Ex-president Kikwete carves out new profile on nutrition

In an interview with The Citizen at the first of its kind Nutrition Africa Invest Forum (NAIF) held in Nairobi, a meeting which highlighted the role of small and medium-sized enterprises (SMEs) in improving nutrition across Africa, and Tanzania, the former president of Tanzania, also the founder of Jakaya Kikwete Mrisho Foundation, chats about his efforts on accelerating an end to malnutrition in the country and his newfound passion in the forefront of health and nutrition advocacy.

The Citizen: You are known as a nutrition champion on a global scale. What inspired you to make nutrition a legacy of your presidency?

Kikwete: After joining the Scaling Up Nutrition (SUN) movement in 2011, I took nutrition very seriously. But the first encounter that I recall on nutrition-related issues was when I was the minister of Energy and Minerals.

It was the first for me to learn about iodine deficiency. A chap called Dr Ashraf came to my office one fine day and said, “minister, I want to come home.” I asked: “Which home... my home?” He replied: “Yes, your home. I want you and I to sit down and watch a video.” I thought to myself, this is the first time I’ve seen this man, I don’t know him and in our first meeting he self-invites to my home. I told him to give me time so that I could do a little background check on him. That’s when I found out he is good man who was a little concerned about nutrition and was working with the United Nations Children’s Fund (UNICEF). After a few repeated requests by him, I told him to come over and I made sure it was just he and I in the room as I wasn’t sure what was in the video. [Laughs]

This video that we sat down to watch was about Iodine deficiency and its adverse effects. A number of reports about Tanzania were there too. That is when I learnt that goiter is a result of iodine deficiency and my mother had it. I came to learn that squinted eyes are a function of iodine deficiency. I didn’t know.

I come from Bagamoyo and, well; we eat a lot of fish. I grew up eating fish and it’s one of the greatest sources of iodine. But it was puzzling, if goiter was a result of iodine deficiency, how come my mother had it while she had been cooking fish all this while. The secret was that she had not been eating fish; she then confessed that she couldn’t stand the smell of fish.

So it was a concern and a learning curve.

So was there anything productive about your meeting with the doctor from UNICEF?

Yes. So the conversation continued like this; he said: ‘Look here minister, the solution for this problem is under your hands. I asked: “How?” He suggested: “Your ministry is responsible for production of salt. It is simple; make sure that all the salt that is produced in the country is iodized.” I told him that if that has got to be done, let us do it. So we then spoke to small and medium-sized enterprises, including the tiny ones which were involved in salt production and we came up with a programme involving all nutrition stakeholders, including the government, whereby we bought iodization machines, distributed among the salt producers and enacted laws and regulations that all salts produced and imported have to meet Tanzania’s iodine requirements.

You know, on the other hand, there is also the imperative of educating leaders on what is meant by nutrition and what constitute good nutrition. To assume that leaders know is the worst assumption people make. I’m an economist, a military man myself; we don’t do iodization of salt. Leaders are open to suggestions from experts who come to them tell, “this needs to be done because of so and so.” My personal experience can testify to this.

Malnutrition accounts for one-third of all child deaths and is something that can be prevented. Did you have a specific call for action on nutrition during your tenure as President of Tanzania?

One of the key actions was to come up with programmes on food fortification. In 2013 a national fortification plan was launched where we spoke and met with rural millers to fortify their flour using special machines in an effort to combat micronutrient deficiencies at the village level. Again, there were people who educated and informed me on effects of malnutrition and what interventions needed to be done. People needed to be educated too and that’s what we did.

What was your succession plan for the fifth phase government on some of the reforms you created that you just spoke of on nutrition wellness?

Though we have a national office that deals with nutrition issues, we also made sure that in every district council there was a nutrition officer, dealing with all the aspects of promoting healthy diets and choices. I believe the current government is continuing with exercising the policies on nutrition. You know, I’m busy with my farm now, looking after my cattle.

This is something I left now to President Magufuli to do. I did my part but those who are currently doing these things on a day-to-day basis, they would know more. In fact I was talking to some of them just recently, they told me the system is intact, the structure is intact and they are continuing to do the work.

