This condensed version of field research in Tanzania focuses on the school and health clinic educational approaches to increase fruit and vegetable consumption. Access the full report to learn more about the research, projects, and recommendations.
Spreading Knowledge through Schools
When entering the courtyard at the Engosengiu primary school in Arusha, Tanzania, the vibrant green leaves of amaranth and spinach immediately stand out. Three long rows of vegetable plots encompass the dirt pathways that connect the school buildings.
Engosengiu is one of the 53 schools in northern Tanzania that has a nutrition and garden club through the co-funded Dutch Ministry of Foreign Affairs Vegetables for All project. Multiple layers of trainings occur to reach the students—organized by the Global Alliance for Improved Nutrition, Tanzania Horticulture Association, and Wageningen University and Research. Eleven local nongovernmental organizations train the school teachers in how to conduct the nutrition and garden clubs.
School gardens are a common nutrition intervention throughout the world. They are an attractive multisectoral method that crosses agriculture, education, health, and nutrition. The gardens in Tanzania are unique because of the pairing of preparation and cooking education with health and nutrition literacy and garden management. Tanzania’s school nutrition and garden clubs are an effective bottom-up, community-integrated approach to tackle malnutrition.
Listen to how children learn about vegetables:
Teachers educate students about nutrition in the classroom through interactive lessons, such as songs about the significance of vitamins. The knowledge is practical and wide-ranging, but there is focus on the health benefits of vegetables, and for good reason.
Fruits and vegetables are among the few food groups that are beneficial for all. They provide necessary vitamins and minerals throughout the lifecycle, like vitamin A, iron, zinc, and folate. These nutrients are imperative during times of growth, such as the first 1,000 days of life from pregnancy to age two and adolescence.
These lessons are particularly vital in Tanzania. The indiscriminate, negative health outcomes of malnutrition deeply affect the prosperity of the country. Starchy staples like cereal make up 70 percent of Tanzanian diets, making fruit and vegetable consumption low.¹ In the southeastern regions of Tanzania, a staggering 82 percent of people did not meet the recommended intake for fruits and vegetables of five portions per day.² And the daily recommendations only were met by 22 percent of Tanzanian adolescents, a crucial time in life for optimal nutrition.³ An estimated 3.9 million deaths globally were attributed to inadequate fruit and vegetable intake in 2017.⁴
Thanks to lessons like the ones Engosengiu primary school provides, children are receiving the tools to take charge of their own diets. These lessons motivate and excite the students, who then apply the learning outside in the garden.
The garden itself is a small business. Teachers provide seeds and the children bring water from home. The students—ranging from 10 to 12 years—manage the garden and sell the vegetables to teachers. The profits then return to the garden.
Because of their elevated nutrition awareness, students evolve into local changemakers. They disseminate their knowledge to families and neighbors, who often have no other way of learning about these important dietary habits.
Fieldwork in Tanzania uncovered that fruit and vegetable consumption is low because of a lack of nutrition knowledge. Rural Tanzanians see nutrition as having a full belly versus an empty belly, so the concept of good nutrition is mixed with the understanding of physically being hungry.
Generational norms and misconceptions also contribute to low consumption, including taboos that are related to certain vegetables. Chinese cabbage and okra are not consumed by men because they believe these vegetables will affect their reproductive health and make them impotent. Bitter eggplant is believed to make women angry. Despite urban migration and increased knowledge access, such myths persist. Luckily, children in communities around the country are helping to change that.
The success of the school gardens has inspired many students to start kitchen gardens at home. Leftover vegetables not consumed by the family are sold to neighbors. In turn, these profits can be used to buy schoolbooks or other essentials, such as shoes.
Young entrepreneurs like Kelvin Rajabu, a shy and happy 12-year-old, have discovered an opportunity to make nutrition profitable. Kelvin fetches well water down the road from his small home on an unpaved street in one of the most poverty-stricken areas in Arusha, Tanzania. The water is used to irrigate his kitchen garden every morning before school and every evening after dinner. Employing the skills learned from the nutrition and garden club, his family’s kitchen garden nourishes his mom and two siblings. As Kelvin describes the garden that he alone manages, his pride fills the room.
Spinach is one of Kelvin’s favorite vegetables because of the taste. He also knows that spinach has vitamin A, which is good for his vision. Kelvin’s mother is busy with her children and small business. She appreciates Kelvin’s help with cooking and the household savings enabled by the kitchen garden. Before, their meals were mostly dried fish. Now, every meal also has vegetables.
About a 10-hour drive south from Arusha, the Bungo primary school nutrition club is being facilitated by the LisheYangu Initiative in Morogoro, Tanzania. This club operates almost exclusively via volunteers from the neighboring university and community. Along with nutrition, students learn how to prepare fruits and vegetables. Quarterly, the school offers cooking demonstrations for the club members.
