia Palermo, PhD
Guest: Jennifer Matafu, MA
Production Assistant: Sarah Robinson
Video/Audio Editor: Omar Brown
Theme Music: Sungmin Shin, DMA
Faculty Consultant: Nicole Klem, MS, RD

Intro 0:00
Welcome to Buffalo HealthCast, the official podcast at the University of Buffalo's School of Public Health and Health Professions. We are your cohosts, Schuyler Lawson and Tia Palermo. In this podcast, we cover topics related to health equity in Buffalo, around the US, and globally. This season we'll be talking about nutrition from a health equity perspective. You'll hear from community members, practitioners, researchers, students, and faculty on topics related to nutrition, including food security, food access, social protection to improve nutrition outcomes, food apartheid, culturally tailored nutrition interventions, and more in this season of Buffalo HealthCast.

Tia Palermo 0:39
Hello and welcome to this episode of Buffalo HealthCast. I'm your cohost, Tia Palermo. Today I'm going to be talking to Jennifer Matafu, who is a Social Protection Specialist at the United Nations Children's Fund for UNICEF, Tanzania. Jennifer is going to be talking to us today about social protection, which is a set of policies and programs aimed at preventing or protecting all people against poverty, vulnerability, and social exclusion throughout their life course with a particular emphasis towards vulnerable groups. Can you tell our listeners a little bit about the work you do for UNICEF?

Jennifer Matafu 1:30
Okay, my name is Jennifer Matafu. I'm a Social Protection Specialist working in social protection. Social protection is about working for the most vulnerable people who are at risk and the people also who are living in very severe conditions. So my work is much more social protection, in terms of helping people in different programming or helping the government through policy or helping the government through developing systems to support the most vulnerable people in our country.

Tia Palermo 2:09
And the Tanzanian's Productive Social Safety Net, or the PSSN, is one type of social protection program. It covers 1 million households in Tanzania. Can you tell us a little bit about the PSSN?

Jennifer Matafu 2:24
Yes, PSSN is Productive Social Safety Net - it's one of the social safety net programs. It covers about 1.3 million households in Tanzania. In Tanzania is the union government, comprised of Tanzania mainland and Tanzania Zanzibar, so we usually call it Mainland and Zanzibar, and it is providing cash transfer to the most poor people household in the country. PSSN provides cash transfer in three forms. One is for income and consumption and to ensure also children go to school, and those who have under five children are taken to clinic. But at the same time the PSSN provides a livelihood component, which provides an additional skill enhancement for the poor families to be able to come together that as a saving group, to save and get some credit to be able to improve their livelihood. And lastly, the PSSN program provides also an opportunity to get extra cash by doing public works, especially during the dry season when most of the people who are in the rural areas, it's not raining and they do not - they don't have an opportunity to earn or get food. So they do some public works like building some roads, improving roads, building some school facilities, and they get paid. And that money helps them again to be able to consume some food and also for the basic necessity for their household.

Tia Palermo 4:12
So this is a very large anti poverty program in Tanzania targeting the extreme poor and providing them with monthly assistance through cash payments and public works and savings groups as you mentioned. Given that the PSSN is run by government, what is UNICEF's role in supporting the PSSN?

Jennifer Matafu 4:34
UNICEF's key role is helping the government/national level put the policy and legislation in place to be able to have some kind of safety net to support poor people who are extremely poor. 2) UNICEF has the role for children. UNICEF has the mandate to support all intervention supporting children, and in the PSSN program, most of the household, half of the people who are covered, usually called beneficiaries, half of them, about 2.3 million, are children from under 5 up to 18 years old. So UNICEF's role, because given its global mandate, is to ensure that these children are able to get proper nutritious food - by the cash that they're given, they provide nutritious food. 2) They go to school. 3) Some of those who cannot go to school are supported with some sort of skill and has been or encouraged to continue school in different level. So UNICEF's role really supports the children, but also looking at the poverty level at the community level, to be able to support them today so that they can have enhanced or improved life, and somehow get through the poverty cycle, which is always an issue for the people who are very poor.

Tia Palermo 4:34
Thank you. Can you tell us if there have been any research studies evaluating the effectiveness of the PSSN and what these have found?

