The Centre for Counselling, Nutrition and Health Care (COUNSENUTH)

By Marie McGrath, ENN

Mothers targeted in some of the COUNSENUTH outreach work

At a recent IBFAN meeting in Swaziland I met Mary Materu who is director and one of the founding members of the Tanzanian nongovernmental organisation (NGO), CONSENUTH (The Centre for Counselling, Nutrition and Health Care). Mary kindly agreed to be interviewed for the agency profile section of Field Exchange. The interview was conducted by phone on my return to the UK.

Mary and colleagues set up COUNSENUTH in 1998. She is currently executive Director of the organisation. Originally trained as a nurse/midwife, her interest in nutrition really took off when she joined the Tanzanian Food and Nutrition Centre in 1979. While working for this national institution she undertook further study in nutrition, first a post-graduate diploma, then BSc and later MSc in the US. At the National Centre Mary felt she gained great experience and enjoyed working on many large projects, often at national level. However after 19 years with the organisation, she felt a strong desire to undertake nutrition work at a community level. This was the main impetus to set up the NGO, COUNSENUTH.

COUNSENUTH aims to contribute towards improving the quality of life through strengthening care for vulnerable groups and promoting preventive healthcare, nutritional care and counselling at a community level. They mainly work with partners, particularly local Community Based Organisations (CBOs), supporting the nutrition component of their work through training, and development, production and distribution of IEC materials on nutrition and health. The materials they develop are in Swahili and offer current, up to date and simple resources to use at ground level. They are also involved in participatory research and have regularly engaged the mass media, particularly radio, at local and national level. They are also sub-contracted by larger organisations like international NGOs (INGOs) and carry out nutrition related consultancies. A key agency activity is nutritional care for people living with HIV and AIDS, including infant feeding in the context of HIV and AIDS, often through home based care programmes. Currently there are 12 staff employed working with more than 20 CBOs in the districts of Tanzania. They also have working partnerships with government and district councils.

Two of their staff have attended nutrition in emergencies courses at Uppsala University in Sweden. Mary explained that while there is a perception that the only emergencies to affect Tanzania are refugee crises, there are actually vulnerable areas that consistently suffer droughts where COUNSENUTH also operate. For example, one activity involves teaching people how to preserve and dry foods using solar driers to use during leaner times. "People often don't value some of the nutritious indigenous foods, so they are seen as food for the poor and only to be eaten when there is a problem". Some of their programmes have a food aid component but only on a small scale, such as supply of perishable foods.

Mary emphasised that capacity building is at the heart of what they do, and is what makes the scale and scope of their work feasible - their operations extend widely because of the capacity building and involvement of community based networks. She described how the wherewithal to get close to individuals in need is one of the great advantages of working with CBOs and how they have been "heartened" by how this has turned out. "CBOs are close to the clients and can identify the most needy. At this local level and scale, we can provide some funds for CBOs to buy perishable foods, like fruit and vegetables, that isn't possible in a large scale food aid operation". Mary suggested that supporting CBOs with local level food aid is complementary to the large scale food aid that may be provided by organisations like WFP.

Mary chuckled when I asked about funding sources. She remembered how little money they first began with. "In fact", she says, "when I first began the organisation, I didn't immediately know where we were going to get the money to operate from. In the very beginning we received a 2000 USD seed grant from International Baby Friendly Alliance Network (IBFAN) Africa that was a blessing to us" - which they used to train a small group of counsellors on infant feeding in 1999 and to produce a small brochure on infant feeding and HIV/AIDS in Swahili. "We continued with another 5000 USD from the National AIDS Control Programme (NACP) Ministry of Health and 5000 USD from the Global Health Council. These gave us the strength to continue" and since then, their portfolio of donors has expanded considerably to include Rapid Funding Envelope (RFE) for HIV/AIDS, Global fund round 4/TACAIDS/ MoH, URC/QAP (Project on infant feeding in context of HIV/AIDS), the Global Health Council, IBFAN and WABA (World Alliance for Breastfeeding Action). They have also formed working partnerships with some international agencies like Care International and FHI to provide the nutrition component of the home based care programme. In sharp contrast to their humble beginnings, their income in the last financial year was about 800,000 USD.

When I said how impressed (and admittedly jealous) I was of their funding success in a very short period of time, Mary emphasised that funding remained one of their biggest challenges. Their funding is typically short-term, usually over a one year period, so that they remain on tenterhooks and have to keep hoping and "trusting" that their needs will be met one year to the next. She also feels that international NGOs have a distinct advantage when it comes to securing funds and as a local NGO they have to work doubly hard in networking to overcome this. Their growth has also presented challenges, particularly with regard to management and monitoring and evaluation systems. Mary openly admits that these need strengthening and talks are ongoing with various partners about doing exactly this.

When asked about challenges she and her organisation face, Mary said one of the key frustrations they encounter on a day to day basis is food insecurity, not only of the beneficiaries but also of the volunteers working in the CBOs. "You see the poverty first hand when you are working within these groups", she says. "If you work as a volunteer in any developed country you normally have some standard of living or means to survive. Here you have volunteers who have nothing, yet they are willing to do the work". Also people sometimes think that if food is scarce, why talk about nutrition? However, Mary feels that it is in times of scarcity when their nutrition counselling can be most valuable - helping people to make the most of what little they have.

Some of the COUNSENUTH staff with a selection of the resources developed

Mary feels one of the big challenges in her work is integration of nutrition in programming. "We favour integration"; she says, "it is a good thing". However integration involves compromises and she feels nutrition programmes inevitably have to compromise more than others. She described how typically you find nutrition being integrated into other big programmes, like PMTCT or large child survival programmes, rather than other activities being integrated into a nutrition programme. Thus, when there needs to be some sort of cutback, the priorities of the core programme will prevail and the nutrition component is often the first to be dropped. Maintaining a strong nutrition component of a programme is an ongoing commitment.

She also feels that one of the great strengths of the organisation is their expertise, and that they have been very lucky to have in-country expertise available in areas like nutrition and infant feeding, development of educational materials and in food and nutrition. Experts are identified and contracted by project, rather than a number of people being permanently employed by the organisation. She feels that this has really worked in their favour as they benefit from seasoned workers. Another strength is their ability to network with and engage CBOs thereby reaching the most needy. At the heart of the organisation is a team of committed people. "Even if staff are working on different projects and one group have a deadline to meet", she says, "we all put our hands in together. We have really built up trust and transparency in the organisation".

One of the COUNSENUTH trainings on infant feeding in the context of HIV and AIDS

As to the future, Mary would like to see COUNSENUTH further expand partnering with CBOs thereby extending the network of small groups within the community. "Small as we all are, we can build the capacity of all to do big nutrition work together at a community level", she says. Overweight and obesity is also an area that she feels they will inevitably become engaged in as these problems are increasing in some areas of Tanzania. Regional forums like IBFAN Africa based in Swaziland, and the Regional Centre for Quality of Health Care based in Makere, Uganda offer great opportunities to network with other agencies in the region. COUNSENUTH have also made informal links with other countries, particularly where their consultants have worked for other organisations.

As a parting comment Mary emphasised that one of the keys to the success of their work in Tanzania is that "whatever we do, we use national guidelines whether training or in material development; we use national policy documents so that we all speak the same language".

I came away from the interview thinking how COUNSEUTH is a heartening example of how much a strong and principled local NGO can achieve in terms of community involvement and capacity building.