Unlike the school in Arusha, the Bungo garden faces multiple challenges. The garden is unprotected at night, and vegetables often are stolen. Morogoro is also a region that suffers from increased floods and droughts from climate change, making irrigation difficult. The lack of water greatly diminishes the garden’s success.
Despite the challenges of school gardens, children ages 10 to 14 are an important time period to influence behavior. Ultimately, the households of these children also play a critical role in their diets and reinforcement of what they learn in school.
Women as Household Decision-makers
About 40 women crowd around the classroom at Sabasaba Health Center in Morogoro, Tanzania and listen intently. A charismatic male nutrition officer leads the class with the help of a picture book. He and his female nurse co-teacher received training by the project Lishe Endelevu, funded through the U.S. government’s Feed the Future Initiative and implemented by Save the Children.
Verbal quizzes, repetition of key nutrition facts, and visual aids keep the women intrigued. They are asked to list the vegetables they consume daily, describe what nutrients (e.g., carbohydrates, protein, and fats) are needed by the body, or explain the importance of consuming nutritious food.
Meena Underson and Nadhifa Ally—both health clinic students—answer these questions and enjoy the class. Clinic staff developed a slogan to serve as a reminder: “Eating healthy results in delivering and raising a healthy child.” The health of their children is critical to both Meena and Nadhifa.
Nadhifa is a young mother of two (aged eight and four) and has one more on the way. Meena goes to the class with her nine-month-old baby in her arms. Both women work but still make time to attend the class regularly.
The Lishe Endelevu project also holds cooking demonstrations that Meena attends. The project conducts trainings that target community health workers and reproductive health and maternal treatment mentors, along with Tanzanian government extension officers. The trainers then provide education through nutrition classes, farm demonstration plots, and cooking lessons.
After the class, Meena and Nadhifa go to a local market to buy fruits and vegetables to prepare at home. Amaranth, Chinese cabbage, tomato, cucumber, watermelon, mango, and papaya are favorites. At their local Morogoro market, a bundle of amaranth or Chinese cabbage costs about 22 cents, whereas a papaya costs $1.30.
When both Meena and her husband were unemployed, they could not afford fruits and vegetables. But after she became a teacher and her husband became a driver, their increased household income allowed them to diversify their diets with the help of Meena’s new nutrition literacy.
Meena has learned that cooking time matters to retain nutrients. She only heats vegetables for five to seven minutes. Before, she would cook them for 15 minutes or more to ensure they were free of pesticides, not knowing that this strips the nutrients from them. Unfortunately, because of generational cooking trends, this is a common practice.
Like many Tanzanians, Meena used to have an overwhelming fear of pesticides used in farming. Smallholder farmers may not know the correct way to use pesticides, so this fear is sometimes warranted. As a result, Tanzanians rarely consume raw vegetables and cook them for a long time to “clean” them. Preference is given to vegetables from kitchen or school gardens.
Meena also uses a range of vegetables for their different vitamins and minerals. Unlike many of the women who attend nutrition classes and demonstrations, she and her husband share the household cooking responsibilities.
The cooking demonstrations instruct participants on the role of nutrition in health and about which nutrients can be found in the fruits and vegetables they consume. Gender plays a significant role in household consumption. For example, cooking and household health are viewed as a female role in Tanzania.
However, the Muslim women at a Mboga na Matunda project cooking demonstration in Zanzibar—funded by Feed the Future and implemented by Fintrac—do not go to the market and ultimately have no control over what is purchased. They ask their husbands to buy the fruits and vegetables used in the demonstrations but indicate that each husband will typically buy “what he wants.” One participant said that if her husband does not like a recipe, she will prepare the nutritious meal for herself and her children and prepare something else for her husband.
Education is a necessary first step in solving the multifaceted scourge of malnutrition across genders and ages. Since nutrition is everyone’s responsibility, support from the Tanzanian government is critical.
Malnutrition in Tanzania
Tanzania has bold goals to combat malnutrition.