According to IFPRI’s Global Hunger Index, between 2000 and 2016, seven African countries namely; Senegal, Ghana, Rwanda, Togo, Cameroon, Angola and Ethiopia have drastically reduced their malnutrition levels compared to other countries on the continent. Why do you think Tanzania is lagging behind?

We shouldn’t blame ourselves too much. About ten years ago, the stunting rate in Tanzania was at 42 per cent, compared to now, which is about 34 per cent. It has been a long road. We are making progress. Back then, nutrition was not in focus, it wasn’t taken very seriously. Now people are putting their act on and making in roads. The battle against malnutrition can be won and must be won. Losing is not an option. The countries that you mentioned have already shown us the way. The question should be; how do we move from that 34 per cent to 15, 10 and 0 per cent?

This forum [NAIF] has initiated a new conversation on SMEs as a solution to curb malnutrition, is that the answer to your aforementioned question?

As I said in my speech earlier [at NAIF], SMEs need support because the problem of lack of reliable sources of finance has been one of the major constraining factors to growth and development of SMEs. You see, if there is no change or improvement in stunting and wasting among children and, anemia among women, and iodine deficiency, a nation is bound to lose a lot in future productivity.

One of my good friends wrote a book, ‘Too Small to Ignore’ – he talks of the under fives. So yes, SMEs can play a pivotal role in ensuring the availability of enough good quality food. They are already playing a significant role but I believe they can do more with regards to agricultural production, fishing, food processing, food fortification and trading in food and nutrition products.

Even at their scale, they need money to continue to be active and productive. If they have the money, they can hire skilled labour, technology etc. But also we need to create an environment that is friendly to help them grow. That is where the governments are important. It is a multifaceted approach; you need government, friends of government, civil society, private foundations, NGOs involved in nutrition space to contribute.

When we speak of nutrition as an investment space – where can Tanzanians exactly invest in?

Nutrition value chain is not only about the way food is produced, but also how it is processed, stored, distributed, marketed and consumed. And this chain starts at the farm. Each SME can be involved in its own way. I met one of the five Tanzanian SMEs present at the forum [NAIF] based in Kibaigwa – Kibaigwa is a major market.

The company works with 7,000 smallholder farmers, buys the maize, grinds it into flour, fortifies it, packs it and distributes it. My point is; there is a lot that needs and can be done when you speak of investing in nutrition-sensitive businesses – I can’t be specific.

Let me give you another example. Let’s take the post-harvest losses. A nutrition-sensitive business idea can intervene on the aspect of storage – which is part of the nutrition value chain. If you don’t store your produce properly, you lose everything. Then there is fortification of foods, such as adding Vitamin A or iodine to products. Each one can choose a niche that interests them, as opportunities in Tanzania are vast.

We know your focus has been much on education, so you venturing into health, especially maternal health, is news to us. Why did your foundation [Jakaya Mrisho Kikwete Foundation] decide to be at the forefront in advocating this particular issue and will nutrition be the primary focus of your foundation?

I have three strategic areas of interest but one of them is health, my key interest is maternal and child health. Speaking of this, there are children and women who die of anaemia – this is a function of nutrition. There are children who are stunted – low height compared to their weight – wasted children – low weight compared to height – so nutrition is going to be a big factor as part of maternal and child health. We are at the formative stage – but certainly when we are in the conception stage – this will definitely be our priority. This is one.

My primary interest is maternal and child health because one of the niches that I identified in this span of years is that many women and children die because of shortage of midwives. I’ll give you an example. Many women die of bleeding when giving birth, but if you have a skilled midwife – they will be able to handle this situation better.

Africa has an acute shortage of midwives. If all women can give birth to children under the care of skilled and trained midwives, we will be able to save two thirds of lives that are lost every year.

How to sensitise this; it is our foundation’s role to develop and anchor good midwifery practices. So, our foundation is mainly trying to see how we can promote midwifery in Tanzania.