Jennifer Matafu 6:17
Yes, there have been. PSSN program has gone through Phase One. And Phase One of the program, which was like 3-4 years ago, there was an impact evaluation and key findings or recommendation coming from the impact evaluations, the cash which was provided to the household enabled a lot of children to go to school, enabled for families to be able to buy uniforms, and school supplies for their children to go to school, and also enabled especially women or pregnant mothers to attend health clinic. The taxed provision of cash transfer, which they did not have, was some sort of an accelerator to support them to reach out for the basic social facilities, education, or health. But also, the impact evaluation study shows that there is some sort of progress in terms of families, improvement of family household. Some few families who are able to get through the saving groups, which I mentioned before, to get some credit, and sort of start a business, small business, not a big business, small business, like a farming or poultry, or a small shop. And they have been able to improve the income, the city income in their family. So that impact studies, it sort of shows that there's no negative impact in providing cash to poor families.

Tia Palermo 7:54
Thank you. So even though this might not seem like a lot of money to some of our listeners here, this is about a maximum annual benefit cash transfer that we're talking about in Phase One - about $195, which comes out to about, you know, a maximum of $15 or $16 a month, but what you're telling us is that for extremely poor families, this is making a big difference in their lives. Is that right?

Jennifer Matafu 8:25
Yes, right. Because most of the families who were part of the program, before the program, there was an assessment, and most of them they didn't have, they only had one meal a day. So now most families are either having two meals a day, or they're having three meals a day, depending on each family - it's a little bit subjective. $16 for a lot of people who would think it's not possible to make a difference. But for the people who are extremely poor, having a second meal is is an improvement, a huge improvement. Without that, most of them, they go back to having either one meal, or having no meal at all. Cash transfer - global evidence has shown that it can improve family's consumption, and it can improve family's livelihoods to make a family better, because now you're just finding them an opportunity to be able to do something which initially they did not have.

Tia Palermo 9:29
Right, thank you. So you've talked a lot about hunger and meals and being able to afford more meals per day. Can you give us a little bit of a background about children's nutrition in Tanzania?

Jennifer Matafu 9:44
Malnutrition and stunting is a big problem in Tanzania. And we know that nutrition is somehow related to poverty because people don't have money and then the consumption of food, they don't have a choice. They eat what they have. So by being provided with the cash, the bimonthly cash, then now they can have a choice to choose nutritious food, the second meal. So, from the problem itself, most of the poor families, now that they have the opportunity to have two or three meals, then there is a demand or the need to sort of help them make the best selection in terms of nutrition to choose the nutritious food for their babies. Also for their children, for the whole family. The statistic in Tanzania, stunting or malnutrition is 34%. And that's huge. And the more poor the people are the more likely to have been affected by malnutrition or stunting factors. We have under 5 or pregnant mothers - to be able to support them with different knowledge in terms of what kind of food and what are the key issues of having a healthy baby, and nutrition plays a key factors in terms of supporting these - supporting the poor families, because cash itself is not enough, but also they need knowledge. Most of the time, they do not have the key factors in terms of improving their nutrition. They're often not aware there is something, so those are the kinds of issues that you need to go another level to support these families.

Tia Palermo 11:40
Wow, that's a really powerful statistic, the fact that one in three children under the age of five are stunted. So this is a key sign of chronic malnutrition. And it's a really serious concern because malnutrition can impair cognitive development and stunt growth. And it can also really contribute to this intergenerational persistence of poverty. You mentioned babies, and I think it's important to know that a lot of stunting is determined in those first 1000 days of life between conception and age two. So you have been working quite a bit with a new program, a cash plus program for nutrition targeted to PSSN households. Can you tell us what this is called, and a little bit about this program?