Throughout Tanzania’s 26 regions, no region has a stunting rate less than 20 percent. Stunting, or low height for age, occurs in 32 percent of Tanzanian children under age five; about 30 percent of Tanzanian women of reproductive age are anemic and 32 percent are overweight or obese.⁵
Tanzania set nutrition targets to tackle the triple burden of malnutrition—undernutrition, overweight or obesity, and micronutrient deficiency—and is striving to reduce stunting to 28 percent by 2021 and 15 percent by 2025.⁶,⁷
The regions with the highest stunting rates occur near Tanzania’s southern and northwestern borders. A 2018 mapping of nutrition donor coverage reported the Katavi, Rukwa, and Tanga regions had few or no district-level nutrition projects.⁸
Political instability and violence of neighboring countries like Burundi and the Democratic Republic of the Congo also cause an influx of refugees and asylum-seekers in Katavi, Kigoma, and Tabora, creating a clash of circumstances. Village disputes are often triggered when local community members receive no nutrition assistance, but refugees and asylum-seekers receive food aid. In 2019 alone, Tanzania accepted $20 million in local and regional food procurement, in-kind food rations, and cash transfers for food from the U.S. Agency for International Development (USAID) Office of Food for Peace.⁹
Tanzania joined the Scaling Up Nutrition Movement in 2011. Additionally, historical plans included the development of a National Nutrition Strategy and the Tanzania Agriculture and Food Security Investment Plan. Momentum continued in 2016 with the National Multisectoral Nutrition Action Plan. Tanzania was one of the original 19 Feed the Future target countries and dropped to an aligned country status in 2018, joining 34 other countries.
The political will of Tanzania—and U.S. foreign aid commitments—is strong and continues to build upon the past 10 active years of combating malnutrition. But even with this political will, malnutrition continues to be a plague impeding the productivity of the country.
The Gap: Creating Consumer Demand
Even with attempts to enhance knowledge on the health benefits of fruits and vegetables, dietary choice is a complex, multifaceted decision where knowledge may not be sufficient to increase consumption. Growing consumer demand is necessary not only to increase intake of fruits and vegetables, but all nutrient-dense food. About half the food in African rural areas is purchased rather than produced at home, making highly processed foods more accessible and desirable.¹⁰
Raising farmer incomes to build the availability and affordability of fruits and vegetables was a predominant strategy in the field projects visited. Yet, higher incomes do not necessarily mean better diets.
When asked what kind of gift participants at a cooking demonstration preferred, the response was Coca-Cola. A sugar-sweetened beverage was clearly not part of their typical daily diet; however, this could be a function of cost and access, not health awareness. In other words, if Coca-Cola becomes more affordable and attainable in rural Tanzania, would soda be consumed more regularly? Tanzania saw a 96 percent increase in sugar-sweetened beverage consumption from 1990 to 2010.11
In Arusha, the cost of one Coca-Cola is comparable to one orange flesh sweet potato. The key to increasing fruit and vegetable demand is making them more convenient (e.g., less perishable and time consuming to prepare) and attractive from a sensory perspective, while maintaining or lowering costs.
Food preferences are as much about taste as about income, geography, knowledge, behavior, culture, gender, and other factors. As high-income countries have shown, the desirability and convenience of food are crucial demand variables within a food system. The blanket concept that guided international development and nutrition research for decades—that lifting people out of poverty will lead to better diets and health—no longer applies.
Sectors like agriculture, health, education, marketing, and finance all have roles in creating demand for fruits and vegetables. Policy and funding approaches require a new lens that goes far beyond educational efforts and raising incomes: they must make a major shift to rethink how the quality rather than quantity of food affects health and how to develop and sustain the demand for healthy food.
With Tanzania’s National Multisectoral Nutrition Action Plan, a gateway exists for USAID and other donors to work alongside the Tanzanian government to build local capacity across ministries, introduce innovative projects, expand public–private engagements, and scale up multisectoral interventions.
Nutrition will only improve if dietary behavior shifts and demand for healthy food increases. The surging Tanzanian youth population needs people like Kelvin and his classmates to be young nutrition entrepreneurs and changemakers, promoting the role of fruits and vegetables in health. They are the new warriors in the fight against malnutrition.
About the Author
Research Fellow, Global Food Security Project and Global Health Policy Center
Amy R. Beaudreault, PhD, is a research fellow in the Global Food Security Project and the Global Health Policy Center at the Center for Strategic and International Studies (CSIS). She focuses on the role of nutrition and food systems in global public health. Her broad experiences range from program development and evaluation to research and its translation, multisectoral partnerships, and consensus building. Prior to joining CSIS, Dr. Beaudreault was the director of nutrition and health at the World Food Center at the University of California, Davis. In addition, she was associate director at The Sackler Institute for Nutrition Science, a program at the New York Academy of Sciences; managed the Ohio State University Extension Agricultural Safety and Health Program; and worked in various capacities in research, health communication, and program management. She holds a B.S. in journalism from the E. W. Scripps School of Journalism at Ohio University and an M.S. in agricultural communication, a Ph.D. in agricultural education and extension, and a graduate certificate in survey research from The Ohio State University.
All photos by Sala Lewis / Copyright CSIS
Special thanks to those who participated in interviews and focus groups, external and internal reviews of the full report, and CSIS project support and field team.
This project was made possible by the generous support of
the Bill & Melinda Gates Foundation.
A product of the Andreas C. Dracopoulos iDeas Lab, the in-house digital, multimedia, and design agency at the Center for Strategic and International Studies.