The New Challenge of Ending Malnutrition: A Look at Ghana’s Progress

Ending all forms of malnutrition by 2030 was the formidable challenge world leaders took at the end of the adoption of the Sustainable Development Goals (SDGs) in 2015.

This was evident in at least 12 of the 17 Sustainable Development Goals which contained indicators that are highly relevant for nutrition; reflecting nutrition’s central role in sustainable development.

They agreed that improved nutrition is the platform for progress in health, education, employment, female empowerment, and poverty and inequality reduction.

In turn, sub-optimal nutrition, they concluded, creates a cascade of individual and societal challenges—with malnutrition and poor diets constituting the number-one driver of the global burden of disease according to global studies.

The annual GDP losses from low weight, poor child growth, and micronutrient deficiencies average 11 percent in Asia and Africa—greater than the loss experienced during the 2008–2010 financial crisis, is a classic analysis of the impact of malnutrition globally.

Global Malnutrition Challenge

Few challenges facing the global community today match the scale of malnutrition, a condition that directly affects one in three people.

Malnutrition manifests itself in many different ways: as poor child growth and development; as individuals who are skin and bone or prone to infection; as those who are carrying too much weight or whose blood contains too much sugar, salt, fat, or cholesterol; or those who are deficient in important vitamins or minerals.

Malnutrition and diet are by far the biggest risk factors for the global burden of disease: every country is facing a serious public health challenge from malnutrition.

According to the 2016 Global Nutrition Report, ‘From Promise to Impact,’ the world is off track to reach global nutrition targets.

“We are off course to attain targets for nutrition. Anemia, for example, is declining so slowly that at current rates we will reach the global target closer to 2130 than 2030,” the report says.

Obesity and overweight, far from declining, are on the rise, putting global nutrition milestones at risk with peculiar situations being the reduction of  the number of stunted children under 5 in every region except Africa and Oceania. Also, the number of overweight children under 5 is increasing most rapidly in Asia, highlights the report.

The nutrition report indicates that if business is done as usual, the world will not meet the global nutrition and Non Communicable Diseases (NCD) targets adopted by the World Health Assembly.

It however indicated that modest changes could put many countries on course to meet global targets like Brazil, Ghana, Peru, and the Indian state of Maharashtra had done with interventions fueled by governments and others that made commitments—and kept them.

Call for Action

“Ending malnutrition is ultimately a political choice that leaders from governments, donors, civil society organizations, and businesses at international, national, and sub-national levels need to take,” the report points.

The 2016 Global Nutrition Report states that making smart commitments to nutrition would plot a different development trajectory for countries—and individuals—across the world adding that investing in ending malnutrition is one of the most cost-effective steps governments can take.

“Every $1 invested in proven nutrition programs offers benefits worth $16,” it states. “Tackle malnutrition in all its forms. This means low- and middle-income-country governments must move to dramatically reduce under nutrition before obesity and nutrition-related NCDs become even more overwhelming.”

The report shows that women’s power and status constitute a particularly important driver of malnutrition: mothers aged 18 or under, are more likely to have stunted children, and children are less likely to be stunted if their mother has secondary education.

“It is thus important to incorporate nutrition targets into development and social sectors, where many governments spend more than 30 percent of their budgets, and to measure the impacts of spending in these sectors on people’s nutrition,” it states.

Ghana’s Test 

Ghana like Brazil, Peru and Indian state of Meharashtra have been cited as countries that have made commitments in addressing malnutrition and following through with that commitment to improve nutrition outcomes.

Through implementing a wide range of policies and interventions affecting the immediate and underlying causes of under nutrition, the country has achieved significant progress in addressing malnutrition.

Ghana coming from a background of early growth faltering with close to 11 per cent of children weighing less than 2,500g, has been able to, through partnership with its agencies and development partners, develop and implement nutritional policies like the growth and poverty reduction strategy, breastfeeding promotion regulation, Vitamin A policy, Anemia Strategy and infant and young feeding strategy which have contributed to the declining rates of under nutrition among women and children, who constitute the most vulnerable groups.

But at the same time, the country has seen an increase in obesity and overweight in selected population groups over the past 5 to 7 years. Ghana has also lost ground on some areas of previous gain such as exclusive breastfeeding and optimal complementary foods.

Furthermore, reductions in stunting are not equally distributed, the Northern Region has 30 percent stunting, compared with 10 percent in the Greater Accra Region.

And while government policy interventions support nutrition, financial commitment remains sub-optimal (Laar et al. 2015). Moreover, obesity and non communicable disease risk factor rates are rising.

National Nutrition Policy

It is in recognizing the daunting challenges of nutrition in Ghana that the Ministry of Health, Ghana Health Service and development partners launched the National Nutrition Policy to scale up evidence based nutrition-specific and nutrition sensitive interventions and ensure an enabling environment for effective and sustained impact.

The policy will also provide the framework for coordinated implementation of high-impact nutrition intervention by government and nutrition stakeholders for maximum impact at all levels.

Minister of Health, Alex Segbefia says malnutrition problems can have serious consequences on the health and survival of those affected with the attendant non-communicable diseases in later life.

“Stunted children grow up to become stunted adults and one of the most significant consequences of adult stunting is reduced physical capacity and productivity.”

Micronutrient deficiencies impair intelligence; strength and energy, sapping much needed vitality, productivity and initiative needed for economic development and also contribute to mortality.

Stunting and anemia among young children are also associated with decreased ability to learn resulting in reduced school performance and contributing to economic productivity losses,” he says.

He notes that under-nutrition is largely preventable and there is evidence of exceptionally high development returns to a number of direct nutrition interventions indicating that investing in nutrition can improve several key development outcomes in Ghana, including child survival, educational achievements, and ultimately economic productivity.

“As a sector, we are working hard to implement a number of both direct nutrition interventions and related actions that have demonstrated effectiveness in improving nutrition outcomes, reducing child mortality and protecting human capital.”

In particular, it is essential that more emphasis is put on improving the nutritional status of women and children from pregnancy to 2 years of age or the first 1000 days of life as this, we are informed, has long-term impact on their survival and development,” he says.

Mr. Segbefia assures that the Health Ministry will provide the leadership in creating the enabling environment that will improve nutrition, governance and accountability among relevant actors “and it is our expectation that increased and sustained support from all partners will lead to the desired nutrition outcome.”

He also suggests the operationalization of strategies and initiatives in the nutrition policy for ensuring healthy diets throughout the life course; while at the same time identifying and fostering appropriate policy options and developing a package of tools for creating institutional capacities and skills to promote healthy and diversified diets.

“We need to strengthen behavior change communication to empower people and create an enabling environment for making informed choices about food products for healthy dietary practices and appropriate infant and young child feeding practices through improved health and nutrition information and we must work towards supporting partnership development by engaging partners from across all relevant sectors to share and integrate best practices and new knowledge,” he adds.

United Nations (UN) Ghana Resident Coordinator, Christen Evans Klock, in her remarks on accelerating nutrition improvement for all in Ghana, indicates that Ghana’s success in attaining the Millennium Development Goals (MDGs) on hunger sets the right foundation for the country to implement successive programmes like the nutrition policy.

She says the test of addressing nutrition cannot be done by one agency or institution adding, “nutrition requires a balance multi dimensional collaboration between agencies, development partners and government.”

She also indicated that apart from the policy which will guide the implementation of projects, there need to be a change in habit which should be facilitated by public education and engagements with key stakeholders on the topic of nutrition.

By Jamila Akweley Okertchiri