Jennifer Matafu 12:35
Yes, so we did a pilot program called Nourishing Life, or Stawisha Maisha. And the pilot was done in two areas, one in the Mainland in an area called Mbeya District, and then one in Zanzibar. That's another area. And the main objective is to promote and improve the infant and children feeding practices. And we were able to, during the course of one year, to get some key findings, and one of the findings that we noted in the end of project evaluation, the increased knowledge in terms of the choice of food feeding practices, for most of these familes, like you said, 1000 days of breastfeeding - most of the people of this household didn't know that you have to breastfeed your baby for the next six months without any additional water or additional food. So that was well received. And also another thing with a very positive outcome during the pilot is that most of these people, especially mothers, they're illiterate. Most of them haven't gone to school, and they have less knowledge of basic issues, which maybe we take it for granted. So during the course of this pilot, we thought we saw that there was also a very good appetite for knowledge. And we saw also confidence increasing between the women groups. And also we saw that also men are interested to be good parents, taking care and ensure that nutrition foods will sort of be a part of their meal in the household.

Jennifer Matafu 12:35
And I understand it's a story about a woman in the community. Can you tell us a little bit about what Stawisha Maisha is and how it's delivered?

Jennifer Matafu 14:41
Yes, Stawisha Maisha, we call it, it's a peer group where you have a group of 12 to 15 women or caregivers who are part of the PSSN program. They come together, and then they have some different edutainment or different activities towards learning on the infant and young children feeding. One key activity was having this comic lady who her name was B. Stawisha, and she was part of the story whereby as a very key person in terms of educating, informing what kind of food she'd provide in her household, and what she had made a difference in terms of having her grandchildren with better meals. And also she has been a key player in the community in terms of providing some information about the choice of food they should have. So this was basically a storytelling, and everybody because it's a storytelling and there was some drama, the names of different actors, players within that community. Then it became very interesting for the group to sort of follow, and this was one of the activities, which was very well received. And everybody now, they tend to talk of B. Stawisha, and some of the names of the children, the grandchildren and some of the names within the community. The key issue is that she was, in terms of providing the right information, why you should eat eggs, why you should fully breastfeed for six months and additional food after six months. So that in itself, being given in a very comic way, and in a storytelling way is very important, especially for people who are illiterate, who cannot read, and they cannot write. So the visual and storytelling became very interesting, and most of them now, if you go to those areas, they could remember the story.

Tia Palermo 17:01
That's really interesting. So for some of our listeners who aren't familiar with the term edutainment, it's basically an entertaining way to educate people. And it's part of one strategy for broader communication for development. And as you mentioned, it seems like it's been very successful for populations that maybe don't have very high literacy levels. And they're also having fun with it, it sounds like she's a comic character. And it gives chances for people to kind of get together and have fun, but also learning. So what is UNICEF and government hoping that Stawisha Maisha will achieve?

Jennifer Matafu 17:42
Like I said, the end of the project review sort of recommended that it should scale up to the whole program area and all program areas, the whole country, of course, including both Mainland and Zanzibar. The aim is really to support the factor that, like you said, that if the child in the 1000 days missed basic nutrients, doesn't get breastfed, then the cognitive issues can be permanent, you cannot repair that. So we have an audience of the very poor, and we have like 300,000 children in the program under five. And if we can be able to reach them with the right messages. And in terms of comic, in terms of using different methodology like radio, I think we would contribute in a better way to minimize the kind of factors of malnutrition in these areas. And if also at the same time, is unintended positive effects, we can empower women in these areas, the whole country and the poor families, to bring more self efficacy/confidence into themselves to participate more. Activating the villages, calling social communities, I think that will be another level of of achieving some good results and for helping poor families not just be dependent, but also to take action in terms of the political economy in the area and also in terms of improving their own livelihood in their household. So the intention really is to reach out all the children in this program under five with their families and their caregivers with the right messages so that they can benefit from these messages and in a way contribute in reducing those cases of malnutrition. I think that would be a very good result for UNICEF.

Tia Palermo 19:51
And you mentioned scaling up, so if I understand correctly, you had facilitators go into the villages to help deliver these messages when you did the pilot in Mbeya, in an area of Zanzibar. As this program is being scaled up to other parts of Tanzania, how is the delivery method changing?

Jennifer Matafu 20:15
We are thinking, we learned one key lesson that most of the community is illiterate - they can't read and write. What will happen is, again, we'll continue the formation of the groups at the community level, and then we'll use radios as the methodology of delivering the storytelling, some of the messages to the groups. The groups will convene, and then they will have a radio program, at a specific time they'll play the program, and they will listen. And they will have some kind of discussion activities too, so that they can understand the messages being casted for them. They will also have that opportunity to influence the behavior of nutrition. How they, in terms of nutrition, infant and child feeding, the breastfeeding case. And also, if we can also create that social network within this poor community, to enable them to move, to be more engaged in community issues that will really be one call of UNICEF in terms of outreach, but then it's not about UNICEF, it's about helping the government, for them to be able to address the developmental issues and results they want to achieve within the social protection and nutrition because then they are complementing each other. But radio is going to be the mode of methodology in that community level. Groups will still remain as a medium so that there can be the interaction and discussion and also show social networking.

Tia Palermo 22:04
When I hear you talk about this fascinating program, some of the themes that really stand out to me are how you and your colleagues have been learning and really interested in finding out what works and how and kind of really taking up that evidence in your next steps. And also how not only the learning and the evidence uptake, but also how you are looking to scale this program up and make it more sustainable. And what type of delivery modes can make it sustainable. I'm wondering if you have plans for more learning and evidence generation as you scale this up further?

Jennifer Matafu 22:42
Yes. Out of the social protections, collecting evidence and data so that the lesson can be sort of disseminated/shared. And also they can influence policy and implementation in different levels. Yes, there's going to be monitoring - an evaluation component like this, given the scale, I think our country is going to be one of the few countries which we are scaling up in the whole country, not just in areas. So the evidence and data and lessons, which are going to be learned during the course of implementation are key, we have set aside specific evaluation on collecting the data during the implementation costs, because that can sort of help in so many level, not just in terms of the high institutional learning, but in terms of policy, and also government's strategic approach in terms of nutrition or mostly in other classes within the poor communities which are involved in the social safety network program. This is, I think, it's key. Otherwise, it would be such a waste if we just scale up and then you don't bring the lessons back to the policy level.

Tia Palermo 24:10
It's really exciting to hear the dedication that your team has to evidence and learning and improving these programs. It's been so interesting to hear you talk about this today. Stawisha Maisha sounds like such an important and needed program that can really have a big effect on families in Tanzania, especially those who are most vulnerable to poverty and malnutrition. I've really appreciated you sharing your time and your expertise to talk to us today. Is there anything else you'd like to share with me and our listeners here at Buffalo HealthCast before we close?

Jennifer Matafu 24:50
Just to emphasize that Stawisha Maisha is a social-behavioral change initiative and behavior is the key objective or term - changing behavior, influencing behavior is really key in terms of the whole implementation, just not supply of delivery, implementation. But behavior change will take a while. But I think that is one of the objectives of sort of scaling up to support and help influence both behavior at community household level, and also bring those lessons at national level, I think that would be a huge, big results, both to TASAF organization. TASAF is the government agency which is implementing the social safety network PSSN. And we are supporting TASAF to be able to bring these results at the national or even regional level. So it's helping out UNICEF by supporting the government to be able to implement in an effective manner.

Tia Palermo 26:08
Well, it sounds like you and your partners in government have your work cut out for you. But it sounds like you're also really passionate about this, and also taking into account learning and evidence and trying to make this program better and scale it up so it can help even more families. So, again, here at Buffalo HealthCast, we really appreciate you taking the time to talk to us today. This has been a really exciting conversation. And we just want to thank you. Thank you so much for being with us today.

Jennifer Matafu 26:40
Thank you, Tia. It was good talking to you.

Outro 26:44
This has been another episode of Buffalo HealthCast. Thank you to our guest, Jennifer Matafu, for taking the time to speak with us today. Nicole Klem is our Faculty Consultant. Sarah Robinson is our Production Assistant. Omar Brown is our Sound Editor. And our theme music was written and recorded by Sungmin Shin of the UB Music Department. My name is Tia Palermo, your cohost and writer for this week's episode. Thank you for listening and tune in next time to learn more about health equity in Buffalo, the US, and around the globe.

Buffalo HealthCast

Tanzania's Cash Plus Nutrition Program, with Jennifer Matafu of UNICEF

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